Practical Oncology Nutritional Alternatives for Cancer

1. Practical OncologyNutritional Alternatives for Cancer Wendy Blount, DVM

2. Nutraceutical NAVNA - North American Veterinary Nutraceutical Association • Non-drug substance • Purified and extracted • Administered orally • Provides nutritional building blocks for normal body structure and function • Intent is to improve health and well being

3. NOT Nutraceuticals • Whole herbs • Unprocessed (raw) natural products • Cartilage powders • Applied topically or injected

4. Quality Control Governmental regulation • Dietary Supplement Health and Education Act of 1994 - gives FDA power of enforcement over all dietary supplements • Nutrition Labeling and Education Act of 1990 - FTC enforces label claims on all products sold in US

5. Quality Control • NASC Membership • NADA Number if claims on the label • Third Party Evaluation • www.consumerlab.com • Veterinary literature - clinical studies in the target species, not in vitro studies or lab animal studies • USP

6. Quality Control Other things to look for • Ingredient List - Beware “proprietary blends” • Nature of the claims • Good instructions for use • Studies provided by manufacturer are on their actual product, not ingredients

7. National Animal Supplement Council www.nasc.cc Member companies submit themselves to rigorous independent inspections Work directly with FDA to improve best manufacturing processes and adverse event reporting Work closely with AAFCO Encourage research on animal supplements

8. NADA - New Animal Drug Application Required by law if medical claims are on the label Often ignored NADA number means the manufacturer has bothered to abide by FDA regulations for drug manufacture

9. ConsumerLabs www.consumerlabs.com Purchases and tests dietary supplements for potency and purity - published reports Compiles information on dietary supplements Compiles a list of recalls and FDA warning letters pertaining to dietary supplement manufacturers Look for the ConsumerLabs Seal on the label

10. USP - United States Pharmacopeia Compiles a list of suppliers that have voluntarily submitted their products for USP verification and approval

11. Diet and Cancer With the exception of lymphoma and some nasal and oral tumors, there is no scientifically proven dietary recommendation for cancer patients RULE #1: KEEP THEM EATING!!

12. Carbohydrates Cancer patients often have increased lactate , which can cause muscle soreness and poor energy Simple carbohydrates contribute to lactate production Tumors preferentially use carbohydrates rather than proteins and fats as nutrition for growth Pets with cancer have increased protein requirements low carb diet is preferred for cancer patients Feed proteins & fats to feed the patient & starve the tumor

13. Arginine & Glutamine Cancer patients often have low blood arginine Supplementation of arginine may improve immune function Supplementation of glutamine may slow cancer cachexia and protect against GI toxicity of chemotherapy Glutamine supplementation can cause diarrhea Hill’s n/d has increased arginine

14. Cancer Diet (as calories) Dogs – 35-45% protein 30-35% fat, 20% carbs Cats – 50-60% protein, 35-40% fat, <15% carbs http://binkyspage.tripod.com/canfood.html Pet Food Percent Calories Calculator Home made diet in Client Handout – Nutritional Alternatives for Cancer (use fish as protein source) When choosing vegetables, choose those with color and low in starch Have a nutritionist balance the diet if used long term

15. Raw Diets Raw meat ever recommended for animals undergoing chemotherapy Probably not recommended for any immunosuppressed pet

16. Cooking Spices with Anticancer Activity • Garlic may induce apoptosis ad differentiation in some tumor lines • in moderation to prevent oxidative injury to RBC • 1 clove per 40 lbs per day is good • Turmeric has preventative antineoplastic and antioxidant effects • 1 tsp per 50 lbs is good

17. Fatty Acids – Omega-3 • DHA - docosahexaenoic acid (22:6n-3) • EPA- eicosapentaenoic acid (20:5n-3) • EPA and DHA in fish oil • DHA also in blue-green algae • ALA - Alpha linolenic acid (18:3n-3) • precursor to EPA & DHA • Present in flax seed (linseed) oil

18. Fatty Acids – Omega-3 • ALA Not well converted to DHA and EPA in dogs and cats • due to lack of delta-6-dehydrogenase • Need fish oil for EPA and DHA benefits • Doses vary • 250-300mg EPA/DHA per 10 lb

19. Fatty Acids – Omega-3 • Powerful antiinflammatory effects • decrease synovial IL-1 production, which contributes to pathogenesis of arthritis • Necessary for mitochondrial function • Residual effects for several weeks after discontinuing therapy

20. Fatty Acids – Omega-3 • Antineoplastic effects • Both fish oil and arginine increased survival time and disease free interval in dogs with LSA • Decrease production of cytokines that mediate cancer cachexia • Antinflammatory effects are accompanied by immunostimulant properties • Slow tumor growth in vitro

21. Fatty Acids – Omega-3 Quality Control • Contamination with heavy metals, dioxins and PCBs is a concern • More of a problem with eating fish than fish oil supplements (stored in tissues) • No fish oil products tested by ConsumerLab have ever been contaminated

22. Fatty Acids – Omega-3 Quality Control • Beware of rancidity of refrigerated, pressed oils • 3-6 and 3-6-9 products not recommended for cancer patients • Cod Liver Oil is not always the best source • High in Vitamins A & D

23. Fatty Acids – Omega-3 Side Effects • Inhibit platelet function at very high doses • Give with food to avoid GI upset • Very high doses without antioxidant support can result in lipid peroxidation • Most commercial products are preserved with antioxidants • Anecdotal reports of pancreatitis and steatitis in cats

24. Fatty Acids – Omega-6:Omega-3 Ratio • Response to omega-3 therapy is due to both omega-3 dose and omega 6:ratio in the diet • Ideal ratio is probably between 3:1 and 9:1 • Many diets >30:1; some >50:1 • The more omega-6’s in the diet, the more omega-3’s needed for therapeutic effect • Presence of excessive omega-3’s can suppress omega-6 production and vice versa

25. Antioxidants • Cancers produce an oxidative state, resulting in free radicals and peroxides that injure tissues • Antioxidants can improve the oxidative state, and may slow neoplastic proliferation and reduce adverse effects of chemotherapy in people • Many oncologists recommend against antioxidant supplementation, for fear of decreasing efficacy of oxidative chemotherapy agents • Most human studies show that cancer patients that take antioxidants do better

26. Antioxidants • Antioxidants such as vitamins A, E, C, zinc, selenium, coQ10, etc., are dependent on one another • Studies that show negative effects of antioxidants are often single agent studies • Though controversial, my personal recommendation for cancer patients is to use a broad spectrum antioxidant supplement such as Cell Advance by VetriScience

27. Flavonoids • Resveratrol from red grapes and red wine Green tea polyphenols • Phytoestrogens from soy • Curcumin in turmeric • Anthocyanadins from berries • Quercetin • Citrus bioflavonoids

28. Flavonoids • Antioxidant effects may help prevent cancer • Promote differentiation and apoptosis • antiangiogenic • Enhanced immune function • Inhibition of local invasion and distant metastasis

29. Hill’s n/d • Restricted carbohydrates • Increased arginine • Increased protein and fat • Increased omega-3’s from fish oil • Dogs undergoing chemotherapy for lymphoma have increased survival time and longer disease free interval after chemo when fed n/d • Similar findings for dogs undergoing radiation therapy for nasal and oral tumors

30. Many, Many Others • Nutritional Alternatives for Cancer – handout • Neoplasene – Buck Mountain Botanicals • Sell only through veterinarians • Bloodroot, halogens and water • Wound balm topical product • Oral product • Injectable product

31. Many, Many Others • Tumexal – CanineCare.us • Some cancer cells have inactivated p53 tumor suppressor gene • Tumexal claims to duplicate the essential functions of p53 • No side effects, per the website • No information on ingredients • Illegally labeled unapproved drug • Dr. John Nice is really Dr. John Nyce