nutraceuticals in cancer treatment

7/30/2019 Nutraceuticals in Cancer treatment

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Nutraceuticals:Nutraceuticals:

Do they Really Work?Do they Really Work?andand

Complementary CancerComplementary Cancer

TreatmentsTreatments

Josh Sosnow, DVMJosh Sosnow, DVM

North Scottsdale Animal HospitalNorth Scottsdale Animal Hospitalwww.nsvet.comwww.nsvet.com


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Who Am I?Who Am I?

!! Native of ArizonaNative of Arizona

!! Attended Veterinary School at Oregon StateAttended Veterinary School at Oregon StateUniversityUniversity

!! Completed internship at The Animal MedicalCompleted internship at The Animal MedicalCenter in NYCCenter in NYC

!! Practiced Veterinary Medicine in Scarsdale, NYPracticed Veterinary Medicine in Scarsdale, NYand NYC prior to moving to Arizonaand NYC prior to moving to Arizona

!! Practiced in N. Scottsdale prior to purchasingPracticed in N. Scottsdale prior to purchasingNSAHNSAH


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North Scottsdale Animal HospitalNorth Scottsdale Animal Hospital

Mission Statement:Mission Statement:

We strive to provide the highest level ofWe strive to provide the highest level ofveterinary care using the latestveterinary care using the latest

advancements in veterinary medicine toadvancements in veterinary medicine to

enhance the bond between pet and owner.enhance the bond between pet and owner.


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My practice philosophyMy practice philosophy

We treat each patient as an individual .We treat each patient as an individual .

The contact between the doctor and clientThe contact between the doctor and client

is paramount.is paramount.Always try to be accessible for calls,Always try to be accessible for calls,

questions and consultationsquestions and consultations

If you always do right by the patient youIf you always do right by the patient youcan never do wrongcan never do wrong


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TonightTonights Topicss Topics

!! TerminologyTerminology

!! Questions you must always askQuestions you must always ask

!! Words of CautionWords of Caution

!! Glucosamine/Chondroitin ProductsGlucosamine/Chondroitin Products!! Coenzyme QCoenzyme Q

!! Milk ThistleMilk Thistle

!! Omega-3 Essential Fatty AcidsOmega-3 Essential Fatty Acids

!! L-CarnitineL-Carnitine!! Traditional Chinese MedicineTraditional Chinese Medicine

!! Complementary Cancer TreatmentComplementary Cancer Treatment


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TerminologyTerminology

!! Nutraceutical:Nutraceutical:

!! Proven Treatment (Western Tradition)Proven Treatment (Western Tradition)"" Evidence-based treatment, subject to peer-review, follows theEvidence-based treatment, subject to peer-review, follows the scientificscientific

methodmethod

!! Research/Experimental TreatmentResearch/Experimental Treatment"" Investigational study evaluating a drug, supplement or treatmentInvestigational study evaluating a drug, supplement or treatment

according to scientific method. Not yet approved by FDA or consideredaccording to scientific method. Not yet approved by FDA or consideredmainstream.mainstream.

!! AlternativeAlternative TreatmentTreatment"" Usually not validated with scientific trials, based on subjectiveUsually not validated with scientific trials, based on subjective

assessments, may complement mainstream treatmentsassessments, may complement mainstream treatments

!! QuackeryQuackery"" Treatment or drugs that claim to diagnose, cure or prevent disease andTreatment or drugs that claim to diagnose, cure or prevent disease and

are known to be ineffectiveare known to be ineffective

www.quackwatch.comwww.quackwatch.com


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Questions youQuestions you mustmust always askalways ask

!! Has the product or treatment been criticallyHas the product or treatment been criticallyevaluated in clinical studies? If so, what type?evaluated in clinical studies? If so, what type?

!! Are there published and validated doses orAre there published and validated doses or

treatment plans in peer-reviewed journals?treatment plans in peer-reviewed journals?!! Is the product or treatment in widespread use?Is the product or treatment in widespread use?

Are there any current clinical trials in progress?Are there any current clinical trials in progress?

!! Can the product or treatment be used with moreCan the product or treatment be used with more

conventional therapies?conventional therapies?!! What are the side effects or risks?What are the side effects or risks?

!! Is the product orally absorbed and utilized?Is the product orally absorbed and utilized?


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Words of CautionWords of Caution

!! Be wary of the wordsBe wary of the words alwaysalways,, nevernever,, betterbetteror 100%.or 100%.

!! Most alternative treatments and nutraceuticals,Most alternative treatments and nutraceuticals,

herbs, etc. in veterinary have not been validated.herbs, etc. in veterinary have not been validated.!! Always ask your vet for legitimate info on aAlways ask your vet for legitimate info on a

product prior to its useproduct prior to its use

!! For more info:For more info:

"" www.quackwatch.comwww.quackwatch.com"" www.nccam.nih.govwww.nccam.nih.gov Nat. Cen.for Comp. and Alt. MedNat. Cen.for Comp. and Alt. Med

"" www.ncbi.nlm.nih.govwww.ncbi.nlm.nih.gov PubmedPubmed


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Glucosamine/ChondroitinGlucosamine/Chondroitin

!! Cartilage buildingCartilage building

blocksblocks

!! Synthesized naturallySynthesized naturally

by the body, but withby the body, but withtime and age thetime and age the

bodybodys productions production

may diminishmay diminish

!! Commonly availableCommonly availablein a variety of forms,in a variety of forms,

little to no guidelineslittle to no guidelines

for productfor product

standardizationstandardization


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(continued)(continued)!! Proposed Mechanisms ofProposed Mechanisms of

action:action:

"" Increased synthesis ofIncreased synthesis ofnew cartilagenew cartilage

"" Reduction of inflammationReduction of inflammation

"" Inhibit destructive enzymesInhibit destructive enzymes!! Feline Idiopathic CystitisFeline Idiopathic Cystitis

"" Not validated for male catsNot validated for male catswith inflammation of thewith inflammation of thelower urinary tractlower urinary tract

!! Availability of controlledAvailability of controlled

studies in veterinary medicinestudies in veterinary medicineis poor, recent large scaleis poor, recent large scalestudy published in the Newstudy published in the NewEngland Journal of MedicineEngland Journal of Medicinesuggests that it may providesuggests that it may provideanalgesia in patients withanalgesia in patients withmoderate--severe arthritis.moderate--severe arthritis.


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Glucosamine/ChondroitionGlucosamine/Chondroition

(continued)(continued)!! Dose:Dose:

"" Empirical-has not beenEmpirical-has not beenstandardized for dogs or catsstandardized for dogs or cats

"" Dosing regimen is traditionallyDosing regimen is traditionallydivided into induction anddivided into induction and

maintenance phasesmaintenance phases"" Time to onset of positive effect,Time to onset of positive effect,

4-8 weeks4-8 weeks

"" Type/Brand not shown toType/Brand not shown toaffect responseaffect response

"" My choice?My choice?

"" Side Effects: Diarrhea,Side Effects: Diarrhea,

vomiting, loose stool,vomiting, loose stool,excessively high doses canexcessively high doses cancould cause blood clottingcould cause blood clottingabnormalities, manganeeseabnormalities, manganeesetoxicitytoxicity

"" No known drug interactionsNo known drug interactions


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(continued)(continued)!! Glucosamine AnaloguesGlucosamine Analogues

"" GlycosaminoglycanGlycosaminoglycanpolysulfate ester (Adequan)polysulfate ester (Adequan)

May inhibit destructiveMay inhibit destructiveenzymes in joint andenzymes in joint and

production of prostaglandinsproduction of prostaglandinsassociated with DJD, mayassociated with DJD, mayalso stimulate new cartilagealso stimulate new cartilageproductionproduction

Short term studies have hadShort term studies have hadmixed results, long-termmixed results, long-termbenefit unknownbenefit unknown

My experience?My experience?

"" Sodium Hyaluronate (Legend)Sodium Hyaluronate (Legend)

Intraarticular injection thatIntraarticular injection thatmay decrease inflammation inmay decrease inflammation injoint tissues, promote jointjoint tissues, promote jointhealinghealing


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Coenzyme Q (CoQ10)Coenzyme Q (CoQ10)

!! Compound found withinCompound found withincells, plays an importantcells, plays an importantrole in producing energyrole in producing energy

!! Deficit may lead to heartDeficit may lead to heartdiseasedisease

!! May act as a free-radicalMay act as a free-radicalscavenger, protectscavenger, protectagainst blood clots inagainst blood clots inheartheart

!! No clinical studies in vetNo clinical studies in vetmedicine, poor evidencemedicine, poor evidenceon human sideon human side


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Milk Thistle (Silybin)Milk Thistle (Silybin)

!! Used to treat liverUsed to treat liver

diseasedisease

!! Acts as a anti-oxidant,Acts as a anti-oxidant,

may also modulatemay also modulateinflammation within theinflammation within the

liver, reduce likelihood ofliver, reduce likelihood of

long-term damagelong-term damage

!! No studies in veterinaryNo studies in veterinary

medicinemedicine

!! Effective dose unknownEffective dose unknown


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Omega 3 Fatty AcidsOmega 3 Fatty Acids

!! Plants and animals normallyPlants and animals normallymake fatty acidsmake fatty acids

!! Fatty acids are the startingFatty acids are the startingpoint for the production of apoint for the production of avariety of hormones andvariety of hormones andstructural components in thestructural components in thebodybody

!! Typical sources of fatty acids,Typical sources of fatty acids,fish, marine plants, andfish, marine plants, andvegetable oilsvegetable oils

!! Omega-3 vs. Omega-6Omega-3 vs. Omega-6

!! EPA-eicosapentaenoic acidEPA-eicosapentaenoic acid

!! DHA-docosahexanoic acidDHA-docosahexanoic acid


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Omega-3 Fatty Acids (continued)Omega-3 Fatty Acids (continued)

!! Ingestion of high levels ofIngestion of high levels ofOmega-3Omega-3s reduces thes reduces theproduction of inflammatoryproduction of inflammatorychemicals in the bodychemicals in the body

!! Commonly used in veterinaryCommonly used in veterinary

medicine to treat allergic skinmedicine to treat allergic skindisease, arthritis, kidneydisease, arthritis, kidneydisease, cancer and heartdisease, cancer and heartdiseasedisease

!! Atopy (allergies)Atopy (allergies)"" May have direct anti-May have direct anti-

inflammatory role, or inhibitinflammatory role, or inhibit

production of inflammatoryproduction of inflammatorycompoundscompounds

"" w/out secondary infections,w/out secondary infections,omega-3omega-3s can be used ass can be used assole treatment or insole treatment or incombinationcombination


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Omega 3 Fatty Acids (continued)Omega 3 Fatty Acids (continued)

!! ArthritisArthritis

"" Several studiesSeveral studies

demonstrate efficacydemonstrate efficacy

"" Increased ROM,Increased ROM,decreased pain,decreased pain,

reduction in use ofreduction in use of

drugsdrugs

"" May be used asMay be used as

supplement or fed insupplement or fed in

specially formulatedspecially formulated

dietdiet


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!! CancerCancer"" Reduces side effects fromReduces side effects from

chemo and radiationchemo and radiationtherapytherapy

"" Improves survival time inImproves survival time in

patients treated w/ chemo,patients treated w/ chemo,improves quality of lifeimproves quality of life

"" Helps minimize metabolicHelps minimize metabolicchanges associated withchanges associated withcancercancer

"" May have direct anti-tumorMay have direct anti-tumor

effectseffects

!! Heart DiseaseHeart Disease"" May improve muscleMay improve muscle

wasting that typicallywasting that typicallyoccurs with heart failureoccurs with heart failure


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!! How to use Omega-3 Fatty Acids?How to use Omega-3 Fatty Acids?"" Initial dose of 50-250 mg/kg per dayInitial dose of 50-250 mg/kg per day

!! Unanswered questionsUnanswered questions""

Which fatty acids are most effective?Which fatty acids are most effective?"" What absolute amount is necessary in animals withWhat absolute amount is necessary in animals with

disease?disease?

"" What trace nutrients may be necessary to assistWhat trace nutrients may be necessary to assistomega-3 fatty acids?omega-3 fatty acids?

!!

Side EffectsSide Effects"" Soft feces, diarrhea, flatulence, vomiting andSoft feces, diarrhea, flatulence, vomiting and fishyfishy

breath most common; cats may develop bleedingbreath most common; cats may develop bleedingproblems with high doses, unlikely in dogsproblems with high doses, unlikely in dogs


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L-CarnitineL-Carnitine

!! L- carnitine is an amino acidL- carnitine is an amino acidsynthesized in the bodysynthesized in the body

!! Helps move fatty acids intoHelps move fatty acids intomitochondria for cellularmitochondria for cellularenergy productionenergy production

!! Used to treat patients withUsed to treat patients withdilated cardiomyopathy, willdilated cardiomyopathy, willimprove heart function andimprove heart function andpossibly survival; Boxers,possibly survival; Boxers,Cocker Spaniels, DobermansCocker Spaniels, Dobermans

!! Difficult to accurately assessDifficult to accurately assesswhether patient has awhether patient has a

deficiency, unknown as todeficiency, unknown as towhether patients without awhether patients without adeficiency will benefitdeficiency will benefit

!! Dose: 1-6 grams dailyDose: 1-6 grams daily(variable)(variable)


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L-Carnitine (continued)L-Carnitine (continued)

!! CatsCats

"" Used to enhance fatUsed to enhance fat

metabolism in cats withmetabolism in cats with

hepatic lipidosishepatic lipidosis

"" Also as an additive toAlso as an additive to

weight loss diets in dogsweight loss diets in dogs

and catsand cats

!! May also reduce cardiacMay also reduce cardiac

damage fromdamage from

chemotherapeutic agentschemotherapeutic agents(i.e. doxorubicin)(i.e. doxorubicin)

!! ExpensiveExpensive


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Traditional Chinese Medicine forTraditional Chinese Medicine for

Cancer TreatmentCancer Treatment!! The goals of traditional medicine are:The goals of traditional medicine are:

"" Induce or aid induction of remissionInduce or aid induction of remission

"" Meet or exceed survivals obtained by conventional treatment, but with reducedMeet or exceed survivals obtained by conventional treatment, but with reducedexpense, invasiveness, and toxicity.expense, invasiveness, and toxicity.

"" Improve quality of life and prolong survivalImprove quality of life and prolong survival

"" Reduce side effects associated with conventional treatments.Reduce side effects associated with conventional treatments."" Enhance efficacy of conventional treatments.Enhance efficacy of conventional treatments.

!! Cancer is thought, to arise by one of two principle pathways:Cancer is thought, to arise by one of two principle pathways:

"" Pathological accumulationsPathological accumulations

The digestive tract was the site of accumulation of toxins, treatment is aimedThe digestive tract was the site of accumulation of toxins, treatment is aimedat improving digestionat improving digestion

Traditional therapies have demonstrated efficacy in treating liver diseaseTraditional therapies have demonstrated efficacy in treating liver disease

Examples of tumors with this presentation include:Examples of tumors with this presentation include:

Squamous cell carcinomaSquamous cell carcinoma

Malignant melanomaMalignant melanoma

OsteosarcomaOsteosarcoma

FibrosarcomaFibrosarcoma

"" Obstructed blood circulation orObstructed blood circulation orblood stasisblood stasis

Examples of tumors with this presentation include:Examples of tumors with this presentation include:

"" Mast Cell tumors, Hemangiosarcoma, Thyroid AdenocarcinomaMast Cell tumors, Hemangiosarcoma, Thyroid Adenocarcinoma


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Traditional Chinese MedicineTraditional Chinese Medicine

(continued)(continued)

Thyroid adenocarcinomaThyroid adenocarcinomaXiao Chai Hu TangXiao Chai Hu Tang

Bleeding tumors; abdominal hemangiosarcomaBleeding tumors; abdominal hemangiosarcomaYunnan Bai YaoYunnan Bai Yao

Blood stasis tumors of the lower abdomen; prostatic adenocarcinoma;Blood stasis tumors of the lower abdomen; prostatic adenocarcinoma;

transitional cell carcinoma; consider for abdominal hemangiosarcomatransitional cell carcinoma; consider for abdominal hemangiosarcoma

Shao Fu Zhu YuShao Fu Zhu Yu

Blood stasis tumors above the diaphragm; cutaneous mast cell tumors;Blood stasis tumors above the diaphragm; cutaneous mast cell tumors;

thyroid adenocarcinoma; external hemangiosarcomathyroid adenocarcinoma; external hemangiosarcomaXue Fu Zhu Yu TangXue Fu Zhu Yu Tang

Cytotoxic and immune stimulating activity; induce cell differentiationCytotoxic and immune stimulating activity; induce cell differentiationHoxsey FormulaHoxsey Formula

Reduce vomiting associated with conventional treatmentsReduce vomiting associated with conventional treatmentsGingerGinger

Inhibit metastasis, angiogenesis, and tumor growthInhibit metastasis, angiogenesis, and tumor growth

Enhance vitamin A activity by up-regulating vitamin A receptorsEnhance vitamin A activity by up-regulating vitamin A receptors

Induce differentiationInduce differentiation

Vitamin D (given inVitamin D (given in

combination with vitamin A)combination with vitamin A)

IndicationsIndicationsKey DrugKey Drug


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Complementary Cancer TreatmentComplementary Cancer Treatment

Cancer patients have aCancer patients have a

greater need forgreater need for

protein due to theirprotein due to theiraltered metabolismaltered metabolism

"" Arginine (amino acid)Arginine (amino acid)

improve quality of lifeimprove quality of life

along withalong with

administration of fattyadministration of fattyacids - mechanism isacids - mechanism is

unknownunknown


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Treatment (continued)Treatment (continued)!! Omega-3 Essential Fatty AcidsOmega-3 Essential Fatty Acids

"" High levels may:High levels may:

Increase survival timeIncrease survival time

Reduces pain associated with radiation therapyReduces pain associated with radiation therapy

Suppresses the clinical signs of cancer for longerSuppresses the clinical signs of cancer for longerperiodsperiods

Help counteract the metabolic changes caused byHelp counteract the metabolic changes caused bycancercancer

Supplementation with omega-3 EFASupplementation with omega-3 EFAs and Arginines and Argininemust be at levels many times that found inmust be at levels many times that found in fish oilfish oilcapsules.capsules.


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Treatment (continued)Treatment (continued)!! Other NutraceuticalsOther Nutraceuticals

of Interest:of Interest:

"" Antioxidant Vitamins:Antioxidant Vitamins:

+/-+/-"" Glutamine (aminoGlutamine (amino

acid): +acid): +

"" Garlic: -Garlic: -

"" Green Tea/Green TeaGreen Tea/Green TeaExtracts: +/-Extracts: +/-

!! Acupuncture: +/-Acupuncture: +/-


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Wednesday, October 18, 2006

Time: 7pm

Location: McDowell Center (HERE)

Topic: "Cats and their Kidneys: What we REALLY know and how to

diagnose and treat Kidney Disease?"

andWhat is the "Canine Flu"?

Next Lecture:Next Lecture:

nutraceuticals in cancer treatment

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