My name is Abraham. I’m a pharmacy resident
at Stanford right now. Together with Eun, we’ve
worked on this presentation about the potential benefits of
herbal and dietary supplements. So first, I’ll give
an overview about what the definition of an herbal
or dietary supplement is. We’ll review some of the
common misconceptions about these supplements
and then review some of the commonly
used supplements. There’s thousands of supplements
available on the market, but I’ll just review
some of the top 15 that are commonly used
in cancer patients, including what the
recommended doses are, what they can be
used for, and what are situations that you should
avoid using those supplements. We’ll quickly go
over some other forms of alternative or
complimentary medicine and then have a summary. And at the end, I’ll have
some other resources online where you can go and learn about
some of the other supplements. So what are dietary supplements? They are defined as
vitamins, minerals, herbs, products made from plants,
animal parts, and yeasts and extracts. The FDA regulates them
differently from food and drug. So drugs have to get
FDA approval before they get put on the market. However, with
dietary supplements, they get put on the market
before FDA approval, and the FDA only really steps
in when a problem is reported. They’re sold over the
counter, however, differently than over-the-counter
medications. They also don’t
get regulated like over-the-counter medications. So drugs are usually
considered unsafe until they’re proven
safe to the FDA, while dietary supplements are
considered safe until they’re proven unsafe to the FDA. And this can make things
a little difficult. So while most supplements
have clean, safe histories, there have been some
reports that there has some contamination in
some of the herbal and dietary supplements. For example, recently they
found some supplements have been found to be tainted
with pesticides, heavy metals, and prescription medicines. For example, a few
years ago, there was this a male
enhancer that was sold at your local pharmacy, and
they found that they actually contained Viagra or Cialis. This is dangerous because it
doesn’t state that it actually has those medications in it. So patients may have
taken it unknowingly and have some
other side effects. So the FDA eventually stepped
in and took those supplements off the market. In 2013, there was a
study done in Toronto that found that out of the 44
herbal supplements, including supplements from Canada and
the United States, about half of them didn’t actually
contain the herb on the label. They contained some
other substitution, or they just contained filler. So the best way to
avoid this is probably to avoid products that claim to
work like prescription drugs, because they might actually
contain some prescription drugs. Also you can avoid products
that are advertised through mass emails,
products that are marketed in a
foreign language, and products that promise
weight loss, bodybuilding, enhanced sexual performance,
and other products that say they’re a legal
alternative to steroids. Some of the common
misconceptions of herbal and
dietary supplements is that it’s natural,
so it must be safe. Well, not necessarily. So the first example on
the left is a mushroom. It looks very similar
to the mushrooms that you buy at Whole
Foods or Safeway, however, it’s actually
quite poisonous, and there’s been many reports of
people going out and collecting these mushrooms and
cooking them and then ending up in the hospital
because of toxicity. Tobacco we all know is a
very natural substance, but used in smoking, and we
know all the harmful effects from cigarette smoking,
including heart disease, lung disease, also cancer. The third one is
the castor bean. So it looks pretty
harmless, it’s just a bean. But it actually contains a
chemical called ricin in it, and about 5 to 20 of these
beans can kill an adult human. So in the 1970s,
the KGB actually used the extract from these
beans and assassinated people. So it’s natural, but
it’s also dangerous. And then the last one
is Ephedra sinica. It’s also known
as Ephedra, and it used to be sold as a dietary
supplement in the United States. It’s a performance enhancement,
gives a stimulant effect, and many athletes
used to use it. However, in 2003, a
famous baseball player actually died from using
this herbal supplement. And then the FDA
went through the data and found that it was
because of the Ephedra that he had a cardiac event,
and it led to his death. So because of this,
FDA has banned Ephedra in the United States. On the flip side,
many chemotherapies also come from natural sources. So for example,
Vincristine is sourced from the Madagascar periwinkle. Vincristine’s often used
in leukemias and lymphomas, and it can cause nerve pain. Cytarabine territory
is from the sea sponge, and it can really decrease
a patient’s blood counts. And Paclitaxel is used
in many chemotherapies, like for breast cancer, and
it comes from the Pacific yew tree. So even though these
are natural substances, you know that the chemotherapy
has a lot of toxicity. So while they may
be safe as a plant, once they become concentrated,
it can become dangerous. Another common misconception
is that more is better, and this is also not
necessarily true. For example, some
people recommend taking a lot of
vitamin C. However, they found that actually
taking too much vitamin C can interfere with
absorption of copper, and copper is important for
making red blood cells and also for nerves. They’ve also found that
taking too much phosphorus can interfere with
absorption of calcium. And calcium is important
for having strong bones and also to stabilizing
the heart rhythm. So what’s important is that
the safety and dose of whatever you’re taking are related. So when you’re taking the
leaves and root of a plant, it may be safe in small
amounts as an herb, but now they sell all these
concentrated pills as extracts, and they may contain very
high concentrations, which may not always be safe. In 2012, the FDA did receive
2,800 reports of dietary supplement adverse
effects, so they’re not necessarily side effect free. In 2011, the US
Poison Control Centers received over 35,000 calls
regarding dietary supplements. So what I want to
make sure you all understand is the
appropriate use of these herbal and dietary
supplements are important, and that the dose is also
important for your own safety. So this is a list of some of
the common supplements that are often used, and I’ll go over
the uses of each one of these. There’s many thousands
of supplements, but through the
literature these seem to be the most popular
ones that I’ll go over. The first supplement I’ll
talk about is Glutamine. This is an amino acid
that’s found in our bodies, and they sell it as an
over-the-counter powder. And this has been
studied to decreased the security and
rate of mucositis from chemotherapy and radiation. Mucositis is basically
all the sores in the mouth, all the
way through the GI tract, due to chemotherapy. Glutamine has also been
found to decrease neuropathy from chemotherapy. It’s mostly studied with
taxanes, like Paclitaxel and also Oxaliplatin. So those are usually breast
cancer and colon cancer patients, but sometimes
they extrapolate that data to other cancers. The common dose for Glutamine
is 10 grams three times a day, and it can be taken with food. The taste is not very
good, apparently. So some patients can
mix it with yogurt, and that makes it
more palatable. Some side effects
from Glutamine are that it can cause stomach
upset and headache. And then there’s a
possible interaction with anti-seizure medications. So if you are on an
anti-seizure medication, it’s probably best
to avoid Glutamine. Next I’ll talk about vitamin D,
also known as ergocalciferol, or cholecalciferol. Vitamin D is basically
a vitamin that controls the calcium,
phosphorus, and also bone metabolism. It’s often used to
help form strong bones, and usually in
combination with calcium. A deficiency in
vitamin D has also been originally found
to have an increased risk in certain cancers. However, the reverse is
not well cleared yet, so boosting your
vitamin D levels does not necessarily
reduce the risk for cancer. That’s still being investigated
in studies right now. The common doses for
vitamin D are usually a dose based on vitamin D levels. So some physicians may actually
draw your vitamin D level, and if it’s too
low, they can set up a plan to replace that
to a regular level. Usually it’s dosed
around 1,000 IU, or international units a day. The over-the-counter tablets
are usually 1,000 or 2,000 IUs. There are some side effects
from vitamin D. Sometimes it can cause stomach
upset, and also if you take too
much vitamin D, it can also increase
the calcium levels in the blood, which can
lead to kidney stones. Next topic I’ll talk about
is fish oil, also known as omega-3 fatty acids. These are usually extracted
from cod, krill, salmon, or sardines. The potential uses of this
is to reduce inflammation, and then some
physicians actually prescribe it to help
reduce triglycerides, if you have high
triglycerides in your blood. There’s been some studies
looking at it as a way to prevent cancer
progression, but there is very mixed results
right now, so it’s not recommended for that. Common doses are about two
to three grams per day. And the side effects is that
it can cause loose stools, because it is greasy. So it makes you go
to the restroom. And then it also has
a fishy aftertaste, because it is sourced from fish. Fish oil does increase
bleeding risk and interacts with some anticoagulants. So if you’re on
anticoagulants like warfarin, it may increase
your bleeding risk, so it’s important to talk
to your physician, whoever monitors your warfarin. Next, green tea. Green tea is from the
unfermented leaves of Camellia sinensis. It’s often used as an
antioxidant and to help improve cholesterol. And then people drink it
because it also tastes good. It’s commonly consumed
through dietary consumption, and now they do sell
extracts of green tea. However, the doses
of those supplements is not very clear yet. Some side effects
of green tea is that it can cause
caffeine-related side effects, because it does
contain caffeine. So it can cause
insomnia at night and cause some jitteriness. It can also increase
stomach acid, which can be a problem if
you have some reflux issues. Green tea does
interact with Warfarin, so it can affect the INR and
the bleeding with warfarin. Green tea also has
some interactions with some chemotherapy
agents, including bortezomib, irinotecan,
sunitinib, and tamoxifen. So in the case of
bortezomib and sunitinib, the green tea actually
inactivates them and reduces their efficacy. While in irinotecan
and tamoxifen, it raises the amount
that’s in the body, which can lead to more side effects. Milk thistle is formed from the
extract of the Silybum marianum flower. The active ingredient in
milk thistle is silymarin, and it’s often used
to protect the liver from chemotherapy damage or
other insults to the liver. The common dose is about 200 to
400 milligrams of the Silybum marianum, and that can
increase to about a max of 13 grams per day. However, if you do go
above 13 grams per day, what usually protects your liver
can actually harm the liver. So this is an example where
more is not always better. Milk thistle can also
cause some stomach upset. Next I’ll talk about
Astragalus or Huang qi. This is the root of the
Astragalus membranaceus. This is a Chinese
herbal medicine that’s used very
often, and it’s thought to strengthen qi or energy. It’s often used to reduce
the fatigue due to cancer or chemotherapy treatments,
and sometimes it’s used for kidney protection. And I didn’t list it,
but some patients also use it to boost
their immune system. There’s been some
studies, mostly in China, looking at Astragalus as an
anti-cancer agent, however, it’s not very well established. All the studies combine
it with chemotherapy, so you don’t really know
if it’s adding much. The common dose is
about 10 to 90 grams per day of the raw herb. You can grind it up and and
make it a tea or a soup. And because it boosts
the immune system, it interacts with
immunosuppressant medications like tacrolimus
and cyclosporine. And they found
that Astragalus can alter the levels of
estrogen in the body, which can be dangerous
if patients have an estrogen-driven cancer
such as breast cancer, ovarian cancer, or uterine cancer. The next one is Dong Quai. This is the root from
the Angelica sinensis. And it’s often used to
help with mental symptoms or menopausal symptoms,
like hot flashes. The common dose
is 1 to 15 grams. You can divide it one
to three times a day. The main side effects
from Dong Quai is that it can
cause stomach upset, and it does also increase
the risk of bleeding and has interaction
with anticoagulants. So if you do have low platelets
or you’re on an anticoagulant, it’s probably best to
avoid this medication. Dong Quai also has estrogen
activity like Astragalus before. So again, it should
be avoided if there’s breast cancer, ovarian
cancer, or cervical cancer. Next I’ll talk about Melatonin. This is a natural hormone that’s
secreted from the pineal gland, but now we can concentrate
it into a pill. Melatonin’s involved
with the circadian rhythm to help with the
sleep/wake cycle. So it’s often used to help
improve sleep and reduce fatigue. There’s also been some
studies looking at it as an anti-cancer agent, but its
role is not well-defined right now. The common doses are about
0.5 to 3 milligrams a day, but this can
sometimes be increased to about 10 milligrams a day. Some side effects
you can expect are to have drowsiness or
confusion, because it’s helping you go to sleep. Some patients do report
that it causes some itching, and it can also cause
a fast heart rate. Melatonin also affects
the levels of estrogen, so again, in breast
cancer, ovarian cancer, and uterine cancer,
it should be avoided. And then probiotics
are a hot topic now. So it’s basically
live microorganisms, usually either Lactobacillus,
Bifidobacterium, or Saccharomyces. And they can be used to improve
diarrhea due to chemotherapy or radiation. So the idea behind
this is that you can take these microorganisms
that are naturally found in your
intestines and replace that to help block out any
dangerous other bacteria. The common doses of
probiotics– it really depends on the brand– but
for example, Culturelle is a commonly used brand. The dose that is
recommend is about 10 to 20 billion cells a day,
and each capsule or Culturelle contains 10 billion cells. And another way to
consume probiotics is to eat yogurt,
because yogurt does have lots of probiotics in it. Some side effects
from probiotics is that it can cause gas. And then it should be used
cautiously in patients that are immunosuppressed,
or if they’re neutropenic. So while these bacteria
are natural flora in your intestines,
they are live organisms. So it can cause an infection
if your immune system is low. Ginger. Well, a lot of cultures
use ginger in cooking. And basically, it’s the
root of the ginger plant. It’s been found that it’s pretty
effective in mild to moderate nausea and vomiting. The common doses are about
250 to 1,000 milligrams a day. It can cause heartburn,
and it can also increase bleeding risk. So use cautiously if
you have low platelets or if you are on anticoagulants. Ginger also antagonizes some
of the immunosuppressants, such as cyclosporine
and tacrolimus. Ginseng is commonly
used as an Asian herb. There’s two main
types of ginseng, Panax ginseng, which
is the Asian ginseng, and Panax quinquefolius,
which is American ginseng. The Asian ginseng is more potent
than the American ginseng, and they do have different
properties that herbalists could tell you more about. Most often, they’re used
to help with fatigue due to chemotherapy
and also disease. And it’s been found to also
help with some diabetes. The common dose
that’s usually taken is about one to two grams
per day of the raw herb. And now they do
sell the extract, the usual dose is about
200 milligrams a day. Some side effects
from ginseng is that it can increase the heart
rate, which can be dangerous if you have a history of
cardiovascular issues, such as a prior heart attack
or if you have coronary artery disease. It can also cause insomnia, and
it does decrease blood sugar. So if you have low blood sugar,
it might make it too low. Ginseng also does
increase bleeding time, and it does have
some interactions with anticoagulants. And they found that ginseng also
has increased estrogen effects. So again, it should
be use cautiously in those three cancers. Next, we’ll talk about
Saint John’s Wort. This is made from the flower
of the Hypericum perforatum. It’s been found to be
fairly effective in mild to moderate depression. In Germany, this herb is
actually a prescription only drug, and some
physicians actually prescribe this more than Prozac. The usual dose is about 300
milligrams three times a day. It can cause some dry mouth,
dizziness, and stomach upset. However, the most
important thing is that does reduce
the effectiveness of many medications,
including chemotherapy and immunosuppressants. So Saint John’s Wort increases
your metabolism of chemotherapy and clears it from
your body faster, so it doesn’t have a chance
to work on the tumor. So we highly recommend against
using Saint John’s Wort, especially while
you’re on treatment. And if you do have
symptoms of depression, it’s always best to
talk to your physician so that they can work with
you to set up a plan for that. Next is the antioxidants. This is a very broad
class of compounds that counteract free radicals. This includes vitamin C,
vitamin E, Beta-carotene, a-lipoic acid. It’s thought that these
have anti-cancer properties, or that they can protect
the body from damage due to chemotherapy
or radiation. So some free radical sources
are from ultraviolet rays from the sun, from
pollution, stress, poor diet, chemotherapy, and these
free radicals damage cells and create mutations. So the idea, they thought, was
that maybe using antioxidants can prevent them from
damaging the cells. So they’ve done
many studies looking at using antioxidant supplements
as a way to prevent cancer. And with vitamin E, they
found that it actually increased prostate cancer risk. With Beta-carotene, they found
that it increased lung cancer risk, and with
vitamin C, they found it has no effect on
cancer incidence. So it looks like it’s not very
helpful to prevent cancer. And then later on they did
more studies looking at it, looking at supplement use
during cancer treatment, to see if it could help
reduce side effects. So they looked at vitamin E
use in head and neck cancer, and they found that it actually
increased the mortality in those patients. And they think that this
is because it decreases the effectiveness of the
radiation and possibly the chemotherapy. So when you’re giving
radiation or chemotherapy, you’re giving a lot of these
radicals to kill the tumor. But with the
antioxidants, it actually helps protect the tumor
as well as your own body. So as a result, the
American Cancer Society does recommend consumption
through food sources rather than as a dietary
supplement because of the high dose that’s found
in the dietary supplement. So those are the
ones I’ll go over, and then there’s a quick
summary at the end. And the summary is
also in your handout. So the first one I talked
about was Glutamine. And it can help with
mucositis and neuropathy. However, it should be avoided
with anti-seizure medications. With vitamin D, it’s
useful for bone health, for bone formation. However, it should be avoided
if you have a high calcium level or if you have kidney stones. Fish oil can be helpful
for reducing inflammation, and it should be avoided if
you’re on anticoagulants. Green tea can be
used as antioxidant and it’s also used to
help reduce cholesterol. But it should be avoided if
you’re on warfarin, and then some of these chemotherapies,
bortezomib, irinotecan, sunitinib, and tamoxifen. Milk Thistle is often used
to help protect the liver from various
insults, and there’s no real absolute
contraindication to anything. Astragalus, or
also known as Huang qi is good for fatigue
and kidney protection. And it should be avoided if
you’re on immunosuppressants. Or if you have a
hormone-sensitive cancer. Dong Quai can be used to help
with menstrual or menopausal symptoms. It should be avoided if
you’re on anticoagulants or hormone-sensitive cancers. Melatonin is effective for sleep
and to help reduce fatigue. It should be avoided if you’re
on hormone-sensitive cancers. Probiotics can be used
to help with the diarrhea from chemotherapy and
radiation, however, should be avoided if you
have low white blood cells, like with neutropenia, or
if you’re immunosuppressed. Ginger is very helpful for
mild to moderate nausea and vomiting, and it
should be avoided if you’re on immunosuppressants. Ginseng can be used for
fatigue and diabetes, but avoided if you’re
on anticoagulants, if you have heart
conditions, or if you have a hormone-sensitive cancer. And then the two we do
recommend against using are Saint John’s
Wort, because it does reduce the effectiveness
of many chemotherapies, and antioxidants as
a supplement form, because its role in cancer
treatment and prevention is very unclear,
but it does show that it can reduce
the effectiveness of some chemotherapy
and radiation. And then there are
also other forms of complimentary medicine,
such as meditation, yoga, guided imagery, or acupuncture. And many of these are available
through Stanford’s Cancer Supportive Care program. So if you’re interested
in any of these, you can talk to Holly, and she
can help set you up with this. So the summary, it’s
always important to ask your doctor or pharmacist
or health care professional if you’re considering
using a dietary supplement, because there are some unknown
interactions that may possibly be found. There’s no supplement
that has been conclusively shown to treat cancer. So there’s no miracle
pill, unfortunately. Supplements may be helpful
as a supportive care agent during chemotherapy
and radiation, however, with every supplement
there still are some risks that must be considered. And then these are some
other online resources from some very
credible societies. So they’re are also
listed on your handout, but I’ll quickly go over
each of these websites. So you can’t really
see it very clear, but the American
Cancer Society website has a section on complementary
and alternative medicine. It has a section that talks
about these different modes of treatment. And at the bottom, there’s a
section on herbs, vitamins, and minerals. And that has
detailed information about specific
herbs and minerals. The National Cancer
Institute, or the NCI, has this booklet that you can
download from their website, and it talks about not only
herbal and dietary supplements, but also other complementary
and alternative medicines. And it’s a pretty good
read, so if you have time, you can download it and read it. The NIH has a section
called the National Center for Complementary
and Integrative Health, and it has a section with many
topics, research-based info from acupuncture
to zinc, so A to Z. It has many different topics. And then the last one is
Memorial Sloan Kettering has a very large Integrative
Medicine department. Memorial Sloan Kettering is one
of the major cancer hospitals in New York City,
and they set up this database where basically,
if you’re interested in about any herb or
botanical or other product, you can find it in the index. And then within each
product, it talks about what they think
it can be used for, or how they think it might work. What are possible
side effects, and when you should avoid using them. And that’s all of
my presentation. I can take any questions. [APPLAUSE] Oh, thank you. Is there synthetic fish oil? Synthetic? No. I don’t– no. Yeah, they do source
them from like krill, which is kind of like a
shrimp, but they’re all usually from the sea. Say you want to take calcium. I heard if you take too much
of it, you don’t absorb it, you excrete it. So is it– for any of
these, or for calcium, do you recommend smaller
doses several times a day? It really depends on some drugs. Most things have
a saturable level of how much you can absorb. And with these
herbal supplements, they probably haven’t
done enough studies to actually know
what that level is. And then with calcium,
they do recommend taking with vitamin D,
because the vitamin D does help absorption of calcium. All right. Got a question? What do probiotics
do to patients who neutropenic and immune
system are compromised? There’s a theoretical risk that
because your immune system is low, if the probiotics
do become mean, they can cause an infection. And there is that
theoretical risk. Actually, we had one
patient, neutropenic, that we found infection source
is sort of similar to lactose. So we had one case that
actually caused infection. But it’s relatively safe. Supplements, we promote
the patient to use it if they want to use it. Especially when you have lots
of issues with digestion, and when they have loads
of– they’re on antibiotics, and may kill the bacteria
that are good for your GI. Is there a reason
that you separated green tea, which can be
used as an antioxidant, and supplements
that you can use. On the back page, you
said supplements to avoid, and it lists antioxidants. Yeah. So I think they
probably recommend not using the actual green tea
capsules as an antioxidant, but if you take it as a
tea, it’s probably OK, unless you’re on those
specific chemotherapies. Does that answer your question? Because it’s more
of a food source. Yeah. Because it’s more–
it’s like a food source. It’s like you can eat
oranges, but you probably shouldn’t take too much vitamin
C as a concentrated tablet. You said to avoid green tea
if you’re on irinotecan. What’s the reason? Irinotecan– it’s supposed to
increase the absorption, more irinotecan in your body. So it might cause more
toxicity from the irinotecan. But I mean, it’s just
very small studies. Can you take milk thistle
if you have liver lesions? If I have what? If you have liver lesions
that you’re being treated for? Can you go on milk thistle
while you’re on treatment? I think that it’s OK to take it. But I wouldn’t go
over too high a dose. Use a low dose to
support your liver. But I do not recommend a
high dose milk thistle. But should you– well, I’m
on it, like one week on and one week off, so
what I’ve been doing is to take milk
thistle on the week that I’m not on the chemo drug. Is that a wise thing to do? Mm-hm. Low dose is like 200 milligrams? Yeah. So the dose is
usually 200 to 400. 200 to 400? 200 to 400, yeah. You were first. Yeah. What about tumors? [INAUDIBLE]. Tumors? Tumors. That’s– Oh, what is a use for? What do you– [INAUDIBLE]? Would you support
the immune system? I’ve had patients that were
interested in supplements, but I’m not sure there is good
enough data to uphold that. So supplements like–
a tumor, I would not use it to as an alternative
to conventional treatment. Oh, no. Clearly. You would not recommend
it as an alternative to allopathic treatment? No. No, but after treatment, as
supporting the immune system. After treatment, if you
are not immunosuppressed from previous chemo
treatment, you’re OK. Just make sure that you
talk to herbal specialists about good products they
can recommend for you. So you don’t [INAUDIBLE]
during treatment? Well, there are
some patients that are taking those treatments
instead of recommended– [INTERPOSING VOICES] I don’t have any opinion on it. How about aloe vera. Some people drink it, or
you may be able to get it as a pill form, I don’t know. Is there any studies
on that at all? Its affect on chemotherapy? What [INAUDIBLE]? Aloe vera? Yeah, I know. But we use it for
the skin conditions. It’s for skin. Yeah, but you can also
get it in liquid form, and people drink it, and
it supposedly helps with– It’s good for the stomach. Stomach and the
complexion and things. I think as long as you
don’t go overboard on it– People cook with it, too. Yeah, as a food source–
like if you eat, consume what would be
natural as a food source, it’s probably OK. As long as you don’t go
overboard and– yeah. You didn’t mention or
talk about cannabis. So that’s a very
controversial topic. But a lot of physicians
are allowing their patients to use it, because it
does help with symptoms. However, if you just smoke
it, if you have lung cancer, and you’re on
certain medications like Tarceva or erlotinib. It does reduce the effectiveness
of Tarceva by smoking. So there are some certain drug
interactions with cannabis. So talk to your
doctor and see if they have any opinion on that. It’s related to NIH has been
doing [INAUDIBLE] research into cannabinoids, which
is an extract of cannabis without the psychopathy. And preclinical, and they’re
starting clinical trials, [INAUDIBLE] significant
impacts on tumor growth and the spread of tumors in
very serious forms of cancer. I was wondering if you had
been looking into this at all, having knowledge into
that level of research, and who might be good
doctors that– [INAUDIBLE]? So I haven’t looked into
the research that deeply. But I don’t know who
would be a good doctor. Yeah, I’m sorry, I don’t know. It is relatively recent. The preclinical trials
have been [INAUDIBLE], but they’re starting
clinical trials. And a very significant
amount of research has been done by the NIH. If you’re interested in clinical
trials for cancer treatment, you can go a website
called clinicaltrial.gov. And then you can find any
clinical trails that you know. [INAUDIBLE]? Yeah, clinical– it’s
like a government program where they list all the
clinical trials that’s being done in the United States. So you can see if there’s
any centers near you. Is it harmful to take
higher doses of probiotics? I’m taking 90 billion, but you
said between 10 and 20 million. Was it million? Does it– well, it
depends on what product it is, because the
cells are different. So are you using
Culturelle also? It’s different
between the products, so you can’t really
compare them. I just go by whatever’s the
labeling on the product. Well, it says 90 billion. But is it way too much? Too powerful for– If it’s within the product
labeling, it’s fine. Yeah. Can you use the
product as a starter to make your own yogurt? Can you use the
probiotic as a starter to make your own
yogurt, which is easy. Yeah, you can make
your own yogurt. There’s a recipe. Yeah. I do not know of that. I only mix drugs. [LAUGHTER] Let me impact the onset of that. The mothers and
grandmothers, they have been doing for ancient
for millions of years, growing their own culture,
and they have survived fine. One of the things that– I have
been actively doing research on the herbology for the last
10 years, Ayurveda and all that, because I was a medical
scientist back in India, and I became a
software scientist. The thing is that the
common denominator is really that you want to use herbs
not as medicine, but more as a food, like [INAUDIBLE]
or that we commonly grow, like the mint family. There’s coriander, there’s
basil, and all these, the oregano, and all that, if
you use in small quantities and combine all of them,
as much as we can do, as it unmollified, means not
try to concentrate them a lot, we have found many
things, that you’ll be able to use many of
these herbs simultaneously. They are helping us in
many different ways, and they will all contribute. Even if they can reduce
diseases by 10%, that’s a lot, and without any side
effects and all that. So that’s kind of the
conclusion of my research. So yes, people
have been growing, and they can– I don’t know
what kind of bacteria they have. I don’t know what normally,
even in this country, we still do the same thing. Growing our own [INAUDIBLE]. Thank you. Me? Yeah. I’d like to know if there’s
a safe source of supplements? So if you look on
the supplements, sometimes they
say USP certified. And those actually go through
the United States Pharmacopeia, and they’re probably safer
than the ones that don’t have that USP label on it. USP? Yeah. There’s a circle with USP. So those are monitored, so– [INTERPOSING VOICES] Those are– –like half of a– Well, it’s not
as– well, it’s not monitored from the FDA level,
but it’s more monitored than the other ones. So it’s more likely safe. Yeah. How about taking selenium? S-E-L-E-N-I-U-M. Taking what? Selenium. Selenium. Selenium. What are you using it for? Is it– They say it’s good
to prevent tumors. Oh. I mean, I haven’t
heard any evidence that it does prevent any tumors. So if you’re taking
it for that purpose, it probably won’t help too much. That’s all I can tell. For the last one and
a half or two years, there’s a lot of
research going on all over the world for vitamin D
and how much is good and safe. And then they’re coming
out that more and more that the higher dose is better. How far are we doing
in Stanford research? They also [INAUDIBLE]
because some of the doctors are using quite a high–
recommend quite a high dosage of the vitamin D.
So I am a diabetic, and my doctor
recommends 50,000 IU. Yeah, you’re taking
it once a week, right? And it’s one. [INAUDIBLE] he’s working with. And I didn’t have any side
effects, or anything like that. But supposedly it really
helps the diabetic, plus also gives you lots of support in
any other parts of your body. I don’t know how much research
is going on here at Stanford. I’m not aware that there are
specific studies going on at Stanford. But vitamin D deficiency is
linked to a lot of disease, including cancer, cardiovascular
disease, and mental illness. And so the 50,000
units once weekly is replacing the vitamin D. If your doctor checked
your vitamin D level and it turned out
to be low, it’s the actual treatment of
vitamin D deficiency. So we do use a high
dose in that case. But to my knowledge,
it’s not recommended to use a high dose for people
who are in the normal vitamin D level. So normally, we do 1,000 to
2,000 international units daily. That’s the recommended dose. I have seen some patients
using higher doses, 5,000, or even higher, but we do
not recommend that high dose unless you were diagnosed
for vitamin D deficiency. Because I know you can see
lots of places even with 5,000. [INAUDIBLE] In the very good places,
it’s not just like that you get anyways. I mean, the theory is that
Whole Foods or very good vitamin stores, where there is
the market for 40 years. So 30 years or
something like that. So it can be got at higher
and higher doses of vitamin D. And it’s all over the world. It’s a big research now, the
vitamin D that does a lot. So you could need it. And that’s why I was wondering
how much we [INAUDIBLE] to see the research. I would be cautious to
taking high dose vitamin D. Because it can be accumulated. So I would avoid
[INAUDIBLE] make sure that you check the– if you
were diagnosed low– vitamin D deficiency, check
the level, make sure that your supplement’s
dose is adequate to keeping your vitamin D level
in the normal range. What is the normal range? Is? Well, depending on the– It’s 20 to 40. 20 to 40, depending
what units, but 20 to 40 is a normal range, about. What about the usage
of honey and olive oil to prevent tumor or cancer? You know, there are lots
of herbal supplements, or any food asserts it
is studied and claims to help the cancer. But I’m not aware of any
single big studies that have proven that that’s
helped a cancer patient or treating cancer. What do you think about soybean
and seaweed product that’s been– you know, now they say
that tofu is not good for you after all, because it’s so
GMO, Genetically Modified. So tofu is– has a soybean. It helps to prevent
breast cancer. And it’s very interesting that
tofu, soy, in food source, it helps to reduce
breast cancer risk. However, soybean as a
supplement has been proven to increase breast cancer risk. And it’s not even a
human study, but it’s been proven in animal studies. So if you’re at high
risk for breast cancer, then I recommend
that you take soybean as a food source,
not as supplements. But even in the
food source, they say the beans are– a
high percentage of beans are growing in America that
are genetically modified, so it’s not really
natural to eat. Well, if you’re– I have to
say, it’s still better than just supplements. Soybean powders, and you
have some soybean supplements you can buy at the
health food store that I do not recommend
that if you wanted to use it for breast cancer. That’s the same
way with seaweed? Because it’s a supplement,
brown seaweed from Japan. And they sell for $330
for 120 [INAUDIBLE]. And they recommend that if
you are a cancer patient, you need to take from
10 to 20 pills a day. I think I would be– I’m not
recommending you spend so much money on those pills,
because first of all, you don’t know how– [INAUDIBLE] I just wanted to
explain to this lady, if you’re concerned
about tofu that has too much GMO, whatever,
go to a health food store and find one that says no GMO
soybeans used in this tofu. I mean, it’s gotta
be out there, and I’m sure you can find what
you’re looking for. [INTERPOSING VOICES] I have a question about
tofu and soy products and estrogen-based cancers. The studies seem to be mixed. Some say yes, eat it, others
say no, stay away from it. So I stay away from it because
I don’t know what to do. I So women from northeast
Asia, so Japan or people from Asia, people have
lower risk of breast cancer. But however, when they
integrate to the United States, their risk is higher
than people who are living in their countries. So the speculation is that
it’s probably from diet. And so as a pharmacist,
and [INAUDIBLE] have experience with herbal
prescribing practice, I do think that soy– I
mean, tofu in natural sources is good for breast cancer. And if you are too
concerned about, oh, I don’t want
to take any chance. But the studies have stronger
evidence– provide more, stronger evidence to the
positive in role in breast cancer risk by taking– Let’s say for ovarian
cancer, would it increase your estrogen levels? That was my concern. Will it increase
your estrogen levels? So my understanding
is some people say it’s good for ovarian
cancer, because the estrogen in the soy product will attach
to the estrogen receptor, and therefore occupying it, so
that the body’s estrogen won’t occupy it. But then other people say,
no, it doesn’t matter. I don’t have any
opinion on that. But I think that I favor the
patient to eat the good quality tofu if you have any risk
for the breast cancer. And how about the tempeh,
which is fermented. Is that less
estrogen, do you know? I’m not sure. OK. Thank you. Me? Yes. Turmeric. What do you think
about that for cancer? Turmeric, I don’t see
that harm of taking it. But I’m not sure that there’s
much efficacy in treating or preventing cancer. Yes? What about soy milk, like
store-bought soy milk with the calcium added in,
versus just the soybean, like from Whole Foods, and
making the soy milk out of produce with a soy milk machine. I’m asking this
question because I’m trying to replace the
milk with soy milk, because there’s
been some studies, I don’t know whether they’re
accurate or not, that real milk promotes cancer cells. Milk promoting cancer cells? I think one thing I would
avoid, the artificial supplement that has soy protein in it. There’s compounds
called isoflavonoids, and it’s one of
the things that we believe that was important
for preventing breast cancer. It’s actually harmful I in
preventing breast cancer. So what are soy milk versus
the soy– what is it you were– Soybean, like bulk
soybean that you– Natural source? It’s from a natural source? Yes, just dry soybean. I think– I’m not sure
which one is better, but they any from
the natural source is better than synthetic powder,
promotes breast cancer health. Do you have any comment
about soy milk versus milk? No, I’m a pharmacist. I’m not not a dietitian. So no preference. I can address that question. I have a very strong opinion. The milk, as such,
is not dangerous, but because there
are the hormones and all that to
the cows and all. Those have been injected. They definitely go
through the milk and eventually in
the human body. So those are the
issues with the milk. Otherwise, the milk is
nature’s production. So though it’s from
a different species, that’s still a problem. But if I were in her place,
rather than using the soybean, I’ll just take the hot water
and put the soybean in that, unground, without breaking it. So whatever ingredients
nature will give me, I would just drink that. And I will depend on the nature
that 99% of the things which are not good for the
health, they will not go into the– they
will not leach out, or they will not
go into the water. So the water wouldn’t have
any– except the soybean. I would rather depend on that. Same thing with the
fenugreek and all that. For the diabetes and all that. That would definitely help. Anything that one wants
to use, the best things you just put in the hot water
as a whole, wholesome substance, and just drink that water. I think that’s the safest
and some effect, some help. How long do you put
it in the water? Just like 30 seconds. Yes. For vegetarians, would the
advice on these supplements be different? For a vegetarian diet? Vegetarian diet. Let me repeat it. Would the recommendation be
different for vegetarians? I don’t think so. No, I don’t think so. Is there any specific
concerns you have? [INAUDIBLE] No. [INAUDIBLE]. So a lot of things that go
into almond milk instead of regular milk, is it
better to eat the milk or to drink the milk? Because you look on the
label of the almond milk, there’s hardly any
nutrition there. So I’m just kind of like, what? It helps if you need
to drink three quarts a day of something. We don’t have any
strong opinions. I do both. I drink the milk and
I eat [INAUDIBLE]. So milk thistle for
liver protection, how effective is it for
detoxification of the liver? I think it’s more of a
prophylactic type thing. So if your liver has
already some issues, it may not work so well. But if you’re anticipating
some chemotherapy or something, it may be helpful in that way. Can you [INAUDIBLE]
traditional Chinese medicine? Sorry, can you say that? Supplements used in the
traditional Chinese medicine? You said you have some
expertise in Chinese medicine? Chinese medicine is– the
concept of Chinese medicine or taking dietary supplements. Chinese medicine
has make sure there are different ingredients,
and also the way you process ingredients
are different. So they enhance efficacy. At the same time, it
minimizes side effects from all the different
herbal medicines. So I don’t have any
specific recommendation with Chinese medicine
this lecture, but the concept of
Chinese medicine is very different from what
we’re taking as supplements from health food stores. Any more questions? So does ginseng
affect the efficacy if you’re on a lot of
prescription medication? Because that’s the thing
that’s going around in the Asian community. That if you’re on
prescription medication, that when you take ginseng,
you’re supposed to space it out two or three hours
after you take the medication. Ginseng has stimulatory effects. So meaning that it can
increase your heart rate. It can increase
your blood pressure. So if you’re diagnosed some
sort of cardiovascular disease, it may affect heart
function and blood pressure. It might not be safe
to take it, especially at the same time that you’re
taking blood pressure or heart medicine. But in general, people,
when they use it, have improved energy
levels and improved fatigue due to chemotherapy
or due to cancer. It might be– it’s
probably safe. But I would work with
an herbal specialist, to make sure that that’s the
right supplement for you. [INAUDIBLE] energy level. Personally, I do not
recommend buying ginseng from health food stores. Just number one, as
Abraham mentioned, the contents are not regulated. So even if you’re buying–
like you said 20%, and they may have
like 10%, maybe 5% of ginseng in the capsule. And second of all, those people
working at health food stores, they’re not health
care professionals. So when they recommend
it, they may not know that it’s not a
safe supplement for you. So if you want to
take ginseng, I recommend that you talk to
herbal specialists about that. This has everything
you mentioned in it, and all together,
74 ingredients. What is your opinion? [LAUGHTER] What is that? [INAUDIBLE] This was given to me by
a man whose daughter, who is very sick, was taking it. And she only got worse. Based on this your
previous experience, probably it won’t
be so good, then. OK. So my opinion that– so Chinese
medicine, that mixture of herbs and how they process,
has been tested thousands of years in people. So it may not have strong
scientific evidence, but it’s proven
to be safe if you have a good herbal specialist
prescribing for you. For those supplements,
make sure– maybe it has all the good
ingredients mixed together, but it has more
harms than benefits. Because first of
all, the people who mix this, all the
ingredients, they may not know what is going
to happen after they mix all those ingredients together. Being a pharmacist, we
all like looking at how drugs interact with each other. Sometimes one drug
is working real nice, the other drug is working well. But if you mix them together,
it causes more harmful side effects than there is benefits. So I would be very cautious
in buying those supplements, especially if they’re
very expensive. And when I worked at the
Cancer Center in Berkeley for five years,
my day to day job was I had patients asking
about, oh, is this good for me to take? And oftentimes,
I’d just give them more concerns than agreement. And I realize that a
lot of times people who are in a disease
like cancer, people want to find the best
type of treatment options, including finding
the best doctor and finding the best alternative
medicine, best treatment options. And I realized that I
will [INAUDIBLE] help them to find a better source. And I want to help them with
how to use the right medication and right timing. So I highly encourage all of
you interested in supplements or anything, talk
to your doctors, talk to your pharmacist. They may not have a strong
opinion about some things, but they may tell
you they’re not safe or maybe wait until your
treatment is finished, and then you can
safely use them. And I also want to emphasize
that the supplements that promote treating cancer
can be very expensive. They’re very expensive. I had some patients
that came to me and asked me the
good supplements, it’s emulsion
products, which is used for treating gastric cancer in
Japan and some Asian countries. Yeah, it is very expensive. But is it going to work
for him, his cancer? Not sure. And so before you’re spending
that hundred dollars to buy all these expensive supplements,
I would do some research and ask some people who are more
health care professionals that may have some knowledge
on those supplements. And make sure that this first
of all, is it safe to use, or is it going to interact
with your treatments. And that’s what I
wanted to tell you. Since the FDA doesn’t test
these or what’s in them, I’ve been told that the
German equivalent of the FDA, they have to be tested. Do you know if that’s true? Herbal supplements in
Germany is way more studied than in
the United States. And I know that their
pharmacists, in Germany, they also have much more
knowledge in the supplements. So I believe that Germany
has more regulation on these supplements
than the United States. But do they actually–
do they sample and test to see that
is has what it says. That’s something I don’t know. Can I address that? Basically, [INAUDIBLE] yeah. Germany has a Commission
E, which they actually take the individual ingredients
and then they test them, rather than a combined formula. If I were to use this one,
I wouldn’t touch that. The reason being that
anything that nature has made, you can combine. You can combine 10, 20, 30
plants, leaves, barks, anything that you’ll be still safer. Once we have concentrated, then
we have really, it can help, it can hurt. So I hope I have
answered your question. Have you got anything
about how to find a good herbal
specialist, or is there a website that prints
them out, [INAUDIBLE]? I know some cancer
institutes, they have– right? Yeah, the NIH also
has a section that’s how to find a practitioner. Yeah. So if they’re registered with
NIH, they should be on there. And then I think UCSF has
an integrative medicine program, not that I’m
promoting UCSF, but they do. Stanford doesn’t have any. They’re trying to develop
one, but as far as I know, they haven’t finished
developing it. You said the dose is very
important, for example, you showed two to
three grams per day. Is that maximum, two to three? Or you have to take at least
two to three to have effect? What if I take one? One a day. I mean, some
[INAUDIBLE] too little? Well, for fish oil, because
it– are you taking it for triglycerides, or are
you just taking it to help– Because people said it’s good. I think the most well studied
are usually about two to three, but I think one is probably OK. Usually the max is
about four grams a day. Is chocolate a good antioxidant? [LAUGHTER] I don’t know. It may be good as
an antioxidant, but it’s bad for
your blood sugar. [LAUGHTER] But it’s good as
a mood elevator. Yes, yes. But it’s bad for your belly. Now some say five cups of coffee
is good for you [INAUDIBLE]. Five cups of coffee? I don’t think so. That’s a little too
much coffee, I think. Maybe for Alzheimer’s symptoms. What is [INAUDIBLE]? So green tea can increase
the levels of tamoxifen in the body. So you might get more side
effects with the tamoxifen. So just one [INAUDIBLE]. Yeah, it’s just side effect. It doesn’t neutralize
it, it just might cause more side effects. OK. I think yeah. Have you heard about they
say this anti-inflammatory, it’s called Cat’s Claw,
it’s from the Amazon. I’ve heard of it, but I
don’t know– I heard of it, but I don’t know much about it. Can I answer that Cat’s Claw? Yeah, sure. [INAUDIBLE] and definitely
has some [INAUDIBLE] uses for people who
have [INAUDIBLE]. OK, sure. This doesn’t have
to do with cancer, but arthritis, I heard as
a supplement, chondroitin? Glucosamine and chondroitin. Does it help? There’s been– as far
as I know, there’s been two big studies with those. One showed that it helps, one
showed that it doesn’t help. So it’s really not harmful. Do they come together
or separately? They usually come
together, yeah. Unless you have some blood
sugar– are you diabetic? No, it’s not for me. It’s for my mom. OK. So if you have any blood sugar
issues, it should be safe. If you have a blood sugar
problem, it’s not safe? If you don’t have a blood sugar. If you don’t have a blood sugar. [INTERPOSING VOICES] Yeah it can raise the
blood sugars in diabetics. One item on the list,
glutamine, can you get that in what kind of food? You can find it in
the health food store. It only comes in
supplement form? You can’t get it in any
kind of vegetables or fruits or anything? It’s a large amount. So I don’t think you
can get it in fruit. So does that help
with neuropathy? It is shown to be helpful
to any neuropathy. But once you have neuropathy
from cancer treatment, I’m not sure that it
would be effective. But studies have shown
it to be effective if you use it as a measure
of preventing [INAUDIBLE]. So it also helps for mucositis
from the cancer treatment? Yeah. Yeah, if you have a lot of
mouth sores or diarrhea. How come your oncologist
never mentions– Exactly. Mine did. Mouth sores? Yes. Absolutely. Yeah, he gave me a strict
mouth program to use. He never gave anything to me. Oh, not this
particular supplement. The supplement? Oh. He’ll give you a
prescription [INAUDIBLE]. No, no. I didn’t get a prescription. He said, brush your
teeth regularly and rinse with baking soda and water. And it’s been working. The supplement will
help with that. They should have told us before. I’m already developing
the neuropathy symptoms from the [INAUDIBLE]. So we can take
glucosamine during chemo to help prevent neuropathy. You can, yes. But make sure that you take
10 grams three times a day. So that’s how the dose is. And after treatment, do most
neuropathies [INAUDIBLE]? That’s something I
don’t an answer to. What is this for? Neuropathy, but I mean– [INTERPOSING VOICES] –is it something that our
bodies are not absorbing [INAUDIBLE]. So what happens is
the range changed? Or our bodies are
not absorbing it? [INAUDIBLE] I think they’re testing it. They’re looking for it,
so they’re finding– [INAUDIBLE] because
vitamin D is not a common test that [INAUDIBLE] Can we get it from sun? Well– There’s been some
controversy about it. So I think because there’s
a lot of skin cancer scare now, so a lot of people
are putting on sun screen, and then that kind of reduces
the amount of vitamin D that your body makes. So then now, because of that,
now everyone’s vitamin D deficient. But then you can’t
really go in the sun, because you might
get skin cancer. And then, so– You can’t win. Yeah. You can never win. I’m going to go ahead and
stop the filming right now. But you’re welcome to stay
and ask more questions. But thank you so
much for a wonderful and [INTERPOSING VOICES]. [APPLAUSE]

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