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Diet
written and compiled by doctordee
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Points to Consider

If you are contemplating a major change in diet because of your cancer diagnosis, consult with a licensed dietician experienced in oncology.

A Vegan diet is probably more cancer preventive than any other. However, vegan diets, diets without any animal products in them at all, are difficult to balance in terms of complete total protein and B vitamins. They require careful construction and observation, and unless you are an expert, you should probably start out with a good dietician.

If you are not expert with nutrition, a low saturated fat, low red meat diet high in fruits, vegetables and whole grains will do. Chicken, fish, egg white, and low and fat-free dairy are all good sources of protein.

If you are recovering from treatment, extra protein and B vitamins are often needed above the resting levels. However, if there is anemia due to iron deficiency, red meat or iron supplementation will probably be necessary.

The standard cruciforms, e.g. broccoli, cauliflower, cabbage, are good to include in your diet as they are cancer preventive. As are tomatoes.

Juicing sounds like SUCH a healthy practice, but considering the amount of constipation that occurs during and because of cancer treatment, it would be better to eat the entire fruit or vegetable, with all of their roughage or fiber. Unless, of course, you have mouth sores.

The raw foods diet may not have enough protein in it, and might not have enough calories as well.

Tumor cells which have estrogen receptors might be stimulated weakly by dietary phytoestrogens. Pre-menopausally, the lower estrogen stimulation might be cancer preventive. Post-menopausally, and if on an aromatase inhibitor, phytoestrogens might stimulate estrogen receptor positive tumor cells.

Keeping proper nutrition during cancer treatment has its problems. Chemotherapy can be associated with loss of appetite from nausea, increased appetite from steroids, mouth sores, constipation, and profound changes in taste and smell of food. Supplements are often used. During radiation therapy there is sometimes nausea, diarrhea or difficulty swallowing. This also has its problems and its solutions. Often dieticians are available for consultation as part of the medical team.

Sometimes people with cancer will be eating a full complete diet and still lose weight. This can decrease survival time. Weight loss and its management is discussed in a later segment.

Avoid any "cancer treatment" diet that removes normal food from your diet, and then requires that you buy their supplements because of vital nutrients that were removed. Any diet that is "faddy" or requires strange ingredients or preparations, or buying special supplements or equipment should be avoided, and checked out on Quackwatch.

It does seem to get complicated, doesn't it? That's why an experienced, registered, licensed dietician is the best place to start if you are contemplating dietary changes.

There is a Website that has suggested foods to eat each week, recipes and 2 weeks of menus. The site is authored by Diana Dyer, MS, RD. She has also written a book called A Dietician's Cancer Story.

Dialogues About Diet and LMS:
>>I have also been to the Block Center in Evanston, IL and am trying to follow their diet and supplement plan. Does anyone else on this list follow a strict (vegan) diet and take supplements to boost immunity?<<

Look at this article on the quackwatch website:
http://www.quackwatch.org/01QuackeryRelatedTopics/Cancer/immuneboost.html


>>I have read about the Block Center, but have no personal experience. When I was first diagnosed I read everything I could get my hands on. These places are springing up everywhere. Even in my hometown alliances are currently forming between naturopaths and cancer providers and their patients. What diet and supplement plan do they suggest? We had a discussion about vegan diets very recently. Check the archives by typing in the keyword vegan.<<

Dana-Farber has the Zakim Center for Integrated Therapies. Their programs are based on peer-reviewed, evidence-based research. I would be guided by their "Fighting Cancer With Your Fork" seminar, "Antioxidants and Cancer" and Herbal Combinations and Cancer" research, their lectures, fact sheets and seminars. I have the American Cancer Society's Health Eating Cookbook I was given when I attended the I Can Cope classes. Buy the best food you can afford and enjoy preparing and eating it.


>>As it seems with the other aspects of LMS, you do what is right for you when its right for you.<<

As it IS with other aspects of LMS, you learn enough to know what your options are, and the risks and benefits and permanent disabilities of each choice. Try not to blindly trust or make rash decisions, especially out of desperation, thoughtlessness, ignorance, or fatigue.

doctordee
December 2003
Dehydration and Clotting

Dehydration is a risk factor for clotting problems. Assuring clear liquid intake and avoidance of alcohol and caffeine are potent dietary factors in managing dehydration.

Clotting [thromboembolism] is one of the most common causes of death in cancer patients. Among the thrombotic complications in patients with cancer are disseminated intravascular coagulation [DIC], pulmonary embolism, stroke, and heart attack. Clearly, these complications arise as tumor cells interact with almost all components of the hemostatic system including platelets.

Most venous clots seem to originate in regions of slow blood flow, like the large venous reservoirs of the calf and thigh or in valve cusp pockets. Decreased blood flow or even stasis due to lack of the pumping action of the large muscle packages is one of the major factors. As blood pools, activation products of the clotting system accumulate locally leading potentially to local hypercoagulability. The activated products of the clotting process [coagulation] can create endothelial damage which in turn leads to further activation of the clotting system. Endothelial damage may also result from distension of the vessel walls by the pooling blood. Blood flow is further decreased by hyperviscosity [less fluid blood, as happens with dehydration.]

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Search Pubmed for cancer and clotting tendency


*Thromboembolic events are a leading cause of death among cancer patients.
*Cancer patients because of the cancer, have an increased tendency to form clots.
*Surgery, used to treat cancer, increases the tendency to clot.
*Chemotherapy, also used to treat cancer, increases the tendency to clot.
*Infections and sepsis [severe infection] often occurs during cancer treatment, and they increase the tendency to clot.
*Lack of movement: post operatively, or because of feeling ill, or various amputations, also predisposes to clotting.
*A patient's body often reacts to the cancer by causing inflammation, increasing the clotting tendency.
*Depression has also proved to cause a tendency to clot. Cancer patients get depressed.
*Dehydration, because of decreased fluid intake due to feeling ill, loss of appetite, or vomiting, is a predisposing factor to clotting.

Of the above, the cancer patient has control over three of the factors.
Depression can be treated by psychotherapy and/or SSRIs [which reverse clotting tendencies]
Leg exercises can be done frequently, even if bedbound.
And Dehydration Can Be Avoided.



Dehydration occurs when not enough free water is taken in by the body, and as a result the blood gets more and more concentrated. This makes it more difficult to fight off infections; it makes it more difficult to eliminate toxins by the kidneys; and it decreases the fluidity of the blood, so it doesn't flow as freely and favors clot formation.

Caffeine dehydrates. Caffeine is a diuretic, which means it makes you pee out more than you drank in. For each cup of coffee, tea, cola drink, or cocoa, take an extra cup of water. Likewise be aware of chocolate also requiring extra water.

Alcohol dehydrates as well. It is also a liver toxin, so shouldn't be used during chemotherapy as well.

Milk does not have free water in it, despite it being a liquid. It has too high a salt and protein load to be considered free water. Do not have more than 4 or 5 glasses of milk or servings of dairy daily.

A minimum of 8 glasses of water a day [or two liters] is needed. You may need more if it is hot, you are active, or you are undergoing treatment. During chemotherapy I needed 4 liters of fluid a day.

When traveling, do not drink alcoholic beverages, get up and walk once an hour to enhance circulation and avoid clots, and drink at least one glass of fluid an hour. Airplane air is very drying, so you may find that your fluid requirements increase.

If someone is having chemotherapy, and is vomiting, take them to the Emergency Room immediately. Most chemotherapy regimes nowadays have effective anti-vomiting drugs. Until the vomiting is controlled, intravenous liquids should be given. Chemotherapy, cancer, and the dehydration caused by vomiting, create a common situation where clotting does occur.


Definitions & Conditions:

Thrombosis is the formation, development, or presence of a clot[also called a thrombus].

Disseminated Intravascular Coagulation, or DIC, is a condition in which all of the clotting elements, factors, platelets & etc., all clot, all at the same time. What happens then is that there are NO clotting agents available because they have been used up, and these people bleed, become covered in bruises and bleed internally as well. This condition can present catastrophically. Can easily be fatal. However, the more usual presentation of DIC in a cancer patient is a low grade clotting tendency, with multiple minor episodes.

Paraneoplastic Syndromes: These are collections of symptoms that occur when people have cancer. The syndromes differ from person to person and cancer to cancer. Often Tumor Secretions play a part. Development of auto-immune disease also occurs.

Auto-Immune disease occurs when people make antibodies to their own tissues. And try to destroy their own tissues. When auto-immune antibodies are made to blood vessel walls, either artery walls or vein walls, there will be an increased incidence of clotting in those vessels.

Trousseau's Syndrome is a migratory thrombophlebitis [inflammation of the veins, associated with clotting] associated with cancer and believed to be an autoimmune phenomenon.

Embolus [emboli is plural]: A clot or other plug brought by the blood from another vessel and forced into a smaller one, so as to obstruct the circulation.

Pulmonary Emboli, the usual cause of which is fragments of clot breaking off from a large clot in the large vein of a leg. These fragments travel to the heart, and pass into the Pulmonary circulation, where they eventually plug a pulmonary arterial vessel. This can be a fatal complication.

Thrombocytosis: High platelet[thrombocyte] counts in the blood. Many cancer patients have high platelet counts, either heralding lung tumors or as a result of inflammatory conditions. If the platelet counts get too high [like 1,000], they actually require treatment to prevent clotting problems.

compiled by doctordee
December 2003
American Cancer Society Diet Recommendations

Diet and Breast Cancer: Evidence That Extremes in Diet Are Associated With Poor Survival by Goodwin, et.al.
From JCO 21:13,2003: 2500-2507

"Diet has been postulated to influence breast cancer prognosis; however, existing evidence is weak and inconsistent. Previous studies have sought evidence of a linear relationship between diet and breast cancer outcomes. Because of a U-shaped association of body mass index (BMI) with survival in breast cancer, we hypothesized that a nonlinear association also existed for dietary variables."

"Four hundred seventy-seven women with surgically resected ... breast cancer completed the Block Food Frequency Questionnaire ... after diagnosis, reporting intake over the preceding 12 months. Data on tumor-related factors, treatment, and outcomes were obtained prospectively from medical records."

"Significant nonlinear survival associations were found for protein, oleic acid, cholesterol, polyunsaturated-saturated fat ratio, and for percentage of calories from fat and percentage of calories from carbohydrates"

"Conclusion: The association of key dietary variables with breast cancer survival may be U-shaped rather than linear. Our data suggest that midrange intake of most major energy sources is associated with the most favorable outcomes, and extremes are associated with less favorable outcomes."


From the American Cancer Society Website:
Good nutrition is especially important for people with cancer. The illness itself, as well as its treatments, may affect your appetite. Cancer and cancer treatments may also alter your body's ability to tolerate certain foods and to use nutrients. The nutrient needs of a cancer patient vary from person to person. Your doctor, nurses, and dietitians can help you identify your nutrition goals and plan strategies to help you meet them. Eating well while undergoing cancer therapy can help you to:

Feel better

Keep up your strength and energy

Keep up your weight and your body's store of nutrients

Tolerate treatment-related side effects

Decrease your risk of infection

Heal and recover quickly

Eating well means eating a variety of foods that provide the nutrients you need to maintain your health while fighting cancer. These nutrients include protein, carbohydrates, fat, water, vitamins, and minerals.
From the American Cancer Society site.

NOTE: Cancer patients who are better nourished survive longer. Better nourished does not mean overweight. There is a negative influence upon survival for overweight postmenopausal women with ESTROGEN RECEPTOR POSITIVE TUMORS, because of the estrogen made in fat tissue.
See the Hormones & Diet Section of this Page.

Nutrients

Protein
is needed for growth, to repair body tissue, and to maintain a healthy immune system. Without enough protein, the body takes longer to recover from illness, takes longer to heal from surgery, and is less resistant to infection. People with cancer often need more protein than usual after surgery, chemotherapy, or radiation therapy, in order to heal tissues and to help prevent infection. Good sources of protein include lean meat, fish, poultry, dairy products, nuts, dried beans, peas and lentils, and soy foods.

Carbohydrates
supply the body with calories it needs to carry out tasks. The amount of calories each person needs depends on his or her age, size, and level of physical activity. Sources of carbohydrates include fruits, vegetables, breads, pasta, grains and cereal products, dried beans, peas, and lentils.

Fats
also supply the body with calories, but some of them, called omega-3 oils, are marked anti-inflammatory agents. Omega-3 fish oils are exceedingly useful not only in cancer prevention/prophylaxis, but also in treating the cancer cachexia syndrome, in which cancer patients lose weight despite an adequate or even more than adequate diet. Fats include butter, margarine, oils, nuts, seeds, and the fat in meats, fish, and poultry.

Vitamins and minerals
help ensure proper growth and development. In addition, they allow the body to use the energy (calories) supplied in foods. A person who eats a balanced diet with enough calories and protein usually gets plenty of vitamins and minerals. However, eating a balanced diet can be challenging when you are receiving cancer treatment, particularly if treatment side effects persist for long periods of time. When that is the case, your doctor or dietitian may recommend a daily multivitamin and mineral supplement.

Water
is a necessity for survival. If you do not take in enough fluids or if you are vomiting or have diarrhea, you may become dehydrated. Ask your doctor or nurse how much fluid you need each day to prevent dehydration. If you are undergoing toxic treatments which are resulting in tissue death, of normal tissues, or of tumor tissue, there are extra requirements of water needed to help your body rid itself of these wastes. Dehydration also is an additional risk factor for clot formation, and 10% of cancer deaths are due to clotting.
NOTE: Coffee, tea and cola drinks contain caffeine, which is a diuretic, causing you to lose more fluid than you took in. Take an extra glass of water for each cup of coffee, tea or coke. Milk, though fluid, does not count as water because of its high protein and salt load. Milk counts as a food.

Eat five or more servings of a variety of vegetables and fruits each day.
Choose whole grains in preference to processed (refined) grains and sugars.
Limit consumption of red meats, especially those high in fat or processed.
Choose foods that help you maintain a healthful weight, with an emphasis on plant sources.
Eat complex carbohydrates instead of sugar.
Decrease or avoid highly processed fatty foods.
Drink enough fluids.

The American Cancer Society has some common sense, research-based diet recommendations on its site.


Some other references:
Healing Foods: How to Nurture Yourself and Fight Illness by Rosy Daniel
The Healing Foods Cookbook by Jane Sen

doctordee
December 2003
Bioactive Food Substances & Cancer

Foods high in antioxidants are preventive of cancer, as they protect against the free radical mutation of DNA which can lead to cancer. Because increased fruit and vegetable intake, but not vitamin supplementation exceeding RDA, is associated with reduced cancer risk, physicians may consider recommending at least five daily servings of fruits and vegetables as an alternative to vitamin supplementation.
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Examples of antioxidants include vitamin C, vitamin E, beta carotene, and selenium. If you want to take in more antioxidants, eat a variety of fruits and vegetables. Taking large doses of antioxidant supplements is usually not recommended while undergoing chemotherapy and radiation therapy. Talk with your doctor to determine the best time to take antioxidant supplements.

There is no evidence that high intake of preventive foods will have any effect on a cancer that has already appeared.


The process of dedifferentiation, during which cancer cells pick up more and more mutations and become more primitive and possibly less controllable, is the normal degenerative course of cancer cells. Intake of antioxidant foods in the diet MIGHT very well decrease the mutations picked up by the cancer cells by sopping up the free radicals that can cause them. In this case, antioxidant ingestion might slow the process of dedifferentiation.

Seven and a half percent of people with LMS will have a second primary cancer within 3 years of their diagnosis.
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Adequate intake of antioxidants might help prevent or slow the presentation or dedifferentiation of these additional primary cancers. People who are at risk for a second primary cancer might very well consider increasing their dietary [not supplemental] antioxidants.

There is, however, no evidence to show that antioxidants taken after a cancer has developed will have an effect on that cancer.

Green tea has antioxidants and other bioactive substances.
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Epidemiological studies have shown that green tea ingestion of 10 cups or more a day decreases the incidence of cancer.

Resveratrol, the red berry and red grape substance present in red wine as well, has several anticancer effects on biochemical pathways. It is also a weak phytoestrogen.

The Brassica family: broccoli, cabbage, cauliflower, brussel sprouts... is a good source of bioactive anticancer substances.

Tomatoes are a source of lycopene.

Olive oil is an excellent source of Vitamin E.

Flaxseed, freshly ground [coffee grinders do it well], 2 Tablespoons a day, is also useful for its anti-inflammatory properties. Flaxseed and flaxseed oil are rich in alpha-linolenic acid (ALA), an omega-3 fatty acid. which has a marked anti-inflammatory effect.

As does fish, from fish oils. The anti-inflammatory effect might prevent some cancers, and might also prevent the cancer cachexia syndrome.

The antimutagenic potential of selected dietary constituents including Diallyl sulfide (DAS), Indole-3-carbinol (I3C), Curcumin (CUR), and Black tea polyphenols (BTP) has been demonstrated in cytogenetic assays.
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There are other bioactive substances in foods that do have an effect on cancer cells in vitro, and some are being tested in clinical trials. The human diet contains a variety of compounds that exhibit chemopreventive effects towards an array of mutagenic processes. Consult reputable sources about the bioactive substances in foods. Consultation with an oncologically experienced registered dietician might be useful, effective, and efficient.
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For an excellent essay on the use of supplementation with cancer, see Barrett's Essay . The point being made that the evidence for antioxidant benefit is from eating the foods, not eating the pills. Well researched, and a clear discussion.

doctordee
December 2003
Dietary Estrogen & ULMS

Phytoestrogens
are bioactive substances present in plant products which, when eaten, act like estrogen in the human body. Usually the estrogenic influence is weaker than animal estrogen products. Soy products, especially tofu, are known to contain phytoestrogens.

Women who have estrogen receptors on their tumor cells may have tumors that are stimulated by estrogens. The risk factors for uterine cancers are very much involved with estrogen levels and stimulation of the cells.
Merck Manual Online

In the premenopausal woman, her ovaries produce estrogen to provide high levels in her body. For these women, competition between the phytoestrogen and estrogen for the same estrogen receptor might result in a LESSER stimulation of estrogen receptor cells, because phytoestrogens are weaker stimulators.
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In the postmenopausal woman, whose estrogen levels are low, and those who are on aromatase inhibitors whose estrogen levels are very low, phytoestrogens might provide a higher level of estrogenic stimulation than there otherwise would be. Furthermore, specific phytoestrogen receptors exist as well. The subject gets complicated.
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Whether postmenopausal women with estrogen receptor positive cancers should avoid phytoestrogens is not known for sure. However, many oncologists recommend caution in use of phytoestrogens in the postmenopausal woman with estrogen receptor positive cancer.
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Which creates a problem for women who wish to adopt a vegan diet, as the major complete protein in those diets is tofu. However, a very reasonable anti-cancer diet can be constructed using fish, egg white, and nonfat dairy as protein sources.

For more information:
Search Pubmed for Phytoestrogens and Cancer Prevention
Search Pubmed for Phytoestrogens and Estrogen Receptors and Cancer



Red Meat
Many studies show an increased risk of some cancers in people who eat more red meat as compared to those who eat less.
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There is also an increased risk of uterine fibroids with those who eat more red meat [beef and ham], and a protective effect from green vegetables.
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It is unknown what the factors in red meat consumption are that are responsible for this. One factor might be hormone levels in the meat.


Being Overweight
Postmenopausal women do not have estrogen made in their ovaries. They make estrogen in their fat tissue, and muscle and breast tissue, from hormonal precursors produced by the adrenal glands. Postmenopausal women who are overweight will make more estrogen. There is evidence accumulating that for estrogen sensitive tumors survival is worse in overweight women.
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doctordee
December 2003
Tumor Induced Weight Loss [Cancer Cachexia Syndrome]

This section discusses weight loss.
Weight loss in cancer is essentially one of two types:

1. A General Weight Loss... where if you increase the calories absorbed, the weight stops being lost. This weight loss is discussed in the first part of this section, further below.

2. And a Tumor-Induced Weight Loss [Cancer Cachexia Syndrome], where the metabolism of the patient's body has gone haywire, and calories are shunted to useless inflammatory pathways. No matter how much the patient eats, he still loses weight. Many things have been tried to stop this, as it kills the patients. What does seem to work is either Ibuprofen 400mg three times a day, or omega-3 fish oils, 2 grams a day for at least four weeks. The second part of this section discusses this.
_________________________________________________________________________


Advances in the Management of Tumor-Induced Weight Loss
Continuing Medical Education Article on Medscape.com
Full Text of Article


GENERAL WEIGHT LOSS IN CANCER PATIENTS
Cancer patients with weight loss live approximately half as long as those without, and those with greater weight loss appear to live a shorter time than those with less or no weight loss. 80% of advanced cancer patients have marked weight loss [cachexia]. Weight loss becomes more pronounced as the disease progresses, and the prevalence of cachexia increases to more than 80% before death. In more than 20% of patients with cancer, cachexia is the primary cause of death.
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Mechanism of General Weight Loss in Cancer Patients
The intake of calories, providing energy to the patient with cancer, has been shown to be substantially reduced among patients who are losing weight.

Weight loss in the cancer patient may occur because of:

Mechanical problems in the gastrointestinal tract
obstruction
malabsorption
constipation
surgical interventions

Side effects of opiates, chemotherapy, radiation therapy:
nausea
vomiting
taste changes
stomatitis
constipation
diarrhea

Electrolyte imbalances from the cancer or from treatment can cause:
nausea
vomiting
decreased appetite

Depression and/or anxiety can affect a patient's appetite and ability to eat.

These factors should be controlled as part of the general care of the cancer patient. Estimates are that more than half of the patients who are receiving cancer treatment are underweight, have decreased appetite, and decreased oral intake. In a large number of patients with cancer, no obvious clinical cause of reduced food intake can be identified.
Patients who are malnourished need a complete nutritional evaluation [determination of nutritional needs as well as assessment of metabolic stress. This evaluation includes the protein, caloric, electrolyte, mineral, and fluid requirements of the patient, most often completed by a dietitian.]

Lab Tests
Serum albumin is one of the most common tests used due to its low cost, and provides a measure of body protein stores. It has been used as a predictor of survival for cancer patients, but is also low in liver and kidney disease, and in other conditions. It also responds slowly to treatment.
Transferrin, also sometimes used, can be affected by infection, active tumorigenesis, inflammation, and hepatic or renal diseases. There is no single measurement or test that solely reflects nutritional status, which must be determined by multiple factors, not just lab tests.

Management of General Weight Loss
Decreased appetite and the subsequent weight loss worry the cancer patient and the patient's family. Patients often report that their family's emphasis on eating is stressful to them, and a family's efforts to increase the patient's intake of food does nothing to change their level of food intake. Clinicians need to attempt to address this symptom in a systematic manner to address both the physiologic and psychological issues.
Providing nutritional support has been shown to increase the patient's weight, measurements, and albumin levels.
For more information see the complete text of the article.
__________________________________________________________________________



TUMOR-INDUCED WEIGHT LOSS or the CANCER CACHECTIC SYNDROME

Despite the efforts above, and increasing food intake adequately, SOME patients will continue to lose weight. The major difference between Tumor-Induced Weight Loss [TIWL] and other forms of weight loss is that TIWL will not respond to feeding or overfeeding. This seems to be due to metabolic changes in cachexia, produced by the tumor or by the host in response to the tumor.

Anorexia and cachexia accompany advancing cancer to a greater extent than any other symptom. Anorexia is loss of appetite. The term cachexia is derived from the Greek words kakos, meaning "bad," and hexis, meaning "condition." There is no clear definition of cachexia, but a reasonable approximation would be the unintentional loss of more than 5% to 10% of pre-illness stable weight with no obviously reversible cause in the presence of a systemic illness.

Cachexia, however, is not just weight loss from starvation, but weight loss from a complex set of metabolic changes in the cancer patient's body. Cachexia is not exclusive to cancer but is also seen in a variety of inflammatory conditions such as AIDS, rheumatoid arthritis, and cardiac failure, and this gives us the first clues toward its etiology [cause].

In TIWL/cachexia, resting energy expenditures are elevated, and abnormal intermediary metabolism, breaking down of proteins, and breaking down of fat occur independently of caloric intake. This means that weight loss will continue despite adequate or more than adequate caloric intake. The tumor, or the body's reaction to the tumor, changes how the body uses its nutrients and caloric intake. A facilitative interaction between catecholamines, prostaglandins, and inflammatory cytokines is responsible for cachexia. Successful treatment requires reduction of energy expenditures, reversal of anorexia, and correction of abnormal intermediary metabolism, lipolysis, and proteolysis.
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TIWL is important to the outcome of the patient's disease. Cancer patients with weight loss live approximately half as long as those without, and those with greater weight loss appear to live a shorter time than those with less or no weight loss. Those cancer patients with TIWL have also been reported to have a reduced performance status and quality of life. Patients with an apparently identical primary cancer and disease stage can vary considerably in terms of the development of cachexia, suggesting variations in tumor phenotype and host response as important determinants.
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Weight loss becomes more pronounced as the disease progresses, and the prevalence of cachexia increases to more than 80% before death. In more than 20% of patients with cancer, cachexia is the primary cause of death.

For More Information Search Pubmed
For More Information on Advances in Management

For possible mechanisms of action for TIWL, see Full Text of Article
Our understanding of the role of inflammatory mediators in cachexia has opened up a new opportunity for intervention to manipulate the inflammatory response and to influence the progress of cachexia.



Treatment of TIWL
Nutritional Approaches

Curing the cancer is the most effective way to treat cancer cachexia. Unfortunately, this may be difficult to achieve among adults with advanced solid tumors. The obvious option -- to increase nutritional intake by enteral or parenteral means-- did not work.

Two randomized trials with more than 100 patients each, and over a 3-month period, demonstrated a significant increase in nutritional intake in the intervention group --without any improvement in weight, anthropometric measures, chemotherapy response rate, survival, or quality of life.

In the 1980's a number of clinical trials of parenteral nutrition showed no benefit in terms of nutritional measures, AND an increase in infective complications. As a consequence, the American College of Physicians to publish a position paper in 1989 that concluded that, in cancer patients, "parenteral nutritional support was associated with net harm, and no conditions could be defined in which such treatment appeared to be of benefit."

The trials of parenteral nutrition with cancer patients since 1989 have shown a significant improvement in energy intake, no improvement in nutritional measures or functional outcome - and increased complications [especially infections], as well as a trend toward a shorter duration of survival.

The disappointing results of increasing nutritional intake led to the suggestion of a block to weight gain in this group of cancer patients due to the metabolic changes described in the footnote below.

Pharmacologic Approaches
Steroids

such as prednisolone, dexamethasone, and I.V. methyprednisolone help short term with appetite improvement, but do not stop ongoing weight loss, and have marked adverse side effects. They may have a palliative role, but cannot stop the cachexia.

Progestational agents
like megestrol and medroxyprogesterone have created weight gain, but the increased weight tends to be fat and water, not lean body mass. These agents have a number of side effects at well. Recently, a study found decreased response to chemotherapy and a trend to poorer survival with these. The appetite-stimulating properties of these agents might be useful in combination with other agents, or in very advanced disease.

Other agents
like anabolic steroids and cannabis have not been tested against placebo. There is no obvious benefit when they were tested against megestrol.

Serotonin is thought to have a role in appetite control, but a trial of the antiserotonergic cyproheptadine showed no obvious benefits with cachectic cancer patients. A controlled trial of pentoxifylline [inhibits the production of TNF-alpha] failed to demonstrate any benefit in terms of appetite or nutritional measures in cachectic cancer patients when compared with placebo. Melatonin appeared to produce a significant slowing of this weight loss compared with controls, and continues to be studied. Some other agents including growth hormone, insulin and related proteins, thalidomide, and beta-2-adrenoceptor agonists are being tested; these are either appetite stimulants or agents directed at some part of the cachectic process, and have a relative lack of success.

An agent that has influence on the wider inflammatory metabolic state driven by the host of mediators described below might be more effective. Studies done using more general anti-inflammatory agents like NSAIDs and omega-3 fish oils to downregulate the cachectic state are very promising.

NSAIDs
Indomethacin 50 mg twice daily or placebo produced a stabilization of Karnofsky performance status and a near doubling of survival in the indomethacin group.
Ibuprofen 400 mg 3 times daily has been shown to reduce levels of acute-phase proteins, IL-6, and cortisol and to normalize whole-body protein kinetics to some extent in cachectic colorectal cancer patients.
Ibuprofen will also reduce levels of acute-phase proteins and resting energy expenditure in those with pancreatic cancer.

The trial combination of an appetite-stimulator progestogent with the anti-inflammatory properties of an NSAID [using megestrol and ibuprofen together] suggest that this combination may stabilize quality of life and weight in cachectic patients.

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Fish oil and eicosapentaenoic acid (EPA)
Fish oil and EPA (the major omega-3 fatty acid component of fish oil) affect potential mediators of cachexia, including cytokine production, PIF, and the APPR. Clinical studies of fish oil (providing 2.2 g EPA per day) and pure EPA (6 g per day) in small groups of weight-losing pancreatic cancer patients have suggested that these agents will stabilize weight. There was no change in the percentage of total body water over the time of the study. Side effects were minimal. A mixed group of 60 cancer patients in a trial of a fish oil preparation providing about 3 g EPA per day suggested a prolonged survival in patients receiving fish oil.

"A combination of fish oil to downregulate the cachectic process and additional nutrients to provide substrate for potential anabolism has also been investigated. The fish oil-enriched nutritional supplement providing 2 g EPA and 600 kcal daily was given to 20 patients with advanced pancreatic cancer losing weight at a median rate of 2.9 kg per month. After 3 and 7 weeks, patients had significant weight gain of 1 kg and 2.5 kg. Body composition analysis suggested a significant gain in lean body mass. Negative nitrogen balance was reversed. The Karnofsky performance score, reflecting the functional ability of patients, also improved significantly. Appetite was significantly improved, with an increase in nutritional intake of around 400 kcal per day. This regimen also produced a stabilization of the APPR and downregulation of a number of inflammatory mediators."

"A controlled trial of 200 cachectic patients received either the experimental supplement enriched with fish oil or an identical supplement without fish oil. Patients were initially losing weight at a rate of 3.3 kg per month. Patients in both groups became weight stable. A number of patients had difficulty ingesting the suggested quantity of supplement, but a subgroup of those in the experimental group who managed the target of around 2 g of EPA and 600 kcal per day achieved a significant increase in weight and lean body mass. Overall, the change in patients' plasma EPA directly correlated with change in lean body mass. A subgroup of these patients underwent detailed analysis of resting and total energy expenditure in an attempt to ascertain whether the supplement resulted in any change in physical activity as an objective measure of the functional aspects of quality of life. There was no change in physical activity in the control group, but there was a significant increase in the experimental group, suggesting the functional ability of the patients receiving the fish oil-enriched supplement was improved. While this work is promising, much remains to be done to confirm the role of fish oil-based preparations in TIWL."
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There are no clear diagnostic criteria for TIWL. Obvious causes of weight loss should be excluded. In patients who describe cachectic symptoms, treatment should be started early. "Cancer cachexia is a complex, multifactorial syndrome that results from a reduction in food intake, a variety of metabolic abnormalities or a combination of the two. Multiple mediator pathways including pro-inflammatory cytokines, neuroendocrine hormones and tumour-specific factors are involved. Therapy requires an approach that addresses both reduced food intake and metabolic change. Combination treatments such as nutritional support plus metabolic/inflammation modulation promise improved functional capacity and quality of life."
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"Possible Mechanisms of TIWL"
From Full Text of Article

includeThe Acute-Phase Protein Response (APPR)

The balance of liver export proteins is altered in many cancer patients such that while albumin synthesis remains unchanged, fibrinogen synthesis rates are significantly increased. These changes occur on a background of a decrease in the circulating concentration of albumin (a negative acute-phase protein) and an increase in the concentration of fibrinogen (a positive acute-phase protein). These changes reflect aspects of the APPR, a reprioritization of liver protein synthesis often seen in trauma, inflammation, and infection.

An APPR is seen in a significant proportion of patients with a variety of cancers. The presence of an APPR has been related to increased TIWL in pancreatic and lung cancer. An APPR is also strongly associated with a reduced quality of life in gastrointestinal cancer patients and a shortened survival in renal, pancreatic, and colorectal cancer.

During an inflammatory response, there are altered demands for amino acids. The cachectic cancer patient may have an insufficient nutritional intake to provide the required amino acids, and, consequently, there may be relatively increased breakdown of skeletal muscle to supply sufficient amino acids. This breakdown may be further exaggerated, as there is an imbalance between the amino acid composition of skeletal muscle and acute-phase proteins. It has recently been shown that in cancer patients, feeding stimulates the synthesis not only of the negative acute-phase protein albumin (as seen in normal individuals) but also the positive acute-phase protein fibrinogen. This may provide a mechanism whereby a proportion of supplied nutrients are diverted away from anabolism toward fueling the inflammatory response in TIWL.

Mediators of TIWL
Neurotransmitters

Several neurotransmitter systems within the hypothalamus have been implicated in the anorexia associated with TIWL.

Proinflammatory Cytokines
Several proinflammatory cytokines, including tumor necrosis factor (TNF), interleukin (IL)-1-beta, IL-6, and interferon gamma, have been implicated in cachexia.
However, individual cytokines do not work alone but in a complex network of multiple cytokines in combination with other factors.

Prostaglandins
Release of prostaglandins is a major step in the signaling pathway leading to muscle protein breakdown in normal tissues. It also appears that prostaglandins may mediate the actions of most proinflammatory cytokines. Specific inhibitors of prostaglandin synthesis prevent the experimental cachectic effects of TNF-alpha and IL-1. It is likely that prostaglandins have a role to play as part of the network of mediators of cachexia.

Neuroendocrine Hormones
Infusion of hormones such as cortisol, glucagon, and adrenaline in humans will produce features of cachexia such as protein loss, an APPR, increased energy expenditure, and glucose intolerance. In humans with cancer, elevated levels of cortisol and glucagon have been observed.

Tumor-Derived Catabolic Factors
PIF has been found to be expressed in tumor cells from patients with significant weight loss but not in those who are reasonably weight stable.

A mouse tumor-derived lipid mobilizing factor has also been described, and this has also been identified in the urine of TIWL patients.
Vegan & Antiangiogenic

A Vegan diet is probably more cancer preventive than any other. However, vegan diets, diets without any animal products in them at all, are difficult to balance in terms of complete total protein and B vitamins. They require careful construction and observation, and unless you are an expert, you should probably start out with a good dietician.

~~~~~~~~~
From Med Hypotheses. 2003 Jul;61(1):1-15.
A wholly nutritional 'multifocal angiostatic therapy' for control of disseminated cancer.
McCarty MF.
Pantox Laboratories, San Diego, California 92129, USA.

A great deal of effort is now being devoted to the development of new drugs that hopefully will control the spread of inoperable cancer by safely inhibiting tumor-evoked angiogenesis. However, there is growing evidence that certain practical nutritional measures have the potential to slow tumor angiogenesis, and it is reasonable to anticipate that, by combining several measures that work in distinct but complementary ways to impede the angiogenic process, a clinically useful 'multifocal angiostatic therapy' (MAT) might be devised.

[Multifocal angiostatic therapy is describing the use of more than one agent to prevent angiogenesis by tumor. Rather than using just one agent, which eventually a mutation in the cancer cells might be able to bypass, the idea is to use multiple agents, which effect multiple pathways simultaneously, and so keep the cancer cells from growing new blood vessels more effectively for a longer period of time. Ed.]

Several measures which might reasonably be included in such a protocol are discussed below, and include:

a low-fat, low-glycemic index vegan diet, which may down-regulate the systemic IGF-I activity that supports angiogenesis;

supplemental omega-3-rich fish oil, which has been shown to inhibit endothelial expression of Flk-1, a functionally crucial receptor for VEGF, and also can suppress tumor production of pro-angiogenic eicosanoids;

high-dose selenium, which has recently been shown to inhibit tumor production of VEGF;

green tea polyphenols, which can suppress endothelial responsiveness to both VEGF and fibroblast growth factor; and

high-dose glycine, whose recently reported angiostatic activity may reflect inhibition of endothelial cell mitosis, possibly mediated by activation of glycine-gated chloride channels.

[Copper or Zinc]. In light of evidence that tumor-evoked angiogenesis has a high requirement for copper, copper depletion may have exceptional potential as an angiostatic measure, and is most efficiently achieved with the copper-chelating drug tetrathiomolybdate. If logistical difficulties make it difficult to acquire this experimental drug, high-dose zinc supplementation can achieve a slower depletion of the body's copper pool, and in any case can be used as maintenance therapy to maintain an adequate level of copper depletion. [This should be done under a doctor's supervision. Ed.]

A provisional protocol is offered for a nutritionally based MAT entailing a vegan diet and supplemental intakes of fish oil, selenium, green tea polyphenols, glycine, and zinc.

[NSAIDs]. Inasmuch as cox-2 is overexpressed in many cancers, and cAMP can boost tumor production of various angiogenic factors as well as autogenous growth factors, adjunctive use of cox-2-specific NSAIDS may be warranted in some cases.

Fetch PMID: 12781633
Low Copper - Antiangiogenesis


Angiogenesis is the formation of new blood vessels.
Tumors need a lot of new blood vessels to supply blood to its rapid growth.
Copper is needed in order to grow these new blood vessels.
Copper Depletion Antiangiogenesis is based upon the assumption that there is a window in which the copper concentration in the body is high enough to carry out the necessary business of the body, but too low to enable tumor angiogenesis.

Ammonium tetrathiomolybdate is a copper chelating agent used to lower body copper stores. It is an FDA approved orphan drug to be used in Wilson's Disease, a copper storage disease. If Ammonium tetrathiomolybdate cannot be obtained, however, then zinc salts can be used. Either way, a doctor's supervision is necessary.

However, if you are on a copper chelating medication [like zinc or tetrathiomolybdate] you might wish to avoid foods high in copper while attempting to attain target copper levels. Green leafy vegetables, nuts, seeds, whole grains and shellfish tend to be high in copper. Vegetable copper levels reflect the ground they grow in. Dairy and rice are relatively copper free.

For more information, see the Angiogenesis and Antiangiogenesis Page on this website. Also:
Full Text of Copper Control as ann Antiangiogenic Anticancer Therapy
Full Text of the Phase I Trial of Tetrathiomolybdate
Pubmed Search of Related Articles


~~~~~~~~~~~~~

From Med Hypotheses. 2003 Jul;61(1):1-15.
A wholly nutritional 'multifocal angiostatic therapy' for control of disseminated cancer.
McCarty MF.
Pantox Laboratories, San Diego, California 92129, USA.

A great deal of effort is now being devoted to the development of new drugs that hopefully will control the spread of inoperable cancer by safely inhibiting tumor-evoked angiogenesis. However, there is growing evidence that certain practical nutritional measures have the potential to slow tumor angiogenesis, and it is reasonable to anticipate that, by combining several measures that work in distinct but complementary ways to impede the angiogenic process, a clinically useful 'multifocal angiostatic therapy' (MAT) might be devised.

Several measures which might reasonably be included in such a protocol are discussed below, and include:

a low-fat, low-glycemic index vegan diet, which may down-regulate the systemic IGF-I activity that supports angiogenesis;

supplemental omega-3-rich fish oil, which has been shown to inhibit endothelial expression of Flk-1, a functionally crucial receptor for VEGF, and also can suppress tumor production of pro-angiogenic eicosanoids;

high-dose selenium, which has recently been shown to inhibit tumor production of VEGF;

green tea polyphenols, which can suppress endothelial responsiveness to both VEGF and fibroblast growth factor; and

high-dose glycine, whose recently reported angiostatic activity may reflect inhibition of endothelial cell mitosis, possibly mediated by activation of glycine-gated chloride channels.

[Copper or Zinc]. In light of evidence that tumor-evoked angiogenesis has a high requirement for copper, copper depletion may have exceptional potential as an angiostatic measure, and is most efficiently achieved with the copper-chelating drug tetrathiomolybdate. If logistical difficulties make it difficult to acquire this experimental drug, high-dose zinc supplementation can achieve a slower depletion of the body's copper pool, and in any case can be used as maintenance therapy to maintain an adequate level of copper depletion. [This should be done under a doctor's supervision. Ed.]

A provisional protocol is offered for a nutritionally based MAT entailing a vegan diet and supplemental intakes of fish oil, selenium, green tea polyphenols, glycine, and zinc.

[NSAIDs]. Inasmuch as cox-2 is overexpressed in many cancers, and cAMP can boost tumor production of various angiogenic factors as well as autogenous growth factors, adjunctive use of cox-2-specific NSAIDS may be warranted in some cases.

Fetch PMID: 1278163

Herbs

From Quackwatch
Unconventional Cancer Treatments
Chapter 4: Herbal Treatments


The therapeutic use of plant products -- herbal medicine -- is among the oldest of medical practices. It is a central feature of many current forms of folk and traditional medicine, e.g., traditional Chinese medicine, Native American healing, and curanderismo, and is used in the treatment of a wide range of disorders, including cancer. More than 3,000 different plant species have reportedly been used to treat cancer in cultures worldwide, according to a survey of the international literature (through 1971) in scientific and folk medicine ... Herbal products are also used in unconventional cancer treatment in the United States, drawing from traditional practices in most cases, but generally offered outside of the overall context of traditional medicine and folk healing.

Plant products are also the source of much of the mainstream pharmacopeia. The use of botanical products in mainstream drug development involves the identification and extraction of active components of whole plants or crude extracts and, in some cases, synthesis of equivalent active compounds. The rationale for this approach is that by reducing or eliminating the variability of chemical composition and concentration that exists in crude plants, precise doses of known compounds can be given to patients.

Several chemotherapeutic drugs used in conventional cancer treatment were developed from botanical sources. One of the best known examples is Etoposide, derived from the mayapple plant (Podophyllum peltatum). Prompted by a 1942 report of the treatment of venereal warts using a constituent (podophyllotoxin) of mayapple, Jonathan Hartwell and colleagues at NCI's Drug Research and Development Program identified the chemical structure for podophyllotoxin and isolated other constituents of the plant... Clinical trials of the substance were continued by a private company (Sandoz Ltd.) in the 1960s, and semisynthetic compounds (etoposide and teniposide) were later developed from the substance. Etoposide was approved by FDA in 1983 ...

Two of the most important chemotherapeutic drugs currently used were originally developed from a folk remedy containing the rosy periwinkle plant (Vinca rosea), which was used in Madagascar for treatment of diabetes. Chemical constituents with antitumor activity were isolated from the plant and tested for antitumor effects in animal systems. The constituents were later approved as vinblastine, used to treat Hodgkins disease, and vincristine, used to treat acute childhood leukemia ...

Traditional herbal practices, in contrast, involve the use of whole plants or crude extracts of whole plants, rather than purified active components. One of the central tenets of herbal philosophy is that constituents in botanical preparations other than the predominant active component may modify physiologic effects of the active component in beneficial ways (945). The effects of crude preparations are generally slower in onset and less dramatic than those of the purified active ingredient, which may be considered advantageous in some instances (946).

In recent years, some aspects of traditional Chinese medicine involving herbal medicine, acupuncture, Qi gong ...
Full Text of Article


From doctordee:
Recognize that Herbal Treatments may incorporate unknown substances as well as the active principle, that there is no effective FDA regulation of their purity, contents, freedom from contamination, or whether there is any evidence for their claims of effectiveness [except if they claim to treat or cure disease.]

Swoops on various commercial preparations, by government departments not only in the US but also in many other countries, show the active ingredient is present in 0% to 150% of the concentration claimed [eg St John's Wort]. Analysis of some herbal preparations show that unlisted but potent pharmaceuticals are added to the contents. These can be steroids, viagra, and/or other substances which are typically used to treat the condition that the herbal preparation is supposedly for.

The pleasant attitude that the herbs are natural, and therefore probably harmless, disregards the plethora of natural poisons [which include amanita muscarina and other deadly mushrooms, foxglove, nicotine, as part of a long, long list.] When ingesting a herbal preparation, there is not the support of a package insert, which describes adverse effects, interactions with other medications, mechanism of action, symptoms of overdosage, and treatment of overdosage.

Some of the herbal preparations that decrease chemotherapy side effects, do so by interfering with chemotherapy levels, and result in the patient being undertreated. Others block the effects. ALWAYS tell your doctors exactly what Vitamins, Minerals, and Herbals you are taking. Remind them before any chemotherapy or radiation or other cancer treatment.

From The American Cancer Society Website
Growing Interest Prompts Caution

Despite the increased interest in herbal remedies, one of the biggest voids in information is knowing what side effects herbs can have. Known side effects include heart problems after discontinuing use of valerian root, an herb used as a sedative. Another known side effect is sensitivity to light in some people who take St. John's wort. It's even possible to overdose on common vitamins such as Vitamin E, iron, or Vitamin B; or experience a reaction if the vitamin supplements are taken with standard pharmaceutical anti-depressants.

David M. Eisenberg, MD, and colleagues in "Trends in Alternative Medicine Use in the United States, 1990-1997" in JAMA sounded the alarm about patients who use these therapies. According to the article, of five patients taking prescription medicine, one is also taking herbs or high-dose vitamins. As many as 40 percent of people do not report their use of these therapies to their doctors.

Regulating Herbs
The market for supplements was flung wide open after the Dietary Supplement Health and Education Act of 1994 eliminated the authority of the US Food and Drug Administration (FDA) to regulate vitamins, herbs and other food-based products. But the FDA is attempting to track adverse reactions to herbs through reports to its MedWatch hotline (800-FDA-1088). The FDA keeps a web site for the reported adverse effects and drug interactions called the FDA Dietary Supplement Information Page.

Prompted by the growth of the industry, another government agency, the Federal Trade Commission (FTC), has issued advertising guidelines aimed at the supplement industry. The new guidelines explain how truth in advertising applies to the supplement industry and spells out the kinds of claims manufacturers can and cannot make.

From The American Cancer Society Website
Understanding Dietary Supplements

Herbal remedies and botanical extracts have taken a firm hold on the minds and pocketbooks of millions. Echinacea (touted as boosting immunity), gingko biloba (said to aid in memory), and St. John's wort (considered a mood elevator), are just a few of the herbs regularly used by millions of Americans. It is estimated that $2.5 billion were spent on herbs in 1996, and estimates for spending on all food supplements are as high as $12 billion a year. The amount is growing about 25 percent per year, according to studies in the November 11, 1998 issue of the Journal of the American Medical Association (JAMA). With the onslaught of advertising for these products, it may be hard to tell just exactly what the difference is between herbs and botanicals, and actual pharmaceuticals.

Botany is the science of plants. The use of plants as medicine is referred to as botanicals and/or botanical medicine. The properties of botanicals are derived from the plant.

Pharmaceuticals are chemical preparations of medication that go through a process of study to determine safety and efficacy, and are regulated by the US Food and Drug Administration (FDA). Pharmaceuticals can be obtained either over the counter or by prescription. Some pharmaceuticals are made from plants.

Herbal medicine is the use of plants or plant parts as remedies for aches, pains, and illness. Herbs can be sold in a variety of forms-dried, finely chopped, powdered, or as liquid in a capsule. Despite the growing popularity of herbs, they are medications and are unregulated, and have not undergone the clinical testing necessary to prove they are effective and safe. With our current system of drug regulations, herbs are considered "supplements."

Herbal Remedies Used for Many Centuries
Consumers may find it comforting that herbal remedies have been used for thousands of years. For example, the herb ephedra, the main ingredient in some over-the-counter asthma treatments, has been used in China for 5,000 years. In modern times, plants also have made a major contribution to the pharmaceutical industry. As many as one-fourth of pharmaceuticals have botanical origins. Taxol, made from the Pacific Yew tree, is used to treat patients with cancers of the breast and ovary.

Most people take herbs in the hopes of preventing illness, however, patients also turn to herbal remedies in hopes they will cure an existing illness. Cancer patients can be particularly susceptible to the lure of herbal remedies or other non-medical therapies. They may perceive a lack of major advancements in cancer treatment and therefore see no reason not to try something else, explained Barrie Cassileth, PhD, a founding member of the advisory board of the National Institutes of Health Office of Alternative Medicine.

While many herbal preparations are safe to use, others can cause severe and harmful side effects and interfere with proven cancer therapies including chemotherapy, radiation therapy, and recovery from surgery. If you are interested in using products containing herbs, talk about it with your doctor or nurse first.

Safety Considerations
Tell your health care team about any herbal products and supplements that you are using or are considering for use. Bring the the supplements in their packaging to your doctor for approval of the dose and to ensure that the ingredients do not interfere with your health or cancer treatments. Ask your doctor or nurses for reliable information on dietary supplements. Check the product labels for both the quantity and concentration of active ingredients contained in each product. Stop taking the product immediately and call your doctor if you experience side effects such as wheezing, itching, numbness, or tingling in your limbs.
From The American Cancer Society Website


The Block Diet
From Quackwatch -- The Block Diet

An Example of an Adjunctive Nutritional Approach to Cancer Treatment
A program developed over the past ten years by Keith I. Block, MD, illustrates one approach to nutritional treatment that can be used in conjunction with mainstream cancer care. The program, as described by its developer, is intended to be used adjunctively and not as a substitute for medical treatment. At present, it is used in Block's private medical practice in Evanston, Illinois, and at an independent medical center in Chicago.

According to Block's protocol, individualized dietary guidelines and nutritional treatment are used in combination with mainstream cancer treatment, exercise, and psycho- social support strategies for stress reduction. Overall dietary guidelines are made on the basis of nutritional assessments, including the use of body composition analysis, blood and laboratory studies, determinations of nitrogen balance, and other biochemical and clinical evaluations. Patients are given a range of food choices within an overall framework that covers five food groups (cereal grains, vegetables, fruits, fats, and proteins). Foods are divided into exchange lists so patients can select foods according to their tastes while still satisfying the overall nutritional requirements of the program.

The semivegetarian diet Block recommends consists of high-fiber, low-fat, protein-restricted foods along with specific items such as soybean products, shiitake mushrooms, and sea vegetables. In general, Block recommends that 50 to 60 percent of calories be derived from complex carbohydrates, 12 to 25 percent of calories from fat, and the remainder from protein sources. The diet, which is modified on an individual basis, emphasizes foods high in vitamins, trace minerals, and substances thought to reduce cancer risks. Developed in part from macrobiotic principles, the diet has been modified to incorporate information from other sources, primarily experimental data from the scientific literature on substances that may be active in inhibiting tumor growth or stimulating immune responses. Nutritional analysis has reportedly shown Block's nutritional program to be nutritionally adequate; the Recommended Daily Allowances (RDAs) were met or exceeded for almost all nutritents for which RDAs have been established and for which nutrient analyses are available, and the diet reportedly exceeds requirements for vitamins A, C, and B12, calcium, iron, magnesium, and several other elements.

Block's use of an adjunctive dietary program for cancer patients has several goals, some of which he believes have been met in many cases, based on observations of patients treated with this regimen. One goal is to maintain adequate nutritional support through oral feeding as much as possible, in order to improve patients' quality of life and help them retain "a sense of self-empowerment and clinical autonomy." He notes that few of the cancer patients on his program experience weight loss, except those with anorexia in late stages of disease, or experience hair loss during chemotherapy. Another goal is to enhance patients' resistance to the disease by focusing on improving immune function and inhibiting tumor growth through the provision of a low-fat diet, which may decrease the intake of tumor- promoting substances. The high intake of vitamin A- containing vegetables in the diet is believed to enhance patients' responses to conventional cancer treatment. Overall, Block believes his program to be of benefit in diminshing the side effects of conventional treatment and in improving patients' quality of life. The treatment protocol has been described in some detail in unpublished manuscripts, but thus far, it has not been studied systematically so that its effects on patients can be judged adequately.
From Quackwatch -- The Block Diet
Green-Red Diet
The Green-Red Diet works like this.
You have a brassica family vegetable with dinner.
For dessert you have red berries or red wine.

The green vegetable has indole-3-carbinol, which induces [causes an increased amount and activity of] an enzyme called cytochrome P450.
The cytochrome p450 works on the resveratrol in the red dessert to create an anticancer substance from it.
More detail below:


1. Indole-3-carbinol
is one of the major anticancer substances found in cruciferous (cabbage family) vegetables. It is found in highest concentrations in broccoli, but is also found in other cruciferous vegetables, such as cauliflower, cabbage, and kale.

Indole-3-carbinol is a member of the class of sulfur-containing chemicals called glucosinolates. It is formed
from parent compounds whenever cruciferous vegetables are crushed or cooked. Indole-3-carbinol and other glucosinolates (e.g., other indoles and isothiocyanates such as sulforaphane) are antioxidants and potent
stimulators of natural detoxifying enzymes in the body. Indole-3-carbinol and other glucosinolates are believed to be responsible for the lowered risk of cancer in humans that is associated with the consumption of broccoli and other cruciferous vegetables like cauliflower, cabbage, and kale

Feeding indole-3-carbinol or broccoli extracts rich in indole-3-carbinol has dramatically reduced the frequency, size, and number of tumors in laboratory rats exposed to a carcinogen. It appears to be especially protective against breast and cervical cancer because of a number of actions, including an ability to increase the breakdown of estrogen. However, while most animal studies report protective effects, a few indicate that indole-3-carbinol may actually promote cancer formation in certain situations, depending upon the chemical initiator of cancer, method of exposure, and species of animal studied.

Until there is further research and more human clinical data to determine if indole-3-carbinol actually inhibits rather than stimulates cancer formation, some researchers have recommended proceeding with caution when using isolated indole-3-carbinol as a dietary supplement. The areas where its use has currently been documented in humans are only preliminary, but the results are promising. Indole-3-carbinol reduced or halted the formation of papillomas (precancerous lesions) in 12 out of 18 patients with recurrent respiratory tract papillomas. In addition, in a small double-blind trial, supplementation with 200 or 400 mg of indole-3-carbinol per day for 12 weeks reversed early-stage cervical cancer in 8 of 17 women. Preliminary studies have also shown indole-3-carbinol has significantly increased the conversion of estrogen from cancer-producing forms to nontoxic breakdown products.

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Search Pubmed for Indole-3-carbinol and Cancer


2. Resveratrol
is a naturally occurring polyphenolic phytochemical and can be found in many plant species, including red wine, grapes, red berries, plums, and peanuts. Several studies have established that Resveratrol can exert anti-oxidant and anti-inflammatory activities and has activity in the regulation of multiple cellular events associated with carcinogenesis.
Resveratrol's anti-cancer effects include its role as a chemopreventive agent, its ability to inhibit cell proliferation, its direct effect in cytotoxicity by induction of apoptosis and on its potential therapeutic effect in pre-clinical studies. Resveratrol also seems to sensitize cancer cells to cytotoxic drugs when it is used with those drugs in drug-resistant cancer cells.

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Search Pubmed for Indole-3-carbinol and Cancer

3. Piceatannol is a closely related compound to Resveratrol. Piceatannol has antileukaemic activity and is also a tyrosine kinase inhibitor. Piceatannol differs from resveratrol by having an additional aromatic hydroxy group. The enzyme CYP1B1 is overexpressed in a wide variety of human tumours and catalyses aromatic hydroxylation reactions. We report here that the cancer preventative agent resveratrol undergoes metabolism by the cytochrome P450 enzyme CYP1B1 to give a metabolite which has been identified as the known antileukaemic agent piceatannol.

This observation provides a novel explanation for the cancer preventative properties of resveratrol. It demonstrates that a natural dietary cancer preventative agent can be converted to a compound with known anticancer activity by an enzyme that is found in human tumours. Importantly this result gives insight into the functional role of CYP1B1 and provides evidence for the concept that CYP1B1 in tumours may be functioning as a growth suppressor enzyme.

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4. The Green-Red Diet
consists of having a cruciferous vegetable, like broccoli, cabbage, cauliflower, or kale with dinner. And then for dessert having red berries, red grapes or a glass of red wine. A green cruciferous vegetable to be absorbed first, the indole-3-carbinol content of which will induce the Cytochrome p450 enzyme responsible for changing the Resveratrol in dessert into Piceatannol.

Professor Potter of De Montfort University in the UK, has postulated that this combination of foods in the diet might have a controlling effect on cancer. He is currently involved in developing trials for a more powerful resveratrol derivative that he has been working on.
About the Clinical Trial


5. In Summary

Resveratrol is classified as a polyphenol, but also as a phyto-oestrogen because of its structural similarity to the oestrogen estradiol.

Piceatannol is a closely related phyto-estrogen with known anti-cancer activity and is a tyrosine kinase inhibitor.

The enzyme CYP1B1 belongs to the cytochrome P450 enzyme family and is highly represented in human tumours. It has been found in a wide range of tumours including brain, breast, colon, lung and ovary, but was not detected in the corresponding normal tissues (Murray et al 1997). CYP1B1 is known to catalyse estradiol to 4-hydroxyestradiol.

The group hypothesised that resveratrol might be converted by the enzyme CYP1B1 because of its similarity in structure to estradiol.

The team are also looking into the beneficial effects of brassica family vegetables (e.g. broccoli, cabbage etc.) which contain a molecule that activates the CYP1B1 enzyme.
Further Relevant Discussion
Search Pubmed for Related Articles
During Treatment

The www.cancer.gov site has a PDQ section, which deals with general information, specific information about specific cancers, and a clinical trials listing. Under its general cancer information, it has an excellent site Overview of Nutrition in Cancer Care

Also go to Coping with Chemotherapy Side Effects on this website.

The American Cancer Society also has information.
From Nutrition Before, During, and After Treatment

Effects of Supplements on Cancer Treatment
"Many people with cancer take herbs and other alternative therapies, hoping to help treat their disease. Types of alternative therapies commonly used include vitamins and minerals, antioxidants, enzymes, amino acids, animal extracts, hormones, herbs, and other dietary supplements. People take these supplements for a variety of reasons, such as the desire to actively participate in treatment and to improve nutrition. In many cases, friends or family members encourage people with cancer to try the supplements. But while many dietary supplements may be touted as cancer cures, to date there is no evidence that these products are effective treatments for the disease."

Vitamins, Minerals, and Other Dietary Supplements
"Some people with cancer take large amounts of vitamins, minerals, and other dietary supplements in an effort to enhance their immune systems or even destroy cancer cells. Some of these substances can be harmful. In fact, large doses of some vitamins and minerals may reduce the effectiveness of chemotherapy and radiation therapy. Your doctor, nurse, or dietitian may advise you to supplement your diet with certain vitamins and minerals during treatment. This is especially true if you are unable to eat an adequate diet. In most cases, however, a supplement that contains 100 percent of the US Recommended Daily Allowances (US RDA) is usually sufficient. Many people believe that if a pill or supplement can be found on store shelves, then it is safe and effective. At this time, there are no regulations controlling the safety, content, and quality or dose recommendations for these products. The US Food and Drug Administration (FDA) does not require manufacturers of these products to print possible side effects on their labels. The FDA cannot pull a dietary supplement or herbal product from the market unless it can prove that the product is unsafe. If you are considering taking dietary supplements, talk with your doctor or nurse first. If you are already taking supplements, bring them with their packaging with you to your doctor for approval on the dose and to ensure that the ingredients do not interfere with your health or cancer treatment."

"Antioxidants are substances that protect the body's cells from damage caused by free radicals (by-products of the body's normal processes). Examples of antioxidants include vitamin C, vitamin E, beta carotene, and selenium. If you want to take in more antioxidants, health experts recommend eating a variety of fruits and vegetables, which are good sources of antioxidants. Taking large doses of antioxidant supplements is usually not recommended while undergoing chemotherapy and radiation therapy. Talk with your doctor to determine the best time to take antioxidant supplements."

"Herbs have been used to treat disease for hundreds of years. Today, herbs are found in a variety of products such as pills, liquid extracts, teas, and ointments. While many of these products are harmless and safe to use, others can cause severe and harmful side effects and interfere with proven cancer therapies including chemotherapy, radiation therapy, and recovery from surgery. If you are interested in using products containing herbs, talk about it with your doctor or nurse first."

Safety Considerations
"Tell your health care team about any herbal products and supplements that you are using or are considering for use. Bring the substances to your doctor along with their packaging for approval of the dose and to ensure that the ingredients do not interfere with your health or cancer treatments. Ask your doctor or nurses for reliable information on dietary supplements. Check the product labels for both the quantity and concentration of active ingredients contained in each product. Stop taking the product immediately and call your doctor if you experience side effects such as wheezing, itching, numbness, or tingling in your limbs. "

From The American Cancer Society Website
Your doctor, nurse, or dietitian may advise you to supplement your diet with certain vitamins and minerals during treatment. This is especially true if you are unable to eat an adequate diet. In most cases, however, a supplement that contains 100 percent of the US Recommended Daily Allowances (US RDA) is usually sufficient. Many people believe that if a pill or supplement can be found on store shelves, then it is safe and effective. At this time, there are no regulations controlling the safety, content, and quality or dose recommendations for these products. The US Food and Drug Administration (FDA) does not require manufacturers of these products to print possible side effects on their labels. The FDA cannot pull a dietary supplement or herbal product from the market unless it can prove that the product is unsafe. If you are taking or considering taking dietary supplements, talk with your doctor or nurse.


Oncology (Huntingt) 1999 Jul;13(7):1003-8; discussion 1008, 1011-2
Possible interactions between dietary antioxidants and chemotherapy.
Labriola D, Livingston R.
Northwest Natural Health Specialty Care Clinic, Seattle, Washington, USA.

Many patients treat themselves with oral antioxidants and other alternative therapies during chemotherapy, frequently without advising their conventional health care provider. No definitive studies have demonstrated the long-term effects of combining chemotherapeutic agents and oral antioxidants in humans. However, there is sufficient understanding of the mechanisms of action of both chemotherapeutic agents and antioxidants to predict the obvious interactions and to suggest where caution should be exercised with respect to both clinical decisions and study interpretation. This article will describe these potential interactions and areas of concern, based on the available data. It will also suggest several potential courses of action that clinicians may take when patients indicate that they are taking or plan to use alternative therapies.
Fetch PMID: 10442346
Constipation

Constipation is defined as stool that is hard. For a cancer patient, constipation can be a way of life.

Eating less food, and it being less bulky can cause constipation.
Drinking less liquids can cause constipation.
Taking less exercise can cause constipation.
Cancer itself can sometimes cause constipation.
Cancer treatments can cause constipation.
Pain medications can cause constipation.
Tranquilizers can cause constipation.
Thyroid problems can cause constipation, and it has been estimated that 16% of patients being treated for cancer have a thyroid problem.

If stool continues to accumulate inside the colon, at some point it will form an obstruction. The symptoms of obstruction can be a feeling of lower abdominal fullness, abdominal pain, nausea and/or vomiting. When the bowel is obstructed by stool, it is called a fecal impaction. It is probably possible, in extreme cases, to even burst a bowel.

Fecal impactions are difficult to remove and requires concerted effort with laxatives, stool softeners, and various enemas and suppositories, often for a couple of days.

Caretakers and patients are warned to pay attention to stool quantity and consistency and frequency, in order to prevent fecal impaction. It is much more comfortable to prevent fecal impaction than to treat it.


From Dick:
Here's a recipe that a hospice nurse friend of my wife gave us for treatment of constipation.


1 pound prunes
1 pound raisins-pitted
1 pound figs
4 oz. senna tea
1 cup brown sugar
1 cup lemon juice


Directions

1. Prepare tea -- use about 2 1/2 cups boiled water added to tea and steep 5 minutes.

2. Strain tea to remove tea leaves and add only 1 pint tea to a large pot, then add fruit.

3. Boil fruit and tea for 5 minutes.

4. Remove from heat and add sugar & lemon juice.
Allow to cool.

5. Use hand mixer or food processor to blend fruit mixture into smooth paste.

6. Place in plastic container and place in freezer.
(Paste will not freeze but will keep forever in freezer)

7. DOSE: 1-2 tablespoons per day. Spoon out what you require each day.

Enjoy eating it straight off the spoon.

Spread it on toast or add hot water and make a drink

* If it's not working -- eat more of it
* If it works too well -- eat less of it
Mouth Sores

A sore mouth during chemotherapy or radiation treatment is called stomatitis. If stomatitis is bothersome during treatment, it can have a severe effect on diet and hydration of the patient, and can be a limiting toxic effect of the treatment. However, not everyone gets stomatitis or mucositis. And if they do, usually the symptoms are relieved by the magic mouthwash [recipe below] and/or anti-thrush medication.

Stoma means "mouth", and -itis means inflammation of. Sometimes other mucous membranes besides those of the mouth are affected: the nose, esophagus [swallowing tube], stomach, small and/or large intestines, eyes, vagina, and urethra, for example. The general term for the inflammation of the mucous membranes of the body is "mucositis".

Stomatitis is sometimes a side effect of radiation to the head and/or neck, sometimes it is a side effect of chemotherapy. These treatments are more toxic to rapidly dividing cells, and the cells of the mucosa [mucous membranes, or lining] of the mouth are rapidly dividing. Stomatitis can involve any or all of the tissues of the lips, gums, inside of the cheeks, tongue, and/or palate. Mucositis can involve any of the mucous membrane tissues.

As the cells of the mucosa are damaged by the chemo or radiation, and die, the mucous membrane thins and then erodes, exposing underlying tissue. This is painful. The pain of eating with an inflamed mouth may prevent adequate nutrition and impair survival of the patient. The fissures and ulcers that occur, exposing underlying tissues, are roadways for oral bacteria to enter the bloodstream. When the white cell count is low [and it often is during episodes of stomatitis], these bacteria entering the blood stream through oral ulcers and fissures can set off a blood borne infection [sepsis] than can progress to death.

Stomatitis can occur 7-14 days after chemo and lasts 2-3 weeks. It often occurs at the same time as neutropenia [low level of white cells.]

If you are going to have chemotherapy or head or neck irradiation, first see your dentist.

The first signs of a problem will probably come from being extra sensitive to foods that are particularly spicy, sour, or acidic. In time, actual sores may develop, similar to cold sores, or white patches, or painful swallowing.

1. Notify your doctor. Ask about magic mouthwash.


2. Try Tylenol for pain relief.

3. Brush your teeth often. It is very important to keep your mouth and teeth clean while you are taking chemotherapy. Buy a brush with soft bristles (you may want to forego electric toothbrushes as they tend to be harsher to the gums), use warm water, and use a fluoride toothpaste. It is best to brush your teeth any time you eat something, but at least 3 times a day. In addition, do not floss or use waterpiks if you are having trouble with bleeding due to a low white count. Not only will you further irritate your gums but you could have a serious problem getting your gums to stop bleeding.

4. Do not use alcoholic mouth rinses. Oral-B makes a great non-alcoholic fluoride rinse, and your dentist can write you a prescription for something stronger. You can also use a baking soda and water mixture (one teaspoon baking soda per 8 ounces of water) to rinse your mouth. It not only serves the purpose of a mouthwash, but it will soothe aching gums. Rinsing your mouth with the mixture for a minute at a time four times a day will help reduce the bacterial count in your mouth as well, and may cut down on infectious complications.

5. Keep your lips moist with glycerine, KY jelly or some other non petroleum product. This will also help you to avoid bleeding problems on your lips if they become so dry they start to crack.

6. Your diet. This really depends upon the person. If you have severe problems, you will want to avoid any foods that are too hot or too cold. Lukewarm, room temperature type foods will be best. See what temperature feels least painful while eating. You also will want to stick with smooth foods that you don't have to chew, like puddings, jellos, applesauce, pureed foods, smoothies, cream soups. Don't be embarrassed to eat baby food -- like Hawaiian Delight, and Blueberry Buckle.

7. Use a straw when you drink liquids. This will help to transport the liquid to the back of your throat without touching the problem areas. Milk can be soothing as it coats, and if you are having problems eating you can kill two birds with one stone by adding Carnation Instant Breakfast to the milk. If you drink three packets a day you will get your total daily protein requirements.
Avoid tomato and orange juices as they are acidic and be painful in your mouth; replace them with grape or apple juices.

8. Use the Magic Mouthwash before eating. If you have thrush [a yeast infection in the mouth] use the nystatin suspension after eating. Usually the stomatitis heals as the white cell count returns to normal.



Magic Mouthwash Recipe

Your doctor writes the prescription and the pharmacist makes it up.
Many hospitals have their own variations.
You swish it around in your mouth and spit it out BEFORE meals.
This mouthwash numbs your mouth, so you can eat.

1/3 Maalox
1/3 liquid Benadryl
1/3 viscous lidocaine 2% solution

If there is thrush [a yeast infection] in your mouth, your doctor will be able to diagnose this. Nystatin suspension, one or two teaspoons to be swirled around to coat your mouth AFTER each meal might be prescribed.
Sometimes tablets of diflucan or other medication are prescribed instead of the nystatin suspension.

References:
Reference 1
Reference 2
Reference 3
Reference 4



For a more detailed discussion of stomatitis, below are some excerpts from an article in the Cancer Control Journal, Volume 2 Number 5, H. Lee Moffitt Cancer Center & Research Institute.

The article is copyright by the H. Lee Moffitt Cancer Center, but the full text is available.


" Many patients who receive standard-dose chemotherapy experience some degree of mucositis, while most patients treated with high-dose chemotherapy experience severe complications. When the mucous membranes are exposed to ionizing radiation, inflammatory changes are expected. Combined modality therapy consisting of concurrent radiation and chemotherapy can produce highly symptomatic stomatitis (in patients with head and neck cancer) or esophagitis (in patients with lung or mediastinal tumors). Mucositis can be a dose-limiting complication that can interfere with attempts to increase the dose intensity of cancer therapy."

"Clinicians tend to restrict the definition and evaluation of mucositis to the oropharynx and lips, perhaps because of the easy accessibility of these areas for evaluation. Chemotherapy can affect all mucous membranes, however, and evaluation should include the eyes, nose, esophagus, vagina, bladder, and entire gastrointestinal tract."

"Oral mucositis from chemotherapy usually is preceded by the sensation of dry mouth and lips starting several days after administration of chemotherapy. If the complication progresses, the lips become chapped and whitish patches develop in the mucocutaneous junctions of the oropharynx. These patches usually are painful and can interfere with eating. If no complication or extension occurs, healing takes place over a period ranging from several days to several weeks... Evidence for mucositis in less visible sites includes dysphagia in the esophagus and abdominal tenderness and diarrhea in the gastrointestinal tract. Involvement of the nasal passages is manifested by dryness and irritation, and periocular involvement is indicated by dryness and excess tearing. Cough may reflect bronchial irritation. Finally, severe mucositis can produce a breakdown in the barrier component of the immune system, allowing for bacterial translocation from the gastrointestinal tract to the bloodstream.... In neutropenic patients, such bacteremia can be life threatening. "

"Chemotherapy can damage the oral and gastrointestinal mucosa through direct or indirect toxicity. The mechanism for direct mucositis is nonspecific cell kill of rapidly dividing basal epithelial cells that results in epithelial thinning, inflammation, decreased cell renewal, and ultimately ulceration. These painful lesions also produce an increased risk for local and systemic infection. "

"Indirect mucotoxicity is a byproduct of chemotherapy-induced myelosuppression. Profound granulocytopenia permits oral infections by Gram-negative bacilli, Gram- positive cocci, fungi such as Candida species, and viruses (particularly Herpes simplex). These infections usually occur at the site of direct mucositis or other oral trauma. A patient with a platelet count of 10 x 10 to the ninth per liter or less is at risk for spontaneous bleeding from oropharyngeal ulcerations. Indirect mucotoxicity is associated with the white blood cell count nadir following chemotherapy and most often occurs 12 to 14 days after drug administration...."

"Those agents that can produce direct mucositis at standard doses include ... alkylating agents such as ifosfamide and anthracyclines such as doxorubicin... This toxicity can be dose- and schedule-related, "


"A well-established prophylaxis for direct mucositis currently is unavailable, other than a prescription of suboptimal doses of chemotherapy, a downward dose modification in subsequent treatment courses following toxicity, ... Prophylactic chlorhexidine ... and nystatin or clotrimazole... may be given to reduce the risk of indirect mucotoxicity from bacteria and fungi in patients at high risk for greater than grade 2 or prolonged toxicity. Prophylactic fluconazole reduces the risk of oropharyngeal candidiasis at the risk of the development of resistance... Herpes simplex virus-antibody-positive patients undergoing high-dose chemotherapy with stem cell rescue should be given acyclovir 250 mg/m squared intravenously every eight hours for prevention of mucocutaneous infections from viral reactivation."

"A patient with stomatitis should follow a regular mouth-care routine of rinsing the oral cavity with distilled water or sterile normal saline solution for a full minute at least four times per day, followed by gently brushing the teeth, gums, and tongue with a fluoride toothpaste. Patients at high risk for neutropenia and thrombocytopenia should use disposable foam sticks instead of toothbrushes to reduce possible pain, bleeding, and transient bacteremia that can occur following brushing. Acidic, salty, spicy, and coarsely textured foods should be avoided. "

"Treatment of mucositis is primarily supportive. Patients with low to moderate pain can be managed with local anesthesiology. Most institutions have their own version of "magic mouthwash," a combination product of the topical treatment of mild oropharyngeal pain. ...Patients with severe pain require systemic narcotic analgesics."

"The consequences of chemotherapy-induced mucositis can be severe and can interfere with patients' quality of life, reduce dose intensity of therapy, and further increase the risk of systemic microbial infection. Agents or techniques are needed to prevent or reduce the severity of mucosal toxicity of chemotherapeutic agents."

"Copyright , H. Lee Moffitt Cancer Center & Research Institute. These sources should be used for informational purposes only. If you have a health-related problem, please consult a physician."

doctordee
compiled December 2003
Snake Oil, Scams, and Quackwatch

Effects of Supplements on Cancer Treatment
Many people with cancer take herbs and other alternative therapies, hoping to help treat their disease. Types of alternative therapies commonly used include vitamins and minerals, antioxidants, enzymes, amino acids, animal extracts, hormones, herbs, and other dietary supplements. People take these supplements for a variety of reasons, such as the desire to actively participate in treatment and to improve nutrition. In many cases, friends or family members encourage people with cancer to try the supplements. But while many dietary supplements may be touted as cancer cures, to date there is no evidence that these products are effective treatments for the disease.

Vitamins, Minerals, and Other Dietary Supplements
Some people with cancer take large amounts of vitamins, minerals, and other dietary supplements in an effort to enhance their immune systems or even destroy cancer cells. Some of these substances can be harmful. In fact, large doses of some vitamins and minerals may reduce the effectiveness of chemotherapy and radiation therapy. Your doctor, nurse, or dietitian may advise you to supplement your diet with certain vitamins and minerals during treatment. This is especially true if you are unable to eat an adequate diet. In most cases, however, a supplement that contains 100 percent of the US Recommended Daily Allowances (US RDA) is usually sufficient. Many people believe that if a pill or supplement can be found on store shelves, then it is safe and effective. At this time, there are no regulations controlling the safety, content, and quality or dose recommendations for these products. The US Food and Drug Administration (FDA) does not require manufacturers of these products to print possible side effects on their labels. The FDA cannot pull a dietary supplement or herbal product from the market unless it can prove that the product is unsafe. If you are considering taking dietary supplements, talk with your doctor or nurse first. If you are already taking supplements, bring the bottle(s) with you to your doctor for approval on the dose and to ensure that the ingredients do not interfere with your health or cancer treatment. The American Cancer Society Website


To check out specific herbal or other unconventional, alternative or complementary cancer treatments, it is recommended that you first check it out on Quackwatch, to see if there is any relevant evidence for the treatment being effective. Quackwatch provides a careful look at corroborative evidence, if any exists, for many touted remedies.

If you are going to spend time, energy and money pursuing a treatment, try to pick one with some evidence that it will give you some benefit.
Quackwatch Home Page


See Quackwatch: Office of Technology Assessment Report
Unconventional Cancer Treatments
Chapter 3: Dietary Treatments

This chapter reviews three examples of unconventional treatments with dietary regimens as the primary or central component: the treatment regimen developed by the late Max Gerson, MD, currently offered at a clinic in Tijuana, Mexico; the treatment regimen developed by William Kelley, DDS, and recently modified by Nicholas Gonzalez, MD, who treats patients in New York; and the macrobiotic regimen, whose educational resources and specialized food products are widely available to patients in the United States. Coffee enemas, which are included in two of these regimens, are also discussed separately
Finding a Dietician
written by Leigh


The information on this site is not a substitute for professional medical advice. You should not use this information to diagnose or treat a health problem or disease without consulting with your doctor. Please consult your doctor with any questions or concerns you may have regarding your condition. Copyright 2001-2010 LMSWEBSITE