Positive Health Online

In December 2012 I helped the Daily Express with an article, Do Cancer Alternatives Really Work?  It was a topic of interest to the media at that time because the young mother ran away with her 7-year-old son to prevent him from receiving conventional cancer treatment for a brain tumour.  I was approached because of my professional knowledge and because I used an alternative approach following a diagnosis of breast cancer in 2001.  I was asked to support the journalist who wrote this and we discussed various helpful complementary approaches that may be supportive in helping your body to overcome cancer.  The article can be seen here:  www.express.co.uk/expressyourself/363132/Do-cancer-alternatives-really-work was balanced and, I felt, cautious because, having gone through a cancer diagnosis myself, I am acutely aware that the last thing a cancer patient needs is to have their faith in any treatment approach stripped away from them.  There is also an important factor that is often overlooked and that is for the patient to find a feeling of empowerment by doing things to help to support health and wellbeing.  This is something Ernst & Co, from the Sense About Science ‘crowd’, have little or no understanding of with their fear-mongering response to the article.  They published a response when the Daily Express declined to publish it and this is my, admittedly, belated reply. Their article can be seen here:  www.senseaboutscience.org/data/files/News/Better_than_the_Daily_Express.pdf

In my opinion, Edzard Ernst and his collaborators have very distorted and narrowly researched viewpoints.  I respond under the headings they outline.

Diet Theory

Ernst & Co say, “Scientific evidence does not support the notion that any particular food can cure cancer. Whether a compound is an antioxidant is irrelevant to whether it has any role to play in treating the disease.  There is no good evidence that any specific food or nutrient improves survival after a diagnosis of cancer.  It is also possible that the oxidative stress caused by free radicals is an important mechanism for killing cancer cells.  Preliminary studies on possible preventive agents have no relevance to treatments.”

I used a very intense diet and nutritional therapy that of course did not focus on one particular food or food element.  Ernst & Co have missed the point completely if they think anyone is silly enough to think that chowing down on one food is going to cure cancer.  They do, however, volunteer that antioxidants (found in fresh fruit and vegetables, for example) are bad for a cancer patient.  They, instead, suggest that oxidative stress (caused by the free radicals that antioxidants mop up), may be a good thing because cancer cells seem to be more susceptible to oxidative stress than normal cells.  What this is suggesting is that it could be highlighting a mechanism that a new drug may be able to utilize.  I’ll say no more because this illustrates one of the major philosophical differences between medicine and CAM.  Medicine and its drugs are based on minute chemical reactions that it aims to manipulate; whereas, a healthy, fresh diet filled with phytonutrients (plant nutrients) connects to the body network through kinases (enzymes) to influence health through a network, or web effect, rather than a single pathway (as a drug does). 

Diet is really important when it comes to cancer as the disease puts the whole system under stress and, as Goodman et al[1] say, “With the complex processes of abnormal cell division, proliferation and invasion which occur with cancer, there is great requirement for food to provide high levels of easily assimilable, immune- and metabolically-regenerating nutrients.”  It’s not about a proposed ‘cure’ (something - a drug or procedure - done to you), it’s more about giving your challenged body quality fuel so that it can promote healing (a reflexive, self-determining process) from within this immense and complex bio-chemical factory that is your body.

Ernst et al’s point about, “Preliminary studies on possible preventive agents have no relevance to treatments,” only serves to reinforce that biomedicine has a very long way to go.  They push this point even further as they dismissively add, “The few trials of specific micro-nutrients that have been carried out, were unsuccessful (e.g. beta-carotene and lung cancer).”  I suggest that this is because phytonutrients are a group of compounds, which has pleiotropic and hormetic effects not yet fully understood in conventional (drug-based) paradigms of evaluation.

Let’s look at an example for pleiotrophy. 

A 2012 study, “Pleiotrophic protective effects of phytochemicals and Alzheimer’s Disease,[2] discusses the complex and multiple causes of Alzheimer’s and how “therapeutic agents acting on multiple levels of the pathology are needed”.  (A similar problem to cancer.) The researchers examined curcumin, catechins and resveratrol.  They found that curcumin is able to clear amyloid plaques through several mechanisms and has additional activity; that ECGC (catechins) has a wide array of biological effects, that includes a synergistic effect with fish oil, in its ability to improve memory; and, resveratrol (in combination with glucose and malate) is under Phase III clinical trials to determine the effects in mild to moderate Alzheimer’s.

What is Hormesis?

Hormesis is defined as, “a process in which exposure to a low dose of a chemical agent or environmental factor that is damaging at higher doses induces an adaptive beneficial effect on the cell or organism”.[3] Wait a minute doesn’t this sound a bit like homeopathy? (But we’ll come to that shortly!)  It means that the impact of phytonutrients, whilst weak compared with drugs, has a much wider (bigger?) impact than we are currently able to evaluate.

Sugar

Ernst & Co are also dismissive of the impact of sugar for people with cancer saying that, “All our cells, cancerous or not, use sugar for energy, which is obtained from all sorts of food, including fruit and vegetables.” 

Well, yes, that really is stating the obvious, however, in the context of cancer, insulin resistance and diabetes are becoming a major health epidemic; and, a generally recognized fact is that there is an over expression of insulin receptors in cancer cells,[4] making them more sensitive to the effects of higher blood sugar.  (It gives them more access to sugar than normal cells, fuelling growth.)

Further to this, impaired glucose tolerance is an independent predictor for cancer mortality,[5] whilst in the American Journal of Epidemiology it is concluded that an elevated waist-to-hip ratio (waist-to-hip ratio is considered to be a reliable marker for insulin resistance and high insulin) is confirmed as a predictor of breast cancer mortality.[6]

These risk factors clearly indicate an area of health in which cancer patients could empower themselves by having relevant counsel on how to improve their diet in a constructive and positive manner.  Ernst & Co’s recommendation, “Some people are advised to have a high-calorie diet during chemotherapy to help them cope with the effects of treatment,” is advice about coping with treatment, not what may be more effective with regard to health, wellbeing and cancer per se.

Stress

Ernst & Co are also way off base with their assertions about stress, “There is no evidence that stress is related to cancer risk. Cancer is not simply a disease of immune deficiency.  It is an extremely complex disease with a combination of causes.  A suppressed immune response (e.g. transplant patients on drugs to reduce their immune reactions) is associated with a slight increase in the risk of some cancer types, but this does not mean that the effect of stress on cortisol is relevant.  Stressful events can alter the levels of hormones in the body and affect the immune system.  But there is no evidence that these changes could lead to cancer.”

I’m not sure where Ernst & Co do their research as there are many studies that discredit this argument and here are a few examples.

Cancer is an immune-deficiency disease[7, 8, 9] yet stress and the stress hormones are a neglected area of medical practice in spite of the fact that stress-related health problems have replaced infectious disease as the primary health concern.[10] With regard to the comment about suppressed immune response and a “slight increase in the risk of some cancer types” expressed above, a 2006 literature review of Occurrence of Malignancy in Immunodeficiency Diseases[11] says, “The incidence of malignancy in patients with primary immunodeficiencies is roughly 10,000 times that of the general age-matched population.”  Is that slight?

It should be noted that stress is often considered to be too subjective for real medical consideration as it is considered to be more about emotional reactions, or feelings, and psychology, and as such is classified as a psychiatric disorder in the Merck Manual.  This shows how reductionist and divisive medical science is with regard to the human body and its systems. But, what is happening on the physical level that relates to stress and cancer?

The hypothalamus, pituitary, adrenal (HPA) axis has a primary function of regulating the production of the stress hormone cortisol in the presence of internal (e.g. infection or cancer) stressors or external (e.g. work pressure or relationship problems) stressors. This action can have far reaching consequences in the context of cancer. For example:

• Excess cortisol can inhibit ovulation[12,13] which will cause a relative excess, or dominance, of estrogen over its partner hormone, progesterone, for premenopausal breast cancer patients;
• The impact of excessive and on-going cortisol secretion has immunosuppressive effects,[14] which will have a notable negative impact on a person’s ability to fight cancer;
• Increase in cortisol in animal models is associated with more rapid tumour growth;[15]
• In 2000 the Journal of the National Cancer Institute published a study, which concluded that variability in diurnal cortisol rhythm (your sleep wake cortisol pattern) is a statistically significant long-term survival predictor for women with metastatic breast cancer;[16]
• In 2006,[17] 2004[18] and 2000[19] published studies highlighting that a flatter cortisol pattern, indicating low function, is associated with more rapid cancer progression;
  If stress is causing cortisol to remain high, causing chronically high levels of cortisol to be circulating, this will:
• Keep blood glucose levels high;[20] precipitating insulin resistance, poorly regulated blood fats, high blood pressure, central obesity[21] and inhibiting immune response.[22]

All of these changes are likely to be evidenced prior to diagnosis for some considerable time.  So, this is just as much about prevention as it is about on-going prognosis.

Ernst & Co also continue to assert that, “There is no evidence to link reduced stress to increased healing.  One study even found that high stress levels can reduce the risk of breast cancer by lowering estrogen levels.”

If cortisol remains high (due to stress) it is closely linked with poor wound healing[23] with increased susceptibility to infection[24]and it is linked with increased risk of cancer and recurrence.[25]

A 2006 study examining the HPA axis in critical illness illustrates how the prolonged severe stress associated with critical illness can result in persistently high and low cortisol, both of which will have an impact on recovery.[26] Whilst this study may have been completed in the context of critical care, this information should be a relevant consideration for cancer care, especially in the light of the conditions and symptoms outlined above and with regard to surgical interventions.

With regard to Ernst & Co’s mention of high stress reducing estrogen levels - high stress will keep blood glucose levels high, precipitating insulin resistance. High insulin inhibits the production of Sex Hormone Binding Globulin (SHBG), which binds to oestrogen and testosterone. A decreased level of SHBG will mean high levels of unbound estrogens (and testosterone) circulating in the blood,[27] raising tissue exposure thereby raising an identified risk factor, the risk of recurrence or the potential of progression of breast cancer.

Stress reduction through therapies such as massage, contraindicated by Ernst & Co, is actively promoted by the American Cancer Society as follows:

“In a 1999 publication, the National Cancer Institute found that about half of their cancer centres offered massage as an adjunctive therapy to cancer treatment. Some studies of massage for cancer patients suggest that it can decrease stress, anxiety, depression, pain, and fatigue. These potential benefits hold great promise for people who have cancer, who often must deal with the stresses of a serious illness in addition to unpleasant side effects of conventional medical treatment. While some evidence from research studies with cancer patients supports the use of massage for short-term symptom relief, additional research is needed to find out if there are measurable, long-term physical or psychological benefits.

“Meanwhile, most patients do indeed seem to feel better after massage, which may result in substantial relief. A 2005 review of research reported that massage therapy has been shown to reduce pain and anxiety in randomized controlled trials.”[28]

Gerson Treatment

Ernst & Co say, “There is no evidence that Gerson treatment can treat cancer.  It can cause serious side effects including serious infections, dehydration, constipation, colitis (inflammation of the colon) and dangerous electrolyte imbalances or even death.”

A 2007 case study analysis of six people with cancer who followed the Gerson therapy concluded that some support, both physical and psychological, appeared to be offered by this regime. The analysis reported that some potential anti-cancer effects appeared to be present in the patients who undertook this regime. The patients also had an increased sense of hope and empowerment. The authors stated however that many cofactors may have influenced these findings; some of the patients were undergoing conventional treatment, some were also using other complementary approaches. The analysis was conducted using the 'Best Case Series' criteria developed by the National Cancer Institute.[29]

Homeopathy

Ernst & Co state emphatically, “ Homeopathy is disregarded because it does not treat the whole person or any part of the person.”

I would like to reiterate the point about hormesis above, which may not prove anything, but should certainly demonstrate that we may have a potential framework of understanding that casts doubt on the emphatic viewpoint expressed above.

The ANH says:[30]

New scientific research may help. Using a laboratory technique called spectroscopy, researchers have found[31]that different homeopathic medicines and different dilutions of the same medicine can be distinguished from each other, even though all should logically contain nothing but water. One explanation for this is that the repeated dilution and succussion (the forceful agitation of the liquid) during classical remedy preparation may break the substance into immeasurably small nanoparticles, that is, ‘top-down’ nanostructures. A novel model for how homeopathic medicines work[32] on living systems has been proposed by researchers Iris Bell MD PhD and Mary Koithan PhD RN CNS. The traditional theory, that some presence remains without actual particles, is of course more controversial.

While homeopathic medicines do not go through the FDA drug approval process, they are absolutely reviewed for safety and effectiveness.[33] The FDA recognizes the monograph published in the HPUS and administered by the Homeopathic Pharmacopia Convention of the United States, a nonprofit standard-setting organization. Currently, 1,286 official homeopathic drug products[34] are recognized by the HPUS. Moreover, homeopathic drugs are subject to FD&C misbranding provisions, and must comply with Good Manufacturing Practice requirements. If homeopathic substance is “new” (that is, used after 1962), manufacturers most commonly gather evidence for safety and effectiveness through a method specifically designed for homeopathics called “proving.”[35]

Concluding Thoughts

The attacks that are going on against people who promote or work with an alternative to the medical view of health are based on politics and economics not on what information has integrity and substance.  The conventional medical community keeps trying to railroad their placebo, randomized control trials as the only way forward to evaluate whether something is appropriate medicine, but the point is that our bodies are not made up of isolated, individual chemical reactions.  These trials are expensive and are based on whether a potentially toxic agent will be tolerated in the body in order to achieve a measurable biochemical outcome.

In 2004 Edzard Ernst[36] argued for the “... rigorous testing of CAM interventions,’ and suggests that clinical trials with their reductionist approach is appropriate. However, in 2002 a group from the University of Arizona researching into integrated healthcare argued that conventional medical practice focuses on the disease process of the end organ rather than, “... healing the individual person”.[37] Moreover, an editorial published in the BMJ (British Medical Journal) in 2001,[38] asserted along the same lines as Wootton in his book, Bad Medicine: Doctors doing harm since Hippocrates,[39] suggesting that medicine has become too reliant on technology, despite its lack of efficacy, ignoring holistic type interventions such as diet, lifestyle and relaxation.

The difficulty with holism is that it refers to a system that cannot be reduced, determined or explained by looking at individual parts in isolation. However, a relatively new science, systems biology, offers a perspective that can be understood through the metaphor, “...a forest cannot be explained by studying the trees individually,”.[40] As this metaphor illustrates, the problem with reductionism is that so much information about the whole is lost.

Systems biology is a complex emerging science that will take years to evolve its theories and mathematical models with regard to the human sciences, but it offers an important philosophical evolution of reductionism (the medical approach) towards a more holistic viewpoint.

From the CAM perspective it’s been revealed that people tend to use CAM because it has a more holistic orientation, providing a greater philosophical congruence and concludes that alternative therapies offer treatments that are more compatible with patients’ world views, values, spiritual or religious beliefs as well as their understandings about the meaning of health and illness.[41]

I rest my case.  I believe in the individual’s right to informed consent about their health and the importance of being able to do things to help yourself as source of empowerment because, with a diagnosis of cancer, you can feel that your life is no longer your own and there is no control.  This is why I have made this reply - I am not suggesting that all the answers are here with regard to cancer, but they are aspects of your health and potential healing that should not be swept under the carpet and denied.

References

1. Goodman, S, MacLaren, J & Barker,W. Nutrition and Life-Style Guidelines for People with Cancer. Journal of Nutritional and Environmental Medicine. 4 (2). 199-214. 1994.
2. Davinelli, S, Sapere, N, Zella, D et al. Peliotropic protective effects o phytochemicals in Alzheimer’s Disease.  Oxidative Medicine and Cellular Longevity. Article ID 386527, 11 pages. 2012.
3. Mattson, M. Hormesis Defined. Ageing Research Reviews. 7 (1). 1-7. 2008.
4. Belfiore, A and Malaguarnera, R. Insulin receptor and cancer. Endocrine-Related Cancer. 18, R125-R147. 2011.
5. Saydah, SH, Loria, CM, Eberhardt, MS et al. Abnormal glucose tolerance and the risk of cancer death in the United States. American Journal of Epidemiology. 157 (12).1092-100. 2003.
6. Borugian, M, Sheps, S, Kim-Sing, C, et al. Waist-to-Hip Ratio and Breast Cancer Mortality. American Journal of Epidemiology. 158 (10) 963-968. 2003.
7. Thomas, L. (1959). Reactions to homologous tissue antigens in relation to hypersensitivity. In: Lawrence H. (Ed.) Cellular and humoral aspects of the hypersensitivity states (pp. 529-532). New York, NY: Hoeber-Harper.
8. Burnet, FM. The concept of immunological surveillance. Progress in Experimental Tumour Research. 13: 1-27. 1970.
9. Gatti, R. & Good, R. (1970). Aging, immunity and malignancy. Geriatrics, 25, 158-168.
10. Khan, MM. The neglected role of stress in illness. Journal Pakistan Medical Association. 57 (8); 383-4.
11. Gatti, R. & Good, R. Occurrence of malignancy in immunodeficiency diseases: A literature review. Cancer. 28 (1): 89-98. 1971.
12. Lee, J. Natural Progesterone: The multiple roles of a remarkable hormone. John Carpenter, Charlbury, UK. 1999.
13. Sakakura, M, Takebe, K & Nakagawa, S. Inhibition of luteinizing hormone secretion induced by synthetic LRH by long-term treatment with glucocorticoids in human subjects. Journal of Clinical Endocrinology and Metabolism. 40 (5) 774-9. 1975.
14. Chrousos, G and Gold, P. A Healthy Body in a Healthy Mind – and Vice Versa – The Damaging Power of “Uncontrollable” Stress. Journal of Clinical Endocrinology and Metabolism. 83 (6) 1842-1845. 1998.
15. Sapolsky, R and Donnelly, T. Vulerability to Stress-Induced Tumor Growth Increases with Age in Rats: Role of Glucocorticoids. Endocrinology. 117 (2). 662-666. 1985.
16. Sephton, S, Sapolsky, R, Kraemer et al. Diurnal Cortisol Rhythm as a Predictor of Breast Cancer Survival. Journal of the National Cancer Institute. 92 (12). 994-1000. 2000.
17. Spiegel, M, Giese-Davis, J & Kraemer,H. Stress Sensitivity in Metastatic Breast Cancer: Analysis of Hypothalamic-Pituitary-Adrenal Axis Function. Psychoneuroendocrinology. 31 (10). 1231-1244. 2006.
18. Abercrombie, H, Giese-Davis, J, Sephton, S, et al. Flattened cortisol rhythms in metastatic breast cancer patients. Psychoneuroendocrinology. 29 (8). 1082-92. 2004.
19. Sephton, S, Sapolsky, R, Kraemer, H, et al. Diurnal Cotisol Rhythm as a Predictor of Breast Cancer Survival. Journal of the National Cancer Institute. 92 (12). 994-1000. 2000.
20. McCowen, K, Malhotra, A & Bistrian, B. Stress-induced hyperglycemia. Critical Care Clinics. 17(1). 107-24. 2001.
21. Bjorntorp, P Holm, G & Rosmond, R. Hypothalamic arousal, insulin resistance and Type 2 diabetes mellitus.  Diabetes Medicine. 16(5). 373-83. 1999.
22. Munck, A, Guyre, P, & Holbrook, N. Physiological functions of glucocorticoids in stress and their relation to pharmacological actions. Endocrine Reviews. 5 (1). 24-44. 1984.
23. Sheridan, J, Padgett, D, Avitsur, R, et al. Experimental models of stress and wound healing. World Journal of Surgery. 28 (3). 327-30. 2004.
24. Rojas, I, Padgett, D, Sheridan, J et al. Stressed induced susceptibility to bacterial infection during cutaneous wound healing. Brain, Behaviour & Immunity. 16(1). 74-84. 2002.
25. Pant, S, & Ramaswamy, B. Association of major stressors with elevated risk of breast cancer incidence or relapse.  Drugs Today. 45(2) 115-26. 2009.
26. Johnson, K & Rn, C. The hypothalamic-pituitary-adrenal axis in critical illness. AACN Clinical Issues in Critical Care Nursing. 17(1). 39-49. 2006.
27. Bernstein, L & Ross, R. Endogenous hormones and breast cancer risk. Epidemiologic Reviews. 15(1). 48-65. 1993.
28. American Cancer Society.  Found online 6 June 2014 here: http://www.cancer.org/treatment/treatmentsandsideeffects/complementaryandalternativemedicine/manualhealingandphysicaltouch/massage
29. Molassiotis, A & Peat. P. Surviving against all odds: analysis of 6 case studies of patients with cancer who follow the Gerson therapy.  Integrative Cancer Therapies. 6(1). 80-88. 2007.
30. Alliance for Natural Health – USA.  Found online 6 June 2014 here: http://www.anh-usa.org/homeopathy-under-attack-in-california/
31. Rao, M, Roy, R, Bell, I, et al. The defining role of structure (including epitaxy) in the plausibility of homeopathy. Homeopathy. 96(3). 175-82. 2007.
32. Bell, I & Koithan, M. A model for homeopathic remedy effects: low dose nanoparticles, allostatic cross-adaptation, and time-dependent sensitization in a complex adaptive system. BMC Complementary & Alternative Medicine. 12. 191. 2012.
33. US Food and Drug Administration. Found online 6 June 2014 here: http://www.fda.gov/iceci/compliancemanuals/compliancepolicyguidancemanual/ucm074360.htm
34. The Homeopathic Pharmacopoeia of the United States. Found online 6 June 2014 here: http://www.hpus.com
35. Hylands Homeopathic. Found online 6 June 2014 here: http://www.hylands.com/news/regulation.php
36. Ernst, E. Distentangling integrative medicine. Mayo Clinic Proceedings. 79(4). 565-6. 2004.
37. Bell, I, Caspi, O, Schwartz, G, et al. Integrative medicine and systemic outcomes research: issues in the emergence of a new model for primary health care.  AMA Archives of Internal Medicine. 162(2). 133-40. 2002.
38. Rees, L & Weil, A. Integrated medicine imbues orthodox medicine with the values of complementary medicine. British Medical Journal. 332. 119. 2001.
39. Wootton, D. (2006). Bad medicine: Doctors doing harm since Hippocrates. Oxford: Oxford University Press.
40. Ahn, A, Tewari,M, Poon, C, et al. The Limits of Reductionism in Medicine: Could Systems Biology Offer an Alternative? PLOS Medicine. 3(6). 0709-0713. 2006.
41. Astin, J. Why patients use alternative medicine: results of a national study. Journal of the American Medical Association. 279(19). 1548-53. 1998.