Reversing Diabetes Without Drugs

It can seem with any chronic illness that the road is one way. You can slow the progression using drugs, but there is no way to go back. This feels particularly true with patients who have diabetes. Yet a new study shows that isn’t the case. 

The researchers in this study used a novel new approach called diet, foregoing the usual drugs. They found that diabetes patients, many of whom had been diabetic for years, were able to reverse their diabetes by using a low-calorie diet and dropping about thirty pounds. 

The numbers the researchers saw in these patients were similar to those seen in weight-loss surgery patients. Surgical practices advertise that they can reverse diabetes, but it usually involves a major surgery and the subsequent loss of over a hundred pounds. 

What happened in the low-calorie diet was that diabetic patients were able to reset their insulin levels and increase their body’s ability to process sugar. The question is why this study needed to be done at all. Shouldn’t diet be the first treatment for diabetes? But doctors reach first for drugs now, even in the U.K. You didn’t honestly think this kind of study would ever be done in the U.S., did you? Here’s more for the geeks among us, and here’s the original study abstract for your doctor.

 

The Truth About the Outback Vision Protocol

Here’s the question: if something is amazingly successful, why does it need to saturate the airwaves with advertising?

That’s the problem with the Outback Vision Protocol, which was first sent to me by a patient. The extremely long infomercial-style presentation promised me that two marvelous supplements would cure very serious vision problems. My hearty presenter informed me that these supplements, with the addition of kangaroo meat, are what a keen-eyed group of soldiers use for superhuman vision. They cured his wife’s eye problems and they could cure mine. 

Some of you already can see what’s coming. But if you’re one of the millions of people dealing with macular degeneration, you might keep reading and pull out your credit card. So let me save you the time. (Read more here). 

At long last, the supplements were revealed to me. They were (drumroll please) lutein and zeaxanthin. If I seem underwhelmed, I am. These are not mysterious or new. They’ve been around for decades. In fact, they’ve even been tested for exactly the sort of use that the presenter is making on his infomercial. AREDS 2 tested the use of lutein and zeaxanthin for macular degeneration because researchers saw enough possible benefit. The study was done, and the results are already back. 

“In the AREDS2 trial, adding DHA/EPA or lutein/zeaxanthin to the original formulation (containing beta-carotene) had no additional overall effect on the risk of advanced AMD.” 

So, yes, some supplementation can help with worsening macular degeneration risk, but it’s unsexy stuff  from AREDS 1 like:

  • 500 milligrams (mg) of vitamin C
  • 400 international units of vitamin E
  • 15 mg beta-carotene
  • 80 mg zinc as zinc oxide
  • 2 mg copper as cupric oxide

These were the original ingredients in AREDS 1, which did show benefit in preventing advancing macular degeneration. The Outback people say that AREDS supports their claims, but no one running the AREDS trials would support claiming that any supplement would reverse eye degeneration. 

I ask myself, if the study has already been done, why is this David Riley pushing supplements that don’t work? Well, to begin with, he’s not David Riley. It says so on his extensive disclaimer page. Another ad campaign features another name with the same protocol: Bill Campbell’s Outback Vision Protocol. We’ve got pages of fake reviews of the protocol by reviewers like “Jrhonest” who claims to write an honest review but just repastes the same information of the other fake reviews. The only place to get real reviews of the Protocol are on sites like Amazon that work hard to prevent the kind of spamming Campbell has done elsewhere. What does Amazon say? (The book has been pulled from Amazon because of terrible reviews, so the link now goes to German.) Save your money. 

So, before all of you ask me to write a book on vision loss, I’ve already started. Here’s a sneak preview: do you know what helps vision? Exercise. NOT eye exercises. Exercise for your body. Study after study supports getting out and moving more. 

 

How turmeric and diet can help NF1 patients.

A new study, brought to my attention by another patient, shows wonderful news for both children and adults with NF1. We finally have evidence that this genetic disease can be seriously improved through dietary intervention. It also gives evidence that supplements added to a bad diet won’t help much.

The study followed NF1 patients for six months, on either the Mediterranean or Western diets. Neither diet impacted the rate of neurofibromas. Then the researchers added 1200 mg (three capsules worth) of turmeric to the diets. Adding turmeric to the western diet did nothing. But adding it to the Mediterranean diet caused a slowing in the buildup of neurofibromas.

Having a diet and a single supplement slow the progression of a genetic disease is wonderful. It means that the disease is not genetic in its symptoms, but epigenetic. Epigenetics is the study of how the body turns off and on genes. The diet and the supplement were able to turn off the progression of neurofibromas.

But what is truly startling is that several of the patients experienced a reversal of existing neurofibromas! That’s not just epigenetic, that’s a switching on of other genes that are significantly repairing previous damage. It opens the door to moving NF1 away from the genetic category, into a metabolic disorder that should be addressed from birth.

In my book, Helping Your NF1 Child: A Parent’s Guide To Neurofibromatosis, I argue for this outlook on the illness. But I did not expect to have this kind of evidence that dietary and lifestyle interventions could reverse the disease.

Here’s the full study available for online reading. It is small and preliminary, but very exciting! We need more studies. 

Why Colon Cancer Won’t Be 100% Cured By A Mouse Study.

As someone who’s had colon cancer, I was excited by the Newsmax headline that trumpeted. “3-Step Treatment Cures Colorectal Cancer in Mice” (yes, I use a variety of news sources, NPR to Newsmax). But when they said that this new treatment was 100% cure, I got suspicious. 

When I get suspicious, I go digging. The Newsmax story didn’t give me enough specifics to find the original medical article, but I found it eventually. The original title is a mind-numbing, “Curative Multicycle Radioimmunotherapy Monitored by Quantitative SPECT/CT-Based Theranostics, Using Bispecific Antibody Pretargeting Strategy in Colorectal Cancer.” It makes me wonder if I missed the class in medical school on how to write the most boring headlines imaginable. 

The most exciting word of the headline is “curative.” These mice were cured. But these mice didn’t get colon cancer the normal way (bad lifestyle choices and poor genetics). They had human colon cancer cells xenografted onto them. If that sounds Dr. Frankensteinish, it is. You get a specifically bred mouse that won’t reject the human cells, then you graft on separately grown cancer cells. The result may or not be relevant to even cancer growth in regular mice. A lot of cancer research has moved away from these mice because regular mice give us a better sense of regular cancer growth. But the xenograft can use human cells, that may or may not give us a better sense of how human cancers would respond to a treatment.  

So maybe this is a cure for colon cancer? Well…maybe. How many mice were treated? Ten. How many got better? Ten, but they only assessed nine of the mice under a microscope. The abstract didn’t mention what happened to the tenth mouse. 

Before I sign up for this particular treatment, I think I’ll at least wait for the bigger mouse trial. Call me a skeptic, but I like at least a hundred xenografted Frankenstein mice in my studies before I think about it. Not to mention a primate trial, small experimental human trials on metastatic patients, and finally a large-scale trial of human patients. In other words, we’re years from having this news really be news you can use. 

Dr. Sarno, All THE RAGE, and Chronic Back Pain.

Today, for those of us in the chronic back pain field, Dr. Sarno is a bit of a legend. He has a perpetually best-selling book, multiple celebrity endorsements, and an established place in the NY medical community. When I wrote my own book on chronic back pain, I looked at him as a leader in the field. 

But the movie All The Rage brings that idea into a sharp contrast with the reality of Dr. Sarno’s ideas being largely ignored by his colleagues. Not just ignored, disregarded as foolish. In a world where we cut, inject, and numb with our strongest painkillers, Dr. Sarno’s solution of the mind has no place. His results were disregarded as placebo, and his colleagues did not refer their patients to him because they did not believe what he was doing could work.

In the past year we have had the medical realization that our strongest painkillers are not more effective than lesser, over-the-counter medication. They are also addictive, creating a crisis that kills patients and robs others of their health. Our surgeries are not as effective as advertised, leaving half of those going under the knife still in agony. We have no better solutions, and Dr. Sarno seems all the wiser for seeing the obvious well before the rest of his colleagues.

Is Dr. Sarno’s mind-over-pain the answer? No. But it is half the answer. The half that has been silenced, ignored, and ridiculed. Today we know that a patient’s emotional state before a surgery has as much effect on the pain after the surgery as the best surgical team. We know that chronic pain can appear and continue with or without any visible mechanical problem. And we know that the mind, when used properly, can be more effective at pain management than our most powerful drugs.

All The Rage captures the profoundly personal journey of chronic pain, detailing one family’s issues with chronic pain and their encounters with the enigmatic Dr. Sarno. Through them, we see his own journey, his progression from traditionalist to staunch pioneer in the pain field. All The Rage captures the beginning, the middle, and the end of Dr. Sarno’s career seen through the lens of a filmmaker forced to cross the fourth wall from objective observer to unwilling participant. In so doing, the film becomes as much autobiographical as biographical, giving us an intimate portrait of the true effect of chronic pain on a family. We see the origin, the arc, and the possible resolution of a lifelong dance with pain. By the end, the viewer wants to see more of the family’s journey, but hopes for their sake that no sequel is ever necessary.

If you have experienced chronic pain and wondered if perhaps there was an emotional aspect, Dr. Sarno is here on the screen to squinch up his bushy eyebrows and tell you, “Of course there is a direct relationship.” All the more helpful, now that he has left his practice and gone to that medical classroom in the sky. He passed away in June, 2017, leaving his books, his legacy, and this movie to catalogue his passing. While they did not appreciate him in his life, the medical community may yet learn to use what he left us to help solve the puzzle of intractable pain.

 

All The Rage (Saved by Sarno) from rumur on Vimeo.

A 200% Increase In Powassan Virus In Maine?

Is your inner anxiety not yet up to “impending catastrophe?” Are you not watching enough political media to make your blood boil? Here’s a new threat, possibly lurking in your backyard, Powassan virus!

The earliest mention of Powassan Virus in online medical journals is from 1959,  when it was first named after a town in Ontario where it was found. That 1959 medical article mentions that Powassan had probably been around for decades. So why are we hearing so much about it now?

Well, we’ve just had two cases of Powassan in Maine. By just, I mean that we just had two more cases. Two earlier cases this year were reported in a Bangor Daily article back in April. Those were from around Portland, and these two new ones are from the midcoast region. Bringing our total for the year to four cases.

At the same time, we’re counting hundreds of Lyme cases, so why do we care so much about Powassan? Well, according to the CDC, Maine only had two Powassan cases IN THE PAST TEN YEARS. So the four this year brings our total up to a headline causing,

“Two hundred percent increase in Powassan in Maine!”

Is Powassan a true terror? Yes and no. It’s not new to Maine, and previous surveys have found it widely spread (but not very common) among Maine’s tick populations. We had another notable outbreak at the turn of the Millenium, four cases that included both Maine and Vermont. Checking residents, between 1% and 4% of Mainers likely have antibodies to Powassan.

But Powassan is scary because it’s viral and we don’t have a good treatment. Arguably, we don’t have great treatments for Lyme either, but that’s a whole different issue (a bit more on that later). 

If you get Powassan, you very likely won’t get symptoms. If you do get symptoms, they feel like the flu and you’ll likely recover. But if you get symptoms and your body doesn’t kick it, there’s very little modern medicine can do for you besides support you. Just like any number of other viruses. 

If it starts to feel vaguely familiar, it should. Powassan is a flavivirus. Yes, like Zika virus. Different subspecies, same family. Powassan’s flaviviral branch includes Russian spring-summer encephalitis, Central European encephalitis, Omsk hemorrhagic fever, Kyasanur Forest disease, and Powassan. Just reading through its close family members, you should get the sense that Powassan is likely coming from a more northern branch of the flavivirus family than Zika.  

Also notice that every one of these viruses has a pretty scary sounding name. Omsk hemorrhagic fever sounds like a reason to never, ever visit Omsk, which Dostoevsky immortalized as “a hateful hellhole” but which likely influenced all his writing since he was imprisoned there. (They now have a museum for him.) 

A large part of the problem of the flaviviruses is that we’re still assigning every member of the flavivirus family a new name. Think about the flu viruses. We had swine flu, avian flu, etc. and they sound much scarier than H1N1, which is another variation of the same family of viruses. All of the flaviviruses should be assigned a number so that we understand that this isn’t a total unknown, this is another member of a well known and widespread set of viruses that has been with humanity for centuries. Public health officials have started the process by labeling the four different strains of Dengue fever (another flavivirus) one through four rather than giving them all different names like the four horsemen of the Apocolypse. 

According to the CDC, “Powassan (POW) virus is transmitted to humans by infected ticks. Approximately 75 cases of POW virus disease were reported in the United States over the past 10 years.” So our four cases of POW will really make the news. Maine, home of the Whoopie pie, the lobster roll, and the obscure tickborne illness. Is this really what we want to be known for? 

So, should we just watch out for ticks to protect ourselves from Powassan? Maybe. I would argue that the flaviviruses are largely misunderstood as only vector-borne diseases. I’ve mapped this out in Zika Virus When You’re Expecting and I talk about focusing on just ticks in Why Chronic Lyme Doesn’t (And Does) Exist. Blood born diseases need to be seen as more widespread and contagious than we’d like to think. 

But, because they are much more widespread, they also may be much less deadly than they would appear from the very few serious cases that get reported. Powassan reports of serious side effects may indicate a spread of the disease in Maine. But the number of symptom-free cases of Powassan will continue to dwarf the number of serious reported cases. 

Should you worry about Powassan? No more than you would about getting a serious flu and not recovering. While this year in Maine we had four hospitalizations from Powassan, we also had 586 hospitalizations for the flu.

For the few of you heedless folk who ignore the Lyme warnings, who’ve still been frolicking in the buff in tick-infested fields, I doubt if the added threat of Powassan will convince you to change your behavior. For those of us who are already avoiding the fields and doing tick checks, don’t let the fear of more rapid transmission of Powassan panic you. Continue doing what you’ve been doing, and take care of yourself if you get sick. As a virus, all of the things you would do to help yourself get better from the flu would apply to Powassan too.   

NYT Article On Salt: A Rhythm And Weight Loss

Salt may not make you thirsty, and it may help with weight loss. 

Yep, those on the conclusions of a NYT article on Russian Cosmonaut studies. Researchers rarely get to put people in isolation and measure all their excretions (what a great job!) so they can be forgiven for missing this particular discovery. 

It turns out that the cosmonauts had twenty-eight-day cycle of salt retention, even if they were on a low salt diet. Because these were men, it’s a new discovery. If they’d been women, everyone would have said, “I knew that.” 

The men also lost weight when they ate lots of salt, and weren’t thirstier overall. Again, this seems miraculous until you remember that iodine reacts with the thyroid to stimulate thyroid function. Lots of salt, lots of thyroid function. But the reason we don’t do tons of salt is because you can’t really control thyroid function well with salt. Sometimes it becomes active (weight loss) sometimes it gets very active (panic attack) and sometimes it desensitizes the body to thyroid (weight gain despite all your best efforts). 

So, while researchers scratch their heads, here’s the take home. Turns out men have a twenty-eight-day cycle too. If he’s cranky and looks bloated, it may really be his time of the month. 

New Norwegian Study Supports The Colon Cancer Diet’s Recommendations.

A recent Norwegian study on aspirin and colon cancer patients was published in May. Unlike many other, smaller studies, they were able to survey the entire population and had automatically recorded their aspirin use from over ten years ago. Bad for personal privacy, good for medical research. 

The study combined all cancer groups, but found a significant (15%) reduction in cancer deaths directly associated with aspirin use. Stage II patients benefitted slightly more. 

 Aspirin is recommended in my book, The Colon Cancer Diet, though my personal experience with it has been that it likely increased my CEA. It’s nice to see it being supported so broadly.

A study of this size is wonderful because it doesn’t just make the alternative medical journals. Not only did the study get written up by N.D.s (article here), it appears on a conservative Texas Colon Cancer Research Center’s site.

2015_12_22_15_55_46

Hopefully, the broad interest will translate into a changing of recommendations for colon cancer patients. The problem is that adding aspirin after surgery might make surgeons concerned about bleeding. So the proper time to recommend aspirin would be at the six week follow-up appointment.

Should Colon Cancer Patients Take Avemar or Fermented Wheat Germ Extract?

So many products have no medical research, it’s hard to say no to one that does. Avemar is sold widely and used by many practitioners, so why would I not recommend it? I don’t, and here’s why. 

 

Patented back in 1998, fermented wheat germ extract (Avemar) was supposedly Dr.Hidvégi’s life work. He based it on Dr. Gyorgi’s idea that compounds like it might balance blood sugars. So how did we get from balancing blood sugars to curing cancer?

The company isn’t saying, but I suspect that this particular extract tastes terrible. The initial studies talked about basically a paste you had to eat. They’ve added more water and an orange flavor, but that usually is a sign of something fairly unpalatable. 

But there are studies. We’ve got test tube studies, rat studies, and an open label human trial for colon cancer patients. Overall, the results are all very positive. An article by another enthusiastic practitioner pushing the product for all cancers brought it to my attention. 

Let’s skip the other studies and move right into the human trial. The open-label trial showed that the product lowers recurrence and metastasis. So sign me up, right?

Not necessarily. The open label trial started with this selection process: “Patients were asked if they prefer to take MSC (Avemar), and thus enrolled in the MSC cohort. Those patients who refused to take the preparation formed the control cohort.” In other words, those who wanted to try anything to get better took the product, while those who couldn’t be bothered didn’t. The researchers note that there were more advanced cancers in the study group, as well as that the control group was older. Both groups got other treatments, including radiation and chemotherapy, and there wasn’t any difference in outcomes between the two groups due to those treatments. Those taking the product took nine mg of it, once a day in water, for months. The effect was startling: “MSC decreased the risk of death among colorectal cancer patients by nearly 70%.”

A 70% reduction is astounding, especially if we’re talking about metastatic patients who made up almost a quarter of those taking the product.

So…where are our follow-up studies? The initial open-label study was published in 2003, and we’ve seen many other test-tube studies since. But these are in other areas, things like Lupus or Rheumatoid Arthritis. Avemar is still being discussed as an addition to chemotherapy because it may help with side effects, but there hasn’t been another study published on a human colon cancer trial since. The initial study was funded by a grant from the Hungarian government, so maybe that grant wasn’t renewed? My suspicion is that a second study did not show as significant a benefit, and they never published it. Instead, they did what every drug manufacturer does. Look for other possible uses for your drug rather than trying to find a new one. 

So, since Dr. Hidvégi is listed as a co-author for several of the Avemar studies, I thought I would look more closely at his life’s work. Interestingly, he seems to have spent much of his career working in the grain industry, switching over to working in the supplement field in 1990. His first patented product was called Esterin (an alfalfa based extract), which supposedly lowered cholesterol. 

Now, there’s a lot of research on alfalfa saponins and lowered cholesterol. It stretches farther back than Dr. Hidvégi. But even in 2014 we’re still looking at rat studies. That didn’t stop Dr. Hidvégi from patenting his compound, exclusively marketing it through a single U.S. company as Cholestaid or on Amazon as Cholestsorb. It’s not available anymore, and a lawsuit in 2004 details how GNC repackaged it for years

Here’s the updated history, then, of Dr. Dr. Hidvégi. He started his own company to sell a patented product, Avemar, after failing to sell another patented product Esterin. With Esterin he made the mistake of reselling it to many supplement companies, but now he’s figured out that exclusivity is the key. 

All of this is interesting, but is it relevant? Yes. Because now we come to cost. A thirty day supply of Avemar will cost around $200. That’s an absurd price, unless you’re a drug manufacturer, which is where Avemar is going with the current research. Rather than focus on the retail crowd, Dr. Hidvégi is angling his product to be included in with chemotherapy. Given that chemo tends to run $1500 a treatment, a $200 add-on makes a lot of sense. 

But in terms of cancer patients, a $200 price tag means trading food for Avemar. And that price tag does not meet the minimum requirements for matching the one human trial. The trial subjects took nine mg of Avemar a day, while the daily dose given for $200 is 5.5 mg. So to match the only human trial, patients would need to double their dosage at $400 a month. 

Even that dosage might not be enough. Japanese researchers found a benefit from Avemar, but at a dose in rates of one mg for every two pounds of body weight. To afford that, a 100 pound patient would need ten standard packets a day at a cost of $2000 (maybe less. They sell it cheaper in bulk). 

If Avemar were priced affordably, I would consider it. The side-effect picture is very mild, and -especially for metastatic patients- the open label results were very hopeful. But given the cost, and the lack of any further studies despite drug-level prices, I’d have to pass on Avemar.  

 

Notes and research for Marijuana and Cancer Pain Talk.

I spoke at the Alfond Cancer Center at 6 pm on Tuesday, October 25, 2016 on pain and marijuana use. These are my extended notes including studies I cited. 

Casket joke: What would you want them to say? Doctor, Teacher, realist.

Discussing Pain

 Who I am.

  1. Naturopathic Doctor
  2. Colon Cancer Survivor? (I prefer the term “careful person”)
  • Researcher Does marijuana help with cancer pain?
  1. No. -side note on politics and medicine.
  2. Maybe. -nausea research.
  • What is pain?
  1. A definition of pain. Unpleasant sensation. physical suffering or discomfort caused by illness or injury”
  2. a) Dental work b) broken arm c) vagovasal response to needles d) “gas pains” post-surgery.
  • Tolerance is based on predictability, expectation, and duration.
  1. Uncontrolled, random, unending pain
  2. Torture is “the action or practice of inflicting severe pain on someone as a punishment or to force them to do or say something” it’s horrible but at least you know when and why.
  • What causes the pain in cancer?
  1. The mass vs. the mind.

In the subgroup of 22 patients who underwent the full cycle of 4 treatments, the mean VAS anxiety score decreased from 6.77 to 2.28 (P <.000001) and the mean VAS pain score from 4.4 to 2.32 (P = .091). Overall, the sessions were felt helpful in improving well-being, relaxation, pain relief, sleep quality and reducing anxiety.”

  1. Not limited to cancer. Knee surgery outcomes depend on a) expection b) anxiety, c) depression, d) the skill of the surgeon.
  2. Not a learned behavior. Touch and sugar on neonatals.
  • Standard treatments for cancer
  1. How well studied are the opiods?
  2. How well done is end of life care?
  3. Prior to hospice, are we taking care of patients?
  • Tracking, meeting and treating pain

Other natural Treatments for Cancer Pain:

A. Ice Locally Proximally

B. Heat Locally Full body Distant

C. Capsaicin Local depletion of substance P. Along entire nerve root

D. Massage

  1. Proximal to the area (upstream and down)
  2. On the opposite side
  3. On the spinal column
  4. On the feet
  5. On the ear

E. Prayer/Reiki

  1. Any area
  2. Hands on/Hands off
  3. Distant, specifically (give time and frequency)
  • Cortisone shots
  1. Proximal
  2. Into nerve roots
  3. Much simpler that nerve cutting
  4. Saline injections may be as effective (nerve pressure)
  • TENS units
  1. Muscle fatigue and natural opiod release
  2. At nerve root to fatigue nerve pathway
  • Anti-anxiety medication
  1. Anticipatory pain relief
  2. Many natural options: valerian, hops,passion flower, etc.
  • Muscle relaxants
  1. Muscle clenching due to pain builds lactic acid=more pain
  2. Natural option Kava releases muscles and lowers anxiety
  • Meditation
  1. Jon Kabat Zinn
  2. Women (colon and gynecologic cancers) experienced significant improvements in mood
  3. Meditation outperforms groups.
  4. Ipads during chemo for meditation-average distress dropped 46% (p < 0.0001).
  5. Telomere length is maintained.
  • Where does marijuana fit in?
  1. Do you mind the side effects?
  2. Do you want the side effects?
  3. Are you cachexic?
  4. Are you nauseous?
  5. Have you experienced relief before?

Pain

How much is objective?

Patients experiencing high levels of pain before surgery should be informed of the chances of improvement by having a TKA (total knee arthroplasty). A validated psychological screening tool that separates depression and anxiety is recommended as part of the pre-operative assessment stage. Patients presenting with symptoms of depression and anxiety should be identified and consulted before a TKA.

How much is subjective?

Based on cut-off scores for the Neonatal Infant Pain Scale, infants receiving skin-to-skin contact during IM injection were more likely to display low pain after injection; and during recovery

Sucrose is effective for reducing procedural pain from single events such as heel lance, venipuncture and intramuscular injection in both preterm and term infants.

How well have we studied the opiods?

Data gathered in this review showed that hydromorphone had a similar effect on participant-reported pain intensity as reported for oxycodone and morphine. Participants generally achieved no worse than mild pain after taking hydromorphone, which is comparable with the other drugs. It produced a consistent analgesic effect through the night and could be considered for use in people with cancer pain experiencing sleep disturbance. However, the overall quality of evidence was very low mainly due to risk of bias, imprecision of effect estimates and publication bias.

How well have we studied end of life care?

often was not implemented properly, and had instead become a barrier to good care; it made over 40 recommendations, including education and training, research and development, access to specialist palliative care services, and the need to ensure care and compassion for all dying patients. In July 2013, the Department of Health released a statement that stated the use of the LCP should be “phased out over the next 6-12 months and replaced with an individual approach to end of life care for each patient”.The impact of opioids was a particular concern because of their potential influence on consciousness, appetite and thirst in people near the end of life. There was concern that impaired patient consciousness may lead to an earlier death, and that effects of opioids on appetite and thirst may result in unnecessary suffering

Meditation

  1. Jon Kabat Zinn http://umassmed.edu/cfm/stress-reduction/mbsr-8-week-online-live/
  2. Women (colon and gynecologic cancers) experienced significant improvements in sex-related distress (p < .001), sexual function (p < .001 and p < .01), and mood (p < .001)”
  3. women in MBCR reported greater reduction in mood disturbance (primarily fatigue, anxiety and confusion) and stress symptoms including tension, sympathetic arousal and cognitive symptoms than those in SET. They also reported increased emotional and functional quality of life, emotional, affective and positive social support, spirituality (feelings of peace and meaning in life) and post-traumatic growth (appreciation for life and ability to see new possibilities) relative to those in SET,
  4. meditation iPads during the chemotherapy session. Among those who accepted the iPads, average distress dropped 46% by the end of the session (p < 0.0001).
  5. TL in the intervention group was maintained whereas it was found to decrease for control participants. There were no associations noted between changes in TL and changes in mood or stress scores over time.
  6. For those already trained in the practice of meditation, a retreat appears to provide additional benefits to cellular health beyond the vacation effect.

Marijuana cancer 752

+cochrane 7

THC cancer 565

  • Cochrane 5

Marijuana cancer pain 150

Cannabinoids bind not only to classical receptors (CB1 and CB2) but also to certain orphan receptors (GPR55 and GPR119), ion channels (transient receptor potential vanilloid), and peroxisome proliferator-activated receptors. Cannabinoids are known to modulate a multitude of monoamine receptors. Structurally, there are 3 groups of cannabinoids. Multiple studies, most of which are of moderate to low quality, demonstrate that tetrahydrocannabinol (THC) and oromucosal cannabinoid combinations of THC and cannabidiol (CBD) modestly reduce cancerpain. Dronabinol and nabilone are better antiemetics for chemotherapy-induced nausea and vomiting (CINV) than certain neuroleptics, but are not better than serotonin receptor antagonists in reducing delayed emesis, and cannabinoids have largely been superseded by neurokinin-1 receptor antagonists and olanzapine; both cannabinoids have been recommended for breakthrough nausea and vomiting among other antiemetics. Dronabinol is ineffective in ameliorating cancer anorexia but does improve associated cancer-related dysgeusia. Multiple cancers express cannabinoid receptors directly related to the degree of anaplasia and grade of tumor. Preclinical in vitro and in vivo studies suggest that cannabinoids may have anticancer activity. Paradoxically, cannabinoid receptor antagonists also have antitumor activity. There are few randomized smoked or vaporized cannabis trials in cancer on which to judge the benefits of these forms of cannabinoids on symptoms and the clinical course of cancer. Smoked cannabis has been found to contain Aspergillosis. Immunosuppressed patients should be advised of the risks of using “medical marijuana” in this regard.

Schmerz, Cochrane Review, this year:

Out of initially 108 studies 9, with a total of 1561 participants suffering from advanced or end stage diseases, were included…The outcome results for cannabis/cannabinoids vs. placebo in patients with cancer were not significant for the 30 % decrease in pain (RD: 0.07; 95 % confidence interval (CI): – 0.01 to 0.16; p = 0.07), caloric intake (SMD: 0.2; 95 % CI: – 0.66 to 1.06; p = 0.65) or sleep problems (SMD: – 0.09; 95 % CI: – 0.62 to 0.43; p = 0.72).Change in appetite was significant for the treatment of HIV (SMD: 0.57; 95 % CI: 0.11-1.03; p = 0.02), but not for treatment of cancer (SMD: 0.81; 95 % CI: – 1.14 to 2.75; p = 0.42). Nausea/vomiting (SMD: 0.20; 95 % CI: – 0.03 to 0.44; p = 0.09) and health-related quality of life (HRQoL; SMD: 0.00; 95 % CI: – 0.19 to 0.18; p = 0.98) did not show significant differences in the therapy of the two diseases. For the outcomes of tolerability the results were not significant for occurrence of dizziness (RD: 0.03; 95 % CI: – 0.02 to 0.08; p = 0.23) or psychiatric diseases, such as hallucinations or psychosis (RD: – 0.01; 95 % CI: – 0.04 to 0.03; p = 0.69) in the therapy of cancer.  Dronabinol vs. megestrol acetate showed a superiority of megestrol in the therapy of cancer-associated anorexia for the endpoints change of appetite (49 vs. 75 %; p = 0.0001), weight gain (3 vs. 11 %; p = 0.02), HRQoL (p = 0.003) and tolerability (p = 0.03). There was no difference in the safety of the therapies (p = 0.12). In the treatment of HIV-associated wasting syndrome megestrol acetate was better than dronabinol for the endpoint of weight gain (p = 0.0001), whereas tolerability and safety did not differ. In the therapy of Alzheimer’s dronabinol was better than placebo in the endpoint of weight gain according to one study (n = 15). A difference between herbal cannabis and synthetic cannabinoids, analysed by one study (n = 62) could not be found.

Also Schmerz, this year:

cannabinoids were superior to placebo in the reduction of mean pain intensity with SMD – 0.10 (95 % CI – 0.20- – 0.00, p = 0.05, 13 studies with 1565 participants), in the frequency of at least a 30 % reduction in pain with an RD of 0.10 [95 % CI 0.03-0.16, p = 0.004, 9 studies with 1346 participants, number needed to treat for additional benefit (NNTB) 14, 95 % CI 8-45] and in the frequency of a large or very large global improvement with an RD of 0.09 (95 % CI 0.01-0.17, p = 0.009, 7 studies with 1092 participants). There were no statistically significant differences between cannabinoids and placebo in the frequency of at least a 50 % reduction in pain, in improvement of health-related quality of life and in the frequency of serious adverse events. Patients treated with cannabinoids dropped out more frequently due to adverse events with an RD of 0.04 [95 % CI 0.01-0.07, p = 0.009, 11 studies with 1572 participants, number needed to treat for additional harm (NNTH) 19, 95 % CI 13-37], reported central nervous system side effects more frequently with an RD of 0.38 (95 % CI 0.18-0.58, p = 0.0003, 9 studies with 1304 participants, NNTH 3, 95 % CI 2-4) and psychiatric side effects with an RD of 0.11 (95 % CI 0.06-0.16, p < 0.0001, 9 studies with 1304 participants, NNTH 8, 95 % CI 7-12).

CONCLUSION:

Cannabinoids were marginally superior to placebo in terms of efficacy and inferior in terms of tolerability.

Another Cochrane Review, this year, Nausea and vomiting only:

We included 23 RCTs. Most were of cross-over design, on adults undergoing a variety of chemotherapeutic regimens ranging from moderate to high emetic potential for a variety of cancers. The majority of the studies were at risk of bias due to either lack of allocation concealment or attrition. Trials were conducted between 1975 and 1991. No trials involved comparison with newer anti-emetic drugs such as ondansetron. Comparison with placebo People had more chance of reporting complete absence of vomiting (3 trials; 168 participants; RR 5.7; 95% CI 2.6 to 12.6; low quality evidence) and complete absence of nausea and vomiting (3 trials; 288 participants; RR 2.9; 95% CI 1.8 to 4.7; moderate quality evidence)

People reported a preference for cannabinoids rather than prochlorperazine (7 trials; 695 participants; RR 3.3; 95% CI 2.2 to 4.8; I(2) = 51%; low quality evidence)

Nurses Cochrane Review:Cannabinoids are effective in controlling CINV, and oral THC and smoked marijuana have similar efficacy. However, smoked marijuana may not be accessible or safe for all patients with cancer. Also, these drugs have a unique side-effect profile that may include alterations in motor control, dizziness, dysphoria, and decreased concentration.Conclusions: This synthesis shows that cannabinoids are more effective than placebo and comparable to antiemetics such as prochlorperazine and ondansetron for CINV

European Review from 2008:

From 12 749 initially identified papers, 30 fulfilled the inclusion criteria for this review, with demonstration of superiority of the anti-emetic efficacy of cannabinoids compared with conventional drugs and placebo. The adverse effects were more intense and occurred more often among patients who used cannabinoids. Five meta-analyses were carried out: (1) dronabinol versus placebo [n=185; relative risk (RR)=0.47; confidence interval (CI)=0.19-1.16]; (2) Dronabinol versus neuroleptics [n=325; RR=0.67; CI=0.47-0.96; number needed to treat (NNT)=3.4]; (3) nabilone versus neuroleptics (n=277; RR=0.88; CI=0.72-1.08); (4) levonantradol versus neuroleptics (n=194; RR=0.94; CI=0.75-1.18); and (5) patients’ preference for cannabis or other drugs (n=1138; RR=0.33; CI=0.24-0.44; NNT=1.8). The superiority of the anti-emetic efficacy of cannabinoids was demonstrated through meta-analysis.

Here’s the Problem:

Based on available evidence, we could find that psychoeducational interventions, music interventions, acupuncture plus drug therapy, Chinese herbal medicine plus cancer therapy, compound kushen injection, reflexology, lycopene, TENS, qigong, cupping, cannabis, Reiki, homeopathy (Traumeel), and creative arts therapies might have beneficial effects on adult cancer pain. No benefits were found for acupuncture (versus drug therapy or shame acupuncture), and the results were inconsistent for massage therapy, transcutaneous electric nerve stimulation (TENS), and Viscum album L plus cancer treatment. However, the evidence levels for these interventions were low or moderate due to high risk of bias and/or small sample size of primary studies. Conclusion. CAM may be beneficial for alleviating cancer pain, but the evidence levels were found to be low or moderate. Future large and rigor randomized controlled studies are needed to confirm the benefits of CAM on adult cancer pain.

Cancer Pain, from 2001:

20 randomised controlled trials were identified, 11 of which were excluded. Of the 9 included trials (222 patients), 5 trials related to cancer pain, 2 to chronic non-malignant pain, and 2 to acute postoperative pain. No randomised controlled trials evaluated cannabis; all tested active substances were cannabinoids. Oral delta-9-tetrahydrocannabinol (THC) 5-20 mg, an oral synthetic nitrogen analogue of THC 1 mg, and intramuscular levonantradol 1.5-3 mg were about as effective as codeine 50-120 mg, and oral benzopyranoperidine 2-4 mg was less effective than codeine 60-120 mg and no better than placebo. Adverse effects, most often psychotropic, were common.

CONCLUSION:

Cannabinoids are no more effective than codeine in controlling pain and have depressant effects on the central nervous system that limit their use. Their widespread introduction into clinical practice for pain management is therefore undesirable.

Free article:

No large trials examined cannabinoids in cancer pain and chronic non-malignant pain

What is already known on this topic

Three quarters of British doctors surveyed in 1994 wanted cannabis available on prescription

Humans have cannabinoid receptors in the central and peripheral nervous system

In animal testing cannabinoids are analgesic and reduce signs of neuropathic pain

Some evidence exists that cannabinoids may be analgesic in humans

What this study adds

No studies have been conducted on smoked cannabis

Cannabinoids give about the same level of pain relief as codeine in acute postoperative pain

They depress the central nervous system

The effect of marijuana and placebo on pain tolerance was compared in cannabis-experienced and naive subjects. A statistically significant increase in tolerance was observed after smoking marijuana. Although there was no statistically significant interaction between the drug effect and having had previous cannabis experience, there was a definite trend towards a greater increase for the experienced (16%) compared to the naive group(8%).

Pain detection thresholds were altered unpredictably with high THC doses, but analgesia as indicated by pain tolerance was less than that after diazepam and placebo. In three subjects low-dose THC (0.022 mg/kg) was a better analgesic than placebo but not diazepam. Six subjects preferred placebo to low-dose THC as an analgesic; this group experienced increases in subjective surgical pain and were submissive, rigid, and less introspective with high State Anxiety