The October 2011 Nevada Homeopathic Integrative Medical Association (NHIMA) annual conference produced an incredible number of revelations in health medicine. This brain trust of treasured integrative physicians and innovative scientists has profoundly enhanced my view of medicine on many levels. The following review of that conference will hit the high points of these great presentations. The whole conference is available on DVD for $145. Contact info@nevadahomeopathy.org or Tiffany at 775-742-4695.

Jonathan V. Wright, MD
Dr. Wright, a great innovator in health medicine (www.TahomaClinic.com), has been writing monthly articles since 1976, beginning with Prevention magazine; authored many books and publications; and has received numerous awards for his teaching and public service. He gave us several presentations.

Male Bioidentical Hormone Therapy, Part 1
Dr. Wright begins with a review of the herbs and nutrients that improve testosterone stimulation. HCG stimulates LH receptors and raises testosterone. He reports that lead, cadmium, mercury, and other toxic metals interfere with testosterone synthesis and recommends appropriate chelation therapy. When replacing testosterone at 50 to 100 mg per day, he recommends the transdermal or transmucosal route via the anal mucosa or scrotal skin route. To enhance free testosterone, he recommends nettle-pygeum complex with Urtica dioica. Checking the metabolites of testosterone, including 5a-DHT (procarcinogen), 5a-androstane-3a, 17b-Adiol (procarcinogen), and 5a-Androstane-3b, 17b Adiol (anticarcinogen) is important in monitoring male sex hormones. Transdermal fatigue or poor absorption may be due to carrier incompatibility, which can be measured by EAV, EDS, or other energetic techniques. Testosterone hyperexcretion can be blocked by using cobalt chloride 370 mcg per drop, 3 drops per day.
 
Estrogen Metabolites Evaluation and Testosterone Treatment in Prostate Cancer
Dr. Wright presents multiple studies which document that elevated 2-hydroxyestrone levels suggest reduced prostate cancer risk and elevated 16 hydroxyestrone levels were associated with increased prostate cancer risk. Testosterone therapy and prostate cancer risk were addressed with new evidence from Abraham Morgentaler, MD, associate clinical professor, Harvard Medical School.¹ "Testosterone therapy in men with untreated prostate cancer was not associated with prostate cancer progression in the short to medium term. These results are consistent with the saturation model, i.e. maximal prostate cancer growth is achieved at low androgen concentrations." Also 5a-adrostane-3b, 17b-diol inhibits prostate cancer cell migration through activation of the estrogen receptor b subtype.² 3b-Adiol reduces growth of established prostate tumors and counteracts metastasis formation in mice.

Treating Benign Prostatic Hyperplasia
Naturally occurring 5-alpha reductase inhibitors are effective in reducing BPH, and include the herbals and nutrients such as zinc, EFAs, GLA>DHA =AA=ALA=LA, saw palmetto, beta-sitosterol, quercitin, and lycopene. Patent medicines such as Finasteride reduced prostate cancer occurrence more than placebo but increased the incidence of the most aggressive types of these tumors.³

Hyperaromatization
Jonathan reminds us to always measure testosterone, estrogen, and metabolites of estrogens. Increased aromatization affects one in three males, especially those over 50, and turns men's testosterone into estrogen, which can be addressed by reducing insulin resistance and type 2 diabetes. Effective alpha reductase inhibitors include Myomin, a Chinese herbal formula containing Aralia dasyphylla, Curcuma zedoria, Cyperus rotundus, and Smilax glabra; also chrysin, a bioflavonoid component of the herb Passiflora; melatonin; quercitin; and grapeseed extract.

Erectile Dysfunction
Testosterone and acetyl-L-carnitine with propionyl-L-carnitine improved all outcomes of male aging and ED and were more powerful than Viagra alone or improved its effectiveness after radical prostate surgery. Homocysteine elevations treated with folic acid and B6 improved ED scores, especially those with MTHFR mutation.⁴ Pycnogenol and L-arginine restored sexual functioning after 90 days of therapy in 92.5% of subjects.⁴ L-arginine glutamate with yohimbine was very effective for ED. Ginseng alone or with saffron herb also improved erectile performance.

Adrenal Fatigue; Is TSH a good test?
As with all Dr. Wright's lectures, he has already written books and extensive training seminars on all of his topics. Adrenal fatigue is a devastating fact of life for all of our chronically ill patients. He first elucidates many of the symptoms of adrenal fatigue, such as lassitude worsened by exercise and relieved by rest, hypotension, postural dizziness, weakness, anorexia, IBS, hypoglycemia, myalgia, arthralgia, anxiety, memory disturbance, depression, psychosis, fainting, insomnia, multiple hard-to-treat food and/or environmental allergies, glaucoma, anxiety, irritability, and many more. He reviews the ACTH stimulation test and thinks that that 24-hour urine testing for all of the adrenal hormones and metabolites (available from his Meridian Valley Lab) is a more complete evaluation of adrenal status along with saliva testing for cortisol 4 times per day.

His treatment strategies include ample sea salt, avoidance of sugar and refined carbohydrates, moderate protein consumption, allergy elimination, and supplementing with mixed tocopherols, vitamins C, B5, A, B6, and B12, and chromium up to 6000 mcg per day for 30 days and then tapering to 2000 mcg per day. Fetal adrenal cortex tissues contain chromium 14:1 in females vs. adult levels and 6:1 in males. Adrenal chromium levels decrease with aging. Botanicals such as licorice, Ashwaganda, Korean ginseng, Siberian ginseng, ginger root, and ginkgo are important adrenal supporters. He laments the absence of adrenal cortex extract first used by William Osler in 1898 in our modern pharmacopeia and reminds us of the important work by William McK. Jefferies, MD, in his book Safe Uses of Cortisol, which recommends 2½ to 5 mg of hydrocortisone q.i.d. for the adrenal impaired. Most cases of adrenal fatigue also have low DHEA, which can be increased by supplementation, stress moderation, recreation, and Ashwaganda.

He presented several good papers documenting the inefficacy of TSH to predict thyroid normalcy.

Childhood Asthma Treatment with B12
Citing a paper from 1931 that documented hypochlorhydria in childhood asthma patients, Dr. Wright recounts his vast literature review and experience with treating these patients with B12 injections.⁵ Elimination of common food allergens such as cow's milk is also important in asthma treatment.¹⁹ He recommends B12 1 mg daily IM for six weeks, which was especially efficacious for children under 16. I have followed his protocol with asthmatic children and have noted very successful outcomes even with patients whose parents misunderstood directions and used only 0.1 mg per day. We also have had success in younger children with 1 mg per week for six weeks with no return of asthma symptoms. It is an amazing intervention that eliminates the need for long-term medication.

Hearing Loss and Glaucoma
One of our modern tragedies is that you can't walk into medical school library stacks anymore; great studies have been buried because of medical politics. Many of Dr. Wright's brilliant discoveries come from medical literature from the 1930s and before. He sites a 1937 article that detailed a significant reduction of intraocular pressure after treatment with adrenal cortical extract and a 2003 paper that described the inhibition of 11 beta-hydroxy-steroid dehydrogenase type 1 which also lowered IOP.⁶ He has personally seen many cases of glaucoma improve with his adrenal support protocol.
Aldosterone 125 mcg, p.o., twice daily returned hearing to more normal levels as well as reversing the severity of tinnitis.⁷

Hyla Cass, MD
Drug-Nutrient Depletion: Issues, Interventions, and Alternatives
Dr. Cass is a delightful physician, orthomolecular psychiatrist, and consummate lecturer (www.cassmd.com). She is a past professor of psychiatry at UCLA and has written 20 books with many national TV and radio appearances such as The Dr. Oz Show, The View, MSNBC, PBS, and Oprah and Friends.

Her major emphasis in this lecture was to review how drugs deplete essential nutrients, how nutrients can remedy this depletion, and natural-supplement alternatives to medication. Fifty percent of Americans take a least one pharmaceutical medicine; 20% are taking 3 or more prescriptions daily with over 100,000 deaths per year from taking drugs as prescribed.⁸ Recent danger issues have caused many drugs to be removed from the market, such as Vioxx, M.I., GI bleeding; Baycol, rhabdomyolysis; Rezulin, liver failure; Avandia, M.I., stroke (still on the market despite FDA panel recommending recall!). Black box warning: Paxil, suicide, homicide; cancer warning: Prempro-WHI study.

Acid Inhibitors
Antacids, H2 blockers, and proton pump inhibitors decrease stomach acid secretion up to 99% and reduce nutrient absorption of minerals and amino acids, especially calcium, iron, zinc, vitamin D, folic acid, and B12, which can cause osteoporosis, anemia, fatigue, and depression. Natural solutions for GERD include testing for H. pylori and treating with mastic gum, zinc-carnosine, betaine HCL, and probiotics. Interestingly, H. pylori overgrowth is also associated with Alzheimer's disease, diabetes, psoriasis/eczema, rosacea, ITP, and hyperparathyroidism. Cass recommends against using the triple antibiotic therapy.

Statins
Statins, the top-selling drugs on the planet, with Lipitor alone garnering $20 billion in sales, cause many side effects, including headache, rash, nausea, heartburn, constipation, diarrhea, and gas. In addition, they cause irritability, mood swings, depression sexual dysfunction, heart failure, muscle pain and weakness, rhabdomyolysis, and cognitive problems, with 15% having impaired ability to think, reason, remember, and concentrate. Statins block CoQ10, which should be supplemented for anyone taking statin drugs. Cass notes that omega-3 oils, sterols, tocotrienols, and niacin are better ways to lower cholesterol if needed.

Diabetes Drugs and NSAIDs
Oral hypoglycemics and sulfonylureas used for diabetes control can cause nausea, vomiting, diarrhea, water weight retention, and headaches. They deplete B12, folic acid and CoQ10. NSAIDs all carry significant risk of GI erosion and bleeding, and most carry cardiac risks. COX-2 inhibitors such as Celebrex cause 16,500 deaths per year in the US alone, and Bextra and Vioxx were removed from the market. NSAIDs also deplete folic acid and vitamin C.

Fabricated Efficacy Studies
On March 11, 2009, Scott Reuben, MD, former chief of acute pain at Baystate Medical Center (Springfield, Massacusetts), and former paid spokesperson for Pfizer, revealed that data for 21 studies that he had authored on the efficacy of Celebrex (along with other such as Vioxx, Bextra, Effexor) had been fabricated: the analgesic effects of the drugs had been exaggerated.

Diuretics
Loop diuretics (Lasix, Bumex) and thiazides (HCTZ) increase the kidneys' water and salt elimination and deplete calcium, magnesium, sodium, potassium, zinc, CoQ10, B1, and B6. Potassium-sparing diuretics (spironolactone, trimanterene) deplete calcium, folic acid, B6, and zinc.

Antihypertensives
ACE inhibitors (Catapres, Aldomet) depelete CoQ10, B6, B1, and zinc. Beta blockers (Inderal, Corgard) deplete CoQ10 and melatonin. Sartan drugs (losartan, valsartan, etc.) deplete magnesium phosphorus, potassium sodium, zinc, and CoQ10. Natural remedies for hypertension include stress reduction, exercise, anti-inflammatory diet, salt issues, heavy metal detection/detox, garlic, grapeseed extract, hawthorn berry, magnesium, calcium, CoQ10, and thyroid support when indicated.

SSRIs and Psychiatric Drugs
SSRIs and SNRIs deplete neurotransmitters by causing large increases of neurotransmitters in the synapse and their subsequent metabolism by MAO and COMT, resulting in low presynaptic neuronal levels of 5-HTP, tyrosine, phenylalanine, levodopa, tryptophan, and cysteine which should be replenished and also used as a first-line treatment for depression. Other psychiatric drugs cause depletion: lithium – inositol; valproate – carnitine; folate, selenium and zinc; carbamazepine – calcium, biotin, vitamin D, and folate; anticonvulsants – folate, B1, B2, vitamin D, and vitamin K (phenytoin); tricyclics – B2 and CoQ10; SSRIs beside neurotransmitters and amino acids, melatonin; phenothiazines – B2 and CoQ10; haloperidol – CoQ10.

Many drug side effects may be due to nutrient depletion, and Cass thinks that supplementing with a high-potency multivitamin with CoQ10 and higher doses of vitamin D and essential fatty acids when needed is a good starting point to balance drug intake.
 
Bradford S. Weeks, MD
CCC (Corrective Cancer Care), IPT (Insulin Potentiated Therapy), CSC (Cancer Stem Cells), QOL (Quality of Life) and the Cordelia Effect in the Treatment of People with Cancer
I thought Dr. Weeks's lecture was truly revolutionary (www.weeksmd.com). A great student of medicine and literature, he is a fine wordsmith and communicator. In Shakespeare's King Lear, Lear's third daughter, Cordelia, proved to be the most beloved and loyal. Using this analogy to cancer therapy, Weeks unwinds the kinder, gentler, and more comprehensive approach to cancer care. He is an orthomolecular psychiatrist, rigorous researcher, humanitarian, musician, and apitherapist from Washington State, with extensive writing and international lecturing experience.
Cancer, he notes, is not the problem; cancer is an adaptive response to the problem. Toxic blood and tissue (the mesenchyme) is the problem.

Insulin Potentiated Therapy
The first IPT was used in 1946 by Donato Perez Garcia Sr., MD, to successfully treat breast cancer. Cancer cells have extensive insulin and IGF-1 receptors and have from 6 to 17 times more insulin receptors per cell than noncancer cells. Insulin targets cancer cells and enhances anticancer drug effects, which can be effective in much smaller doses than usual chemotherapy treatment. Only 2% of all cancers respond to traditional chemotherapy at the five-year survival level.⁹ Insulin enhanced the cytotoxic effect of methotrexate in MCF-7 human breast cancer cells in vitro by a factor of up to 10,000-fold.¹⁰

Glucose is the only fuel that cancer cells can use. Cancer cells have 10 times the IGF -1 receptors as regular cells.¹¹ Insulin increases delta 9-desaturase, which makes cancer cells become permeable. IGF-1 doubles the number of cancer cells in S-phase: increasing vulnerability to chemotherapy drugs. Cancer cells are selectively targeted so that lower doses of chemotherapy can be used, which are very effective and preserve immune function. It also increases appetite, weight and, euphoria.

Nutrients
Lifestyle, exercise, quality thoughts, and supplements are all part of Weeks's program for corrective cancer care. He notes that caffeine forces apoptosis, along with curcumin and turmeric. Theanine increases gamma interferon, arginine increases natural killer cells and T-cell function. American ginseng increases T-cell function, melatonin increases IL-2 and epidermal growth factor. Vitamins A, C, and D are also important along with aromatase inhibitors, BioDim, and Myomin. To prevent metastases, Weeks recommends modified citrus pectic, heparin, and thalidomide. Fermented soy in Haelan 951 contains isoflavones, protease inhibitors, saponins, phytosterols, and phytic acid compounds. Proteolytic enzymes taken away from food selectively attack and kill cancer cells, clean up debris, unmask cancer cells (membrane effect), prevent metatstatic disease, and offer systemic immune enhancement with a compelling scientific, clinical record.

Vitamin D3 has 63 recent studies that have shown that the incidence of colon, breast, and ovarian cancer can be dramatically reduced by increasing the public's intake of vitamin D.¹² Vitamin K3 especially in combination with vitamin C showed synergistic effects. High-dose IV vitamin C infusions have been shown to have cytotoxic effects in most cancer cell lines in vitro. The mechanism appears to be intracellular accumulation of H2O2 with low catalase enzyme activity native to cancer cells. Vitamin C has also been found to potentiate the effects of chemotherapy drugs.¹³

Cancer Stem Cells
Max Wicha, MD, distinguished professor of oncology and director of the University of Michigan Comprehensive Cancer Center, has delivered a startling revelation that standard cancer treatments not only often fail to eradicate cancer, but can make it worse. The reason that breast cancer and other malignancies often return aggressively after treatment is that when tumor cells die under assault from chemotherapy and radiation, they give off substances that can reactivate a special set of master cells known as cancer stem cells. Dr. Wicha's lab has found that inflammatory molecules secreted by dying tumor cells (IL-8) can hook up with the stem cells and cause them in effect to come out of hibernation. Cancer stem cells are relatively resistant to cytotoxic chemotherapeutics and radiation. "Chemotherapy and radiation makes cancer worse."^14,15

Dr. Weeks offers many treatments to help suppress cancer stem cells. Please get his entire lecture from NHIMA; and he had a lecture scheduled at the Orthomolecular Health Medicine conference February 24, 2012, in San Francisco. He thinks that it is necessary to reeducate confused cancer stem cells by changing the body's environment with anti-inflammatory agents to disrupt the IL-8 cytokine "SOS" and allow differentiation of cancer stem cells. Such agents include Reprotaxin, a cancer cell receptor 1 blocker (per Dr. Wicha), soy, above nutrients, and enzymes, as well as iodine (iodolactones), which increased apoptosis in 80% of breast cancer cell lines.

High on Fermented Soy
Haelan 951 is a potent treatment for cancer that decreases pro-inflammatory cytokines including IL8 and promotes cell differentiation in five cancer cell lines in vitro, as shown in studies dating from 1990.¹⁶ This fermented soy product also promotes antiangiogenesis and stem cell metastasis by its anti-inflammatory mechanism. It improves apoptosis of cancer cells, and DNA repair, reactivates P-53 tumor suppressor gene, and increases P21 activity. It also reduces estrogen levels, increases estrogen receptor-beta receptors (ER-b), decreases estrogen receptor-alpha (ER-a), and decreases matrix metalloproteinase enzymes, which erode collagen containment of tumor cells and allow cancer stem cells to spread throughout the body, creating metastases. This product also helps prevent protein calories malnutrition (cachexia or starvation), which kills 80% of cancer patients. It shuts down that NF-kB mutation pathway, which is used by cancer cells to escape death, and enhances tumor necrosis factor (TNF), a pillar of our immune system required to fight cancer. Fermented soy overcomes depression with improved quality of life and increases nonspecific immune stimulation by 400%, with macrophage levels improving 3-fold, and doubles the number of active macrophages. Other positive characteristics include reduction of exosomes, which are particles that inhibit both NK cells and gamma interferon, and increasing BAX gene 500% that kills cancer cells via allowing apoptosis and decreasing BCL2 gene by 200%, which allows cancer cells to thrive by evading apoptosis.

Taking Haelan fermented soy 4 oz twice per day may be challenging in regard to taste; it is very bitter. Weeks recommends taking it with stevia/xylitol and Ola Loa Orange drink, one packet in cold water. It may also be taken via retention enema.

Metformin for CSC
New data from Cancer Research Journal 2011 in May demonstrate that metformin selectively kills chemotherapy-resistant cancer stem cells in breast cancer cell lines, and studies in Medical Oncology February 2011 suggest several mechanisms for its ability to suppress cancer growth in vitro and vivo.^17,18 It activates LKB1/AMPK pathway, induction of cell cycle arrest and/or apoptosis, inhibits protein synthesis, reduces insulin levels, inhibits the unfolded protein response, activates the immune system, and eradicates cancer stem cells.

Summary: Stem Cells and Cancer
"Cancer mortality is directly related to cancer stem cell activity (metastatic and proliferative processes). Chemotherapy and radiation do not kill cancer stem cells. Chemotherapy and radiation make cancers grow faster and more virulently. Treatment of cancer patients requires adjunctive care. Treatment which fails to address the toxicity of cancer stem cells is futile and irresponsible". Please go online to Dr. Weeks's websites to get all of the citations for further reading on stem cell treatments and leading researchers in the field, including Walter Wainright (Haelan Research Foundation); Max Wicha, MD; Michael Clark, MD, director, Stanford Institute for Stem Cell and Regenerative Medicine; Max Diehn, MD, oncology radiologist, Stanford University; and Ursula Jacob, MD.

Clinical Case Studies
Dr. Weeks presents five clinical case studies with phenomenal outcomes. Stage 4 cancers with a death sentence responded to his therapies with great success. Please read his full reports from his lecture on NHIMA DVDs or from his website. In addition to the above treatments, he uses LDN 4.5 mg, low-dose naltrexone touted to stop tumor growth. Cimetidine is also added for its antitumor effect. He uses chemosensitivity testing via Biofocus in Germany, which grows cancer cells in culture and determines which chemotherapy and nutrient therapies induce apoptosis and focus on which chemotherapeutic agents are most effective in IPT. In addition, he uses IV vitamin C 50 to 75 g backed by alpha-lipoic acid 600 mg by IV push 3 hours later to improve the oxidative stress on cancer cells by vitamin C. (Thanks to Bert Berkson, MD, who has championed alpha-lipoic acid for many decades.) Weeks also uses homeopathic and anthroposophical remedies such as aurum stibium, Hyoscyamus, hepar stannum, Lien cichorium, lymphocytes 8, thrombocytes 6, and erythrocytes 6. In addition to Haelan 951, Ioderal, multivitamin and mineral supplements, niacin, selenium, CoQ10, vitamin D3, LDN 4.5 mg, and metformin 500 mg b.i.d.

Quotations from King Lear
Cordelia: Time shall unfold what plighted cunning hides.
Who covers faults, at last shame them derides. …
…
We are not the first
Who with best meaning incurr'd the worst.

Tune in for our next installment of the Brain Trust next month.

Michael Gerber, MD, HMD
contact@gerbermedical.com

Notes
1.   Morgentaler A et al. Testosterone therapy in men with untreated prostate cancer. J Urol. 2011 Apr;185(4):1256–1261.
2.   Guerini V, Sau D, et al. Cancer Res. 2005;65:5445–5453.
3.   Wilt TJ, et al. Five-alpha-reductase Inhibitors for prostate cancer prevention. Cochrane Database Syst Rev. 2008 Apr 16;(2):CD007091.
4.   Stanislavov R, Nikolova V. Treatment of erectile dysfunction with pycnogenol and L-arginine. J Sex Marital Ther. 2003 May–June;29(3):207–213
5.   Bray GW. The hypochlorhydria of asthma in childhood. Q J Med. January 1931;24:181–197.
6.   Josephson E. Glaucoma and Its Medical Treatment with Cortin. New York: Chedney Press; 1937.
7.   Trune DR, Kempton JB, Gross ND. Mineralaocorticoid receptor mediates glucocorticoid treatment effects in the autoimmune mouse ear. Hear Res. 2006 Feb;212(1–2):22–32.
8.   Lazarou J et al. Incidence of adverse drug reactions in hospitalized patients:a meta-analysis of prospective studies. JAMA. Apr 15, 1998;279(15):1200–1205.
9.   Morgan G, Ward R, Barton M. The contribution of cytotoxic chemotherapy to 5-year survival in adult malignancies. Clin Oncol (R Coll Radiol). 2004 Dec;16(8):549–560.
10. Alabaster O, Vonderhaar BK, Shafie SM. Metabolic modification by insulin enhances methotrexate cytotoxicity in MCF-7 human breast cancer cells. Eur J Cancer Clin Oncol. 1981;17:1097–1103.
11. Cullen JK et al. IGF-1 receptor expression and function in HBCC. Cancer Res. 1990;50:48–53.
12. Professor Cedric Garland the University of San Diego, California, after reviewing 63 recent studies on Vitamin D and cancer.
13. Zaizen et al. J Cancer Res Lin Oncol. 1986; Prasad et al. Pol J Pharmacol Pharm. 1992; Koch, Biaglow. J Cell Physiol. 1978; Hanck AB. Vitamin C and cancer. Prog Clin Biol Res. 1988;259:307–320.
14. Weeks B. Corrective Cancer care – inhibiting the lethal cancer stem cells [blog post]. WeeksMD. http://weeksmd.com/?p=5014; Wicha M. Breast cancer stem cell regulation [online video]. http://wn.com/professor_max_wicha__breast_cancer_stem_cell_regulation.
15. Baker, M Stemcells: Fast and furious. Nature. 2009 Apr 23;458(7241):962–965.
16. Handayani R. Soy isoflavones alter expression of genes associated with cancer progression, including interleukin-8, in androgen-independent PC-3 human prostate cancer cells. J Nutr. January 2006;136:75–82.
17. Iliopoulos D, Hirsch HA, Struhl K. Cancer Res. 2011 May 1;71(9):3196–3201.
18. Kourelis TV, Siegel R. Metformin and cancer; new applications for an old drug. Med Oncol. 2011 Feb 8.
19. Kokkonen J, Simila S, Herva R. Impaired gastric function in children with cow's milk intolerance. Eur J Pediatr. 1979 Sep;132(1):1–6.