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Patients Against Lymphoma

 

CAM & Life Style > F - L 

Last Update: 05/20/2013

TOPICS
Fats | Fish oil | Garlic | Gerson Therapy? | Ginger | Glutamine | Green tea | HerbsHoxsey Therapy? | Homeopathy? | Hyperthermia / Hot baths with chemo?  | Hyperbaric Therapy? | Immune support - boosting  | Iron | Licorice root
 
 
To avoid potential adverse interactions, be sure to let your health care provider know 
if you use any type of complementary therapy.

Fats

Questions and related abstracts

Also see 
Fats in Risk Factors

Related Abstracts
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Background: wikipedia.org 

There are many kinds of dietary fats.  A consensus is forming about which fats are best to use or avoid for general good health, which is briefly summarized here:

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Saturated Fats from animal sources (limit) 

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Monounsaturated Fats - olive oil, canola oil (good-neutral),

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Polyunsaturated Fats - there are two kinds: 
 
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Omega-6 - vegetable oils 
 
Limit, spoil easily, avoid cooking with
 

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Omega-3 - fish oil, flaxseed oil, pumpkinseed oil  

Considered good oils in moderation


Note: Don't cook with flaxseed; store cold. (Also see fish oil below.) 

Eicosapentaenoic acid (EPA) is a member of the omega-3 family of fatty acids. The oils derived from cold-water fish (salmon, tuna, sardines, and cod) are concentrated sources of EPA. To a limited extent, the human body can make EPA from ALA.

Docosahexaenoic acid (DHA) is a member of the omega-3 family of fatty acids. This fatty acid is found in cold-water fish and in some types of algae.
 

bullet Trans-fatty acids - hydrogenated or partially hydrogenated oils 

Avoid this type.
Look for "Hydrogenated" in ingredient list. Included in many products, such as breads and crackers. FDA will soon require listing of this as a fat on food labels.
More Information:
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FDA Acts to Provide Better Information to Consumers on Trans Fats - FDA.gov
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About short/medium/long chain fats - iastate.edu 
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Trans fat lurks in a multitude of foods. It’s not labeled. And it’s bad for your heart. Here’s how to avoid it.  - ComsumerReports.org 02_23_03
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Dietary Fats—Are there "good" fats and "bad" fats? - uhcs.universityhealth.org
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What Oils are best for cooking - Ken Fawcett, RNC 
Questions:
bullet Should patients increase intake of omegag-3 oils and restrict intact of vegetable oils, trans-fats, and saturated fats?
 
bullet Do fats contribute to inflammation, and can diets that promote or inhibit inflammation influence the clinical course of patients living with lymphoma?
 
bullet Does the dietary intake of certain fats increase the risk of developing lymphoma?
 
bullet Which fats, if any, can we cook with without putting our health at risk?
Abstracts and Articles: 
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Fish Oil Supplements May Be Safer Than Eating Fish CME - Medscape (free login req.)
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Antiproliferative effect of polyunsaturated fatty acids and interleukin-2 on normal and abnormal human lymphocytes. Experientia. 1994 May 15;50(5):489-92. -  PubMed
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Modulation of human immune and inflammatory responses by dietary fatty acids.
Nutrition. 2001 Jul-Aug;17(7-8):669-73. Review. PMID: 11448594 - PubMed
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New epidemiologic leads in the etiology of non-Hodgkin lymphoma in the elderly: the role of blood transfusion and diet.  Biomed Pharmacother. 1997;51(5):200-7 - PubMed
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Dietary fat and protein in relation to risk of non-Hodgkin's lymphoma among women. J Natl Cancer Inst. 1999 Oct 20;91(20):1751-8 - PubMed
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Diet and risk of non-Hodgkin lymphoma in older women. 
JAMA. 1996 May 1;275(17):1315-21 - PubMed

Fish oil

Natural sources: cold water fish, such as salmon and herring
Recommended resource:
The Natural Pharmacist
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Fish oil is rich in omega-3 oils.  It contains EPA (eicosapentaenoic acid) and DHA (docosahexaenoic acid). 

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Can supplementing with fish oil help to slow the progression of indolent lymphomas?  
 

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What are safe doses of fish oil?  Might this vary among individuals?
 

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Can fish oils enhance the uptake and efficacy of chemotherapy drugs? 
 

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Can fish oil protect normal cells from side effects of treatment without interfering with treatment?
 

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Might supplementing with fish oil inhibit immune function and therefore interfere with immune therapies?

Open Clinical trial: Phase I/II Study of Omega-3 Fatty Acids in Advanced Cancer Patients with Cachexia -NCI

CAUTION: Fish oil consumption may increase the risk of bleeding in susceptible individuals. While beneficial in many respects, using fish oil might compromise some immune-based therapies.  See Alerts for details.

Garlic
garlic powder

Recommended resource:
The Natural Pharmacist
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Garlic (Allium sativum) 

Cell-culture experiments are poor models for biological activity in humans
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Cell culture experiment: Z-ajoene (a compound of garlic) induces apoptosis (cell death) of HL-60 cells: involvement of Bcl-2 cleavage. Nutr Cancer. 2002;42(2):241-7. PMID: 12416266 - PubMed | Related abstracts
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Cell culture experiment: Siegers CP, et al.  *[See Related Articles] The effects of garlic preparations against human tumor cell proliferation. Phytomedicine. 1999 Mar;6(1):7-11. PMID: 10228605; UI: 99245289.
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Cell culture experiments: Unnikrishnan MC, et al. * [See Related Articles] Cytotoxicity of extracts of spices to cultured cells.  Nutr Cancer. 1988;11(4):251-7.

 Gerson Therapy?

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Background: wikipedia.org 

"The Gerson therapy uses a special diet, supplements and also coffee enemas to detoxify and stimulate the body’s metabolism. Proponents of the Gerson therapy have made claims that it is an effective treatment for cancer and other illnesses, through balancing the levels of potassium and sodium in the body, removal of toxins and regeneration of liver function and also improving overall nutritional status. 

No substantive evidence exists in the scientific literature to support the view that the Gerson therapy is an effective alternative therapy for cancer. However, some evidence does exist which suggests that elements of the therapy (coffee enemas in particular) are potentially dangerous if used excessively. In addition to this the excessive demands of time, money and other resources on the patient undergoing the therapy may be extreme." 1 http://www.cam-cancer.org/mod_product/uploads/gerson.pdf

  1. Gerson Therapy - Report by Concerted Action for Complementary and Alternative Medicine Assessment in the Cancer Field (CAM-Cancer) Project funded under the European Commission 5th Framework Program “Quality of Life”. - http://www.cam-cancer.org/mod_product/uploads/gerson.pdf 
  2. ACS report on - caonline.amcancersoc.org  
  3. Alternative nutritional cancer therapies.
    Int J Cancer Suppl. 1998;11:69-72. Review. PMID: 9876483 | Related articles
  4. BC Cancer Agency - GersonTherapy.htm 

  Genistein

Recommended resource:
The Natural Pharmacist
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A naturally occurring compound present in soy, has attracted scientific interest for its possible benefits in cancer and heart disease prevention. 

Background: wikipedia.org 
 

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The phytoestrogen genistein induces thymic and immune changes: a human health concern? Proc Natl Acad Sci U S A. 2002 May 28;99(11):7616-21. PMID: 12032332 
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Genistein sensitizes diffuse large cell lymphoma to CHOP (cyclophosphamide, doxorubicin, vincristine, prednisone) chemotherapy. Mol Cancer Ther. 2003 Dec;2(12):1361-8. PMID: 14707277

Glutamine

Natural sources: fish, meat, beans, and dairy
Recommended resource:
The Natural Pharmacist
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Glutamine is the most abundant amino acid (protein building block) in the body and is involved in more metabolic processes than any other amino acid.

Background: wikipedia.org  

  • Can supplementing with Glutamine protect against side effects of chemotherapy without interfering with efficacy?

CAUTION: See Alerts

Related Abstracts and text:
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Oral glutamine in the prevention of fluorouracil induced intestinal toxicity: a double blind, placebo controlled, randomised trial. Gut. 2001 Jan;48(1):28-33.  PMID: 11115819
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Glutamine: essential for immune nutrition in the critically ill. Br J Nutr. 2002 Jan;87 Suppl 1:S3-8. Review
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Glutamine supplementation in cancer patients receiving bone marrow transplantation and high dose chemotherapy. J Nutr. 2001 Sep;131(9 Suppl):2578S-84S; discussion 2590S. Review | Full Text article
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Parenteral glutamine protects hepatic function during bone marrow transplantation. Brown SA et.al.
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Oral and parenteral glutamine in bone marrow transplantation: a randomized, double-blind study. Schloerb PR, Skikne BS.

Ginger

Recommended resource:
The Natural Pharmacist
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Ginger seems to relieve nausea and calming the intestinal tract. It may also inhibit the cox-2 enzyme, which promotes inflammation.

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NEW Ginger Eases Nausea From Chemo healthday.com  

Participants were randomized to receive either a placebo or one of three doses of ginger supplement: 0.5 grams, 1 gram or 1.5 grams for three days before the start of chemo and three days after for the next two cycles. All also received traditional antiemetic drugs on the first day of treatment.
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Tjendraputra E, Tran VH, Liu-Brennan D, Roufogalis BD, Duke CC. * Related Articles Effect of Ginger Constituents and Synthetic Analogues on Cyclooxygenase-2 Enzyme in Intact Cells. Bioorg Chem. 2001 Jun;29(3):156-163. PMID: 11437391

Green tea extract

(EGCG)

Recommended resource:
The Natural Pharmacist
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Green tea has components, such as EGCG, that may fight certain types of cancer.  

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ASCO 2010: Oral green tea in asymptomatic, Rai stage 0-II CLL AbstView_74_47574  (fixed link)

Comment: Here are reported what appears to be good signals of activity and relatively modest side effects at the chosen dose (compared to other CLL treatments).  Note that there were also toxicities at what appears to be the active dose - including signals of liver toxicities - transaminitis (31% grade 1, 12% grade 2), and nausea in 55%. These are modest side effects compared to standard CLL treatments, but this has to be weighed against no treatment, because treatment is not given for early stage CLL.

When estimating the treatment effects you need to consider also the natural history of the condition in the selected population, in this case early stage CLL ... What is its typical clinical course? Does it wax and wane? How long until treatment is needed? I think it can be ten years or more.  So are these clinically meaningful responses - leading to better quality of life or survival?  If anything, quality of life was impaired by the side effects (up to 6 months of nausea in 55%), so long term impacts on survival - or time to first treatment (compared to observation in a controlled study) could be the key questions going forward.
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Green Tea Extract in Treating Patients With Stage 0, Stage I, or Stage II Chronic Lymphocytic Leukemia http://clinicaltria ls.gov/ct2/ show/NCT00262743
 
Comment: Entering a study is preferred to self-medicating. In this way you get a reliable product at a controlled dose, and can be monitored closely for adverse affects. And when you participate in a study you contribute to the clinical science.
CAUTIONS: Green tea might contain high levels of fluoride - bruha.com  and high doses may cause liver toxicity  pubs.acs.org  pdf
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Caution on high dose green teas supplements: 
Green tea can be toxic at therapeutic dose levels pubs.acs.org  pdf 

"Despite several human studies that showed no toxicity of tea polyphenol preparations and that the major adverse effects associated with consumption of high doses of tea preparations are due to gastrointestinal irritation, there have been a number of recent case reports of hepatotoxicity related to the consumption of high doses of tea-based dietary supplements (10-29 mg/ kg/day po) (18)."
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CLL Pilot study: A Phase 1 Trial of Daily Oral Green Tea Extract in Asymptomatic, Rai Stage 0-II Patients with Chronic Lymphocytic Leukemia. Session Type: Poster Session, Board #237-II   abstracts2view.com 

RESULTS: As of August 2007, 33 patients have been accrued to dose levels 1-8. The maximum tolerated dose(MTD) has not been reached. Side effects have generally been mild. The most common toxicities were nausea(grade 1: 42%; grade 2: 3%), elevation in SGOT (42%; all grade 1), and abdominal pain (36%; all grade 1). 

To date, no patient has had a sustained 50% reduction in both absolute lymphocyte count (ALC) and lymphadenopathy that would meet the NCI WG criteria for partial response. 
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Bertolini F, Fusetti L, Rabascio C, Cinieri S, Martinelli G, Pruneri G. * Related Articles Inhibition of angiogenesis and induction of endothelial and tumor cell apoptosis by green tea in animal models of human high-grade non-Hodgkin's lymphoma. Leukemia. 2000 Aug;14(8):1477-82. PMID: 10942245 
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Saeki K, Sano M, Miyase T, Nakamura Y, Hara Y, Aoyagi Y, Isemura M. * Related Articles Apoptosis-inducing activity of polyphenol compounds derived from tea catechins in human histiolytic lymphoma U937 cells. Biosci Biotechnol Biochem. 1999 Mar;63(3):585-7. 

Herbs

Recommended resource:
The Natural Pharmacist
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Links to guidance about herbs from reputable sources will be posted here.

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HerbMed® -  herbmed.org 

An interactive, electronic herbal database – provides hyperlinked access to the scientific data underlying the use of herbs for health. It is an evidence-based information resource for professionals, researchers, and general public.
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Misconceptions on herbs and cancer - scienceblogs.com 

The bigger question in using these remedies for humans with cancer has been whether the concentrations used in cell culture can be acheived in the bloodstream of patients. Most naturally-occuring compounds must be concentrated hundreds or thousands-fold from their natural source, and then be given at doses that would choke a horse.
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Herbs: Uses & Abuses - Forest Hills Medical Associates

Hoxsey Therapy?

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Background copied from wikipedia.org
 

"Hoxsey herbal treatment includes a paste of antimony, zinc and bloodroot, arsenic, sulfur, and talc as external treatments, and a liquid mixture of licorice, red clover, burdock root, Stillingia root, barberry, Cascara, prickly ash bark, buckthorn bark, and potassium iodide for internal consumption.[4]

In addition to the herbs, the Hoxsey treatment now also includes antiseptic douches and washes, laxative tablets, and nutritional supplements. A mixture of procaine hydrochloride and vitamins, along with liver and cactus, is prescribed.

During treatment, patients are asked to avoid consumption of tomatoes, vinegar, pork, alcohol, salt, sugar, and white flour products.

The Hoxsey treatment is not supported by the American Cancer Society or National Cancer Institute, as neither have found objective evidence that the treatment provides any tangible benefit to cancer victims. A controlled experiment using lab mice found no difference in tumor growth between untreated mice and those given the Hoxsey tonic.[7] The FDA investigated 400 people claiming to have been cured by the Hoxsey method and found no indication that any had been cured by the mixture.[2]"

 

Homeopathy?

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Dilute traces of elements - like fights like

 
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A 19 page comic strip explanation of homeopathy http://bit.ly/bYNidX
 
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Commentary on Homeopathy PDF 

"A competing theory of the time, blood letting, was likely based on the presumed need to eliminate from the body that which was causing it harm.  In its day such harmful practices were not difficult to displace by good hygiene, bed rest, and yes, providing water with dilute trace elements – adequate hydration."
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Orac: The "frontier science" of homeopathy? http://scienceblogs.com/

"Mr. Goldacre's statement is at odds with the excellent therapeutic results of homeopathic patients reported at the time of the epidemic"
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Background on Homeopathy  wikipedia.org
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Are the clinical effects of homeopathy placebo effects? A meta-analysis of placebo-controlled trials.

INTERPRETATION: The results of our meta-analysis are not compatible with the hypothesis that the clinical effects of homeopathy are completely due to placebo. However, we found insufficient evidence from these studies that homeopathy is clearly efficacious for any single clinical condition. Further research on homeopathy is warranted provided it is rigorous and systematic.

Publication Types:  Meta-Analysis  PMID: 9310601 
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FDA on homeopathy http://www.fda.gov/fdac/features/096_home.html 

Hyperthermia / Hot baths with chemo?

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Comments on risks of taking hot baths close to administration of chemo:

In addition to the known risk of hand/foot syndrome, the doses of chemotherapy agents are carefully calculated to achieve blood levels within the therapeutic window (to be effective with acceptable toxicity).  It may be that a hot bath will raise the temperature of blood in your skin and extremities, which could increase drug accumulations in those areas and reduce blood flow to other areas.  

That is, the practice of taking hot baths close to the administration of chemotherapy might not be safe to do, or beneficial.

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Hyperthermia in Cancer Treatment: Questions and Answers http://1.usa.gov/pccdOj
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See for avoiding risk of Hand/Foot Syndrome 

"HFS is a skin reaction that appears on the palms of the hands and/or the soles of the feet as a result of certain chemotherapy agents " 
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See for avoiding risk of infection: cancer.gov

  

Hyperbaric Therapy?

 
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Does Hyperbaric Oxygenation accelerate cancer? Professor John Feldmeier Professor in Oncology, Medical College of Ohio, USA 2002 - spinalrehab.com  

"Lotovin (1981) reported the effects of 6-HBO sessions at 2.5 ATA resulted in an increase of T lymphocytes in guinea pigs. However raised HBO to 5 ATA resulted in immune suppression. Animals given HBO at 2.5 ATA daily resulted in T lymphocyte elevation 1.4 fold (140% elevation) and that of B lymphocytes 2.8-fold* (280% elevation). Also noted were significant elevations in ALL immunoglobulin responses. "

CAUTION:   The above suggests that this intervention could *promote* growth of lymphomas. 
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Hyperbaric Oxygen Therapy - emedicine  

Provides a good history of medical uses ... includes caution that HBO is angiogenic - promotes growth of new blood vessels which may be cancer promoting.

Immune support

Boosting immunity with supplements to fight lymphomas?
Th1/Th2
Avoid Immune stimulation?
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Many thanks to help from Jerry (Webmagic) 
for his assist on writing this perspective.

Can boosting immunity help fight lymphoma and other cancers?

The immune system is very complex. Understanding of how the immune system interacts with lymphoma cells is only now beginning to unfold.1  

Thinking of immunity as a police force can be a useful way of thinking about how it works, but the immune system only acts upon recognition of non-self, i.e., something is foreign to it. Therefore, non-specific boosting of immunity that does not help the immune system to recognize tumor proteins (antigens) as being abnormal and not belonging is unlikely to be effective as a treatment strategy. 

The immune system can build armies of specialized forces when a foreign element is recognized as such: as an antigen. Activating the expansion of antibody-creating cells (B-cells) and specialized cells (T-cells) that can kill infected or abnormal cells. These activations are antigen-specific, not nutrient-based. 

The triggers of activation can be remembered or learned, such as a virus with a unique sequence of amino acids, or a protein expressed abnormally on a cell. There is cross-talk between the two arms of immunity, and also many internal controls. Regulatory T-cells, for example, that inhibit immune activation as a way to protect against autoimmunity. 

Thus, we might ask, “What part of the immune system (if any) are we boosting with herbs or vitamins? Like a police force, the immune system can subdue a criminal, but it needs to "know" its identity first. Once subdued, the armies are programmed to turn off the attack and self-destruct. Memory cells may remain so that a new insult can be dealt with more quickly and efficiently a second time.. 

One way of looking at a lymphoma is that it is an immune cell that has a flawed program, one that is not capable of turning off the attack on an antigen. Instead, it is misdirected by mutations for continued survival and expansion. 

It may be that normal cells surrounding and infiltrating the tumor are aiding and abetting the wrong cause, contributing to sustained growth and activation of these cells--the malignant behavior. So what triggers and boosts immunity is the detection of foreign antigens. An insect bite that leaves a non-self protein beneath the skin is an example.

As noted, activating immunity without providing information about what it should attack is not likely to help fight a lymphoma. Strategies that boost immunity by introducing antigen-like substances (pokeweed, etc.) are more likely to just rev up the system, like sirens and whistles without a plan. This course of action is unproductive and perhaps may contribute to immune depletion in the long run. 

Lymphomas may also depress immunity. The malignant cells may secrete factors that activate regulatory T-cells, whose job it is to suppress the immune response. Or, lymphoma cells crowding out normal cells in the bone marrow may inhibit the creation of new infection-fighting white blood cells (WBC). In this case, clearly, treatment that ablates (kills) tumors in the marrow may best address the underlying problem. 

Perhaps diet and supplements can influence immunity, but only modestly. This can occur in two ways: directly, if the body considers the supplement to be an antigen (foreign body), and indirectly, as building blocks (nutrients) for formation of new blood cells. A healthful diet and exercise will take care of the latter; the former (mushrooms, pokeweed, etc.) should probably be avoided because it may distract immunity from addressing the lymphoma (if it is) as described above, or potentially stimulate the lymphoma to grow. 

It should be noted that Beta glucans (from mushrooms) may improve the immune complement function, a process in which immune cells kill mab-coated cells. Testing is being done to see if it enhances response to Rituxan.

By far the most potent immune boosters are the new biologics. These are growth factors that actively induce certain types of blood cells to grow and mature. Leukine, Procrit, Neupogen are the brand names for these colony-stimulating factors. They also go by G-CSF or GM-CSF. 

CSF stands for “colony stimulating factors.” GM stands for granulocyte and macrophage respectively, which are the cells stimulated. For example, G-CSF is sometimes given to reduce the risk of infection between rounds of chemotherapy. Leukine is being tested in a controlled study to see if it provides benefit as an adjuvant with Rituxan to treat follicular NHL.   Leukine is also administered at injection sites for therapeutic vaccines. 

Note that despite the proven potency of biologic agents, they are not administered as single agents to treat lymphomas but only to keep treatment on schedule (rebuild WBC after chemo), or given with immune therapies to potentially enhance or complement treatment effects (with vaccines or Rituxan).

One exciting direction in research is the use of immune modulating compounds. Agents like Lenalidomide (Revlimid) may profoundly change the *profile* of immunity in ways that lead to tumor regressions. Recently, this agent was rapidly approved by the FDA for treating myeloma (a blood cancer). It is being tested for follicular NHL as well as a single agent and also as a potential adjuvant (booster) of Rituxan.

[1] "There is considerable clinical evidence that immune responses are important in follicular lymphoma. In some cases, the lymphoma regresses spontaneously,29 an observation that has also been made in melanoma and renal-cell carcinoma and that may indicate an effective antitumor immune response. The response of follicular lymphomas to idiotype vaccines also highlights the potential of the immune system to recognize and counteract this type of lymphoma.8,9,10 Although these findings suggest that the clinical course of follicular lymphoma can be modulated by immune responses, our study provides a molecular signature of the *type* of immune response that is associated with long-term survival.

It is also possible that the lymph-node cells responsible for the immune-response 1 signature provide trophic signals that promote the survival or proliferation of the malignant cells. This signature could represent a variant germinal-center reaction that includes T cells, follicular dendritic cells, and the malignant cells. The dependence of the malignant cells on these environmental signals may prevent them from leaving the lymph node, possibly accounting for the association between the immune-response 1 signature and prolonged survival. An understanding of the nature of these trophic signals provided by the microenvironment in follicular lymphoma could provide new targets for therapy."

Source:  http://content.nejm.org 

Depressed immunity is a known risk factor for developing lymphoma. And both the disease and the treatments of it can impair immune function.

"Cancer patients may wish to use these botanicals to inhibit tumor growth or to boost resistance to infections. However, passive immunotherapy with herbs, with no mechanism to expose tumor antigens, is unlikely to be effective in inhibiting tumor growth. Although the margin of safety for these herbs is large, more research is needed to demonstrate the clear value of using herbs to improve resistance to infections." 1

Be aware that supplements that stimulate immunity in theory can also stimulate lymphomas, a cancer of immune cells. (See the caution below.)

Iron

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Iron is an essential mineral. Excessive iron, however, may promote tumor growth.

Also see Alerts

Licorice root

Recommended resource:
The Natural Pharmacist
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Licochalcone-A is one flavonoids extracted from licorice root with antiparasitic and anti-tumor activity. Immunoblot analysis demonstrated that LA decreased the anti-apoptotic protein bcl-2, a gene that's often over expressed in lymphomas - in cell culture. 

Background: wikipedia.org 

Also see Alerts
 
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Rafi MM, Rosen RT, Vassil A, Ho CT, Zhang H, Ghai G, Lambert G, DiPaola RS. *Related Articles Modulation of bcl-2 and cytotoxicity by licochalcone-A, a novel estrogenic flavonoid. Anticancer Res. 2000 Jul-Aug;20(4):2653-8. PMID: 10953339 
 
Disclaimer:  The information on Lymphomation.org is not intended to be a substitute for 
professional medical advice or to replace your relationship with a physician.
For all medical concerns,  you should always consult your doctor. 
Patients Against Lymphoma, Copyright © 2004,  All Rights Reserved.