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Did You Know That Most Cancers Can Be Linked To Nutrition Deficiency?
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Prevention
of Cancer by Nutrition
The increased awareness of the protective role of dietary
antioxidants is due largely to the results of epidemiological
studies undertaken in the developing countries and in the
USA. Researchers found that dietary levels of the major
antioxidant vitamins could be related to the prevalence
of cardiovascular diseases and cancer; in general the higher
the intake of these vitamins the lower the level of disease.(1,2)
Laboratory experiments demonstrated that dietary antioxidants
could reduce the degree of oxidation of cholesterol that
was associated with atherosclerosis and depress tumour growth
by mechanisms still not fully understood but believed to
act by preventing free radical damage to DNA or the production
of carcinogenic metabolites from food or foreign chemicals.
The next step was to initiate intervention studies in populations
susceptible to cancer, studies in China supported by the
US National Institutes of Health (NIH) showed that dietary
supplementation with nutritional antioxidants could reduce
the incidence of cancer in the 'at risk' populations.(3,4)
Treatment of Cancer by Nutrition
While it is now widely accepted that nutritional factors
can act to prevent some forms of cancer there is less recognition
of the therapeutic potential of antioxidant therapy to arrest
or cure diseases. The populist literature abounds with reports
of miraculous cures of cancer, these have been either isolated
cases of recovery or reported by doctors usually outside
the mainstream of medicine and mostly done without adequate
monitoring or ineffective controls. In some instances the
maverick researchers have been treated less than justly
by the medical establishment.
The Pioneers
Two examples of the many that could be quoted serve to illustrate
this situation.
Linus Pauling, the double Nobel prize winner, teamed up
with Ewen Cameron, an eminent Scottish surgeon to pursue
observations made by Cameron in his unfashionable Vale of
Leven Hospital, that large doses up to 10g/day of vitamin
C as sodium ascorbate could improve the survival time of
patients with terminal cancer.(5) The observations made
in Scotland were replicated in the USA and Canada and justified
initiating placebo controlled clinical trials.
As there was no potential profit in selling vitamin C no
pharmaceutical company could be persuaded to undertake such
expensive studies but after pressure from doctors and patients
the NIH agreed to sponsor a clinical trial of sodium ascorbate
that they designed without reference to Cameron or Pauling.
The results of this trial were essentially negative. Pauling
protested that the doses of ascorbate that were used were
too low; that the duration of the study was much shorter
than they had recommended and that the patient selection
process was defective but the results of this study virtually
were widely publicised and effectively put an end to Pauling's
claim that vitamin C had any value in cancer treatment.
In the 1950s Dr. Max Gerson promulgated a dietary treatment
for cancer that included high doses of antioxidant vitamins
and other nutrients and published his results of fifty well
documented cases who benefited from his programme.(6) No
controlled studies were done and the Gerson dietary therapy
has been largely derided by the medical establishment, but
Gerson's precepts are still widely practised with a level
of benefit to patients that can not readily be dismissed
as a placebo effect.
Unfortunately both Pauling and Gerson did not live to see
that many of their observations have been vindicated by
the results of the Chinese cancer intervention trials. Neither
of these eminent researchers appeared to recognise that
the vitamins they were studying were acting as antioxidants
and free radical scavengers but they were close to the truth
when they attributed the benefits of the treatments to stimulation
of the immune system.
Antioxidant Therapy in Breast Cancer
Now that the antioxidants have been shown to prevent cancer,
interest in their possible curative potential has been rekindled,
particularly as nutritional antioxidants are generally devoid
of the major toxic side effects of current anti-cancer drugs,
whether emanating from the test tube of the synthetic chemist
or the bio-reactor of the bio-technologist.
Karl Folkers and other investigators(7) have shown that
the blood levels of the naturally occurring antioxidant
Coenzyme Q10 ( CoQ10 ) or ubiquinone are lower in patients
with a variety of cancers than in matched controls. CoQ10
has also been shown to stimulate the host defence system
and to inhibit growth of chemically induced neoplasias.(8)
The commercial availability of this biochemical has encouraged
investigators to determine if this substance has any potential
anti-cancer activity in man. Ethical constraints make it
practically impossible to perform clinical trials in cancer
patients when single agents alone are used and this is even
more difficult when nutrients are to be investigated. Consequently
in most clinical trials of potential new therapies in cancer
the agent under investigation is given in addition to conventional
anticancer therapy and placebo alone controls are rarely
used.
In man the natural antioxidant defences against free radical
damage work in an integrated manner and experimental and
clinical studies suggest that the natural antioxidants work
synergistically; for example vitamin C is used by the body
to regenerate vitamin E that is destroyed in inhibiting
lipid peroxidation. Thus in the major antioxidant intervention
study in Linxian, China against oesophageal cancer, tablets
containing vitamins A, B1, B2, B3, C and E together with
zinc, selenium and molybdenum in various combinations were
tested.
In studies in women with breast cancer Lockwood and his
colleagues(9) have tested CoQ10 combined with other antioxidant
nutrients and fatty acids as an adjunct to conventional
radio- and chemotherapy. In the Chinese studies which were
aimed at preventing the development of oesophageal cancer
doses of antioxidants that were up to double the US RDAs
were used.
Lockwood argued that because of the compromised metabolic
picture of patients with advanced breast cancer who were
already receiving powerful immunosuppresant therapy, much
higher doses of antioxidants should be used. This approach
could be justified as any risk from nutrient toxicity would
be minimal against a background of the cytotoxic effects
of the powerful chemotherapeutic drugs that the patients
were already receiving. As it was impractical to determine
the dose levels of the antioxidants by conventional animal
studies as would be done with a novel anti-cancer drug,
the levels used in the study were estimated from the known
safe limits of each constituent of therapeutic regimen to
be tested.
Some natural oils, plants and animals high in long chain
polyunsaturated fatty acids (PUFAs) have been shown to have
anti-tumour activity under laboratory conditions. Evening
primrose oil containing the (-6 PUFA (-linolenic acid (GLA)
appeared in uncontrolled clinical trials to be effective
against some forms of cancer.(10) Fish oils containing the
(-3 PUFAs, EPA and DHA also may protect against other forms
of cancer.(11)
Women Patients
Thirty two women with breast cancer all of whom were regarded
as being at high risk were included in Lockwood's study,
their ages ranged from 32-81 years at the start of the trail.
The first patients were started on the treatment in 1992
and further patients have been added in the years since.
All patients were treated according to routine procedures
for managing breast cancer in use at the Copenhagen clinic,
they were given a combination of surgery, chemotherapy,
radiotherapy and in some cases tamoxifen according to clinical
need.
They were given a comprehensive check every three months
and a full clinical examination including mammography and
radiology and X-ray examination where indicated. Blood samples
were taken and full blood haematological and biochemical
profiles were determined, in addition to conventional determinants
these included CoQ10 and antioxidant blood levels. The levels
of the tumour fighting t-lymphocytes and their subsets,
the natural killer cells and helper and suppressor cells,
were counted. Open biopsies of the tumour sites were taken
for histopathological examination.
The Researchers
Knut Lockwood, a Danish cancer specialist from Copenhagen,
noted the work of Karl Folkers and his colleagues from Texas
on CoQ10 levels in cancer patients that was published in
1982.(12) He approached Folkers with a view to exploring
the potential of CoQ10 in the treatment of his women patients
with breast cancer. They recruited the help of Sven Moesgaard
of the Danish firm Pharma Nord to develop a feasible dosage
regiment for Lockwood's patients. A Japanese researcher
Takashi Hanioka later joined the team to perform the laboratory
determinations. They decided to use a multivalent, or blunderbuss
approach, and combine CoQ10 , the antioxidant vitamins and
minerals with borage oil containing higher levels of GLA
than evening primrose oil, and a concentrated fish oil preparation.(13)
Treatments - The Strategy and Weapons
The nutritional supplements given to the women in this study
were provided by one manufacturer as commercially available
preparations providing a full spectrum of recognised antioxidant
nutrients:(not listed here - see issue 8 for full listing).
In the light of experience and in order to boost the blood
levels of CoQ10, the daily dose of Bio-Quinone Q10 was increased
to from 90mg to 390mg after the first year. Because of compliance
problems due to the number of capsules required, the daily
dose of the fatty acid preparations was reduced as shown
above. These dose levels are now being used in the ongoing
study.
It should be emphasised that supplements from other manufacturers
should not be regarded as equivalent to the above product
as the bioavailability of the active ingredients and especially
CoQ10 has been shown to vary widely with the form in which
the nutrient is presented. In the above formulation the
CoQ10 is dissolved in a vegetable oil in a gelatine capsule
with a bioavailability that is double that from a typical
tablet.
Results
After the first year the patients showed a significant increase
in the mean blood level of CoQ10 from 0.82mg/l to 1.6mg/l,
similar increases were found in the levels of the other
major antioxidants which have been maintained ever since.
The average total lymphocyte count and the total number
of natural killer cells increased significantly but there
was no change in the helper/suppresser cell ratio. There
has been a general improvement in the clinical status of
the patients. Actuarial data suggest that four of the patients
with the level of disease present in these patients could
have been expected to have died during the period of the
trial14 but to date, mid 1995, none of the women entered
into the trial have died. None of the patients have shown
evidence of progression of distant metastatic spread.
All patients have maintained their body weights, the use
of pain killers has been reduced and their quality of life
measures have improved. In six of the patients there is
evidence of some degree of remission with either disappearance
of the tumour or absence of any evidence of enlargement
or metastatic spread. By 1993 two patients had shown complete
regression of tumoursand since then three additional cases
have been reported.(13) One of these three cases had metastases
derived from intra-ductal carcinoma of the breast and these
were found to have disappeared during continued therapy.
In a further patient with metastatic spread to the liver
with usually a poor prognosis the liver metastases also
appear to have disappeared. Despite the high levels of nutrition
supplements given and the state of health of the women there
were no significant adverse side effects attributable to
the treatment.
Study Progress
Lockwood's studies are continuing and new patients are being
added to the group but the study is planned to last for
a further two years before a full assessment can be made
of the long term benefits of the treatment. However, the
results are sufficiently encouraging that further studies
using CoQ10 are being planned in additional centres in different
countries.
The studies of Lockwood and Folkers offer hope to women
diagnosed with breast cancer and might encourage women with
this common form of cancer to pressurise their oncologists
to add CoQ10 and other antioxidant nutritional supplements
to their usual chemotherapy regimens. There is now firm
evidence that this adjunctive approach may increase the
effectiveness of treatment with no toxicological penalties.
References
1 Halliwell B & Gutteridge JMC. Free Radicals in Biology
and Medicine. Oxford University Press. Oxford. 1989
2 Folkers K, Ellis J, Yang O et al. in Vitamins and Cancer
Prevention. pp103-118, Wiley-Liss. N.Y. 1991
3 Blot W, Li J-Y, Taylor R et al. Nutrition intervention
trials in Linxian, China: Supplementation with specific
vitamin/mineral combination, cancer incidence and disease
specific mortality in the general population. J. Nat. Cancer
Inst. 85: 1483-98, 1993.
4 Li J-Y, Taylor R, Li B. et al. Nutrition intervention
trials in Linxian, China: Multiple vitamin /mineral supplementation,
cancer incidence and disease specific mortality among adults
with esophageal dysplasia. J. Nat.Cancer Inst. 85: 1492-148,
1993.
5 Cameron E. & Pauling L. Cancer and Vitamin C. Linus
Pauling Institute, Menlo Park, California. 1979.
6 Gerson M. A Cancer Therapy: Results of Fifty Cases. Totality
Books, Del Mar. 1958.
7 Folkers K, Brown R, Judy WV and Morita M. Survival of
cancer patients on therapy with coenzyme Q10. Biochem.Biophys.Res.
Comm. 192: 241-251, 1993.
8 Folkers K. Critique of 30 years of research on haematopoietic
and immunological activities of coenzyme Q10 and potentiality
for therapy of AIDS and cancer. Med.Chem. Res. (in press)
1994.
9 Lockwood K, Moesgaard S, and Folkers K. Partial and complete
remission of breast cancer in patients in relation to dosage
of coenzyme Q10. Biochem. Biophys. Res. Comm. 199: 1504-8
, 1994.
10 Van der Merwe C.F., Booyens J and Katzeff IE. Oral gammalinolenic
acid in 21 patients with untreatable malignancy. An ongoing
pilot open clinical trial. Brit.J.Clin. Practice 41: 907-915,
1987.
11 Nielsen N and Hansen J. Gastric and colorectal cancer
in Greenland. Diagnostic basis and minimum incidence. Scand.
J. Gastroent. 14: 697-703, 1979.
12 Folkers K, Shizukiushi S, Takemura K , et al. Increase
in levels of IgG in serum of patients treated with coenzyme
Q10. Res. Comm. Path. Pharm. 38: 335-338, 1982.
13 Lockwood K, Moesgaard S, Hanioka T and Folkers K. Apparent
partial remission of breast cancer in patients supplemented
with nutritional antoxidants, essential fatty acids and
coenzyme Q10. Mol. Aspects Medicine. 15: Supp. s231-s240.
1994.
14 Dombernowsky P, Brincker H, Hansen M. et al. Adjuvant
therapy of premenopausal and menopausal high risk breast
cancer patients. Present status of the Danish Breast Cancer
Cooperative Group Trials. 77-B & 88-B. Acta Oncol. 27:
691-7, 1988
Further Information:
Professionals requiring detailed reports and copies of the
published papers covering Lockwood's work can be obtained
on request from Pharma Nord (UK) Ltd. Spital Hall, Mitford,
Morpeth. NE 61 3PN.
http://www.positivehealth.com/
PERMIT/ARTICLES/Cancer/breast.htm
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