Note: This article comes from the International Journal of Integrative Medicine; a subscription costs about $68/year and is well worth it; order by calling 1-800-477-2995 (USA) or 1-888-292-2229 (Canada).
A COMPLEMENTARY APPROACH
COMPLEMENTING ALLOPATHIC TREATMENTS
Complementing Radiation Therapy (RT)
Enhancing the Efficacy of Radiation Therapy
RT Side Effects and Post-RT Healing
SUPPORT DURING CHEMOTHERAPY
Enhancing Efficacy and Reducing Resistance (RT)
BIOLOGICAL RESPONSE MODIFERS
Table 1 - Summary of Case Studies
Table 2 - Natural Agents for Chemotherapy Side Effects
Resources for Brain Tumor Patients
KEYWORDS (bold or red to make them easy to locate):
surgery, radiation, chemotherapy
high-quality multi-vitanin/mineral supplement
impaired intestinal permeability
hepatic detoxification, redox homeostasis
Omega-3 fatty acids, eicosapentanoic acid (EPA), docosahexanoic acid (DHA)
Omega-6 fatty acids
stabilized fish-oil product (Tyler Eskimo-3)
Alkylglycerols, Bromelain, Eicosapentanoic Acid
Gingko Biloba, Hypericin,
Inositol Hexaphosphate (IP-6) Melatonin, Niacin, nicotinamide, Selenium
Glutamine, Taurine, glutathione (GSH), whey
Vitamin C, Bioflavonoids
Vitamin E, d-alpha tocopheryl succinate
Vitamin A, zinc, Proteolytic enzymes,
Echinacea, Astragalus, Ashwaganda, Panax or Siberian Ginseng, Oregon Grape Root, Goldenseal, Silymarin
Anaplastic astrocytoma (AA III) and Ghoblastoma multiforme (GBM IV), neoplasms arising from the brain's supportive glial cells, are particularly aggressive malignant brain tumors. They affect some 20,500 individuals every year.1 Approximately 15,000 deaths occur annually in the United States from brain tumors.2
Glioblastoma multiforme (GBM IV) has been called the "ultimate expression of anaplasia."3 Capable of doubling as rapidly as every 7-10 days, these aggressive tumors spread by forming tendrils, or "roots," which infiltrate surrounding tissues. Complete surgical resection is nearly impossible. Mimicking invasive garden weeds, a single errant root portion can allow the tumor to regrow, despite attempts at eradication. As a brain tumor grows within the confines of the skull, normal brain tissue is displaced and intracranial pressure intensifies, depriving the patient of neurological function. Headaches, seizures, loss of motor function, cognitive impairment, and personality changes may occur, depending on the tumor location.
Morbidity and mortality rates associated with these tumors are unacceptably high. Median survival time for adult glioblastoma patients is generally less than 6 months.4 Only 10% survive for two years, and only 1% for five years.5 For tumors that have progressed in size before diagnosis and surgery, the prognosis is considerably worse.
Conventional approaches--surgery, radiation, and chemotherapy--are designed to preserve function and lengthen survival time. However, they may negatively
impact quality of life. This article explores the role of adjuvant nutritional and botanical support for improving the quality of life, and perhaps survival time, of these patients.
Research in this area is not abundant, and this approach is purely experimental. However, delaying care for want of more research does not serve the interests of brain tumor patients. These individuals face prognoses of short duration and have much to gain from the incorporation of natural agents, which pose little risk of adverse effect. This complementary approach is to be undertaken in collaboration with a qualified oncologist.
A COMPLEMENTARY APPROACH
The objectives of a comprehensive complementary protocol for brain tumors are multi-faceted:
A nutrient-dense diet and high-quality multi-vitanin/mineral supplement provide an excellent foundation. Two additional dietary strategies are important: regulating blood sugar and modulating Prostaglandins.
Cancer cells are obligate sugar feeders and have increased glucose uptake. In fact, brain tumor cells may consume as much as 10-15 times more glucose than normal brain cells.6 A diet emphasizing complex carbohydrates, fiber, adequate protein, and essential fatty acids- while minimizing sweets and processed foods-helps regulate normative blood glucose levels. While most cancer diets advocate low fat intake (less than 20% of calories), higher fat diets may offer some benefit to brain tumor patients. indeed, a ketogenic diet decreased glucose uptake to tumors by 20%, impairing tumor metabolism and significantly improving clinical status in astrocytoma patients.7 Seizure control may also improve on this diet.
Careful attention to the quality of dietary fats is essential. Omega-3 fatty acids, particularly fish and flaxseed oils (precursors of tumor-fighting and immune-boosting 3- series eicosanoids) should be emphasized. Saturated, hydrogenated, trans-, and Omega-6 fatty acids (precursors of tumor-promoting and immune-suppressing eicosanoids) should be restricted.
Cholesterol may play an important role in the metabolism of malignant brain tumors. Recent research shows the growth of human glioblastoma can be arrested by drugs that inhibit cholesterol synthesis at the mevalonate pathway.8 This finding suggests a supportive role for dietary and nutritional strategies to control cholesterol. Supplementation wthh pantethine (which inhibits cholestrol synthesis via the mevalonate pathway)9 may offer some benefit. Further research into thismechanism is indicated.
|NATURAL AGENTS FOR USE WITH BRAIN TUMORS|
COMPLEMENTING ALLOPATHIC TREATMENTS
Numerous published protocols confirm the importance of nutrition in speeding post-surgical healing and reducing pain, swelling, and complications. 10 11 Supplement protocols begun 1-2 weeks prior and continuing 3-4 weeks post-surgery-commonly include a daily intake of Vitamin C (3,000 mg, tid), Bioflavonoids (1,500 mg),Vitamin E (400 IU), Vitamin A (25,000 IU), and Zinc (30 mg). Proteolytic enzymes--well researched in cancer treatment--are particularly helpful in reducing swelling and enhancing wound healing. The author has observed greater benefits in brain tumor patients with the use of Bromelain than with digestive enzyme preparations. Bromelain has several actions that make it an ideal adjunct for surgery and for the care of brain tumor patients. It combats inflammation and tumors, modulates cytokines, boosts immunity, promotes wound healing, improves circulation, and enhances the absorption of substances taken with it.12 The recommended dose of Bromelain is 500-750 mg (2,400 mcu strength), three times daily on an empty stomach.
Complementing Radiation Therapy (RT)
Radiation therapy (RT) is generally palliative, not curative, in astrocytonia and gliolastoma. As many as 30% of GBMs do not respond to RT, and the tumor may even continue to grow despite the treatment. Adjuvant nutrition and phytotherapy during radiotherapy have at least 3 objectives: selectively enhancmg the cytotoxic effects on neoplastic cells while protecting healthy cells, reducing unwanted side effects, and supporting post-treatment repair of healthy tissues. Radiation therapies for which adjunctive nutritional and botanical support are indicated include the following:
Enhancing the Efficacy of Radiation Therapy (RT)
RT side effects and post-RT healing.
Side effects commonly associated with brain irradiation include loss of hair, skin burn, loss of taste, and pervasive fatigue.
Radiation damage to salivary glands and tastebuds can result in a dry, irritated mouth and loss of taste perception. This can decrease the desire and ability to eat, seriously impacting nutritional status. Zinc supplementation (15-45 mg, tid, as lozenges or liquid zinc sulfate) at onset of loss of taste can restore taste perception.51 Supplementation with antioxidant nutrients--from 14 days prior through 12 days post-RT---can reduce damage to salivary glands.52 Water extracts of flaxseed can provide relief of dry, irritated mouth and replace lost saliva.53 Topical vitamin E is effective in oral mucositis.54
Topical application of 100% concentrate of Aloe Vera after daily RT treatments can be helpful for radiodermatitis.55 Vitamin E supplementation (1,600 IU/day), begun one week prior to RT, allowed more than half the patients to keep their hair, and dramatically reduced fatigue.56
Astragalus can help address radiation-induced fatigue. Panax or Siberian Ginseng is also indicated and works synergistically with Astragalus. However, Ginseng is best restricted to recuperation following RT (15-30 days post-RT), because it stimulates DNA repair.57-58
Over the course of several months, radiation causes the death of brain tumor cells (necrosis). As intracranial necrotic tissue cannot be adequately resorbed, irritation can lead to headaches, inflammation, edema, and seizures, which may necessitate surgical removal of necrotic tissue. Bromelain,Vitamin E, and Ginkgo Biloba appear to address the effects of necrosis (see Table 2). Their use in this application should be researched.
SUPPORT DURING CHEMOTHERAPY
The decision whether to utilize chemotherapy can be agonizing. The efficacy of chemotherapy in glioblastoma and astrocytoma is debatable. Although a plethora of literature compares the efficacy of various chemotherapy drugs against one another, no literature has compared the drugs to supportive care alone. In his work, Questioning Chemotherapy, Ralph Moss quotes a prominent surgeon: "Chemotherapy [of malignant gliomas] adds little if anything to post-surgical irradiation in terms of median and/or mean survival." 59
While it is beyond the scope of this paper to fully address the pros and cons of chemotherapy for brain tumors, patients are encouraged to investigate the topic before committing to a course of action. For those who choose chemotherapy, adjunctive nutrition may improve the efficacy of the drugs, reduce side effects and after- effects, and lessen the negative impact on quality of life.
The most commonly employed agents against AA III and GBM IV are the nitrosoureas: BCNU (carmustine) and FVC (procarbazine, vincristine, CCNU/Lomustine). Clinical trials are currently exploring dozens of other agents. A major obstacle is the blood-brain barrier, which limits concentration of chemotherapeutic agents in the brain, thereby limiting their effectiveness. New strategies are being explored to surmount this problem and make chemo more selective.
Clinical trials are also investigating the use of blood brain barrier-disrupting agents, such as mannitol. Other new approaches involve the direct application of chemotherapeutic agents via intra-arterial delivery, intracranial pumps, or placement of Gliadel wafers (chemo wafers surgically implanted in the tumor bed). Chemosensitivity testing also shows promise. While in vitro testing cannot ascertain how well a drug will work in vivo, it may help screen out agents that are clearly ineffective or to which the tumor cells are resistant.
Enhancing Efficacy and Reducing Resistance
BIOLOGICAL RESPONSE MODIFIERS
Additional agents can be utilized to complement allopathic care, to provide a therapeutic approach when the patient has exhausted conventional treatment options, or to use between treatment cycles. Rather than directly attacking the tumor cytotoxically, these agents are selected to impact a wide variety of biological mechanisms of the cancer process (e.g., angiogenesis, invasion, differentiation, apoptosis). While a discussion of these agents is beyond the scope of this article, some examples should be mentioned.
Shark cartilage appears to inhibit invasion and angiogenesis.85 Shark cartilage is currently the focus of clinical trials on malignant primary intracranial tumors.86 Phenylacetate stimulates differentiation and blocks the mevalonate pathway, reducing the production of sterols and isoprenoids vital for glioma growth.87-88 Inositol hexaphosphate (IP-6) has shown growth-inlubiting, differentiating, and immune-stimulating capacities.89-90 Vitamin A induces differentiations, 91 Vitamin C, proanthocyanindins, and anthocyanidins reduce invasion via collagen strengthening.92 Vitamin E (d-alpha tocopheryl succinate) induces apoptosis and differentiation.93
Side effects common to chemotherapy agents used for brain tumors include fatigue, nausea, vomiting, constipation or diarrhea, myelo-suppression, leukopenia (decreased white blood cell counts), thrombocytopenia (decreased platelets), and anemia. Table 2 shows the use of various natural agents in addressing many of these side effects.
Antioxidants play a key role in protecting against many chemotherapy-induced side effects.70 Silymarin (140 mg of milk thistle containing 80% silyrnarin, tid) protects the liver against damage during chemotherapy, and may help protect the immune system. Glutamine supports the immune system, maintains intestinal integrity, and reduces gastrointestinal side effects from chemo.71 Siberian Ginseng (1,000 mg/day), Astragalus (500 mg),72-73 and Ashwaganda (Withania somnifers) are particularly beneficial adjuncts to chemotherapy (refer to Table 2).
Adjunctive nutrition and botanical therapies are a growing field. A complementary approach appears to provide a signifciant contribution to the management of primary brain tumors. Further research into this area is clearly warranted.
TUMOR PATIENTS UTILIZING COMPLEMENTARY NUTRITION AND PHYTOTHERAPY
SUMMARY OF CASE STUDIES (details omitted due to complexity and size)
Table 1 presents survival data on 23 brain tumor patients who have utilized various, individually tailored nutritional and botanical agents during their oncological care. While no statiscally significant relationship can be certain, the intent of this table is to suggest an association compelling enough to inspire credible scientific research in this area.
NATURAL AGENTS FOR CHEMOTHERAPY SIDE EFFECTS
|Nausea/vomiting||Ginger (2-4 gm/day)," acupuncture|
|Mucositis||Topical Vitamin E 75|
|Maldigestion||Digestive bitters, digestive enzymes, pancreatin, bromelain, glutamine, slippery elm|
|Diarrhea||Carob powder (2 Tbsp, bid)," Lactobacillus acidophilus'|
|Constipation||Flaxseed meal, increased fiber (>30 gm/day), magnesium (400 mg HS)|
|Myelosuppression||Vitamin E succinate (400 to 800 IU/day)," ashwaganda|
|Leukopenia||Vitamins C and E, zinc, selenium, astragalus" Panax ginseng (1,000 mg, tid)," Siberian ginseng," echinacea," alkylglycerols (100 mg, tid), ashwaganda, Oregon grape root or goldenseal (500 mg, fid), glutamine (2-4 gm/day)|
|Thrombocytopenia||Alkylg@cer-ols (I 00mg, fld)" ashwaganda|
|Anemia||Liquid liver extract, alkylglycerols (I 00 mg, tid), folate (400-800 mcg/day), vitamin B[2 (1,000- 3,000 mcg/day)|
|Fatigue||Astragalus, vitamin E (up to 1,600 IU/day)l|
|Depression||St. John's Wort (300 mg @ 0.3% hypericin, tid)|
|RESOURCES FOR BRAIN TUMOR PATIENTS|
|American Brain Tumor Association
2720 River Rd, Des Plaines, IL 60018, 800-886-2282
|National Brain Tumor Foundation|
785 Market Street, Suite 1060, San Fran, CA 94103
|Al Musella's Brain Tumor website
(includes a listing of clinical trials, links, survivor stories)
|Libutti R: That's Unacceptable|
Krystal Publishing 1997
PO Box 221, Martinsville, NJ 08836,
|Ovist D: Second Chance, Eureka, MT:
Danashan Publishing, 1997
|Rolof T (ed): Navigating Through a Strange Land: A Book for Brain Tumor Patients and Their Families
West Fork, AR: Indigo Press, 1995
1. About Gliobtutoma Multiforme and Anaplastic Astrocytoma(informational brochure). Des Plaines: American Brain Tumor Association, 1994.
2. Willis D: Intracranial astrocytoma: pathology, diagnosis and clinical presentation. J Neurosci Nurs 23(l):7-14, February 199 1.
3. Black P, Io--ffler JS: Cancer of l@e Nervm System, P. 3 1. Cambridge: BhckweU Science, Inc., 1997.
4. Black P, Loeffler JS, ibid.
5. American Brain Tumor Association, ibid.
6. Black P, Loeffler JS, ibid.
7. Nebeling LC, et al. Effects of a ketogenic diet on tumor metabolism and nutritional status in pediatric oncology patients: two case reports. J Am Coll Nutr 14(2):202-208, April 1995.
8. Prasanna P, Thibault A, Liu L, Samid D: Lipid metabolism as a target for brain cancer therapy: synergistic activity of lovastatin and sodium phenylacetate against human glioma cells. J Neurochem 66(2):710-716, February 1996.
9. Murray M: Niacin (Vitamin B3). The Encyclopedia of Nutritional Supplements, pp. 88-99. Rocklin: Prima Publishing, 1996.
10. Wright TV: Surgery? Quicker, stronger, less painful healing. Nutrition & Healing 12, January 1996.
11. White LB: Recovering from surgery. Health & Nutrition Breaktbrougbs 2(8):30-33, August 1998.
12. Kelly GS: Bromelain: a literature review and discussion of its therapeutic applications. Alt Med Rev 1(4):243-257,1996.
13. Brown JM, et al. Structure-activity relationships for turnour radio-sensitization by analogues of nicotinamide and benzamide. Int J Radiat Biol 59(3):739-748, March 1991.
14. Kim JH, et al.- Use of vitamins as adjunct to conventional cancer therapy. In Prasad KN, et al (eds): Nutrients in Cancer Prevention and Treatment. Totowa: Humana Press, 1995.
15. Kjellen E, et al-. A therapeutic benefit from combining normobaric carbogen or oxygen with nicotinamide in fractional X-ray treatments. Radiother Oncol 22(2):81-91, October 1991.
16. Horsman MR, Chaplin DJ, Brown DM: Radiosensitization by nicotinamide in vivo: a greater enhancement oftumor damage compared to that of normal tissues. Radiat Res 109:479-489, 1987.
17. Horsman MI, Chaplin DJ, Overgaard J: The use of blood flow modifiers to improve the treatment response of solid tumors. Radiother Oncol 20(Suppl):47-52, 199 1.
18. Murray M: ibid, P. 93.
19. Cheraskin E, et al-. Effect of diet upon radiation response in cervical carcinoma of the uterus: a preliminary report. Acta Cytol 12(6):433, November/December 1968.
20. Funegard U, et al. Can alpha-tocopherol and beta-carotene supplementation reduce adverse radiation effects on salivary glands? Europ J Cancer 31A(13-14):2347-2353, December 1995.
21. Stahelin HB: Critical reappraisal of vitamins and trace minerals in nutritional support of cancerpatients. Supportive Care in Cancerl(6):295-297, November 1993.
22. Wood U- Possible prevention of adriamycin-induced alopeia by tocopherol. New England Journal of Medicine 312(16):1060, April 1985.
23. Wadleigh RG, et al-. Vitamin E in the treatment of chemotherapy-induced mucositis. Am J Med92(5):481-484, May 1992.
24. Lissoni P, et al-. Melatonin as a new possible anti-inflammatory agent. J Biol Regul Homeeost Agents 11(4):157-159, October/December 1997
25. Okunieff P, et al-. Interactions between ascorbic acid and the radiation of bone marrow, skin, and tumor. Am J Clin Nutr 51(12):128 IS- 1283S, December 1991.
26. Prasad KN: Vitamin E induces differentiation and growth inhibition, and enhances efficacy oftherapeutic agents on cancer ccfls. In QuiUin P, Williams RM (eds): Adjuvant Nutrition in Cancer Treatment. 1992 Symposium Proceedings, pp. 235-252. Arlington Hgts: Cancer Treatment Research Foundation, 1993.
27. Myers CE,et al-.Effect of tocopherol and selenium on defenses against reactive oxygen species and their effects on radiation sensitivity. Ann NT Acad Sci 393:419-425,1982.
28. Yoshida S, et al-. Compression-induced brain edema: modification by prior depletion and supplementation of vitamin E. Neurology 33(2):166-172, February 1993.
29. Prasad KN: ibid.
30. Lissoiii P, et al. Increased survival time in brain goblistomas by a radio-neuroendocrine strategyy with radiotherapy plus melatonin compared to radiotherapy alone. Oncology 53(l):43-46, January/February 1996.
31. Ussoni P, et al. Melatonin as a new possible anti-inflammatory agent. J Biol Regul HomeostAgents 11(4):157-159, October/December 1997.
32. Panzer A, Vgjoen M: The validity of melatonin as an oncostatic agent. J Pineal Res 77(12):184-202, May 1997.
33. Brohult A: Effect of alkoxyglycerols on the frequency of injuries following radiation therapy of carcinoma of the uterine cervix. Acta Obstet Gyn Scand 56(4):441-448, 1977.
34. Brohult A: Regression of minor growth after administration of alkylglyccrols. Acta Obstet Gyna Scand 57:79-83, 1978.
35. Berdel WE, et al-. Antitumor action of alkyl-lysophospholipids. Anticancer Research 1(6):345-352, 1981.
36. Pugliese PT, et al. Some biological actions ofalkylglycerols from shark liver oil. J Alt Complement Med 4(l):87-99, 1998.
37. Desai TY, et al-. Taurine deficiency after intensive chemotherapy and/or radiation. Am J Clin Nutr 5 5(3):708-71 1, March 1992.
38. Feuer L, Benko G: Effect of glutaurine and its derivatives and their combinations with radiation protective substances upon irradiated mice. Acta Radiol Oncol 20(5):319-324, 198 1.
39. Bergamini L, et al-. First clinical experience on the anti-epileptic action of taurine. Eur Neur 11:261-269, 1974.
40. Braverman ER, et ak- The Healing Nutrients Within: Facts, Findings and New Research on Amino Acids. New Canaan: Keats Publishing, Inc., 1997
41. Zhang W, Anker L, et al. Enhancement of radiosensitivity in human malignant glioma cells by hypericin in vitro. Clin Cancer Res 2(5):843-846, 1996.
42. Zhang W, Hinton DR, Couldwell WT: Malignant glioma sensitivity to radio- therapy, high-dose tamoxifin, and hypericin; corroborating clinical response in vitro: case report. Neurosurgery 38(3):587-590, March 1996.
43. Clostre F: From the body to the cell membrane: the different levels of pharmacological action of Ginkgo biloba extract. Presse Med 15(31):1529-1538, September 25, 1986.
44. Krieglstein J, et al: Influence of an extract of Ginkgo biloba on cerebral blood flow and metabolism. Life Sci 39(24):2327-2334, December 15, 1986.
45. Barth SA, et al-. Influences of Ginkgo biloba on cyclosporin A-induced lipid peroxidation in human liver microsomes in comparison to vitamin E, glutathione, and N-acetylcysteine. Biockem Pharmacol41(10):1521-1526, May 15,1991.
46. Maitra 1, et al.- Peroxyl radical scavenging activity of Ginkgo biloba extract EGb 761. Biochem Pharmacol 49(11):1649-1655, May 1995.
47. Emerit 1, et al-. Clastogenic factors in the plasma of Chernobyl accident recovery workers: anticlastogenic effect of Ginkgo bilvba extract. Radiat Res 144(2):198-205, November 1995. 48. Attella MJ, et al-. Gingko biloba extract facilitates recovery from penetrating brain injury. EV Neurol 105(l):62-71, July 1989.
49. Etienne A, et al-. Mechanism of action of Ginkgo biloba extract in experimental cerebral edema. Presse Med 15(31):1506-1510, September 25, 1986.
50. Smith IF, et al-. The neuroprotective properties of the Ginkgo biloba leaf: a review of the possible relationship to platelet-activating factor (RAF).J of Ethnopharm 50(3):131-139, March 1996.
51. Ripamonti C, et al-. A randomized, controlled clinical trial to evaluate the effects of zinc sulfate on cancer patients with taste alterations caused by head and neck irradiation. Cancer 82:1938-1945, 1998.
52. Funegard U, et al. Can alpha-tocopherof and beta-carotene supplementation reduce adverse radiation effects on salivary glands? Europ J Cancer 31A(13-14):2347-2353, December 1995.
53. Andersson G, et al-. Comparison of the effect of the linseed extract salinum and a methyl cellulose preparation on the symptoms of dry mouth. Gerodantoloffl 12(l):12-17, July 1995.
54. Wadleigh RG, et al. Vitmiin E in the treatment of chemotherapy-induced mucositis. AmjMed92(5):481-484, May 1992.
55. Lushbaugh CC, Hate DB: Experimental acute radiodermatitis following beta radiation. V. Histopathological study of the mode of action of therapy with Aloe vera. Cancer 6:690-698, 1953.
56. Wood LA: ibid.
57. RheeYH, etal-. Inhibition of mutagenesis and transformation by root extracts of Panax ginseng in vitro. Planta Medica 57:125-128, 1991.
58. Yonezawa N, Katoh N, Takeda A: Restoration of radiation injury by ginseng. 11. Some properties of the radioprotective substances. J Radiat Res 22(3):336-343, September 1981.
59. Moss K- Questioning Chemotherapy, p. 120. Brooklyn: Equinox, 1995.
60. Spector AA, Bums CP: Biological and therapeutic potential of membrane hpid modification in tumors. Cancer Res 47:4529-4537, 1987.
61. Das UN, et al-. Can tumor cell drug resistance be reversed by essential fatty acids and their metabolites? Prostaglandins Leuk & Essen Fatty Acids 58(l):39-54, January 1998.
62. Lowell JA, Pames I-IL, Blackburn GL: Dietary immunomodulation: beneficial effects on oncogenesis and tumor growth. Crit Care Med 18(2Supp):SI45-148, 1990.
63. Unger C, Eibl H: Enhanced drug penetration through biological membranes by short chain atkylglycerols. Drugs of Today 30(Supp B):53, 1994.
64. Luostarinen R, et al.- Vitamin E supplementation counteracts the fish oil- induced increase of blood glucose in humans. Nutr Res 7:953-968, 1995.
65. Kennedy RS, et al. The use of a whey protein concentrate in the treatment of patients with metastatic carcinoma: a phase 1-11 clinical study. AntiCancer Res 15(6B):2643-2649, November/December 1995.
66. Weijl NI, Cleton Fl, Osanto S: Free radicals and antioxidants in chemotherapy induced toxicity. Cancer Treat Rev 23:209-240, 1997.
67. Panzer A, Vljoen M: ibid.
68. Schwartz JL: The clinical control of tumor cell growth through the action of carotenoids, retinols, and tocopherols. In Quillin P, Williams RM (eds): Adjuvant Nutrition in Cancer Treatment. 1992 Symposium Proceedings, pp. 173-233. ArliVon Hgts: Cancer Treatment Resemh Foundation, 1993.
69. Zhang RX, Dougherty DV, Rosenblum ML: Laboratory studies of berberine used alone and in combination with 1'3-bis(2-chloroethyl)-l-nitrosourea [BCNU] to treat malignant brain tumors. Cbin Mcdj(Engi) 103(8):658- 665, August 1990.
70. Weijl NI, Cleton Fj, Osanto S: ibid.
71. Torosian MH: Metabolic abnormalities and conditionally essential nutrients in the cancer patient. In Quillin P, Williams RM (eds): Adjuvant Nutrition in Cancer T-reatment. 1992 Symposium Proceedings, pp. 157-172. Arlington Hgts: Cancer Treatment Research Foundation, 1993. 72. Ziauddin N, etal. Studies on the immunomodulatory effects of ashwaganda. J of Ethnopharm 50(2):69-76, February 1996.
73. Schauss AG, Milholland RBR, Manson S: Therapeutic applications of Withania somnifera (ashwaganda), popular Ayurvedic botanical medicine. Nat Med J 1(10): 16-19, December 1998.
74. Kawai T, et at. Anti-emetic principles of Magnolia obovata bark and Zingiber officinale rhizome. Planta Med 60:17-20, 1994.
75. Wadleigh PG, et al.- ibid.
76. Loeb H, et al.-Tannin-rich carob pod for the treatment of acute onset diarrhea. J Pediatr Gastroent Nutri 8:480-485, 1989.
77. Murray M, Pizzomo J: Encyckpedia ofNaturaiMedicine (2nd Ed.), p. 435. Rocklin: Prima Publishing, 1998.
78. Gogu SR, et al.- Selective protection of murine erythroid progenitor cells with vitamin E from drug-induced toxicity. Proc of Ann Meeting of Am Ass Cancer 31:A24OO, 1990.
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