Letters

a logical healthy diet, exercise, andconsider hormonal intervention suchas the use of testosterone, nandrolone,oxandrolone, and other anabolicsteroids.

The medical establishment didn'tlike our message at first but found suchsuccess that they eventually embracedus and our message, because theirpatients were alive, energetic,happier, and healthier. Dr. MichaelGottlieb, who reported the first casesof HIV+ men in 1981 and practicesHIV medicine in Los Angeles, will tellyou good things about Nelson andme.

I also had been an HIV denialist inthe early '90s and worked with oneof the denialist organizations until itstopped making sense. Afterward, Ididn't speak with anyone from thatgroup until a couple of years ago; Iwas told that one of the two leadershad died at a young age, refusing totreat his HIV with medications. Sogoes it.

That all being said, I wouldcondemn the support, promotion, andengagement of the HIV denialists inthe natural-health medical communityas a distraction from the real goal ofhelping people with HIV to surviveand be healthy. In some cases I know,it is also simply part of a habit patternwithin an effort to oppose mainstreammedicine, rather than having solidscientific footage that might savelives and real-world experience thatconfirms their hypothesis by seeingwhat's happening with real peoplewho live with HIV. My feeling itthat it's bad for natural health care tobe seen as embracing this rubbish.Some of my friends who have HIVand know it well look at this as justanother example of how "nutty"natural heaith-care people can be.And, typically, those natural health-care proponents who embrace thisnotion do not work in the HIV world.Having little or no direct experiencewith it, how can they really knowwhat's going on?

Over the years I have seen maybea dozen people die, people wholistened to the denialists and didn'taddress their HIV, when they had hadthe same chance of survival as otherswho did use mainstream antiviralmedications along with CAM and arestill alive and well today in 2009.

Please consider this when readingpro-HIV-denialist information. Thereare those of us long-term active natural-health proponents who disagreeentirely with this notion and feel thatit actually has done great harm topeople with HIV who believe it andforgo appropriate treatment. Believingin it can be a death sentence.

Sincerely,Michael Mooneywww.michaeimooney.netwww.medibolics.com

EnhancingChemotherapyEffectiveness withSimple Vitamin C?My ClinicalExperiences

Generally it is not advised by theoncology community for patientswith cancer to take any other formof treatment when they are receivingchemotherapy, for fear of a negativeinteraction. The rationale for thisrecommendation, particularly withvitamins, largely stems from fears ofthe antioxidant debate or from thevery limited information published.A recent article published October1, 2008, in the journal CancerResearch cast further doubt on thissubject area to a point that evena senior scientist here at the B.C.Cancer Agency [regional publichealth authority] publicly discouragedpatients to use vitamin C together withchemotherapy.

If I were an oncologist and trainedonly in conventional medicine, I could

understand some of their concerns; inaddition, one has only so much freetime to personally investigate suchsubjects when dealing with withcancer patients - I understand this aswell. However, being a naturopathicphysician, my training and expertisein the use of natural methods ofhealing, vitamins, and minerals, etc.,is definitely much more involved andextensive than those of an oncologistor most other conventionally trainedhealth-care providers - it's one of mystrengths, and so my understanding ofthe subject is much more entrenched.

Unfortunately, most people do notrealizethatthestudy in this article useda form of vitamin C that is not evenused by consumers: dehydroascorbicacid; while for the good old ascorbicacid form of vitamin C that everyoneuses with chemotherapy, there hasbeen an overwhelming amount ofpositive research around the world.It is important to highlight that therealready exist two research papers onhumans (not in test tubes or micelike the one above) that studied theeffects of regular oral vitamin C eitherwith or without chemotherapy inwith cancer patients, none oí whichshow any evidence of interference! Inaddition, vitamin C by injection (aneven stronger method) has also beenused In people with cancer (again,not in test tubes or mice) along withselect chemotherapy agents, and thepreliminary findings demonstrate thatthe combination works quite well.

Throughout the years of helpingpatients with cancer, I have observedthat some patients who wereinterested in using vitamin C to helpfight their disease, in particular,pharmacological doses via intravenousinjection, together with or alongsidechemotherapy, often demonstratedvery noteworthy responses. In fact,I have seen many cases wherein apatient is about to be removed fromreceiving a chemotherapy protocolbecause they showed signs that thetumor was unresponsive or becomingmore resistant to treatment. As aconsequence, the patient becomes alittle more desperate and willing to try

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more unconventional approaches. The patient then beginsto incorporate vitamin C into their treatment protocol and,from that point, begins to show impressive signs of tumorresponse (i.e., shrinking). I have seen this kind of effectin non-Hodgkin's lymphoma as well. Moreover, I haveseen when a patient has suffered serious side effects froma palliative chemotherapy combination cocktail, and so asingle agent is used to provide a gentler level of treatment.The patient then decides to incorporate intravenous vitaminC alongside the chemotherapy agent (Adriamycin) and fromthat point begins to respond and shrink the tumor unlikenever before - and to the surprise of the oncologist.

In the medical literature, I was interested to findevidence to support my observations in clinical practice thatvitamin C incorporated with chemotherapy can make themsynergize and work better ( known as chemosensitizing)and/or help to overcome chemotherapy resistance. I found23 research papers from around the world incorporatinga selection of more standard chemotherapy agents usedtogether with vitamin C and demonstrating just that! Therewas actually more using arsenic trioxide, an experimentalchemotherapy medicine; however, this is not a commonagent and so I did not include it in this analysis. Therewas one paper that demonstrated mixed effects (more onthe positive side) depending on the cancer cell type used.There are also two papers on experiences using vitamin Cby intravenous injection, and some of which together withchemotherapy demonstrated positive outcomes as well.The only negative research paper I found on this subjectwas the latest article above that has managed to get allthe press. There are 2 more human studies, as previouslymentioned, that used oral vitamin C either with or withoutchemotherapy; however, these trials did not demonstratean effect either way (other than they are safe and help todecrease side effects of treatment); but this is not the basisfor this letter.

In general, vitamin C together with chemotherapymedicines has been shown in the scientific journals to:• reverse chemotherapy-resistant cancer cells• increase the delivery of chemotherapy into cancer cells

(helps overcome drug resistance)• make the tumor cell membrane more permeable

(enhanced drug delivery)• stabilize p53 genes, increase Bax, decrease Bcl-2 and

telomerase activity (decreases drug resistance)• inhibit transiocation of NF-kappaB and AP-1 (decreases

drug resistance)• inhibit Nrf2-mediated gene expression (decreases drug

resistance)• activate the MLHl, c-Abl, and p73 signalling cascade

(enhanced drug killing effect).Note: On its own, vitamin C - in particular by

intravenous injection - also has chemotherapeutic effectsand supportive properties for the rest of the body (unlikestandard chemotherapy agents).

The researched chemotherapyagents used together with vitaminC showing a positive effect haveincluded the following:• arsenic trioxide• cisplatinum (platinum-based)• Cyclophosphamide (Cytoxan)• Doxorubicin (Adriamycin)• Dacarbazine (DTIC)• Gemcitabine (Gemzar)• Interferon-alpha 2b• Imatinib (Gleevec)• Mitomycin C• Paclitaxel (Taxol)• Etoposide• 5-FU (fluorouracil)• Tamoxifen• Vincristine (Oncovin).

So you decide: 1 negative,1 neutral, or 23 positive papers(researched independently around theworld).

The above information tends topaint a very different picture of thepotential therapeutic properties ofvitamin C (ascorbic acid) as a means toimprove the benefits of chemotherapymedicines, and vice versa; I haveseen this to be true in my clinicalexperience. It is the classic saying: "isthe cup half full or half empty?" Someof the positive data have even showna lower chemotherapy dosage neededto produce the same effect of regular-strength chemotherapy (i.e., cisplatin)when vitamin C was added; moreimportantly, in the animal studies,subjects lived longer. Moreover, incancer cells that were resistant tochemotherapy (Gleevec, Vincristine),the addition of vitamin C reversedthat effect. What alarms me is thatnone of these articles were evenmentioned or referenced in the recentnegative article - science should beabout objective reporting of the totalevidence.

The fact that the recent negativetrial used dehydroascorbic acid (a"rusted" form of vitamin C), whichis not even used in the marketplace,sheds some light in explaining thefindings. At the University of KansasMedical Center, intravenous vitaminC is being studied together withchemotherapy for patients withovarian cancer, and preliminary

published case reports appear quitepromising (in humans and not testtubes or mice). Other human clinicalreports using vitamin C together withvarious chemotherapy agents again donot show a negative effect - but ratherthe exact opposite (and of course thereare also my personal experiences).Moreover, some research has shownthat patients with cancer have lowerlevels of vitamin C in their bloodeven though they consume more thannoncancer patients - they appear toneed more as well!

While I understand that mostoncologists are hesitant about com-bining vitamins with chemotherapymedicines, the bulk of the evidenceshows that there may a certain levelof harm in their recommendation.It is everyone's goal to improvethe outcomes and quality of life inour patients; however, when beingtoo restrictive, important tools orapproaches can certainly be missed -the patient loses here.

The above information raises someserious questions about the morenegative chemotherapy concerns thathave been highlighted with respect tovitamin C - it's a lot more complicatedand involved! For example, somechemotherapy medicines also possessantioxidant activity and yet producecancer-killing effects that do not hitthe radar of concern (e.g., Ftoposide,Oxaliplatin). Moreover, the majorityof the medical community does noteven realize that when vitamin Cis used in high or pharmacological(intravenous) doses, it operatesmore like a prooxidative medicine,not an antioxidant, similar to somechemotherapy agents.

It is not my intention in this letterto place the patient in the middle of amedical debate, but rather to simplyprovide honest information so thatthey can make good decisions, withno regrets. I regularly see patients whoare upset that they were never giventhis kind of information to begin withor could not discuss it in better detail- a "no" answer is not enough forsome, and so this letter is for them.

I have found that while peoplebelieve that an either/or approach is

Lettersthe safer course of action in cancercare, a combination of both at somelevel often works even better if thepatient chooses to do so - hence theterm "integrative cancer care."

The current negative article onvitamin C, using the dehydroascorbicacid form, should not be held in highregard. There exists an overwhelmingamount of positive evidence to thecontrary on using simple ascorbicacid - the way nature intended.

Walter Lemmo, ND1, Hedney ML el j l . Viumln C dnuguni/es ihc

cytotoxtt effects of antineopldsric drugs. Cancer Res.2008;68I19);80Î1-Ii03fl.

2, Prasad KN et al. Modiritalion of Ihp effpn o( lamonitpn.CispJdIinum, DTIC, and interffton-dlphd 2b on human(neldm»na (.eti; in cullure bv a mixiuie ul vitamins, NulrCancer. 19í4i22131:233-245,

3, Chiang CDet al. Ascorbic acid incrpaspsdrugaccumularionand revtH-ses Vinrnsline resistance of human non-small-cell lung cancer. Biocbeml. 1994;301if!i 3i:759-764.

4, Sor>g EJ et al, Potenliálion of growth inhibition dueto Vincristiiie bv aworbic acid in a resistant humannon-small cell lung cancer cell line, fur / Pharmaco/,1995;292(21:1I9-125,

5, Kurbacher CM et af, Ascorbic acid (vitamin C) improvp-'the antineoplastic activiry of donorubicin, Cisplatinum,and pacltitaxei in human breast carcinoma cplls in viir».Cancer letf, 1996:103(21:183-189,

6, Wells WW et al. Ascorbic acid and cell survival olAdriamycin resislanl and sensitive MCF-7 breaM tumorcells, free Radie Biol Med T995;16[4):b99-708,

7, Marian M et al, Potentiation of the biological activiiii>sof daunomycin and Adriamycin by ascorbic acid anddimethvlsulfoxide. Experientia. 1982;38t5):573-574.

B. Nagv B et al, Chemosensitiïing effect of vitamin Cin combination with 5-fluorouracil in vilro. In Vivo.2OO3;17(3):289-292.

9, Kammerer C el al. Enhancement of milomycin C efficiencyby vitamin C, E-acetale and beta-carolene under irraifiatiiid.A study in vitro, Anticgncpr Res, 1999;1916B):5)19-5321,

10, Abdel-Latiff MM et al. Vitamin C enhanceschemosensittzation of esophageal canter cells in vilro, /Ctíemother, 2O0S:t7(5)t539-549

Tl, Catani MV et al, Ascorbate up-regulates MLHI (MutL homologue-t| and p73: implications for the cellularresponse to DNA damage, Biochem I. 2002^364 (|>t3);441-447,

12, Reddy VG et al, Viiamin C augments rhcmolherapputiiresponse of cervical carcinoma HeLa cells by stabili/inRp53, öiochem Biophys Res Common, 2O01;282(2):4O9-415,

13, Tarumoio T et al. Ascorbic acid restorei sensiiivitylo imatinib via suppression of Nrf2-dependent genpexpression in the imatmib-resistant cell line. Exp Hemalol.2OÖ4;3214):375-381,

14, Yam D et al, Suppreision of tumor growth and metastasisby dietary fish oil combined with vitamins E and C andcisplatin. Cancer Chemother Pharmacol. 2001;47(l):34-40,

15. Kassouf W et al, Vilamins C and K3 SKnsJti/e humanurothelial lumors to Gemcitabinp, I Urol. 2006. 17614 pt1): 1642-1647,

16. Taper HS el al. Non-toxic sensitizalion of canrprchemotherapy by combined vilamin C and K3 prelreatmenrin a mouse tumor resistant to oncovin, Anticancer Res,1992;S: 5651-11)54.

17. Pathak AK et al, Potentiation of the effert of pdclitaxel andcarboplatin by antioxidani mixture on human lung cancerh52O cells. M m Co//NWr, 2002 Oct;21(5):416-421,

18. Shimpo K et al. Ascorbic aiid and adriamycin tonicity. AmI Clin Nutr. 1991:54(b supjjl). 1298S-U01S,

19, WoOniak G et al. Influence ot vitamins C and E oncytotoxic adivity of adriamycin in chosen cell cultures,ArtaPo/fflarm, 2OO2:59n):31-35-

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Letters20, Cdscia'i II el dl. C/totoxicity of ascorbate, lipoic acid, and

other antioxída^t^ in holbw fibre ¡n vitro tumours, Br /Cancer. 2O01;d4l1l>:l544-550.

l^. De Loecker W et al. Effects of sodium ascofbate (vitamin Oand 2-rneihyl-l,4-naplirhoquinone (vitamin K3) ireatmpnion human lunar cell growth in viiro. II. Synergismwith combined chemotherapy action. Antkancer Res.1993:1îlt):tO3-1O6.

22. Samd S et al. Chpmo-immufiothetdpeutical studies onDalton's lymphoma mice usir)g cisplatin and ascorbicacid; synergislic antitumor effect in vivo and in vitio. ArchImmunolJher Enp Mam). 1993;4l(5-6):327-333.

2). Prasdd SB et al. Use of subtherapeutical dose o( cisplatiriand vitamin C against murine Dallon's lymphoma. Pol IPharmacol Pharm. 1992;44(41J83-39I.

24. Nichuld 6M el al. The effects of cyclophosphamidealone and in combinatior» with ascorbic acid againstmurine ascites Dallon's lymphoma, Indian I Pharma<:ol.2006; 18(41:260-265,

25. Pathak AK et al. Chemotherapy alorie vs. chemotherapyplus higb dosp multiple antioxidants in patients withadvanced non small cell lung cancer. / Am Coll Nutr.2O05;24i1):t6-2t.

26. WeijI NI et dl. Supplementation with antioxidantmicronulrients and chemothprapy-induced tonicily incancer patients treated with cisplaiin-based chemotherapy;a rat>damise(i. double-blind, placebo-controlled study. Eut/Cancer, 2004:400Ol:17i3-t723,

2 7. Cafcamo |M et al. Vitamin C is a kinase inhibitor:dehyriroasrorbic acid inhibits IkappaBalpha kinase beta.Mol Cell 8;o. 2004^24(1 !;¡:6645.-6652,

2fl. Seung-VVoo Hong et al. Ascorbale (vttamin C) inducpscell death through the apoptosis-inducing factor in humanbrpast cancer celts. Oncology Rep, 2O07;18:811-8)5.

29. Koh W5 p| al. Differential effects and transport kinetics ofascorbate derivatives in teiikemic cell lines. Ant/cancer«es. t998;1BI4A);24B7-2493.

30. Nevestani TR et al. Vitamin C status in Iranian childrenwith acute lymphoblastic leukemia; evidence of increasedutilisation. ) Pediêtr Cssiroenterol Nutr. 2007;45(l);t4t-144,

31. Anthony HM etal. Severe hypovilaminosis in lung-cancerpatients; the utiliiation of vitamin C in surgical repairand lymphocyte-relaied host resistance, Br I Cancer.1982;46(3}:354-367.

iz. Nakdgawa K et al. Effect of chemotherapy on ascorbaleand ascorbyl radical in the cerebrospinal fluid andscrum of acute lymphoblastic leukemia. Cell Mol Biol.2OQO,Abm.M7ñ\.

33. Drisko |A et al. The USP of antioxidants with fint-line1 hemotherapy in two cases of ovarian cancer. / Am CollNutf. 20O3;22(21;11B-t23.

Ï4. Riorctan NH et al. Intravenous vitamin C as achemothetapeutic agent: a report on clinical cases. PRHSI20O4;23[2]:tl5-118.

35, Chang ) et dl. Phasellstudy of arsenirtriotiide and ascorbicacid for relapsed iir refractory lymphoid malignancies: aWiwonsin Ontologv Network study. Hematol Oncol.2OO8;Jul31.

PSA Tests,Prostate Cancer,and Vitamin C

A critique of the PSA (prostate-^|)ecific antigen) screening testhas made the news, circa August2008, whereby the 16-memberU.S. Preventive Services Task Forceconcluded that the test causesunnecessary anxiety, surgery, andcomplications for elderly men - withthe benefits unclear for younger men.These guidelines were praised by boththe National Cancer Institute and the

American Cancer Society, althoughothers will always disagree. In furtherfact, an article by Sharon Begleytitled "The Myth of Early Detection"appeared in the April 6, 2009,Newsvi/eek, and "What's Wrong withCancer Tests" by Shannon Brownlee(and Heather Harris) appeared in theApril 2009 Reader's Digest.

Considerably more on the subjectis furnished in A Physician's Guide toNatural Health Products That Work(2nd ed.), by James A. Howenstine,MD, which was favorably reviewedin the April 2009 Townsend Letter.Thus, in a chapter on malignancies.Dr. Howenstine first notes thatinflammation can damage theprostate gland and contribute to thedevelopment of prostate cancer (p.393ff.). It is mentioned, moreover, thata prostate biopsy can cause cancercells to enter the bloodstream (with theimplication of metastasis). It is furthermentioned that early in the course ofprostate cancer, the patient will havelow levels of testosterone and low PSAvalues. Increasing the testosteronelevels will increase the PSA values,but this does not mean that the canceris growing. A restoration of normallevels of progesterone, testosterone,and estradiol is recommended, as thisheals prostate cancer by eliminatingthe hormone abnormalities.

(The term androgen is used for aclass of male sex hormones, with so-called androgen deprivation therapyor ADT used against prostate cancer- but not viewed as a sure-fire, long-term cure. The disadvantages andside effects are reviewed by Alan R.Gaby, MD, in the December 2008Tov/nsend Letter. These i ncl udean "increased risk of fractures,diabetes, coronary heart disease, andmyocardial infarction, not to mentionthe adverse effects of chemical orsurgical castration on quality of life."Prosear, or finasteride, is a low-levelversion used to reduce the size of theprostate gland.)

Dr. Howenstine continues,whereby elevated PSA values occurin patients merely having an enlarge-ment of the prostate gland (benignprostatic hypertrophy, or BPH), as well

as in prostatitis and prostate cancer:"A surprisingly high percentage ofpatients have cancer with very lowvalues of PSA (below 4), supportingthe idea that low values of PSA areindicative of poor cellular energysecondary to low testosterone levels."

(Speaking of the inflammationor infection of the urinary system, aroutine test used is the quick-and-easy "paper" test, but which is notinfallible, indicating also that a culturetest be made - which if positive leadsto an antibiotic. Thus the patient caninsist that a culture test be performed- but which may require a changein doctors. Additionally, the routineblood test used to detect PSA-levelsmay also indicate a high whiteblood cell count - also indicative ofinfection. It was mentioned in NickLane's book Oxygen that inflammationand oxidative stress can lead to cancer[p. 312].)

In the same chapter, Dr.Howenstine cites a number oftherapies used against cancer. Theseinclude vitamin C (or ascorbic acid),cesium, urea, lycopene, Laetrile, noni,the Burzynski therapy, Coley's toxins,and others - for which the referencemay be consulted. Of special noteis the treatment named LifeOneCancer Therapy, with the multipleingredients specified. (A commentcan be made that these are at leastanticancer agents, but a completecure does not necessarily follow.) Dr.Howenstine also offers anticancer dietregimens. Interestingly, he furnishesthe following comment aboutchemotherapy (p. 421): In a survey ofoncologists at a medical meeting, theywere asked, "In the event you werefound to have cancer, would you takechemotherapy?" Most responded no.

As to Coley's toxins, firstdeveloped in the 1890s by prominentphysician William Coley, MD, usingheat-ki 1 led bacterial preparations;his daughter Helen Coley Nautssubsequently founded the CancerResearch Institute; and the successesare described in an article in the June2004 Townsend Letter. (A notationis that it also acts against suchvascular diseases as thromboangiitis

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