Life Extension Magazine February 2002
Integrative approaches to cancer, cardiovascular disease and diabetes treatment
by Ivy Greenwell
"Integrative" was a key word at the latest ACAM conference held in Nashville, Tennessee. ACAM stands for American College for the Advancement of Medicine. It is an organization dedicated to the promotion of a more physiologically based medicine, one that combines the best of mainstream and alternative therapies-hence the term "integrative." Through its conferences, ACAM tries to educate physicians in innovative approaches to prevention and treatment.
The recent conference included lectures on new breakthroughs in our knowledge of hypercoagulability and the role it plays in diabetes, cardiovascular disease, cancer and aging-related tissue atrophy. Keeping blood viscosity from rising as we age adds another important goal for anti-aging medicine.
As usual, there were also fascinating lectures on new treatments for heart disease and cancer, and question-and-answer workshops where a topic could be explored in depth.
New light on hypercoagulability in disease and aging
The most exciting lectures of this conference were devoted to the topic of hypercoagulability: the increased propensity of the blood to abnormal viscosity and the deposition of fibrin in the blood vessels. Hypercoagulability is a shift in haemostatic balance toward the dominance of pro-clotting factors. The typical result, however, is not the formation of a clot, which requires the cross-linking of fibrin caused by a burst of thrombin, but rather the deposition of fibrin (fibrinogen is the precursor of fibrin), obstructing blood flow and causing local ischemia, meaning deficient blood flow to certain areas.
When tissues don't receive sufficient blood, the cells are starved for oxygen and nutrients. Pain can result, as in headache or fibromyalgia. According to the speakers, David Berg, director of Hemex Laboratories and Carol Ann Ryser, M.D., a pediatrician, many chronic conditions such as attention deficit disorder, autism and schizophrenia, as well as multiple sclerosis, Parkinson's disease, irritable bowel, endocrine (hypothalamic-adrenal axis-related) sleep disorder, and the type of infertility that manifests itself in repeated miscarriages (fetal wastage syndrome), are all related to elevated blood viscosity and organ dysfunction caused by impeded, insufficient blood flow.
Dr. Ryser stated that in her clinical practice, every cancer patient she had tested turned out to suffer from hypercoagulability. It appears that cancer cells produce a protein that acts as a pro-coagulant. Research confirms that cancer patients have an increased incidence of blood clots, and that low-dose heparin can be a useful adjunct therapy in cancer, increasing survival. Diabetics and AIDS patients also appear to benefit from low-dose heparin, according to Ryser.
Hypercoagulability is part of the inflammatory response. It has not received the full attention it merits. We know that an excess tendency toward clotting is undesirable, and may indeed be fatal in the case of heart attacks and strokes. So far, however, not too much has been said about increased blood viscosity without actual clots, or about fibrin deposition inside blood vessels of individuals who suffer from chronic hypercoagulability.
When a trauma occurs, such as a severe infection, a car accident or severe emotional stress, most people eventually recover. But a minority go on to develop a chronic condition such as fibromyalgia. These individuals may be suffering from a genetic protein defect that makes them especially prone to develop hypercoagulability. High lipoprotein(a) also promotes hypercoagulability by blocking fibrinolysis. High homocysteine (over 10) is also associated with with hypercoagulability. High blood sugar and high triglycerides also promote elevated blood viscosity. Thromboxane, an eicosanoid derived through the metabolism of polyunsaturated fatty acids, is yet another factor promoting hypercoagulability. Altogether, the regulation of coagulation is quite complex, involving the balance of more than a dozen factors. It takes special tests to establish if a patient might be deficient in proteins C and S, for instance, or shows elevated fibrinogen.
Hypercoagulability can be easily detected through the use of the well-known "sed-rate" blood test. Sed rate of less than 5 indicates hypercoagulability. The difficulty comes in trying to find out the major factor(s) causing the condition. Thus the need for additional testing, so that the right factor (e.g., high lipoprotein(a) or high fibrinogen) can be targeted for treatment.
Virus infections have been singled out as particularly likely to provoke excess fibrin production. This fibrin accumulates in certain places, creating a "fibrin block" that impedes blood flow and deprives a certain area of the body of sufficient oxygen. Ryser said that she finds a history of two to six serious infections per every chronic fatigue patient. There is also suspicion that certain vaccines can act as precipitating agents for inflammation-induced hypercoagulability (e.g. anthrax vaccine contaminated with mycoplasma, a suspect in the Gulf War Syndrome).
Once hypercoagulability is understood, it comes as no surprise that low-dose heparin (a natural anticoagulant, one of several produced by our own body) dramatically improves blood flow and can quickly clear up conditions such as inflammatory bowel syndrome, or help certain women avoid repeated miscarriage.
One item of special interest was the new finding that glucosamine is a mild anticoagulant. Its unexpected benefit is the prevention of migraines in a percentage of cases, at a dose as low as 1,500 mg/day. Some patients need twice or more that dose, however. Using safe, mild, natural anticoagulants adds a useful new technique for migraine prevention.
Some conference participants expressed concern over the long-term safety of heparin administration. This matter requires further research. For milder cases, and for prevention, we have access to safe hypocoagulant agents such as fish oil, curcumin (turmeric extract), ginger and ginkgo.
Hypercoagulability, like inflammation in general, is one of the characteristics of aging. This topic was addressed by Richard Kunin, M.D., founder and president of Society for Orthomolecular Health Medicine, and author of MegaNutrition. His thesis was that the emphasis on hypercoagulability represents a "paradigm shift" in our thinking about disease and aging. For instance, we can now make sense of the finding that cancer mortality drops dramatically if cancer patients are given heparin.
Our understanding of the aging process is also enhanced by the perception that impeded blood flow leads to local ischemia (oxygen deficiency), and this is turn translates into progressive tissue atrophy. Only fifteen seconds of ischemia turns off the mitochondria. This initiates an apoptosis (programmed cell death) cascade. The shrinking of our organs with age leads to ever-greater pathology. Loss of heart tissue eventually results in congestive heart failure. Loss of glandular tissue results in hormone deficiencies, loss of neural tissue brings on cognitive dysfunction and eventually senile dementia, loss of lung tissue leads to emphysema, and so on. This is the atrophy of aging that we see throughout the body. The new insight is that "ischemia is a silent cause of aging and degenerative disease."
In order to fight ischemia, we need to keep the blood from getting too viscous and sluggish, and platelets from clumping too readily. We now see that various micronutrients are not only antioxidants, but also anticoagulants. Their great advantage is safety. We know how to counteract various procoagulant factors: high homocysteine, for instance, can be remedied through the use of folic acid, B12 and B6; aspirin, curcumin, ginger and ginkgo inhibit platelet aggregation; curcumin is also known to lower fibrinogen.
High lipoprotein(a) responds to niacin (or inositol hexanicotinate), high doses of vitamin C, and the amino acids lysine and proline. Hormone replacement and exercise also help maintain a more youthful blood circulation. Enzymes such as bromelain and Wobenzym have been found to lower blood viscosity. Even massage is seen in a new light when we learn that it helps release tissue plasminogen activator (tPA) from the lining of blood vessels, thus promoting better circulation.
Once we understand the need to guard against local ischemia, we are better motivated and equipped to take the right countermeasures. Kunin cautioned, however, against accepting hypercoagulability as a primary cause of aging. In his view, hypercoagulability is secondary in importance to the aging-related dysfunction of the hypothalamic-adrenal axis (HPA). Hypothalamic-adrenal axis governs our neurohormonal response to stress. Oxidized adrenaline is a free radical, Kunin stated. "You're not neurotic; you're just living under enormous stress," he said. Ultimately, of course, stress, inflammation and hypercoagulability are inextricably linked. Stress reduction is an important measure we must take to reduce the pathologies of aging, including hypercoagulability.
Integrative cancer treatment
The first lecture on a new approach to cancer treatment was quite exciting from the point of view of theory. Steven Ayre, M.D., Medical Director of Contemporary Medicine Center in Chicago, presented the method he has used in his clinical practice for over 20 years. He calls it "insulin potentiation therapy." Developed by a Mexican physician, Donato Perez Garcia, in the 1930's, the therapy consists of administering insulin together with low-dose chemotherapy.
Insulin is a potent mitogen: it makes cells proliferate. Thus, giving insulin to a cancer patient induces more cancer cells to go into the division state, and thus renders them more susceptible to chemotherapy, which targets rapidly dividing cells. It has been found that cancer cells have six times more insulin receptors than normal tissue. Exogenous insulin thus transforms chemotherapy into the equivalent of a "smart bomb." Because the effective dose of chemotherapy is much lower thanks to the affinity of cancer cells for the extra insulin, side effects are relatively minor.
The difficulty of this technique lies in the proper administration of insulin. Obviously, the patient's glucose levels need to be closely monitored. The other problem is that, as always, there are some patients who do not respond. All agree, however, that the theory behind this therapy sounds plausible, and controlled research would be of great value. Once chemotherapy ends, insulin therapy should stop. Some cancer patients undergo insulin suppression therapy because they don't want to stimulate the propagation of residual cancer cells.
Another speaker was Friedrich Douwes, M.D., Director of St. George Hospital (Klinik St. Georg) in Bad Aibling, Germany. His approach stresses hyperthermia and electrotherapy, but includes conventional treatments as well. Psychotherapy is also available to the patients. Cancer is seen as a complex all-body disease, not just as a tumor that needs to be destroyed. Another principle is that treatment needs to be individualized.
Perhaps the greatest success story of the St. George Hospital is the use of local hyperthermia for prostate cancer, using a catheter with heating electrodes. The heat treatment is combined with a short-time androgen blockade. St. George Hospital boasts of 100% five-year survival for its prostate cancer patients. Local hyperthermia has also turned out to be very effective for brain cancer. Pancreatic cancer patients, on the other hand, aren't so lucky; even with combination of hyperthermia and chemotherapy, the median survival is 21 months-an improvement on mainstream outcome, to be sure, since most pancreatic cancer patients treated with chemotherapy alone die within six months.
Douwes also presented dramatic slides showing the progress of electrotherapy in a patient with breast cancer. Electrotherapy, also called galvanotherapy, is simply the use of electricity to destroy the tumor tissue. It has been found effective also for head and neck cancers. In many cases, electrotherapy makes surgery and radiation unnecessary, according to Douwes.
Isaac Eliaz, M.D., a holistic physician in private practice in Northern California, concentrated on integrative treatment for prostate cancer. He uses androgen-blocking drugs (chiefly Casodex), but also employs a wide array of supplements. Chief among them is modified citrus pectin, shown to inhibit metastasis. Another important supplement is fermented soy protein, tested by Eliaz in an experimental study. The bacterial fermentation process apparently dramatically increases soy protein's anti-cancer activity, as shown by the dramatic inhibition in the rise of patients' PSA in the fermented soy group compared to placebo. Eliaz emphasized that this is not a matter of increased genistein content, but more likely of other compounds found in soy protein. Eliaz found no correlation between serum genistein and the PSA response.
Eliaz individualizes each patient's program. Some of the supplements that he recommends include green tea extract, curcumin and D3, among others.