Nutraceuticals are generally considered safe as they are derived from food and are easily available on store shelves and health food stores. However, it should not be forgotten that nutraceuticals contain large quantities of bioactive molecules. As such, patients should take into account that these bioactive components may interact adversely with medication. If patients should commence any form of therapy, it is advisable to consume only under guidance of the treating haematologist and any other health care provider (ie naturopath, pharmacist).
Prebiotics and probiotics:
The gastrointestinal tract is the "seat of good health". To ensure a properly functioning gut one needs to ensure a good supply of prebiotics and probiotics.
Prebiotics are foods that encourage and sustain the growth of "good" probiotic bacteria in the gut. Prebiotic foods include raw garlic, asparagus, chicory root and Jerusalem artichoke.
Probiotics are a live form of “good bacteria” in your intestinal tract that produce natural antiobiotics to keep the “bad” or pathogenic bugs in check, thus preventing diarrhea and infections. They play a vital role in determining how we absorb the nutrients from the food we eat. They produce some B vitamins in the small intestine, where they can be absorbed. Various probiotic species have demonstrated immune enhancing and anti-tumor effects, but they also play a critical role in the detoxification of many cancer-causing substances. Probiotic foods or cultured foods include live culture yoghurt, kefir, cultured beverages such as Kombucha, as well as fermented vegetables such as sauerkraut or kimchi.
The supplements mentioned below have shown clinical efficacy in some patients with "watch and wait" cancers of the blood.
Green tea extract:
Extensive evidence exists which suggests that extracts from green tea may have clinical benefits in some patients with "watch and wait" malignancies in the blood and bone marrow.
Phase 1 and phase 2 studies by Shanafelt et al with green tea extract (they used EGCG in the Polyphenon E preparation) and early chronic lymphocytic leukemia patients showed a decline in absolute lymphocyte count and lymphadenopathy in a number of patients.
A recent case report shows a complete and durable remission of chronic lymphocytic leukemia following treatment with EGCG.
After 3 case-control studies demonstrated that green tea intake was associated with a reduced risk of leukemia and non-Hodgkin lymphoma, a population based cohort study of approximately 42,000 individuals prospectively followed for 9 years was conducted and found that green tea consumption was inversely associated with the risk of lymphoid malignancies.
Curcumin - the extract from turmeric:
Curcumin, the active ingredient from the spice turmeric, has been extensively studied over the past 4 decades for its potential anti-inflammatory and/or anticancer effects. It has been found to have anti-cancer effects against many different types of cancer including "watch and wait" cancers of the blood.
A number of clinical studies have been carried out at St George Hospital and Southern Sydney Haematology, Kogarah, Sydney from 2007 until 2016 and found that curcumin (using C3 complex curcumin at a dose of 4-8 grams per day) decreases paraprotein load, bone turnover, free light chains and % plasma cells in the bone marrow of some patients with monoclonal gammopathy of undetermined significance (MGUS) and smoldering multiple myeloma (SMM) - see publication list.
Long-term follow up of 13 MGUS/SMM patients taking 4-8 grams curcumin daily showed that over a 9 year period, 12 of the 13 patients maintained stable disease with one patient progressing to amyloidosis. Patient tolerance has been good and none have developed clinical infections. To view the details of this follow-up study, see publications.
In addition, based on the demonstrable effects of curcumin in MGUS and SMM, curcumin was administered to a patient with IgG lambda SMM with supraglottic AL amyloidosis. In this patient, the beneficial effects of curcumin were demonstrated by the size of his laryngeal amyloid deposit after 5 years of curcumin therapy - see publications.
Curcumin, as Meriva - a standardized mixture of natural curcuminoids and lecithin in a 1:2 ratio, was administered to 21 individuals (at a dose of 2 grams per day) with stage 0/1 chronic lymphocytic leukemia (CLL). The results of this 6-month study suggested that a small percentage of patients with early CLL may derive benefit from curcumin therapy by decreasing their absolute lymphocyte count, perhaps through stimulating an immune response by increasing certain cells of the immune system ie CD4, CD8, and NK cells - see publications.
Based on the above-described studies with patients with early hematological malignancies (ie, MGUS, SMM, or stage 0/1CLL) it is suggested that early intervention with curcumin may lead to delay in progressive disease and prolonged survival in some of these patients.
Curcumin does not have long term toxicities as evidenced by the number of patients with stable disease who have been taking curcumin for more than 5 years.
If you have gallstones or gall bladder disease, curcumin needs to be taken with caution! Please discuss with your doctor.
The authors of these studies suggest that larger studies are warranted to assess curcumin's benefits in early hematological malignancies.
Maitake Mushroom extract:
Medicinal mushrooms have long been postulated to have anti-cancer properties. It is generally believed that the anti-cancer effects of these medicinal mushrooms are related to the immunomodulatory effector functions of polysaccharide components.
A clinical study done in 2015 with 21 patients with early myelodysplasia (MDS), who are at increased risk of bacterial infections, showed that a Maitake mushroom (Grifola frondosa) liquid extract enhanced immune function by improving the activity of neutrophils and monocytes – both of which are important in responding to bacterial infections.
Dandelion Root Tea:
A number of case studies have reported patients with acute myeloid leukemia (AML) achieving remission and sustaining low myeloblast counts by drinking dandelion root tea (DRT). These patients self-medicated by drinking 3 cups per day of dandelion root tea.
Based on these findings, a phase 1 clinical trial has commenced to assess dandelion root extract (DRE) in patients with refractory hematologic malignancies.
Studies have determined that a fat derived from avocados, avocatin B, has in vitro and in vivo effectiveness against acute myeloid leukemia stem cells. These are a small subset of leukemia cells which are responsible for disease onset and patient relapse. Currently, there is work going on toward avocatin B’s clinical development. The avocatin B targets the mitochondria of leukemia cells.
Shogaol - a ginger extract:
Plants of the ginger family have been credited with therapeutic and preventive powers and have been reported to have anti-cancer activity.
The substance called -gingerol is the main active compound in ginger root and the one that gives ginger its distinctive flavor. At least two recent studies suggest that this compound can suppress proliferation of human leukemia cells through the induction of apoptosis .In general, researchers have considered gingerols as the active principles of the plant while ignoring shogaols, the dehydration products of corresponding gingerols during storage or thermal processing. Eight major components have been identified including three major gingerols and corresponding shogaols from ginger extract and compared for their anti-carcinogenic and anti-inflammatory activities. Results showed that shogaols have much stronger growth inhibitory effects than gingerols on H1299 human lung cancer cells and HCT-116 human colon cancer cells, especially prominent when comparing -shogaol with -gingerol .
A recent pilot study of -shogaol in six patients with early myelodysplasia (MDS) showed a decrease in ferritin levels in some of these patients. A raised ferritin level is commonly found in MDS patients. Additionally, an improvement in liver function was noted in one of these patients - see publications.
Rice bran arabinoxylan:
Rice bran arabinoxylan (Ribraxx) – a proprietary formulation of rice bran and shitake mushroom extract – has been extensively studied and found to have immune stimulating, anti-inflammatory and pro-apoptotic effects.
A clinical study on 48 multiple myeloma patients showed that Ribraxx, at a dose of 2 g per day, increased NK cell activity, increased the level of mDC’s in the peripheral blood and augmented levels of Th-1 related cytokines in the plasma of these patients compared to a placebo group.
A curcumin/ribraxx combination study carried out by our group at St George Hospital and Southern Sydney Haematology showed a positive clinical impact in MGUS/SMM patients by increasing neutrophil counts in these patients as well as decreasing inflammation, as determined by an improvement in the ESR - see publications. Neutropenia is a common and serious complication in multiple myeloma and patients with early stage disease. A neutropenic patient is at significant risk of bacterial or fungal infections. The fall in ESR was perhaps a result of a synergism in anti-inflammatory activity of both curcumin and Ribraxx.