Saturday, January 08, 2011

Alternative therapies for CLL

First I have a confession. I very seldom censor comments to this blog, but yesterday I had a comment that promoted an alternative therapy for CLL. I did not think it was appropriate to give it the oxygen of publicity on this site, because I think that such alternative therapies, which often involve odd diets and dental clearance and strange supplements, don't do anything for CLL.

CLL is an infinitely variable disease in which spontaneous remissions occur. Patients with the mutated sub-type of CLL, in particular, find that their disease is to some degree subject to homeostatic control. This means that the things that influence normal B cells continue to have an effect on the CLL population. The best example is exercise. One of my patients is able to control his white cell count by running. He has produced impressive graphs which show that when he runs (and he runs enormous distances) his white count falls. But when it comes to the more aggressive subtypes, exercise does little or nothing to control the disease.

Exaggerated claims for lifestyle changes are made, and there is no doubt that most people eat too much, smoke too much and take too little exercise, but there is precious little evidence that changing your lifestyle will do much for your cancer. Anybody who smokes should certainly stop. Second cancers are probably more likely in CLL and it's foolhardy to court one of these by inhaling carcinogens. The evidence that diet influences cancer is much less than certain cancer charities will tell you. Food preserved with nitrites excepted, most dietary associations with cancer have not stood up to rigorous testing. This doesn't mean that I don't advocate healthy eating and regular exercise. Most people will feel better if they follow sensible dietary advice and take plenty of exercise and they will lower their blood pressure, have a trimmer figure and ward off heart disease and stroke.

What about dietary supplements? A normal diet contains everything that humans need to keep healthy. Megadoses of vitamins have been promoted by various individuals including a double Nobel Prize winner in Linus Pauling. The truth is that in most cases the excess vitamins are passed out in the urine. They are safe, but an expensive waste. The exceptions are fat-soluble vitamins A and D. When I was younger there was some laboratory evidence that these vitamins had a physiological effect on cells. The leukemic cell line, HL60, could be made to mature into neutrophils with vitamin A and into monocytes with vitamin D. Indeed, vitamin A derivatives have entered conventional medicine as treatments for acne and promyelocytic leukemia. However these derivatives can be very toxic when taken in excess and are even teratogenic and should not be taken during pregnancy.

Vitamin D is being used for the bone thinning that occurs after the menopause, because its primary action is to control calcium metabolism. Whether it has a role in cancer and in CLL in particular is controversial. Certainly, CLL patients with low levels of D3 have a poorer prognosis, but it is not clear whether this is cause or effect. Clinical trials of vitamin D3 supplements will give us an answer, but until then, those who have faith in D3 should monitor their serum calcium levels, since hypercalcemia can be lethal.

When I talk about a normal diet I mean one that includes meat and vegetables. People who don't eat meat either do so for religious reasons or from distaste at the idea of slaughtering animals or because they have fallen for the propaganda of the vegetarian industry. Strict Hindus are vegans. In rural India such people are likely to be iron deficient since iron from vegetables is poorly absorbed and is not well used for making blood cells. They do not become vitamin B12 deficient because their food is contaminated with bacteria which manufacture the vitamin. In the Western world vegans become vitamin B12 deficient eventually, though B12 stores can last for 20 years if the decision to become a vegan takes place after years on a normal diet. Iron deficiency is not so common because so many foods contain iron supplements. It is most likely to occur in teenage girls.

Some Christians, especially those of the green persuasion, become vegetarians. I'm not sure how they support this theologically, but to my mind the Bible is quite clear on the subject. In Genesis 9:3 God instructs Noah after the Flood: "Everything that lives and moves about will be food for you. Just as I gave you the green plants, I now give you everything." and in the New Testament St Peter's vision in Acts 10:11-15 not only abolishes any food laws, but seems to give the green light to bush tucker: "He saw heaven opened and something like a large sheet being let down to earth by its four corners. It contained all kinds of four-footed animals, as well as reptiles and birds. Then a voice told him, “Get up, Peter. Kill and eat.” “Surely not, Lord!” Peter replied. “I have never eaten anything impure or unclean.” The voice spoke to him a second time, “Do not call anything impure that God has made clean.”

How about herbal medicine? It is certainly true that many of our current drugs including aspirin, quinine, digoxin, atropine and vincristine are derived from plants. One of my old bosses had atrial fibrillation caused by thyrotoxicosis. When he played squash his heart would race, but he kept in the pocket of his shorts some dried foxglove leaves of which he would take a handful for the digitalis effect. That is the problem with herbs. They contain the active ingredient at variable concentrations and often antagonists to the active ingredient as well. Dosing is unpredictable. Better to extract the activity and purify it, then give the optimum dose which has been determined by a clinical trial. There may well be some way of using these active ingredients from herbs like curcumin and green tea, but the raw stuff is variable, weak and unpredictable in its effect.

The placebo effect plays a big part in the beneficial effect of alternative therapies. Practitioners are expert in utilizing it. Spending time with a patient with a good bedside manner and using a spectacular apparatus has an immense placebo effect. How does this work? My daughter thinks it is about neuro-immunology and there is some evidence for this. Pavlov's famous experiment of getting dogs to salivate at the sound of a horn, even when it is not rewarded by food, has been repeated for vaccine studies, so that an immune response can be generated at the sound of a horn, even when no vaccine is given. It is certainly possible that feeling good and optimistic about the future may influence the internal environment of growth factors, chemokines, cytokines, receptors and antibodies.

So I would not discourage people from seeking aromatherapy, exercise, green tea, acupuncture, massage or any other complementary treatment with this proviso: do not let it deter you from an established treatment when the time comes, and do not proselytize so vehemently that you send others on a guilt trip because they are not following your advice.

27 comments:

Anonymous said...

Professor Hamblin

I think it was I who had written the post that has energised you to post your latest thread on your blog. I agree wholeheartedly with your last paragraph that when the time comes, ignoring tried and tested treatment is potential dangerous and stupid! However, I also think no-one should go into anything that is life threatening with their head buried in the sand. Many people do this because they are unwilling to at least explore all possibilities. There is evidence to suggest that those who are more pro-active researching the disease and open to alternative ways of thinking have a better prognosis than those who remain passive and do not think about their condition.

Thank you for your post on 'Alternative therapies for CLL'. I do value your opinion in this area and think it will stimulate a response from your avid readers.

Bill

Lucy said...

Thanks for writing this, Dr Hamblin, I have felt a total failure because I couldn't stop CLL progressing with any of the supplements etc that kind people have thrust upon me over the past two years. And this in spite of knowing that my reaction is illogical. It can be very difficult when you know that the motives behind the advice are so good and kind - but the effect is rather depressing!

Anonymous said...

xThis post settles the matter for me. I've been struggling to become totally vegetarian thinking in so doing, I might achieve a better remission from CLL. I know other CLL patients who are trying to overcome their disease with such a diet and exercise. I've felt so guilty when I give in to my craving for meat. Now that guilt will no longer haunt me.

Thank you so very much, Dr. Hamblin. God bless!

Barbara

Anonymous said...

'Propaganda' by vegetarians is not misleading. Those on a vegetarian diet live longer and are healthier than meat-eaters. There is ample proof of this.

When I am faced with the dilemma of what to eat, I picture the poor chicken, cow, pig or turkey who is just living his life the best way he can. To torture him and then kill him is barbaric.

Certainly the average Westerner eats too much meat. If one does kill and eat, it's better to do so to an animal who has been fairly treated, and humanely executed. There are many horror stories about how animals are killed and processed.

The best solution will be lab-grown meat, that gives the flavor and mouth-feel of meat, but doesn't involve killing animals.

And reducing the human population would be a good idea. Caucasians by and large are at replacement levels fertility-wise. Other groups, not so much.

Anonymous said...

Well said!

Barry Lambert said...

So, for clarification, Terry, are you recommending that we, including those of us with mutated type CLL, avoid food preserved with nitrites?

Andy said...

I love this post Terry, and I shall be linking to it to support common sense in the way we deal with our CLL for years to come.

Lets put a stop to all the nonsense we see around all teh various CLL websites on teh internetz.

Terry Hamblin said...

Even the nitrite story is dubious. Nitrosamine is crtainly a carcinogen, but how important it is as a cause of human cancer is disputable. Plenty of bacon sandwiches have been eaten without any harm.

Andy said...

To Bill -

Are you sure there is evidence to suggest that those who are more pro-active researching the disease and open to alternative ways of thinking have a better prognosis than those who remain passive and do not think about their condition?

To the veggies -

Perhaps a veggy diet is healthier than the average western diet, but you will not guilt most of us into vegetarianism. Bacon is to nice.

Andy said...

Arrrrgh.

Bacon is TOO nice.

George said...

Therry, it's quite amazing that this particular post attracted the most comments. It would also be interesting to know whether your patient's B cell count rather than total WCC fluctuated after running.

Terry Hamblin said...

Yes, it did.

Brian Koffman said...

I am vegan, mostly raw, mostly organic. I have no fantasy that this will cure me and even less impulse to convert anyone else to my diet. And I am not fanatical. I cheat when I travel and eat egg and dairy.

I do it because I believe a plant based diet is the healthiest diet for me (with a B12 supplement), and I already have CLL, so I don't need anymore problems.

I do it because I believe it is more sustainable for the planet and is clearly better for the animals. And it supports the local organic farmers' co-operative.

I do it because it makes my GI tract feel the best it has ever felt.

I do it because because I love the taste of fresh local organic fruits and vegetables. It helps to live in southern California

And I do it because it is a form of discipline that I enjoy.

Anonymous said...

Terry: I run a little myself,15 to 20 miles a week. I'd be interested to know more about your runner. What is his WBC? How long has he had CLL? How far and often does he run? If you get a chance.

john liston

Vitamins Canada said...

There are a lot of alternatives out there. Dietary supplements can be one. Proper dieting and vitamins can also help.

Andy said...

Terry,

I wonder if you feel able to give us a few more details about the Alt-Med comment that you felt you had to delete?

Given the wide scope of comment in all sorts of areas that you do allow, I would be very interested in knowing what was so left field as to move you to disallow it?

Terry Hamblin said...

It was a very complex treatment method that had so many flaws in its understanding of basic physiology and pathology that I did not feel it right to give it publicity. I think anybody embarking on that treatment procedure would waste a lot of money without seeing any benefit. All on the basis of what was probably a spontaneous remission in one patient.

Terry Hamblin said...

John, I'll see if the individual concerned would like to communicate directly with you.

Andy said...

Thank you.

Wayne said...

Terry,

Regarding your comment "......their disease is to some degree subject to homeostatic control." This suggests that in some of us the damage in the chromosomes and associated pathways that could override the body's defenses for aggressive cell progression/drug resistance is within tweaking tolerances from the observation of disease fluctuation. Why would it not be reasonable to suspect that some activity, whether ingesting some substance or stimulating the body through exercise could not tip the balance in favor of increased control and prolonging disease progression?

I view what I do in keeping myself as healthy as possible in the context of giving my body the best chance to keep what is still functioning, immune wise, in the best condition I can and not in any illusionary way as cure. Many of us in the mutated camp who are doing well are folks who exercise regularly which may well not be universally true. I have often wondered if the metabolic processing of fat through exercise may help.

I think it is time for a clinical trial of "health nuts" vs "couch potatoes" What say you Prof. :)
WWW

Anonymous said...

I am running 50 plus miles a week and training for a spring marathon (Boston) if anyone wants to compare my previous, current and future WCC and B cell counts!

At minimum the training is great for my mental health!

I continue to be amazed by how much wisdom Dr. Hamblin offers our community!

Carter said...

Very well said.

Terry Hamblin said...

Mea culpa! The 'runner' I referred to was a 'walker'. The years had dulled my memory. See you don't even have to be a runner - walking is good enough, but he is a long distance walker.

Terry Hamblin said...

Wayne

Yes, you are right. the tweakability of the mutated group does admit to healthy manipulation.

Jorge said...

Thank you Prof.for your post.Your posts about CLL are always very welcome, because you are an authority in this matter.

Mandy said...

The meat/vegan debate always provokes a lot of heated debate. However I challenge anyone to read The China Study by T Colin Campbell PhD and not decide to give up as much animal protein as they can. This book is based on years of extensive research. Colin Campbell has authorised hundreds of scientific papers, sat on numerous government expert panels and is a well respected scientist.

Unfortunately the science community and food industry are too closely related and have too many vested interests to want the public to give up on eating meat and dairy, even though it costs thousands of lives through cancer, diabetes and heart disease.

Cosmic Trinity said...

Just one example, and there are many: proanthocyanidins.

These are the effects against cancer,

http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2562893/figure/F2/

http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2562893/

Why is the cancer community not doing more research? Because these are not patent-protected substances. Chocolate is high in proanthocyanidins, but Nestle is not financing cancer research. Perhaps they should.

Chuck