Chapter 3 Dietary Treatments CONTENTS Page General Comments about Unconventional Dietary Approaches Compared With Other Forms of Nutritional Treatment ... ... ... .., ... .. 41 Adjunctive Use of Dietary Approaches in Cancer Treatment . ...........,.,....,,, 42 The Gerson Treatment . ... ... ... ... .,. ... 44 Background and Early Use . 44 Rationale for the Treatment . ... ... ... ... ... ,.. .,. .. .,e 45 Current Gerson Treatment Regimen ... ... ... .,. ... ... ... 46 Potential and Reported Adverse Effects ... ... ... ... ... ... .. 47 Claims of Effectiveness . 47 Attempts at Evaluating the Gerson Treatment . 48 The Kelley Regimen ... .,. ... ... ... ... ... ... ... ... .. 51 Background and Rationale . .... ● . ● . 51 Development and Use of the Treatment . 52 Current Applications of the Kelley Regimen . ................,... 54 Attempts at Evaluating the Kelley Regimen ... ... ... ... *.. ... 55 Macrobiotic Diets . 58 Background and Philosophy . 59 Rationale ● . .... ... .., ... ,.. ... .,. 60 Macrobiotic Dietary Guidelines ... ... ... ,.. ... ... ... 62 Possible Adverse Effects . ... ... .,. ... ... ... .., **o**, 63 Claims of Effectiveness ... ... ... .. ... .. ... .. c , 64 Attempts at Evaluating Macrobiotics in Cancer Treatment . ....,.....,., 64 Boxes Box Page 3-A. An Example of an Adjunctive Nutritional Approach to Cancer Treatment . 43 3-B. Coffee Enemas .. ... ... .. ... ... ... ... ... ... 51 Chapter 3 Dietary Treatments A specified diet is the primary component of some resort” offering ‘‘a multi-dimensional program for unconventional cancer treatments. This chapter the serious health seeker” (405). The wheatgrass reviews three examples of unconventional treat- diet is described as a “nutritional lifestyle that ments with dietary regimens as the primary or embraces an all natural way of eating” (405). Using central component: the treatment regimen devel- books and products commonly available in health oped by the late Max Gerson, M. D., currently food stores and through mail order houses, patients offered at a clinic in Tijuana, Mexico; the treatment can also follow the wheatgrass regimen on their regimen developed by William Kelley, D. D. S., and own. recently modified by Nicholas Gonzalez, M. D., who The wheatgrass regimen eliminates all meat, dairy treats patients in New York; and the macrobiotic products, and cooked foods from the diet, while regimen, whose educational resources and special- emphasizing “live foods” (including uncooked ized food products are widely available to patients in sprouts, vegetables, fruits, nuts, and seeds), the United States. Coffee enemas, which are in- wheatgrass juice, “detoxification” (enemas and cluded in two of these regimens, are also discussed high colonies), enzyme supplements and chlorella separately in box 3-B later. (green algae tablets). Proponents believe that In other chapters of this report, treatments are wheatgrass is the key element of the program and described that also include dietary elements, but in claim that it bolsters the immune system, kills those cases, the diet may be one of several major harmful bacteria in the digestive system, and rids the elements in the approach, with a non-nutritional body of waste matter and toxins (405,959). Anecdo- treatment usually considered primary in the regi- tal case reports of tumor regressions and life men. In the Livingston-Wheeler regimen (described extension among cancer patients who followed the in ch. 5), e.g., dietary guidelines are specified, but wheatgrass regimen have been published in the the regimen is centered on its original anti-infective proponent literature (see, e.g., (344)), but thus far, no treatment. In addition, many of the clinics in the studies of its clinical role in the treatment of cancer United States and Mexico that promote “meta- have been reported. bolic” treatment for cancer specify particular foods to include or avoid as part of a regimen that also GENERAL COMMENTS ABOUT includes pharmacologic and biologic agents, exer- UNCONVENTIONAL DIETARY cise, and spiritual and psychological components APPROACHES COMPARED (289). WITH OTHER FORMS OF Other dietary approaches used in unconventional NUTRITIONAL TREATMENTS cancer treatment for which more limited information is available are not covered in detail in this chapter. By relying for the most part on vegetarian, One of these is wheatgrass, a component of a low-fat, high-fiber foods, the dietary regimens regimen that has been available for several decades described in this chapter share certain characteristics in the United States. Originally developed by Ann with the kinds of foods currently recommended by Wigmore, the wheatgrass regimen is advocated for mainstream groups for lowering the risk of develop- prevention and treatment of a variety of conditions ing cancer and heart disease. Recent American and for general health maintenance. Individuals Cancer Society (ACS) guidelines for cancer preven- attending one of three U.S. centers that offer tion, e.g., suggest reducing the intake of fat, alcohol, instruction in following the wheatgrass regimen and salt-cured and smoked foods, while increasing (289) are taught “an enlightened approach to the the intake of fruits, vegetables, and whole grains understanding of health and various cleansing and (681). One way they differ, however, is that the rebuilding techniques to restore and/or maintain a unconventional cancer treatment diets may empha- vigorous life” (198), according to promotional size a few particular foods and limit or totally literature. One of the centers, the Hippocrates Health eliminate others. The macrobiotic regimen, e.g., Institute in Florida, describes itself as a “health advises against consuming vegetables and fruits that 41– 42 • Unconventional Cancer Treatments are not grown locally, such as bananas and other tube). These measures are normally limited to tropical fruit, and against certain types of vegetable, cachexic patients in advanced stages of disease, to such as those in the nightshade family (including patients who have particular cancer- or treatment- tomatoes, green peppers, eggplants, e.g.). The related nutritional problems that prohibit normal wheatgrass diet excludes all cooked vegetables and intake of food, or to malnourished patients under- fruits in favor of raw foods exclusively. The Kelley going major surgery (34,473,798). regimen emphasizes certain categories of food, e.g., vegetables or red meat, over others, on an individual It is well accepted that cancer and its treatment basis. (The Kelley diet does not necessarily conform can cause malnutrition and that malnutrition itself to current mainstream dietary recommendations.) It predicts a poor outcome (253). A number of has been noted that in some circumstances, cancer physiologic factors associated with cancer are be- patients who follow overly restrictive diets of any lieved to contribute to malnutrition, including the kind, whether unconventional or not, maybe at risk metabolic state of the tumor and its effects on the for malnutrition and uncontrolled weight loss (8,84). body’s metabolism, catabolic effects of conven- It has also been noted that diets that may be useful tional treatment, and physiologic stress associated in preventing cancer are not necessarily effective in with rapid tissue growth and cell destruction (407), treating cancer, since substances in food that may although the ways in which these factors influence play a role in the initiation of cancer may be different nutritional status are still poorly understood. The from those that may contribute to tumor progression issue of how to ensure that patients obtain an optimal (84). daily intake of nutrients and calories in order to preserve lean body mass without stimulating tumor The goals of the unconventional dietary treat- growth is considered unresolved (407). Total paren- ments also overlap with the goals of conventional teral nutrition has been found to be of limited use, nutritional support for cancer patients in that both try and in some cases even detrimental (798). In general, to counteract the metabolic and nutritional effects of oral dietary treatments have not been evaluated for the disease and of some forms of treatment. The possible prevention of malnutrition or for possible unconventional treatments go beyond the conven- effects on the course of the disease in cancer tional support measures, however, by claiming to patients, although the initial stage of a multicenter reverse the course of the disease, to enhance host study involving a low fat dietary intervention in function, and to improve quality of life. patients with breast cancer was recently begun (35). The fact that the unconventional treatments spe- c@ particular dietary regimens for cancer patients at all, regardless of their condition, stage of disease, or ADJUNCTIVE USE OF DIETARY type of tumor, separates them from mainstream APPROACHES IN CANCER cancer treatment. Nutritional support has a well- TREATMENT 1 established place in conventional cancer treatment, but generally does not include dietary recommenda- The unconventional dietary treatments for cancer tions for patients with cancer. At present, no diet is described in this chapter are also distinct from the recommended publicly by NCI or ACS for use in adjunctive use of dietary treatment in other contexts, cancer treatment. In practice, patients are not com- e.g., in the more numerous and diverse practices monly given nutritional advice at the time of where physicians and other practitioners offer what