Transcript General Herbal Support

A Natural Approach to Breast
Cancer Care
Dr Christopher Etheridge
PhD, MRSC, MCPP, CChem, DoIC, ARCS, BSc (Hons) Phyto, BSc (Hons) Chem
Natural Approach to Breast Cancer
Introduction

Breast cancer: an overview.

Natural Approaches: dietary factors for breast and prostate cancer.

Natural Approaches: nutriceutical support for breast and prostate
cancer (Part 1).

Natural Approaches: general herbal medicine support (Part 1).

Natural Approaches: specific herbal medicine breast cancer support.

Case Study 1
© Dr Christopher J. Etheridge 2012
2
Breast Cancer: an overview
3
Breast Cancer: an overview

Breast cancer is the most commonly diagnosed female cancer
in UK (very rare in men).

Accounts for 30.90% of cancer diagnosed in women.

In 2008, 47,963 new cases of breast cancer diagnosed in
women in the UK.

1.4 million new cases of breast cancer diagnosed in whole
world in 2008.
Sources: Cancer Research UK and World Cancer Research Fund
4
Breast Cancer: an overview
Source: Cancer Research UK
5
Breast Cancer: an overview

Woman has 1 in 8 chance of developing breast cancer in her
lifetime.

Incidence increasing with time in all age groups.

Breast cancer incidence gradually increasing in younger
patients (25-35 y/o range) – clinically rare 50 years ago.

Incidence increasing most in 65-69 y/o age group.
Sources: Cancer Research UK and World Cancer Research Fund
6
Breast Cancer: an overview
Sources: Cancer Research UK for 2007-2009
7
Breast Cancer: an overview
Sources: Cancer Research UK for 2007-2009
8
Breast Cancer: an overview

Various different kinds of breast
cancer are known.

Most commonly diagnosed is
adenocarcinoma (formed from
glandular cells).

Various subtypes of adenocarcinoma:


non-invasive (ductile carcinoma in situ (DCIS) and lobular carcinoma
in situ (LCIS)).
invasive (infiltrating ductile (ID), infiltrating lobular (IL)).
9
Breast Cancer: an overview

Breast cancer can be further divided histologically depending
on presence of oestrogen receptors (ER), progesterone
receptors (PR) and/or Human Epidermal Growth Factor 2
receptors (HER2/neu), on their cell surface:

42-59%: ER/PR +ve (lower grades more likely to be ER +ve) and
HER2/neu –ve.

6-19%: ER/PR/HER2/neu +ve (triple positive).

7-12%: HER2/neu +ve (ER/PR –ve).

14-20%: breast cancers triple negative.
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Breast Cancer: an overview


Main orthodox treatments for breast cancer are:

Surgery.

Chemotherapy.

Radiotherapy.

Hormone therapy (e.g. Tamoxifen for ER +ve cancers) or biological
therapy (e.g. Herceptin for Her2/neu +ve cancers).
Newer treatments such as Photodynamic Therapy (PDT) and
Radiofrequency Ablation (RFA) are currently being researched for the
treatment of early breast cancer without the need for surgery.
11
Breast Cancer: an overview

Type of treatment(s) given depend upon:

The type of breast cancer.

The stage of the breast cancer (1-4).

The grade of the breast cancer (1-4).

The receptor status of the breast cancer.

Family history (BRCA-1 and BRCA-2 genes).

Whether the cancer is new or a recurrence.
12
Breast Cancer: an overview

Today, we will be focussing on the natural treatment of
breast cancer.

However, many of the breast cancer patients we see decide to
have one or more conventional treatments.

For example, more than half of people diagnosed with breast
cancer elect to have chemotherapy.

Of 309,527 people diagnosed with treatable, invasive primary
breast cancer in 2008 in UK, approximately 160,000 received
chemotherapy.
13
Breast Cancer: an overview

As non-medically trained health professionals, under the
Cancer Act 1939 we must not give or say we can give, advice
or treatments for breast cancer to either our patients or their
families.

However, we can give information and supporting herbs and
nutriceutical supplements to patients who either:

Wish to undergo some or all of the orthodox treatments suggested by
their oncologist i.e. work in an integrated (integrative) way.

Do not wish to undertake any conventional treatments, but instead
wish to try complementary therapies.
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Natural Approaches to Breast and Prostate
Cancer: dietary factors – 14 key steps
15
Dietary Factors
1) Avoid refined carbohydrates - increase cancer growth and
deplete immune system.

Replace with complex carbohydrates : wholemeal/whole-wheat
flour, bread, pasta, porridge oats and brown rice - low glycaemic
index.

Foods can be sweetened with small amounts of natural
sweeteners such as maple syrup, Agave syrup, Stevia extract and
honey if necessary. Xylitol can also be used if wished.

50% of daily calories should come from carbohydrates, with at
least 80% of these coming from complex carbohydrates.
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Dietary Factors
2) Plenty of whole grains, nuts and seeds – rotate frequently to
avoid food intolerances.

Watch out for grain intolerances.
3) ↓ salt intake (pro-inflammatory – link to increase in metastatic
growth).

Increase potassium-rich foods (potatoes, pears, passion fruit and
pomegranates) to counteract sodium.
17
Dietary Factors
4) ↓ saturated fats and cut out trans-fatty acids: red meats, dairy,
hydrogenated margarine etc.

Pro-inflammatory (n-6 fatty acids), increase IGF-1, deplete
immune system efficiency.

Total fat intake should not exceed 20% of total daily calories,
with no more than 10% of these coming from saturated fats.
18
Dietary Factors
5) Increase intake of anti-inflammatory n-3 fatty acids (e.g. αlinolenic acid (ALA), eicosapentaenoic acid (EPA), and
docosahexaenoic acid (DHA)).
ALA

Reduce other seed oils (sunflower, canola, corn, palm, safflower,
hemp, soya) as high ratio of pro-inflammatory n-6 fatty acids.
19
Dietary Factors

It is thought that ideal ratio for n-6:n-1 should be approximately
1:1 (evolutionary hunter-gatherer).

Industrial revolution (140 years ago), marked shift in n-6:n-3 fatty
acids in diet (↑ seed oil and animals fed on cereal).

1935-1939, n-6:n-3 was 8.4:1.

1935-1985, this ratio increased to 10.3:1 (a 23% increase).

Today, estimates of ratio range from 10:1 to 20:1, with a ratio as
high as 25:1 in some individuals in USA.
20
Dietary Factors
Adapted from thehealthyskeptic.org
21
Dietary Factors

Olive or coconut oil should be used in cooking/stir-frying.
Neutral fatty acids, heat stable. Polyunsaturated fats oxidise
readily to procarcinogens.

Salad dressings should be made with flaxseed oil.

These changes can bring the n-6:n-3 closer to theoretical
optimum 1:1.
www.food.gov.uk; Calder American Journal of Clinical Nutrition (American Society for Nutrition) (June 1,
2006). 83 (6, supplement): 1505S–1519S.
22
Dietary Factors
6) ↓ red meat and dairy intake as relatively high n-6 fatty acids
such as arachidonic acid and other pro-inflammatory compounds
such as cholesterol: increase inflammation, cancer growth;
deplete immune system.

Also high in compounds that increase IGF-1 levels, linked with
increase risk and growth of breast cancer.

Animal protein increases acid production in the body.

Cheese also high in salt.
Renehan et al. Lancet 2004;363:1346-1353.
23
Dietary Factors

7) High protein (preferably vegetable-based) to aid energy,
immune system, prevent cachexia e.g. quinoa, mushrooms, soya,
buckwheat, beans and pulses.

Soya contains isoflavones such as genistein which have marked
antiproliferative activity. Much clinical evidence for this – soya
can be seen as controversial - see next slide.

Milk replaced with rice, almond, oat or soya milk.
24
Dietary Factors

The latest research suggests that soya, as a dietary foodstuff, does
not increase the risk of cancer growth in patients with breast
cancer, or increase the risk of cancer recurring once treated.

Research not clear on soya isoflavone supplements – I avoid
them in patients with breast cancer or at high risk of breast
cancer (interestingly research on red clover extracts shown safe).
JAMA, December 9, 2009—Vol 302, No. 22 2437; www.aacr.org/home/public--media/aacr-in-the-news.aspx?d=2326.
25
Dietary Factors

There is a lot of negative press about soya in CAM world and
amongst some practitioners.

E.g. Fermented versus non-fermented products.

As far as I am concerned, unfermented soya, if eaten as an
occasional part of the diet should not cause any health problems
(unless pre-existing intolerance present) and should not cause
malnutrition due to metal ion chelation or vitamin binding by
phytic acid (if consumed in sensible amounts).

Fermented soya is fine but is expensive and tastes foul.
26
Dietary Factors

Phytic acid is present in many seeds and nuts, particularly (but
not exclusively) in members of the Fabaceae and Poaceae
families.

Destroyed by cooking, soaking and fermentation.
27
Dietary Factors
28
Dietary Factors

Many practitioners vocal against soya due to its phytic acid
content, are happy to prescribe inositol-6-phosphate (IP6) to
cancer patients, as a nutriceutical support, for its antioxidant,
cancer preventative and immunomodulating properties.

Spot the difference!
29
Dietary Factors
Phytic acid

IP6
What’s the difference? None – they are exactly the same
compound
30
Dietary Factors
8) Balanced diet essential with plenty of fresh vegetables and
fruit (at least 10 portions/day (ACS)) to aid liver function,
detoxification and reduce oxidative stress antioxidants). Rainbow
diet. Organic and locally grown if possible.

Vegetables generally more important than fruit (alkalising) –
avoid excess high sugar fruits and vegetables.

Members of Apiaceae family (celery, parsley, lovage, Florence
fennel, fennel, angelica, cicely, carrot, coriander) all very
alkalising as have potassium-sparing diuretic effect, as well as
being rich in potassium.
31
Dietary Factors

Apples (raw, cooked, juiced) – rich in glucuronic acid – reduce
enterohepatic recycling (cider vinegar?).

Cabbage family (indole-3-carbinol). Increase activity of liver
detoxifying enzymes convert hormones and toxins to non-active
products; some direct anticancer activity.

Garlic: antimicrobial, detoxifying, anticancer,
hypocholesterolaemic.
32
Dietary Factors

Mushrooms (“non-medicinal”): high protein, anti-breast cancer
properties.

↑ vitamin E rich foods (olive oil, tahini, houmous, peppers,
tomatoes, avocadoes, nuts and seeds). Antioxidant, antiinflammatory and anti-breast cancer properties. Best as natural
food source where possible.
33
Dietary Factors

↑ lycopene: Tomatoes (especially cooked), watermelon, apricots,
papaya and guava (and red/pink grapefruits) are all good sources
of lycopene. Lycopene is a potent antioxidant that is helpful in
reducing breast cancer growth.
34
Dietary Factors

↑ vitamin A/carotenoids: Vietnamese gac (Momordica
Cochinchinensis), crude palm oil, yellow and orange fruits
(mangoes, pumpkins, papayas), orange root vegetables (carrots,
yams), and green leafy vegetables (spinach, kale, sweet potato
leaves, sweet gourd leaves), are all rich in β-carotene and other
carotenoids – a safe source of vitamin A. Vitamin A and βcarotene are potent antioxidants that are helpful at slowing
cancer growth.
35
Dietary Factors

Linseeds/flax seeds: crushed - rich n-3 essential fatty acids,
prebiotics for detoxification and elimination and phytoestrogenic
compounds (lignans) that can reduce breast cancer growth.

Lignans also ↑ sex-hormone binding globulin (SHBG).
Metabolised by commensal bacteria to
enterodiol and enterolactone
Secoisolariciresinol
36
Dietary Factors
9) Alkaline diet: cancer prefers acidic environment - low in oxygen
and high in carbon dioxide (low pH) - which supports
inflammation and cancer growth. Advise vegetable juices (e.g.
celery, Florence fennel, parsley, cucumber, ginger, beetroot).

Avoid acid fruits such as citrus fruits (esp. orange juice –
grapefruits are fine occasionally unless contraindication with
medication) and rhubarb, as ↑ acidity of the body. Berry fruits
(raspberries, strawberries, blackberries, blueberries, cranberries,
black currants, red currents) fine in moderation.
37
Dietary Factors
10) Prebiotics/probiotics to ↓ gut toxin load and enterohepatic
recycling – ↑ gut immunity and excretion of oestrogen
metabolites. ↑ calcium absorption, ↑ pH, better intestinal
regularity.

Important prebiotics: slippery elm, ground flaxseeds, chicory
root, dandelion leaves and root, raw leeks/garlic/onion,
Jerusalem artichoke, inulin, fructooligosaccharides (FOS).

Probiotics: Lactobacillus acidophilus and Bifidobacterium bifidus key –
non-dairy cultured essential.

Start at low doses to ↓ side effects.
Stephanie, Watzl; J Nutr 2007; 137: 2563S; Macfarlane et al.; Aliment Pharmacol Ther 2006; 24(5), 701-14.
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Dietary Factors
11) ↑ water consumption for detoxification.

2-3 litres of total fluid/day - ensure bottled or filtered water..
Cancer linked to dehydration.

Patient should not drink lots of water with meals (apart from
some white tea which can beneficially reduce sugar absorption).
12) ↓ coffee (caffeine and other compounds proinflammatory/dyslipidaemia). Some research that reduces risk of
developing breast and prostate cancer, but can increase growth
of cancer once formed.
39
Dietary Factors
13) ↓ black tea (↓ mineral absorption), replace with white tea.

White tea made from buds of tea plant not leaves. Steamed, not
fermented before drying, so ↑ in potent antioxidant and
anticancer chemicals (epigallocatechin gallates (EGCGs)).

Green tea OK, but less rich in EGCGs and slightly more acidic.
40
Dietary Factors
41
Dietary Factors
14) Dark chocolate – good as occasional treat. Very rich in
available antioxidants with anticancer activity.
(-)- Epicatechin.
42
Natural Approaches: nutriceutical
support (part 1)
43
Nutriceutical Support
1) Bromelain

Sulphur-containing protease from pineapple stems (Ananas
comusus) (different enzyme in fruit).
44
Nutriceutical Support
1) Bromelain

Anticancer effect in vivo (Maurer et al. Cell Mol Life Sci 2001; 58:1234-45).

Activates key immune functions often deficient in cancer
patients – augments chemotherapy (Eckert et al., Oncol Rep 1999; 6(1):1191-99).

Anti-inflammatory effect (anti-prostaglandin effect) – reduces
cancer growth. Blocks pro-inflammatory
prostaglandins/leukotrienes/thromboxanes – promotes
formation of anti-inflammatory prostaglandins.
45
Nutriceutical Support
1) Bromelain

Bypasses digestive tract and absorbed through the stomach and
gut undamaged and still functional. Fibrolytic action – destroys
protective fibrin coating around cancer, allows entrance of drugs,
immune cells and phytochemicals into tumour.

↑ absorption of phytochemicals with relatively poor
bioavailability such as turmeric and quercetin.
46
Nutriceutical Support
1) Bromelain

For anticancer/anti-inflammatory action, should be taken 30-60
minutes before food, or else just acts as digestive enzyme.

Normal dose for cancer patients is 500 mg three times a day.
47
Nutriceutical Support
1) Bromelain

Possible side effects

Rarely skin rashes or allergic reactions. Bromelain should not be
used directly on the skin, as it can damage the skin.

Possible interactions

Cytochrome P450 2C9: Bromelain inhibits CYP2C9 activity
and may affect metabolism of its substrates.
48
Nutriceutical Support
2) Calcium D-glucarate

Calcium salt of D-glucaric acid, produced in small amounts by
humans; larger amounts in apples, grapefruit and cruciferous
vegetables.

Increases phase 2 detoxification in liver.
49
Nutriceutical Support
2) Calcium D-glucarate

Inhibits β-glucuronidase, enzyme produced by some gut flora
that enables enterohepatic recycling.

↑ β-glucuronidase activity associated increased risk for various
cancers, particularly hormone-dependent cancers such as breast,
prostate, and colon cancers.

Can be used to reduce enterohepatic recycling of oestrogen
metabolites, balancing endogenous levels.
50
Nutriceutical Support
2) Calcium D-glucarate

Some direct anticancer activity for breast and prostate cancer,
independent of these mechanisms.

In phase 1 clinical trial at Sloan-Kettering Cancer Center in US.

Possible side effects

Not expected at normal doses.

Possible interactions

None known.
51
Nutriceutical Support
3) Coenzyme Q10

Essential for normal metabolism.

Speeds up metabolic processes
needed for digestion, healing, healthy
muscles and energy.

Especially protective of heart.

Good antioxidant.
52
Nutriceutical Support
3) Coenzyme Q10

Levels can be depleted by chemotherapy and radiotherapy, and
can be low in patients diagnosed with breast cancer.

Some small studies suggest prolongs survival in patients with
breast cancer.

Dosage of 30-200 mg per day (use lower doses during
chemotherapy and radiotherapy).
53
Nutriceutical Support
3) Coenzyme Q10

Possible side effects:

Very occasional GIT irritation.

Possible interactions:

As is an antioxidant, theoretically is should not be used in high
doses during chemotherapy or radiotherapy.
54
Nutriceutical Support
4) Green/white tea

Derived from Camellia sinensis - not fermented but steamed
(green tea leaves, white tea young leaf buds).

High in flavonoids such as epigallocatechin gallate (EGCG).

Flavonoids are potent antioxidants and anti-inflammatories.
55
Nutriceutical Support
4) Green/white tea

↑ activity of antioxidant enzymes in small intestine, liver and
lungs (Nihal et al. Nutr Rev 1999; 57:78-83).

Inhibit cancer formation and progression by inhibiting
nitrosamine formation, suppressing carcinogen formation and
trapping cancer-causing agents.

Triggers apoptosis in cancer cells (Wollowski et al. Am J Clin Nutr 2001; 73(2):451S55S).
56
Nutriceutical Support
4) Green/white tea

Does not damage non-cancerous cells – in fact protects normal
cells from damage during treatments.

EGCG inhibits production of urokinase, enzyme cancer cells
need to grow. In animal trials has caused tumour shrinkage and
in some cases complete remission Jankun et al. Nature 1997. 387,561.

Inhibits VEGF action – preventing angiogenesis Jung et al. BJC 2001. 84,
844-850.
57
Nutriceutical Support
4) Green/white tea

Also has anti-inflammatory effect and suppresses damage caused
by LDL cholesterol – reduces arterial plaque formation.

Dosage: 240-320 mg of polyphenols per day for cancer patients
(4-5 cups per day – caffeine lowest in white tea).

Possible side effects

Occasionally nausea or gastric irritation. In patients sensitive to
caffeine, use decaffeinated supplements.
Should not be used with some biological therapies.

58
Nutriceutical Support
5) Indole-3-carbinol/DIM


Found in Brassicaceae family, especially broccoli seed sprouts.
Breakdown product of the glucosinolate glucobrassicin catalysed
by myrosinase.
59
Nutriceutical Support
5) Indole-3-carbinol/DIM

↑ detoxification in gut, decreases carcinogenic nitrosamine levels
and heterocyclic amines.

↓ breast and prostate cancer growth.

Triggers apoptosis in cancer cells.

Inhibits Akt and NF-κB (Sarkar et al. J Nutr 2004. 134(12), 3493S-98S).

Role in hormone modulation - ↑ conversion to metabolites.
60
Nutriceutical Support
5) Indole-3-carbinol/DIM


The body contains different forms of oestrogen:

Oestradiol which has most cell proliferative activity. E2

Oestrone which has intermediate proliferative activity. E1

Oestriol which has the least proliferative activity (thought to be
protective against breast cancer). E3
Essential to ensure balance of these oestrogens and their
metabolites is optimal for ER +ve breast cancer.
61
Nutriceutical Support
5) Indole-3-carbinol/DIM

Oestrogen metabolised mainly in liver – hydroxylation in Phase I
detoxification yields either:



16-a-hydroxyoestrone (16OH) – major product.
4-hydroxyoestrone (4OH) .
2-hydroxyoestrone (2OH).

All three conjugated in Phase II detoxification by methylation,
glucuronidation or sulfation.

Metabolites mainly excreted in bile, but some in urine.
62
Nutriceutical Support
5) Indole-3-carbinol/DIM

16OH and 4OH metabolites tend to undergo enterohepatic
recycling – increase oestrogen load in body and both strongly
oestrogenic.

2OH metabolite (2OMe) – no tumour promoting properties
(potent antioxidant and antiproliferative) and most water
soluble of all metabolites – easily excreted and does not
undergo ready enterohepatic recycling.

Need to increase production of 2OH metabolite and to limit
enterohepatic recycling of 16OH and 4OH metabolites in
patients with ER +ve breast cancers.
63
Nutriceutical Support
64
Nutriceutical Support
5) Indole-3-carbinol/DIM

I-3-C (and other glucosinolates)stimulate latter pathway by
stimulating CYP1A1 in liver, reducing tumour promoting
breakdown product, favouring anti-tumour product and
balancing overall oestrogen levels.

Recommended dose: 200 mg two-three times a day with food.

Possible side effects

Occasionally nausea or gastric irritation.
65
Natural Approaches: general herbal
medicine support (Part 1)
66
General Herbal Support

To support patients against cancer we need to concentrate on:
o
↓ inflammation.
o
↑ immunity and immune surveillance.
o
↓ local congestion
o
↑ lymphatic drainage.
o
↑ detoxification.
o
↑body resistance and vitality.
o
↓ stress levels and ↑ coping mechanisms.
How do we do this?
67
General Herbal Support
How do we do this?
1) ↓ inflammation: anti-inflammatories, antioxidants,
vulneraries.
2) ↑ immunity and immune surveillance:
immunomodulators, antimicrobials, liver herbs, bitters.
3) ↓ congestion: circulatory stimulants, lymphatics,
diuretics.
4) ↑ lymphatic drainage: circulatory stimulants, lymphatics,
diuretics.
5) ↑ detoxification: alteratives, liver herbs, diuretics.
6) Strengthen body resistance/vitality: adaptogens, adrenal
tonics, system tonics.
7) Manage stress: adaptogens/nervines.
68
General Herbal Support
Herbs with anticancer activity (Part 1)
1)
2)
3)
4)
5)
6)
Astragalus membranaceus
Calendula officinalis
Centella asiatica
Echinacea angustifolia
Eleutherococcus senticosus
Galium aparine
7) Phytolacca americana
8) Rhodiola rosea
9) Silybum marianum
10) Trifolium pratense
11) Withania somnifera
12) Zingiber officinale
69
General Herbal Support
1) Astragalus membranaceus (milk vetch)





o
Immunomodulator.
Tonic.
Adaptogen.
Cardiotonic.
Diuretic
Active constituents: Astragalosides (triterpene saponins),
flavonoids, isoflavonoids, polysaccharides.
70
General Herbal Support
1) Astragalus membranaceus (milk vetch)

Astragalus shown to improve response to platinum
chemotherapies for cancer (J Clin Oncol. 2006. 24(3), 419-30).

Study on Astragalus as an aid against the effects of chemotherapy:
“the results suggest that decoctions of Astragalus compounds
may stimulate immunocompetent cells and decrease side effects
in patients treated with chemotherapy.” (Cochrane Database Syst Rev. 2005;
(1):CD004540).
71
General Herbal Support
1) Astragalus membranaceus (milk vetch)




Increases cytostatic activity of macrophages against cancers.
Increases tumour necrosis factor (TNF) production.
Increases natural killer cell (NKC) activity.
Restores bone marrow activity after chemotherapy.
“Collectively, the results showed that A. membranaceus could exhibit
both in vitro and in vivo anti-tumor effects, which might be achieved
through activating the anti-tumor immune mechanism of the host.”
(Cancer Lett 2007. 252(1), 43-54)
.
72
General Herbal Support
1) Astragalus membranaceus (milk vetch)

Possible side effects:

No known adverse reactions.

Possible interactions:

May possibly reduce effectiveness of cyclophosphamide – more
research required.
73
General Herbal Support
2) Calendula officinalis (marigold)







o
Immunomodulator.
Lymphatic.
Antimicrobial.
Hormone balancer.
Vulnerary.
Anti-inflammatory.
Choleretic
Active constituents: Triterpenoid saponins), flavonoids, bitter
principles (calendulin), mucilage, resin.
74
General Herbal Support
2) Calendula officinalis (marigold)

Strong history of traditional use for treatment of cancer –
research backs this up.

Cytotoxic anti-tumour activity against breast, prostate and other
cancer cell lines and lymphocyte activation (BMC Cancer 2006. 6(119).

Anti-inflammatory, antitumour-promoting and cytotoxic
activities of constituents of marigold flowers (J Nat Prod 2006, 69 (12), 1692–1696).
75
General Herbal Support
2) Calendula officinalis (marigold)

Anti-inflammatory response of C. officinalis extract may be
mediated by the inhibition of proinflammatory cytokines (such
as IL-1β, IL-6, TNF-α and IFN-γ and CRP), Cox-2, and
subsequent prostaglandin synthesis (Indian Journal of Experimental Biology, 2009. 47(2), 113-20).

“Calendula is highly effective for the prevention of acute
dermatitis of grade 2 or higher and should be proposed for
patients undergoing postoperative irradiation for breast cancer”
(JCO April 15, 2004 vol. 22 no. 8 1447-1453).
76
General Herbal Support
2) Calendula officinalis (marigold)

Possible side effects:

None known.

Possible interactions:

None known.
77
General Herbal Support
3) Centella asiatica (gotu kola)





o
Adaptogenic.
Vulnerary.
Anti-inflammatory.
Depurative.
Nervine tonic.
Active constituents: triterpenes (asiatic acid, madecassic acid),
triterpenoid ester glycosides (asiaticoside, brahminoside).
78
General Herbal Support
3) Centella asiatica (gotu kola)

Increases wound healing after surgery and radiotherapy,
decreases inflammation and reduces scar tissue formation (Eur J
Dermatol 1999. 9(4), 289-296).

Antitumour action on solid cancers (J Ethnopharmacol 1995. 48(1), 53-57.).

Induces apoptosis in human cancer cells (Afr J Tradit Complement Altern Med 2008.
6(1),9-16).
79
General Herbal Support
3) Centella asiatica (gotu kola)

Induces apoptosis of tumour cells and enhances antitumour
activity of vincristine (Ai Zheng 2004. 23(12), 1599-1604; Cancer Lett 2005. 218(1), 81-90).

Asiatic acid induces apoptosis in human breast cancer cells (JPET
2005. 313(1), 333-344 ).

Review on anticancer activity of Centella (ABIM Natural Product Radiance 2007 6(2), 158170).
80
General Herbal Support
3) Centella asiatica (gotu kola)

Possible side effects:

Potential for irritation of stomach in sensitive individuals; rare
allergic dermatitis reported.

Possible interactions:

None known.
81
General Herbal Support
4) Echinacea angustifolia (coneflower)

Immunomodulator.

Depurative.

Anti-inflammatory.

Vulnerary.

Lymphatic.

Sialogogue.
o
Active constituents: caffeic acid derivatives, (polysaccharides),
alkylamides and polyacetylenes.
82
General Herbal Support
4) Echinacea angustifolia (coneflower)

Cytotoxic effect on human cancers (J Ethnopharmacol 2007. 110(1), 148-53; Br J
Pharmacol 2008. 153(5), 879-85).

Reduced chemotherapy-induced neutropaenia (Phytother Res 2002. 16(2), 13842).

Cytotoxic effects of Echinacea root hexanic extracts on human
cancer cell lines (J Ethnopharmaco 2007. 110 (1), 148–153).

Review of anticancer properties (eCAM 2005. 2(3),309–314).
83
General Herbal Support
4) Echinacea angustifolia (coneflower)

Possible side effects:

Allergic dermatitis (rare with root extracts), very occasional GIT
irritation.

Possible interactions:

May reduce cytotoxic activity of doxorubicin; should not be used
with immunosuppressant drugs.
84
General Herbal Support
5) Eleutherococcus senticosus (Siberian ginseng)

Adaptogenic.

Immunomodulator.

General tonic.
o
Active constituents: eleutherosides, triterpenoid saponins and
glycans.
85
General Herbal Support
5) Eleutherococcus senticosus (Siberian ginseng)

As part of mixture with some other adaptogens, was found to
boost immunity during chemotherapy (Phytother Res 2006. 20(5), 424-5).

Boosted survival and promoted self-repair mechanism in
experimental irradiation studies.

Inhibited carcinogen-induced tumours.

Potentiated effect of some chemotherapy drugs.
86
General Herbal Support
5) Eleutherococcus senticosus (Siberian ginseng)

Another study showed that Eleutherococcus enhanced non-specific
immunity, reduced the side effects of chemotherapy,
radiotherapy and surgery, while improving healing rates and wellbeing.

Lengthened survival times in patients with advanced disease.
87
General Herbal Support
5) Eleutherococcus senticosus (Siberian ginseng)

Possible side effects:

Caution with cardiovascular disorders due to palpitations,
hypertension, headache reported in a few cases.

Possible interactions:

May interfere with digoxin metabolism; may interfere with CYP
450 drug-metabolising enzymes in liver.
88
General Herbal Support
6) Galium aparine (cleavers)

Alterative.
Lymphatic.
Astringent.
Diuretic.
Anti-inflammatory.
o
Active constituents: asperuloside, galiosin.




89
General Herbal Support
6) Galium aparine (cleavers)

Very little research on this valuable herb – a strong traditional
use as an anticancer herb and for treatment of enlarged prostate.

Immunostimulant and anti-tumour activity of crude extracts
against metastatic cancer (Korean J Pharmacog 2005. 36(4), 332-337).

Possible side effects:
None known.



Possible interactions:
None known.
90
General Herbal Support
7) Ginkgo biloba (maidenhair tree)




Anti-allergic.
Anti-inflammatory.
Antioxidant.
Active phytochemicals include:
ginkgolides, bilobides, quercetin,
kaempferol.
91
Supporting research
7) Ginkgo biloba (maidenhair tree)

Anti-inflammatory action by inhibiting action of phospholipase
A2 and having COX-2 and iNOS down-regulating actions (Planta
Medica 1999. 65; 465-7; ibid 2002. 68; 316-21).

Clinical studies have shown anti-cancer actions linked to this
anti-inflammatory activity in breast, liver, ovarian and pancreatic
cancer lines (World J Gastroenterol 2004. 10(1);37-41; Journal of Surgical Research 2008. 148(1); 17-23).

Anti-angiogenesis activity also linked (Curr Oncol2006.13(1): 14–26).
“Ginkgo biloba extracts and cancer: a research area in its infancy” Fundam Clin Pharmacol 2003. 17(4);405-17.
92
General Herbal Support
7) Ginkgo biloba (maidenhair tree)

Possible side effects:

Can cause gastric irritation in sensitive individuals.

Possible interactions:

May interfere with antiplatelet and anticoagulant drugs.
Avoid with sodium valproate and haloperidol.

93
General Herbal Support
8) Phytolacca americana (poke root)




o
Anti-inflammatory.
Lymphatic.
Depurative.
Immunomodulator.
Active constituents: phytolaccosides (triterpene saponins),
sterols, lectins (poke root mitogen).
94
General Herbal Support
8) Phytolacca americana (poke root)

Traditionally used for cancer treatment (internally and externally)
– no relevant clinical trials reported.

Possible side effects:
Gastrointestinal irritation at high doses.



Possible interactions:
Should not be used with lymphocytic leukaemia.
95
General Herbal Support
9) Rhodiola rosea (rose root)

Adaptogen.
Antidepressant.
Antioxidant.
Immunomodulator.
Cardioprotective.
Neuroprotective.
o
Active constituents: rosavins, salidrosides and flavonoids.





96
General Herbal Support
9) Rhodiola rosea (rose root)

As part of mixture with some other adaptogens, was found to
boost immunity during chemotherapy (Phytother Res 2006. 20(5), 424-5).

In trials shrank some superficial cancers (Urol Nefrol (Mosk) 1995. (2),46-7).

Acts to prevent or treat immune depletion caused by
chemotherapy and radiotherapy.
97
General Herbal Support
9) Rhodiola rosea (rose root)

Possible side effects:

None known.

Possible interactions:

Some recent work suggests may activate CYP450 in animal
models.
98
General Herbal Support
10) Trifolium pratense (red clover)

Alterative

lymphatic.

Anticancer.

Expectorant.

Phytoestrogenic (not tincture).
o
Active constituents: flavonoids, essential oil, isoflavonoids
(formononetin), coumarins, quercetin.
99
General Herbal Support
10) Trifolium pratense (red clover)

Very little research on anticancer activity (most focuses on
prevention of breast cancer and menopausal symptoms).

Traditional use for both prostate and breast cancer.

Anti-inflammatory and anti-angiogenic activity reported (Phytomedicine
2009. 16 (12), 1083-1088).
100
General Herbal Support
10) Trifolium pratense (red clover)

Possible side effects:


None expected at normal doses.
? Phytoestrogens with breast cancer.

Possible interactions:

None known
101
General Herbal Support
11) Withania somnifera (ashwagandha)

Adaptogenic.
Anti-inflammatory.
Immunomodulator.
Thyroid and general tonic.
Mild sedative.
Anti-anaemic.
o
Main constituents: withanolides (saponins) and alkaloids.





102
General Herbal Support
11) Withania somnifera (ashwagandha)

Shown to significantly increase white blood cell count during and
after chemotherapy and radiotherapy.

Exhibits antitumour and radiosensitising activity.

Withania showed to selectively kill cancer cells (Clin Cancer Res 2007. 13(7),
2298-306 ).
103
General Herbal Support
11) Withania somnifera (ashwagandha)

Possible side effects:

None known.

Possible interactions:

None known.
104
General Herbal Support
12) Zingiber officinale (ginger)

Powerful anti-inflammatory.

Antioxidant.

Analgesic activity.
[6]-Gingerol

Contains gingerols, zingerone and shogaols.
Chemoprevention of Cancer and DNA Damage by Dietary Factors: Chapter 28. Antioxidant, Anti-Inflammatory, and
Anticarcinogenic Effects of Ginger and Its Ingredients; 2009; Wiley.
105
General Herbal Support
12) Zingiber officinale (ginger)

Anti-inflammatory effect thought to be primarily due to COX-1
and -2 inhibition, thus reducing inflammatory prostaglandin
synthesis. Also down-regulates TNF which reduces NF-κB
production and thus COX expression (Biochem Biophys Res Commun 2007. 362(1);18-23 ;
Clinics 2008. 63(6); 807-13).

5-LOX inhibitory action also important (J Med Food 2005. 8(2); 125-132).
106
General Herbal Support
12) Zingiber officinale (ginger)

“Ginger extract has anti-cancer and anti-inflammatory effects”
(Clinics 2008. 63(6); 807-13).

Ginger inhibits cell growth and modulates angiogenic factors
such as VEGF and IL-8 in cancer cells (BMC Complement Altern Med 2007. 7; 44).

[6]-Gingerol suppresses cancer growth by inhibiting TRAILinduced NF-κB activity(Biochem Biophys Res Commun 2007. 362(1);18-23; Mol Carcinog 2008 .;47(3):197-208;
Cancer Res 2009. 69(13);5584-91).
107
General Herbal Support
12) Zingiber officinale (ginger)

Possible side effects:

Caution if history of gallstones (Commission E), GORD or
gastric ulcers.

Possible interactions:

May interfere with antiplatelet and anticoagulant drugs.
108
Natural Approaches: specific herbal
medicine support for breast cancer
109
Specific Herbal Support
1) Support during conventional cancer treatments

Very complex due to range of different treatments available.

Rapidly changing treatments.

New contraindications/interactions.

Different advice from hospitals/oncologist/pharmacists.

Compliance during treatment.
110
Specific Herbal Support
1) Support during conventional cancer treatments

Battling cancer through diet.

Fundamental and most important part of any treatment plan.

Patients who change diet according and lifestyle:
o
o
o
o
o
Tolerate treatments more easily.
Have fewer side effects.
Better results to therapy.
Quicker recovery.
More positive outlook.
111
Specific Herbal Support
1) Support during conventional cancer treatments

Even better results obtained when patients take nutritional
supplements and herbal supplements as well.

Different supplements discussed today and tomorrow have place
in support during treatment, though some more appropriate than
others, some contraindicated during specific treatments
(discussed later).
112
Specific Herbal Support
1a) Surgery

Extensive surgery imposes huge demand on body for healing repair/production of: blood vessels, connective tissue, muscle,
immune cells, control of inflammation.

Anaesthetic puts large strain on liver.

High quality nutrition is essential for rapid recovery from
surgery.

However some nutritional supplements contraindicated.
113
Specific Herbal Support
1a) Surgery

Key Supplements
o
o
o
o
o
o
o
o
o
o
β-carotene/vitamin A
Bromelain
Copper
Iron
Magnesium
Probiotics
Selenium
Vitamin B
Vitamin C
Zinc

Vitamins/minerals best
obtained from good quality
multinutrient supplement.
114
Specific Herbal Support
1a) Surgery

Additional supplements:
o
o
o
o
Gotu kola (Centella asiatica) for healing.
Modified citrus pectin (MCP)/cranberry to reduce metastasis.
Milk thistle to prepare and support liver for anaesthetic and for
detoxification after surgery.
Protein: whey/pea/tofu protein extremely good (immune stimulant).

Supplements should be started month before surgery and
stopped 3 days before surgery (unless otherwise stated).

Restarted as soon as possible after surgery to maximise recovery.
115
Specific Herbal Support
1a) Surgery

Additional supplements:
o
o
o
o
Gotu kola for healing.
Modified citrus pectin (MCP)/cranberry to reduce metastasis.
Milk thistle to prepare and support liver for anaesthetic and for
detoxification after surgery.
Protein: whey/pea/tofu protein extremely good (immune stimulant).

Supplements should be started month before surgery and
stopped 3 days before surgery (unless otherwise stated).

Restarted as soon as possible after surgery to maximise recovery.
116
Specific Herbal Support
1a) Surgery

Contraindicated supplements (anticoagulants/effect on liver):
o
o
o
o
o
o
o
o
o
o
Bromelain- theoretical anticoagulant – stop 3 days before surgery
Fish oil: theoretical anticoagulant – stop 7 days before surgery.
Garlic: anticoagulant- stop 7 days before surgery.
Ginger: anticoagulant- stop 3 days before surgery.
Kava kava - interfere with anaesthetic – stop 3 days before surgery.
Korean ginseng: anticoagulant- stop 7 days before surgery.
Maidenhair tree: theoretical anticoagulant – stop 3 days before surgery.
St John’s wort: interfere with anaesthetic - stop 7 days before surgery.
Valerian: interfere with anaesthetic – stop 7 days before surgery.
Vitamin E: anticoagulant- stop 3 days before surgery.
117
Specific Herbal Support
1b) Radiotherapy



Kills normal cells as well as
diseased ones, therefore highly
toxic.
Beam can “graze” and damage
organs (heart, lung, colon).
Long term increased risk of
new cancer (lymphoma etc.)

Side effects include:
o
o
o
o
o
o
o
o
o
o
Alopecia.
Anaemia.
Burning.
Constipation.
Diarrhoea
Emesis.
Fatigue – often very severe, lasts
month after finished.
Immune suppression.
Nausea.
Sterility.
118
Specific Herbal Support
1b) Radiotherapy

Dietary modifications: as per general guidelines.

Additional lifestyle modifications

Rest well – plenty of naps. Stop work for duration if possible.

Gentle exercise.

Treat skin gently: no perfumes, soaps, shampoo near affected
area. Wash skin with tepid water and baby soap.

Protect damaged skin from heat and sun.
119
Specific Herbal Support
1b) Radiotherapy

Key supplements

β-carotene/vitamin A: reduce inflammation, increase cancer
sensitivity. 100 mg β-carotene/10,000 IU vitamin A for duration.

Coenzyme Q10: reduces tiredness and fatigue. Maximum dose of
30 mg per day. Higher doses contraindicated.

Melatonin: better responses to treatment (20 mg on).
120
Specific Herbal Support
1b) Radiotherapy

Key supplements

Fish oils: anti-inflammatory and aid effectiveness.

Maitake: increase immune function, better long term results.

Probiotics for bowel health and detoxification, reduce
inflammation.

Turmeric: protect healthy cells from side effects without
reducing effectiveness. Much research now to support this.
121
Specific Herbal Support
1b) Radiotherapy

Key supplements

Vitamin C: better responses, fewer side effects. 3000 mg max.

Vitamin E: enhance effect of radiotherapy and reduce cancer cell
division during treatment. 400 IU daily. Higher doses may
interfere and reduce effectiveness of therapy.
122
Specific Herbal Support
1b) Radiotherapy: Key herbs
Aloe vera: juice for GIT; gel
externally
Astragalus
o
Glycyrrhiza glabra
o
Calendula
Centella
o
o
o
Echinacea
Eleutherococcus
Hypericum perforatum (IO)
externally.
Matricaria
Rhodiola
Silybum
o
Withania
o
Ginkgo biloba
o
Zingiber officinale
o
o
o
o
o
o
123
Specific Herbal Support
1b) Radiotherapy

Contraindicated supplements
o
Supplements mentioned above as being contraindicated in
large amounts.
o
St John’s wort: theoretical systemic sensitiser - stop 7 days
before treatment. In practice helpful topically. I usually
incorporate infused oil with Calendula, in an Arnica montana
base cream for use after each radiotherapy session.
124
Specific Herbal Support
1c) Chemotherapy

Attacks any cells that are actively dividing, therefore kills normal
cells as well as diseased ones, again highly toxic.

Side effects dependent on drug(s), dosage, timing, patient’s
genetics, general health, co-morbidities and history of previous
chemotherapy/radiotherapy etc.

Move towards more targeted drugs with less severe side effects.
125
Specific Herbal Support
1c) Chemotherapy

Side effects include:
o
o
o
o
o
o
o
o
o
Alopecia.
Anaemia.
Anorexia.
Bone marrow suppression.
Confusion and short term
memory impairment.
Cystitis.
Constipation.
Diarrhoea
Emesis.
o
o
o
o
o
o
o
o
Fatigue.
Hand-foot syndrome.
Immune suppression.
Mouth ulcers.
Myalgia.
Nausea.
Peripheral neuropathy
Sterility.
126
Specific Herbal Support
1c) Chemotherapy
Additional dietary and lifestyle modifications

High protein smoothies (whey/pea/tofu protein) 1-2 daily (1030 g) – prevent weight/muscle loss, soothing on gut (glutamine
content) and increase immunity.

Adequate hydration for detoxification: vegetable juices best – as
snack between meals better.

Small, frequent meals best (every couple of hours) rather than 3
large meals less frequently.
127
Specific Herbal Support
1c) Chemotherapy
Additional dietary and lifestyle modifications

Extra spices and herbs in food – counter hypo- and dys-geusia.

Avoid very bitter and very sweet flavourings.

Eat moist, soft foods: mucilage-rich, easy to swallow and digest
(bananas, smoothies, sweet potatoes, potatoes, brown rice, apple
sauce).

Avoid hard, dry foods (toast, biscuits, crackers, cereals).

Eat slowly and chew thoroughly – small bites only.
128
Specific Herbal Support
1c) Chemotherapy
Key supplements

Antioxidants: ACE, selenium, zinc – controversial. No evidence
that contraindicated if used at recommended doses. In fact a lot
of evidence that helpful (Simone et al. Alternative Therapies 2007. 13(1), 22-28; Simone
et al. Alternative Therapies 2007. 13(2), 40-47).

Bromelain: studies show aids chemotherapy.

Coenzyme Q10: reduces tiredness and fatigue. Maximum dose of
30 mg per day. Higher doses contraindicated.
129
Specific Herbal Support
1c) Chemotherapy
Key supplements:

n-3 fatty acids: essential for immune function and to prevent
cachexia.

Quercetin and turmeric both best avoided during
chemotherapy for breast cancer as can theoretically
interfere with epirubicin and cyclophosphamide (both
components of main chemotherapy for breast cancer FEC).
130
Specific Herbal Support
1c) Chemotherapy
Key supplements

Maitake: increase immune function, better responses and long
term results.

Melatonin: 20 mg – better responses to treatment and long term
survival.

Probiotics for bowel health and detoxification, reduce
inflammation.
131
Specific Herbal Support
1c) Chemotherapy
Key supplements

Vitamin C: better responses, fewer side effects. 1000 mg, time
release with bioflavonoids. One study suggested vitamin C
reduces effectiveness of chemotherapy, but flawed study (Heaney et
al. Cancer Res 2008. 68, 8031-8038).

Vitamin E: enhance effect of chemotherapy and reduce cancer
cell division during treatment. 400 IU daily is safe.
132
Specific Herbal Support
1c) Chemotherapy

Additional supplements

Glutamine for gut irritation (3-10 g per day).

Multivitamin (not antioxidants as well).

Soya isoflavones for platinum-containing chemotherapy (reduces
side effects and increases effectiveness) – 200 mg.
133
Specific Herbal Support
1c) Chemotherapy

Additional supplements

For mouth ulcers: liquorice or DGL tablets – chew/suck.

Hand-foot syndrome – B6: 50 mg twice a day; Aloe vera gel topically.

Cardiotoxic drugs – coenzyme Q10, Astragalus, Rhodiola.

Peripheral neuropathy – α-lipoic acid (150 mg tds), N-acetylcysteine
(500 mg tds) or B12 (1000 mcg sid).
134
Specific Herbal Support
1c) Chemotherapy
Key Herbs:
o
o
o
o
o
o
Aloe vera juice
Astragalus
Centella
Eleutherococcus
Glycyrrhiza glabra
Matricaria
o
o
o
o
o
o
Panax ginseng
Rhodiola
Silybum
Ulmus
Withania
Zingiber
135
Specific Herbal Support
1c) Chemotherapy

Contraindicated herbs and supplements

St John’s wort with any chemotherapy.

Grapefruit or pomegranate products with any chemotherapy.

Very high dose antioxidants.
136
Specific Herbal Support
1d) Hormone therapy

Hormone agonists or antagonists.

E.g. Gosarelin (Zoladex) – GnRH antagonist, Tamoxifen –
breast ER competitive antagonist, Arimidex – β-aromatase
inhibitor.

Side effect depends on mechanism of action. Generally more
annoying than debilitating.
137
Specific Herbal Support
1d) Hormone therapy
Hormonal agonist/antagonist drug
Side effects (selected)
Tamoxifen
Thrombosis, myalgia, arthralgia, uterine
cancer, peripheral oedema, osteoporosis,
menopausal symptoms.
Gosarelin
Menopausal symptoms, hypertension,
arthralgia, peripheral oedema, muscle
wasting.
Arimidex
Menopausal symptoms, GIT symptoms,
arthralgia, alopecia.
138
Specific Herbal Support
1d) Hormone therapy

Standard dietary and lifestyle advice – exercise key.

Tamoxifen and Arimidex: address hot flushes, fluid retention,
dyslipidaemia, osteoporosis, low energy (vitamins C, D and E,
coenzyme Q10, calcium, I-3-C, phytoestrogens(!), Asparagus racemosus,
Astragalus, Coleus forskohlii, Gymnema sylvestre, Glycyrrhiza, Salvia fruticosa,
Zizyphus spinosa).

Zoladex: address hot flushes, energy, hypertension (vitamins C, D and
E, coenzyme Q10, calcium, I-3-C, herbs, phytoestrogens!) – see
prostate cancer tomorrow for more.
139
Specific Herbal Support
2) Support after conventional cancer treatments or when no
orthodox treatments undertaken

Dietary and lifestyle changes essential.

Supportive supplements and herbs important.

Work to ensure liver working efficiently for detoxification
(Arctium, Cynara, Rosmarinus and Schisandra). Silybum as liver tonic
if needed.

Ensure bowel is working properly (for absorption) (Calendula,
Centella, Matricaria).
140
Specific Herbal Support
2) Support after conventional cancer treatments or when no
orthodox treatments undertaken

Ensure gut flora optimal – prebiotics and probiotics to reduce
enterohepatic recycling of oestrogens – key for ER +ve cancer.
Consider Berberis, Hydrastis or Mahonia if microflora dysbiosis –
Genova CDSA tests.

Ensure lymphatic system working efficiently (Echinacea, Calendula,
Galium, Phytolacca, Trifolium, Viola). Dry skin brushing. External
creams (Phytolacca, Trifolium).
141
Specific Herbal Support
2) Support after conventional cancer treatments or when no
orthodox treatments undertaken

Ensure immune system properly balanced (Astragalus, Echinacea,
Calendula, Phytolacca, maitake, vitamin D3).

Work to reduce inflammation in patient’s body (ESR and CRP
useful measures) – Curcuma, quercetin (for ER +ve BC),
bromelain, fish oil.
142
Specific Herbal Support
2) Support after conventional cancer treatments or when no
orthodox treatments undertaken

Anti-angiogenesis herbs useful: Aesculus, Ginkgo, Ruscus, Scutellaria
baicalensis, Zingiber, white tea.

Reduce metastatic spread with immunomodulators, maitake,
Galium, Thuja, Viola odorata, MCP, cranberry extract, vitamin D3.
143
Specific Herbal Support
2) Support after conventional cancer treatments or when no
orthodox treatments undertaken

For oestrogen receptor positive need to check oestrogen and
metabolites – Genova Diagnostics carry out a good test.

Work to reduce imbalances in oestrogen metabolism using I-3-C,
calcium D-glucarate, ground flaxseeds, probiotics, liver
stimulants, B vitamins if necessary.

Ensure thyroid function is optimal – most of my breast cancer
patients are hypothyroid (usually latent, poor conversion of T4
to T3 - Genova). Address if necessary (selenium, iodine,
Schisandra).
144
Specific Herbal Support
2) Support after conventional cancer treatments or when no
orthodox treatments undertaken
Key Herbs:
o
o
o
o
o
o
o
Astragalus
Calendula
Galium
Eleutherococcus
Glycyrrhiza glabra
Panax ginseng
Phytolacca
o
o
o
o
o
o
o
Rehmannia
Rhodiola
Silybum
Thuja
Viola
Withania
Zingiber
145
Case study 1
146
Case study
Case 2: breast adenocarcinoma
20/10/08
PC: 36 y/o, nulliparous, non-drinker or smoker, found lump in
right breast, “prickly pain”.
PMH: Dysmenorrhoea, uterine fibroids, menorrhagia, urticaria.
FH: N/a
Examination: Prominent tumour in RRUQ
ESR/CRP: 7 mm/hr (1-15) and 1 mg/l (<5).
VEGF: normal; 150 units/μl of plasma (100-1000).
Tumour markers: -ve (CEA, CA 125, CA 15-3, CA 27-29).
147
Case studies
Case 2: (cont)
20/10/08
Mammogram/CT/US: 5 x 8 cm tumour, stage 2, no metastases to
liver or lungs, but spread to 2 lymph nodes (sentinel and next).
Biopsy: Grade 2, infiltrating lobular BC, ER & PR +ve, HER2-Neu
-ve. Sentinel node biopsy +ve for cancer.
Isotopic bone scan: no metastasis to bones.

Refused conventional treatment as wanted to preserve fertility.
148
Case studies
Case 2: (cont)
20/10/08
Supplements:
 Acidophilus (1 tab sid)
 Bromelain (500 mg tds ac)
 Fish oil (1000 mg tds)
 Maitake (1000 mg tds ac)
 Multivitamin/mineral (1 tab
sid cc)
 Quercetin (500 mg tds ac)


Turmeric (500 mg tds ac)
Vitamin D3 (5000 IU sid cc)
149
Case studies
Case 2: (cont)
20/10/08
Dietary and lifestyle modifications:

Cut out red meat, dairy, reduce saturated fats, refined
carbohydrates, increase vegetable – alkalising diet. Increase
cabbage family etc.
 Increase exercise, reduce weight, work on stress.
150
Case studies
Case 2: (cont)
Herbs:
20/10/08
Rx: Immune mix
Astragalus membranaceus Tr. 1:2 25%
® Chelidonium majus Tr. 1:5 45%
Echinacea angustifolia 1:2 60%
Glycyrrhiza glabra Tr. 1:1 25%
Phytolacca americana Tr. 1:5 45%
Schisandra chinensis Tr. 1:2 45%
Trifolium pratense Tr. 1:2 25%
Vol/ml
25
20
25
20
5
25
20
140
Weeks
4
Sig 10 ml bid cum aq gel ac
151
Case studies
Case 2: (cont)

Saw regularly and medicine etc continued until 31/03/09.

Tumour had continued to grow.

Consultant concerned and patient started Zoladex to shrink
ready for surgery.

Prescription altered to address menopausal symptoms.
152
Case studies
Case 2: (cont)
06/05/09
Rx: Immune mix
Astragalus membranaceus Tr. 1:2 25%
® Chelidonium majus Tr. 1:5 45%
Echinacea angustifolia 1:2 60%
Glycyrrhiza glabra Tr. 1:1 25%
Phytolacca americana Tr. 1:5 45%
Salvia fruticosa Tr. 1:2 45%
Zizyphus spinosa Tr. 1:2 25%
Vol/ml
25
20
25
20
5
20
25
140
Weeks
4
Sig 10 ml bid cum aq gel ac
153
Case studies
Case 2: (cont)

Continued until 30/09/09.

Tumour still growing even on Zoladex.

Patient decided to start chemotherapy (FEC), while still on
Zoladex to preserve fertility.

Prescription changed accordingly.
154
Case studies
Case 2: (cont)
Herbs:
30/09/09
Rx: Chemotherapy mix
Astragalus membranaceus Tr. 1:2 25%
Centella asiatica Tr. 1:1 45%
Eleutherococcus senticosus Tr. 1:2 25%
Glycyrrhiza glabra Tr. 1:1 25%
Matricaria recutita Tr. 1:2 60%
Silybum marianum Tr. 1:1 70%
Zingiber officinale Tr. 1:2 90%
Vol/ml
25
20
25
20
20
20
10
140
Weeks
4
Sig 10 ml bid cum aq gel ac
155
Case studies
Case 2: (cont)

08/03/10: Chemotherapy success, tumour shrunk to 2
x 2 cm. Surgically removed with lymph nodes.

Healing mix before and after surgery, and added milk
thistle tablets.
156
Case studies
Case 2: (cont)
Herbs:
11/05/10
Rx 4: Healing mix
Asparagus racemosus Tr. 1:2 25%
Centella asiatica Tr. 1:1 45%
Echinacea angustifolia 1:2 60%
Glycyrrhiza glabra Tr. 1:1 25%
Hypericum perforatum Tr. 1:2 45%
Phytolacca americana Tr. 1:5 45%
Vol/ml
30
35
30
20
20
5
140
Weeks
4
Sig 10 ml bid cum aq gel ac
157
Case studies
Case 2: (cont)

Elected to have radiotherapy, but refused Tamoxifen.

Changed prescription and added in red clover extract and I-3C (after Genova Diagnostics oestrogen test).
158
Case studies
Case 2: (cont)
Herbs:
24/08/10
Rx 5: Radiotherapy mix
Astragalus membranaceus Tr. 1:2 25%
Centella asiatica Tr. 1:1 25%
Ginkgo biloba Tr. 2:1 50%
Glycyrrhiza glabra Tr.1:1 25%
Withania somnifera Tr. 1:1 45%
Zingiber officinale Tr.1:2 90%
Vol/ml
30
30
20
25
30
5
140
Weeks
4
Sig 10 ml bid cum aq gel ac
159
Case studies
Case 2: (cont)

Have kept on support medicine and I-3-C and red clover
(latter temporarily).

Wanted to start family (had frozen embryos stored before any
treatments in case infertile).

Had severe dysmenorrhoea once Zoladex started and
menstrual cycle started again.
160
Case studies
Case 2: (cont)
Herbs:
18/04/11
Rx 5: Support mix
Achillea millefolium Tr. 1:2 45%
Asparagus racemosus Tr. 1:2 25%
Glycyrrhiza glabra Tr.1:1 25%
Paeonia lactiflora Tr. 1:2 45%
Zingiber officinale Tr. 1:2 90%
Vol/ml
25
30
20
25
5
105
Weeks
4
Sig 5 ml tds cum aq gel ac
161
Case studies
Case 2: (cont)

Have worked on fertility for last 10 months and found out last
week that was pregnant with twins!
162
A Natural Approach to Breast
Cancer Care
Dr Christopher Etheridge
PhD, MRSC, MCPP, CChem, DoIC, ARCS, BSc (Hons) Phyto, BSc (Hons) Chem