- Written by Mark Hancock MD MPH
- Category: Humanizing Oncology
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Collection of Clinical Mistletoe Studies
This compilation is an attempt at an organized directory of all the published and available clinically relevant studies on mistletoe use for the treatment of cancer. I have not attempted to dismiss any negative study. I have made comments where the title is not self-explanatory and in some of the more important studies I have quoted from the results or conclusions. I have included case series and case reports. I have not included all bench trials but have included some I felt noteworthy. Several studies have been left out that were not reviews and did not focus on a particular cancer type.
My database was pubmed and search terms were “viscum album cancer” and “mistletoe cancer”.
Updated October 3, 2018
Systematic Reviews and Meta-analysis
“The quality of the studies was satisfactory and the majority reported positive outcomes. Nevertheless, there is a great deal of methodological heterogeneity among the studies, which precludes conclusive comparisons. Based on these results, the present authors strongly suggest developing guidelines for reporting in vivo mistletoe cancer treatment experiments.”
A qualitative review: “Patients reported demonstrable changes to their physical, emotional, and psychosocial well-being following MT, as well as a reduction in chemotherapy side effects” “Given the variation in context of MT delivery across the articles, it is not possible to ascribe changes in patients' quality of life specifically to MT.”
Based our literature search, Allium sativum, camptothecin, curcumin, green tea, Panax ginseng, resveratrol, Rhus verniciflua and Viscum album had satisfactory instances of clinical evidence for supporting their anticancer effects.
Important systematic review of safety of mistletoe therapy. “Application of higher dosages of VAE or ML is not accompanied by immunosuppression; altogether VAE seems to exhibit low risk but should be monitored by clinicians when applied in high dosages.”
“VAEs seem to have an impact on QoL and reduction of side effects of conventional therapies (chemotherapy, radiation) in experimental trials as well as in routine daily application. The influence on fatigue especially should be investigated further.”
“Pooled analysis of clinical studies suggests that adjuvant treatment of cancer patients with the mistletoe extract Iscador is associated with a better survival. Despite obvious limitations, and strong hints for a publication bias which limits the evidence found in this meta-analysis, one can not ignore the fact that studies with positive effects of VA-E on survival of cancer patients are accumulating. “
“Supportive 'mistletoe therapy' seems safe and beneficial for QoL in adult patients with solid tumours”
“19 randomized (RCT), 16 non-randomized (non-RCT) controlled studies, and 11 single-arm cohort studies were identified that investigated VAE treatment of breast or gynaecological cancer. They included 2420, 6399 and 1130 patients respectively. 8 RCTs and 8 non-RCTs were embedded in the same large epidemiological cohort study. 9 RCTs and 13 non-RCTs assessed survival; 12 reported a statistically significant benefit, the others either a trend or no difference. 3 RCTs and 6 non-RCTs assessed tumour behaviour (remission or time to relapse); 3 reported statistically significant benefit, the others either a trend, no difference or mixed results. Quality of life (QoL) and tolerability of chemotherapy, radiotherapy or surgery was assessed in 15 RCTs and 9 non-RCTs. 21 reported a statistically significant positive result, the others either a trend, no difference, or mixed results. Methodological quality of the studies differed substantially; some had major limitations, especially RCTs on survival and tumour behaviour had very small sample sizes. Some recent studies, however, especially on QoL were reasonably well conducted. Single-arm cohort studies investigated tumour behaviour, QoL, pharmacokinetics and safety of VAE. Tumour remission was observed after high dosage and local application. VAE application was well tolerated. 34 animal experiments investigated VAE and isolated or recombinant compounds in various breast and gynaecological cancer models in mice and rats. VAE showed increase of survival and tumour remission especially in mice, while application in rats as well as application of VAE compounds had mixed results. In vitro VAE and its compounds have strong cytotoxic effects on cancer cells.
VAE shows some positive effects in breast and gynaecological cancer. More research into clinical efficacy is warranted.”
PDQ US Government Review of Mistletoe
Positive survival noted but difficulty with data/methodology also noted.
Positive effect on quality of life.
Cochrane review. “The evidence from RCTs to support the view that the application of mistletoe extracts has impact on survival or leads to an improved ability to fight cancer or to withstand anticancer treatments is weak. Nevertheless, there is some evidence that mistletoe extracts may offer benefits on measures of QOL during chemotherapy for breast cancer, but these results need replication.”
Written by a biased researcher (Edzard Ernst), this review in my opinion shows how not to do a systemic review more than it shows anything conclusive. There have been numerous critiques of this review. “Rigorous trials of mistletoe extracts fail to demonstrate efficacy of this therapy.”
“Among 23 identified studies evaluated for clinically relevant outcome measures, 12 studies showed one or more statistically significant, positive results, another 7 studies showed at least one positive trend, 3 showed no effect and 1 had a negative trend. All studies, however, suffered from methodological shortcomings to some degree, and many of the studies are not conclusive. As several reasonably well conducted studies indicate beneficial effects, further properly designed trials should be encouraged.”
Safety and Interactions
The results of this study indicate that mistletoe therapy is safe. ADRs were mostly mild to moderate in intensity and appear to be dose-related and explained by the immune-stimulating, pharmacological activity of mistletoe.
“VAE (mistletoe) did not inhibit chemotherapy induced cytostasis and cytotoxicity in any of our experimental settings. At higher concentrations VAE showed an additive inhibitory effect.”
Anaphylaxis is rare but possible. A case report.
3 cases of anaphylaxis. Case series.
Subcutaneous mistletoe use safe. Significant impact on quality of life and less chemotherapy side effects. No observed impact on recurrence noted- mistletoe again only used during chemotherapy in this trial.
No induction of pro inflammatory CRP or IL-6 in healthy volunteers with subcutaneous dosing.
Quality of Life
“patients experienced an improvement of QoL during MT. This therapy seemed to offer a platform for an integrative coping with the disease, which might be important in reconciling the perceived shock of an existential illness with a good QoL.”
A review noting evidence for increased quality of life with mistletoe in breast cancer. Not conclusive about protection from toxicity.
Improved quality of life demonstrated.
Iscador Qu used with conventional treatment extended mouse survival in glioma.
An important review of benchside and mouse models of mistletoe and glioma treatment.
Rat study showing positive effect of mistletoe in glioma.
Young boy used Iscador and Helleborus without conventional treatment and had complete remission of diffuse pontine glioma. Abstract does not mention therapies but paper available at this link:
Appears safe, effectiveness needs more studies.
Mistletoe doubled survival in treatment group.
A case series for pediatric use of intravenous high dose mistletoe. Paywall
Positive effects on survival in stage 4 Lung cancer in patients using mistletoe. Median survival was 17.0 months in the CTx plus VA group (95%CI: 11.0–40.0) and was 8.0 months (95%CI: 7.0–11.0) in the CTx only group (χ2 = 7.2, p = .007).
Long 5+ year survival in a patient with small cell lung cancer treated with subcutaneous iscador (no chemotherapy).
Only effect noted in this trial was that mistletoe group tolerated more chemotherapy.
Positive findings of prolonged survival.
Use of mistletoe in pleurodesis. Paywall
Mistletoe safe and effective for malignant pleural effusion.
Mistletoe safe and effective for pleurodesis.
Mistletoe twice as effective as Bleomycin for malignant pleural effusion.
Targeted Therapy (monoclonal antibodies (mAbs), tyrosine kinase inhibitors (TKIs),and immunotherapy) and Mistletoe
Addition of mistletoe to targeted therapy studied in a multicenter observational study. . Addition of VA to targeted therapy significantly reduced the probability of oncological treatment discontinuation by 70%.
Monoclonal antibody treatment reactions occurred 1/5th as often in patients concurrently using mistletoe.
This study showed no evidence of interaction between mistletoe and immune checkpoint inhibitors.
No interaction found.
Lymphoma and Leukemia
Not clear this should be considered an adverse reaction but is an important consideration in mistletoe use.
Bench trial showing positive results.
Case report. Paywall.
2 patients treated with high dose mistletoe alone with total regression of cutaneous B-Cell Lymphoma.
12 year old girl with remission after mistletoe.
Case report. Article not available.
Investigation of the proliferation, apoptosis/necrosis, and cell cycle phases in several human multiple myeloma cell lines. Comparison of Viscum album QuFrF extract with vincristine in an in vitro model.
Bench test. Mistletoe more effective than conventional chemotherapy.
Intratumoral Mistletoe Therapy
“The frequency of ADRs to IT mistletoe injections was 3 times and 5 times higher than has previously been found for subcutaneous and intravenous applications of mistletoe, respectively. Nearly all ADRs were mild to moderate however, and no serious ADRs occurred. Furthermore, it is possible that immune-related ADRs such as pyrexia and local inflammatory reactions might be critical for tumor response.”
Mouse model demonstrating key concepts of intratumoral mistletoe injection.
Case report. Abstract only.
Phase II study. Patients given mistletoe intra-abdominally needed less frequent removal of fluid than prior. No adverse events.
Case report of woman who received intra-abdominal mistletoe and improvement of malignant ascites.
High Dose Mistletoe
Adverse effects were mild and anticipated.
Generally safe with fevers reaching >38.5C
Overall, patients were almost two times less likely to experience an ADR to intravenous compared to subcutaneous application of mistletoe. No serious ADR’s occurred.
Merkel Cell Carcinoma
Rare tumor with poor prognosis held in check with mistletoe.
Discusses a large German hospital that has implemented integrative concepts including use of mistletoe in cancer treatment.
Chemo plus mistletoe is better.
“Six of 28 patients in one of the VaL groups and eight of 29 patients in the control group developed relapse or metastasis within 5 years. Subgroup analysis for hormone- and radiotherapy also showed no difference between groups. Additional VaL therapy during chemotherapy of early stage breast cancer patients appears not to influence the frequency of relapse or metastasis within 5 years.”
Note that mistletoe group only used for the duration of chemotherapy (most experts would continue subcutaneous injections for a longer sometimes pulsed, duration.) Also, the study may be underpowered to “see” a significant result- there were fewer recurrences in the mistletoe group but this was not statistically significant.
“the overall results point to a relevant stabilisation of Health Related Quality of Life during various chemotherapy regimes, possibly due to a reduction of chemotherapy caused side effects with an excellent tolerability of the mistletoe therapy.”
Consistent positive survival results and positive quality of life results.
“Iscador shows a clinically relevant effect on breast tumor progression as measured by overall survival as well as by the time to recurrences, lymphatic or distant metastases.”
Gene expression profiles of different breast cancer cells compared with their responsiveness to fermented mistletoe (Viscum album L.) extracts Iscador from oak (Quercus), pine (Pinus), white fir (Abies) and apple tree (Malus) in vitro.
Presurgical Iscador prevented suppression of immune system as compared to controls.
[Efficacy and safety of long-term complementary treatment with standardized European mistletoe extract (Viscum album L.) in addition to the conventional adjuvant oncologic therapy in patients with primary non-metastasized mammary carcinoma. Results of a multi-center, comparative, epidemiological cohort study in Germany and Switzerland].
“The results of the present study confirmed the safety of the complementary therapy of patients with primary, non-metastatic mammary carcinoma with a standardized mistletoe extract and showed considerably fewer ADRs attributed to concurrent conventional therapy, as well as reduced disease and treatment-associated symptoms, and suggested a prolonged overall survival in the mistletoe extract group as compared with controls.”
Mistletoe protecting the immune system. Only abstract available.
Abstract only. Iscador significantly improves survival in breast cancer (stage 1+2 studied).
Paywall. No difference noted in treatment group.
Mistletoe improves quality of life significantly.
Increased quality of life demonstrated.
Individual Patient Data Meta-analysis of Survival and Psychosomatic Self-regulation from Published Prospective Controlled Cohort Studies for Long-term Therapy of Breast Cancer Patients with a Mistletoe Preparation (Iscador).
Increased quality of life in Iscador group.
Positive findings for quality of life with mistletoe.
Paywall. Retention of quality of life with mistletoe.
Quality of life is improved in breast cancer patients by Standardised Mistletoe Extract PS76A2 during chemotherapy and follow-up: a randomised, placebo-controlled, double-blind, multicentre clinical trial.
Improved quality of life with mistletoe.
Mistletoe improved quality of life and lengthened relapse free intervals.
Paywall. Positive survival and quality of life with mistletoe in ovarian cancer.
Abstract only. Iscador improves survival in ovarian cancer.
Paywall. Positive impact on survival and quality of life.
Remission from abnormal cervical pathology CIN1 and CIN2 with mistletoe.
In Polish, abstract in English. CIN changes in cervix impacted favorably by Iscador.
Increased survival and quality of life with mistletoe.
Mesothelioma is an aggressive cancer that typically has poor survival even with optimal chemotherapy. This response is remarkable. (I have seen a case with 9+ year survival with mistletoe as well).
Patient used mistletoe treatment alone and had complete remission.
Low dose iscador associated with complete remission 14+ year survival of metastatic melanoma patient.
Safety and efficacy of the long-term adjuvant treatment of primary intermediate- to high-risk malignant melanoma (UICC/AJCC stage II and III) with a standardized fermented European mistletoe (Viscum album L.) extract. Results from a multicenter, comparative, epidemiological cohort study in Germany and Switzerland.
“The long-term FME treatment in patients with primary intermediate to high-risk MM appears safe. Tumor enhancement was not observed. When compared with an untreated parallel control group from the same cohort, the results of the FME treatment suggested a significant survival benefit in primary stage II-III MM patients.”
Final results of the EORTC 18871/DKG 80-1 randomised phase III trial. rIFN-alpha2b versus rIFN-gamma versus ISCADOR M versus observation after surgery in melanoma patients with either high-risk primary (thickness >3 mm) or regional lymph node metastasis.
Iscador M compared to 2 other investigational drugs, compared to control. No difference in recurrence or survival noted. Paywall.
Mistletoe induces apoptosis and works synergistically with chemotherapy in this effect in osteosarcoma.
Pay wall. Description of 6 patients with response to VAE therapy.
High-dose Viscum album treatment may have interrupted frequently recurring tumors in individual patients with recurrent bladder cancer.
Bench Trial with Iscucin
Pilot study showing similar efficacy to adjuvant BCG.
No effect seen in treatment group.
Renal Cell Carcinoma
A phase II trial with iscador. No difference noted in treatment groups. All patients enrolled as stage 4. Nonrandomized study.
Iscador helped reduce cancer related fatigue
Isorel (a mistletoe extract) beneficial for advanced colorectal cancer.
Systematic evaluation of the clinical effects of supportive mistletoe treatment within chemo- and/or radiotherapy protocols and long-term mistletoe application in nonmetastatic colorectal carcinoma: multicenter, controlled, observational cohort study.
Positive survival effects noted.
No effect seen in tumor progression in resistant stage 4 colon cancer.
Positive impact on quality of life in patients using mistletoe. Concluded to be safe.
Abnoba Fraxini showed survival benefit in HCC.
Adenoid Cystic Carcinoma
Increased survival in mistletoe group.
“Median OS (overall survival) was 4.8 for VaL (Mistletoe) and 2.7 months for control patients (prognosis-adjusted hazard ratio, HR=0.49; p<0.0001). Within the 'good' prognosis subgroup, median OS was 6.6 versus 3.2 months (HR=0.43; p<0.0001), within the 'poor' prognosis subgroup, it was 3.4 versus 2.0 months respectively (HR=0.55; p=0.0031). No VaL-related adverse events were observed.”
Phase III randomized trial. Positive findings. Note that mistletoe was only given subcutaneously in this trial.
Findings of improved quality of life and survival with mistletoe.
Mistletoe improves quality of life in pancreatic cancer.
Head and Neck
Bench trial. Positive findings.
“Adverse effects of radiotherapy and chemotherapy on the microcirculation and the immune system were decreased and reconstitution processes were accelerated by complementary administration of a standardized mistletoe extract (Iscador).”
Case report with discussion. Paywall.
Paywall. No difference seen in quality of life.
No difference noted in treatment group. Paywall.
Cutaneous Squamous Cell Carcinoma
- Written by Mark Hancock MD MPH
- Category: Humanizing Oncology
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Alpha Lipoic Acid: An Intravenous Therapy Worth a Closer Look
Dr. Berkson, a brilliant physician working in New Mexico, recounts a harrowing story from his earlier career. A patient had accidentally eaten a death cap mushroom.
These fungi are very bad and typically cause acute and severe liver failure. His patient was actively dying from these exact symptoms in his ICU. Berkson had a hunch (he had previously studied mycology) and had alpha lipoic acid (ALA) flown in from across the country. It was infused as a last ditch effort to save his patient's life. After some time the liver stabilized and the patient recovered without needing a transplant! ALA had saved the day- and Berkson went on to continue using ALA in new roles of therapy, as well as saving dozens of other similar poisoned people.
Actions and Origins
Alpha lipoic acid, also known as thioctic acid, is an essential compound involved in aerobic respiration. It has two sulphur groups and serves as a cofactor for mitochondrial energy production deep in every cell. Nutritionally we obtain lipoic acid from food- organ meats are relatively high as is cruciferous vegetables and spinach. But though we obtain ALA from simply eating, it is in almost trace amounts compared to supplementation. For instance a person would need to eat 200 pounds of spinach to consume the equivalent of 300mg of alpha lipoic acid, the starting dose used in most of our infusions. Flooding the body with this essential cofactor to mitochondrial health can have many positive health effects.
Dr. Berkson's presentation notes multiple actions of ALA.
The sulphur containing ALA promotes the generation of glutathione directly in the cell.
ALA works in the pyruvate cycle and works to recycle vitamin c and other antioxidants.
Free Radical Scavenger
Modifies Gene Expression
The sulphur components have been shown to acetylate histones (sort of like the suitcase that DNA comes in) so cancer promoting genes are not expressed. It has also been shown to stabilize NF KB, a major cancer promoter.
Prevents Reperfusion Injury
Alpha lipoic acid generates hydrogen sulphide in ischemic cells which protects them from lack of blood supply.
Enhance Insulin Sensitivity
Insulin resistance is a key contributor to many disease processes including Diabetes Mellitus and fatty liver disease. Insulin levels independently drive tumor growth and propagation. ALA has been shown to counter insulin resistance, lowering insulin levels. This study found women with polycystic ovarian syndrome (associated with insulin resistance) benefited from ALA.
Restores T Cell Function
The immune system is complex. ALA has been found to modulate against autoimmune responses from an overactive Th1 response in T cells and Natural Killer cells. This effect can have a role in Multiple Sclerosis and many other disease processes. This study on chickens showed that ALA protected a group of chickens with inflammatory toxins in their food. They were protected from an inflammatory cascade that occurred in the non-ALA group. Though I advocate for eating as clean a diet as possible it is important to be able to counter any toxins that we are exposed to through the nature of the times we live in.
A phase 2 study is looking at the immune restorative benefit of alpha lipoic acid in treatment resistant AIDS patients.
Chelates Heavy Metals
As if all the above were not enough of a job well done, ALA has also been found to remove heavy metals from the body through chelation.
Alpha lipoic acid crosses the blood brain barrier (so it can have effects on our brain and central nervous system). The helpful effects in ischemic damage also are of help in heart attack and stroke. There is limited but evolving data here: this rat study is intriguing. Rats had an artery feeding their brains occluded to mimic stroke. One group was given ALA the other was a control. The control group experienced over 50% mortality while the ALA group had less than 30%. The ALA group had much greater recovery of function and there was found to be increased neuro-regeneration.
Use in Cancer
The above effects of alpha lipoic acid provide a basis for trials in cancer treatment. ALA is an essential cofactor for healthy mitochondrial processes. It would logically play a role especially in metabolic tuning of the body (use of ketogenic diet, intermittent fasting). It recycles vitamin C so would make sense to use around this widely used therapy. Cancer cells have a broken or altered metabolic pathway. There are researchers who propose (and attempt) to fix these pathways and thus reverse the propensity for cancer growth. Berkson's later work involved clinically administering ALA to patients with cancer. He never proposed this was the cure for cancer. It is clear that much of the ALA data is basic science and clinical data is limited to case reports and case studies. Berkson had several case reports of long term survival from nearly 100% quickly fatal cancers, with good quality of life and no side effects from ALA. Berkson presented this case report of several such cases treated with a healthy diet, Low Dose Naltrexone and ALA.
This case series was performed on patients with terminal cancers with no hope even of shorter term survival. ALA was given with Low Dose Naltrexone (LDN) and Hydroxycitrate (HCA). Though several patients did succumb to their cancer, many patients had tumor responses, benefit and survival. Clearly a balance of potential risk versus potential benefit weighs very favorably toward this protocol.
Alpha Lipoic Acid may have benefit for:
We are excited to offer this therapy in our intravenous services.
- Written by Mark Hancock MD MPH
- Category: Humanizing Oncology
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A Coarse Sieve
Subtle effects of daily human life are very difficult to observe and study with our current methods. I'm always interested to see reviews such as this one but it can be difficult to interpret the findings. It is so common today to see a report that a substance is bad for humans, then to find a report the next week that says the opposite. The silver lining is that contradictions make us think. My summary and thoughts on the above review hopefully will help this thinking process.
Overweight and obesity is a common risk factor for many cancers. This has emerged from many studies including in cancers of breast, colon, pancreatic tissue (and more). It is estimated that up to 1/5 of cancer deaths are related to overweight and obesity. Thinking needs to go deeper to understand this and the review does mention insulin growth factor (IGF) and metabolic triggers that spur cancer cell growth. Carrying too much weight increases inflammation and changes sugar and fat metabolism which have been linked to cancer repeatedly.
The review mentions a study on protein intake where low protein intake was associated with reduced cancer risk. This suggestion has come out of humanizing medicine for a century. Modern naturopaths also warn about too much protein when on the ketogenic diet (as well as healthy protein sources which is hardly studied at all).
The authors pull the party line on diet, suggesting a diet with "reduced calorie intake combined with a significant limitation in red and processed meats, refined grains, saturated fats, sugar, sugar-containing beverages." The sieve of science is coarse here and I worry that there are confounding elements. Saturated fats are often combined with high sugar foods. It may be that the fats are fine (even necessary) and the sugars potentiate the damage. Red meat varies greatly in inflammatory potential depending on if the animals are pastured or raised in factory farms.
The protective effects of vegetables and fruits have come out of several studies. There is potential confounding here too. The Gerson diet is diet very rich in vegetables and fruit. There are components in this diet that certainly can be helpful. Perhaps it depends on what is missing or needed in the patient. But the fact is that sugars are sugars in the end. All carbohydrates are metabolized to sugar whether processed or organic. Gerson does not limit sugar intake- in fact it may increase overall sugar intake. But Gerson will raise a person's intake of protective compounds like vitamin C, sulfurophanes and much more. These are potent substances but the picture is complicated and honestly poorly studied.
The article notes a study on high olive oil consumption and protective effect from post-menopausal breast cancer.
The review notes a possible deleterious effect of using antioxidant compounds in high risk populations (such as smokers at risk of lung cancer). Bata carotene has trended to be more risky in such populations and it is thought that cancer cell death may depend on some oxidative stress. Using these supplements might take the pressure off the bad cells.
Randomized controlled trials on fat intake are mentioned in regards to breast cancer recurrence. There seemed too be conflicting results with the consistent variable not being low fat but weight loss associated with greater survival. Other cancers are mentioned and the only consistent finding seems to be lower obesity. To me this is a sign that we see confounding of several variables.
I am happy that these reviewers mentioned some key supplements and noted positive data on them as well. Curcumin was mentioned as a supplement "not to be discouraged" due to recent positive studies showing it significantly impacted the cancer in 1/10 to 1/3 of patients that used it in trials. Meanwhile we have TV ads for super-expensive medicines (hundreds of thousands of dollars) that prolong life by a couple of months with their use!
This review also looks at quality fish oil and states these are "not to be discouraged" as there is evidence they can help against cancer. They were less positive with green tea and interestingly found vitamin c, especially intravenous high dose, to be promising. They were also optimistic about artemisinin- the antimalaria drug that has been given a new role in cancer. Vitamin D they were less excited about- though I will save my commentary for another place as I feel this is an important and complex subject. The reviewers did not really know what to say about fasting in terms of drawing conclusions- though they did point out some of the relevant positive literature they were worried about too much weight loss and too little intake of essential nutrients. It is unfortunate that these reviewers did not address the ketogenic diet at all. I understand very well the academic constraints on what researchers can say (or risk not getting their paper published) and their review does try to push the envelope of academic medicine- that I support. One has to pull the slow to change mainstream along slowly in the process of scientific advancement.
- Written by Mark Hancock MD MPH
- Category: Humanizing Oncology
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This infographic of mine (feel free to share) shows the basics of a key combination that has some intriguing science behind it. Here is the presentation link.
Vitamin C plus Doxycycline plus the ketogenic diet all leverage against cancer.
- Written by Mark Hancock MD MPH
- Category: Humanizing Oncology
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Why Vitamin C?
Humans and other primates do not have the ability to create their own vitamin c. Interestingly several bat species, guinea pigs, and some birds also must obtain vitamin c from their diet. Humans' daily requirement for vitamin c is the highest of all vitamins. Officially it is recommended that women consume 75mg and men 90mg vitamin c. There may be compelling reasons to take in more. Intravenous vitamin c has a tolerable safety profile in cancer treatment, and has been associated with spontaneous remissions though high quality evidence is still forthcoming. It actually creates hydrogen peroxide inside cancer cells- causing them to die. New exciting research shows a potent effect of combining vitamin c with doxycycline as a metabolic shutdown for cancer stem cells.
But Vitamin c has also been shown to be essential in other areas of health. Most people know it is needed for our collagen- literally holding us together. Without vitamin c we develop scurvy. The collagen impact reaches all the way to our blood vessel health as we see a protective role in heart disease. Vitamin c is essential in brain health. It is essential in the processes creating many neurotransmitters- when these malfunction we see depression, anxiety, bipolar and other mood disorders. Ascorbic acid modulates dopamine, GABA, and cholinergic effects and thus plays a role in dementia and Parkinson's.
Vitamin C is absorbed by the gut up to a point- 200mg at a time seems to saturate our body. We can absorb more but our kidneys work fast to excrete it and we don't end up benefiting so much. We can take lots of small doses per day to do the best job we can with oral intake. Vitamin C (ascorbic acid) is high in osmolarity- this means it acts to pull fluid to itself like a magnet (sort of like a salt shaker in the humid South). If it is not absorbed this means it pulls fluid into the gut and will cause diarrhea.
Some Precautions in Intravenous Use
Vitamin c at extreme doses can be generated only with intravenous dosing. We will look at dosing protocols at a later point. Because of a rare genetic disorder called G6PD deficiency, which can cause bursting of red blood cells if given IV vitamin c, the precaution must be taken to first rule the condition out with a lab test. Almost everyone I test is negative.
The other precaution is more complex.
Ascorbic acid is bound to sodium. In fact for every gram of intravenous vitamin c, we are giving 111mg of sodium. This can add up- it is not unusual to give 100 grams of intravenous vitamin c (this is not medical advice, just my musings). Assuming it is given in sterile water or dextrose (I prefer sterile water because SUGAR...) we are giving 11100mg or 11 grams of sodium. Hot dogs have about 500mg sodium per dog (not encouraging anyone to eat these). So this dose of vitamin c is as salty as eating 20 hot dogs.
In the hospital we have to think about this sort of sodium load. A healthy person can tolerate this much sodium- slowly. But even smaller amounts can cause trouble. Some people need saline and need it fast for giving back their volume. Giving a large bag (a liter) of saline to a person with kidney failure, liver failure, or heart failure exceeds their recommended daily intake of 2000mg of sodium (a liter of normal saline contains 3542mg of sodium). Sometimes we can inadvertantly cause issues like pulmonary edema when giving such fluids. We can definitely cause these issues with high dose vitamin c if we are not thinking about it. Fortunately there are ways to prevent these complications and continue giving the patient benefits from vitamin c.