Aspirin and NSAIDs Appear To Reduce the Progression of Barrett’s Esophagitis to Cancer

Written by Steve on 26 September 2010

Esophageal Cancer is a terrible disease that has an extremely high mortality rate. It often occurs as a progression from Barrett’s Esophagitis, which is believed to be caused by repeated exposure of the esophagus (the ‘tube’ that transports what you eat to your stomach) to stomach acid – aka acid reflux.

There are numerous studies that have indicated that chronic use of aspirin and some NSAIDs can significantly reduce the risk of Barrett’s Esophagitis progressing to Esphogeal Cancer.

The mechanisms behind this abilty to stop or slow the progression of inflammed tissues of the Esophagus to cancerous conditions appear to be the same as those behind the reduction of cancer risks at other sites when aspirin is taken on a continuous basis.

We’ve talked about this before. I won’t belabor the point or the mechanisms. Instead, I’m going to post excerpts from a couple of journal articles that I think summarize the situation best.

The first article is titled ‘NSAIDs Modulate CDKN2a, TP53, and DNA Content Risk for Progression to Esophageal Adenocarcinoma’. It was written by Galipeau PC, Li X, Blount PL, Maley CC, Sanchez CA, Odze RD, Ayub K, Rabinovitch PS, Vaughn TL and Reid BJ – and it was published in 2007 in the journal PLoS Medicine (February 2007, Volume 4, Issue 2, e67 – pp 0342-0354).

You can get a free copy of it at http://www.plosmedicine.org/article/info:doi/10.1371/journal.pmed.0040067 .

In the abstract for this article the authors say ‘In patients with zero, one, two, or three baseline panel abnormalities, there was a significant trend toward EA risk reduction among NSAID users compared to nonusers (p=0.01) The strongest protective effect was seen in participants with multiple genetic abnormalities, with NSAID nonusers having an observed 10-y EA risk of 79%, compared to 30% for NSAIDS users (p < 0.001)’. They close their abstract by saying ‘A combination of 17p LOH, 9p LOH, and DNA content abnormalities provided better EA risk prediction than any single TP53m CDKN2A, or DNA content lesion alone. NSAIDs are associated with reduced EA risk, especially in patients with multiple high-risk molecular abnormalities.’ In the editor’s summary for this article they say ‘Overall, just 12% of patients with no abnormalities but nearly 80% of patients with three abnormalities developed esophageal cancer. NSAID risk reduced the risk of cancer in all of the participants, but its effect was greatest in those with three genetic abnormalities.’

So – what the heck did they say? Well, EA is their abbreviation for Esophageal Cancer. Progression from normal esophageal cells to cancer cells appears to follow a path of repeated mutation as a result of chronic irritation caused by repeated exposure to stomach acid. The genetic mutations and characteristics they identified in this study seem to be very highly associated with the final progression of Barrett’s Esophagitis to cancer. Aspirin and NSAID use appears to cause a reduction in the progression of Barrett’s Esophagitis cells to cancer, and the higher the number of mutations that are observed in a person’s cells the higher the protective effect of aspirin and NSAIDs.

The second article is titled ‘Non-steroidal anti-inflammatory drugs and risk of neoplatic progression in Barrett’s oesophagus: a prospective study’, and it was published in the journal Lancet Oncology in November of 2005. (Lancet Oncology, 2005; 6:945-952). The authors were Vaughn TL, Dong LM, Blount PL, Ayub K, Odze RD, Sanchez CA, Rabinovitch PS and Reid BJ. (Yes – I know – these authors contributed to the other article also.)

You can get a copy of this article – but it will cost you unless you can get access to it through your library’s reference librarian, or at a major university’s library – or maybe even through a major hospital’s medical library. Look for a ‘teaching’ hospital, they usually have good online access.

Anyway, in closing their discussion of the findings for this study the authors said ‘Our findings lend support to previous observational studies and animal studies, in that use of aspirin and other NSAIDs might protect against development of oesophageal adenocarcinoma in NSAID users; the incidence of oesophageal adenocarcinoma for former users approached that of never users about 36 months after baseline assessment. People with high-grade dysplasia who reported current NSAID use had a lower risk of neoplastic progression than did those with high grade dysplasia who reported former or never use of NSAID, suggesting that NSAID use might be an effective intervention even at late stages of neoplastic progression.’

Translation: If you have Barrett’s Esophagitis aspirin and NSAIDs reduce your risk of having the cells of the esophagus turn cancerous – even in cases where the cells are really screwed up. So, it might be possible to reduce the progression to cancer in even very severe cases with aspirin or NSAIDs.

To make sure you know I am looking at the studies that don’t support my belief in aspirin and NSAIDs and their ability to prevent or slow the progression of cancer I am also posting the link to a journal article that disagrees with the idea that aspirin can change the rate of progression of Barrett’s Esophagitis to cancer. I haven’t been able to get a copy of the article yet… but I  will the next time I’m at the library.

‘Aspirin is not chemoprotective for Barrett’s Adenocarcinoma of the oesophagus in multicentre cohort’ http://journals.lww.com/eurjcancerprev/Abstract/2009/09000/Aspirin_is_not_chemoprotective_for_Barrett_s.7.aspx

That said… I’m going to keep taking my regular strength aspirin every day till this argument gets sorted out.

You know the drill by now… I’m a Pharmacist, not a physician. You MUST talk to your physician and get his/her guidance before changing your medication regimen or adding aspirin or NSAIDs to your daily routine. Remember, Pharmacist Pharmacist – Doctors Doctor. As it should be.

Does Acetaminophen (aka ‘Tylenol’) Increase Cancer Risks?

Written by Steve on 23 September 2010

What if I could show you evidence that strongly suggests that frequent acetaminophen use appears to be associated with substantial increases in the risk of cancer occurence?

Well, I can – and the journal articles that the information is in were published in world class publications and written by world class investigators from world class institutions who were documenting the results of world class investigations.

Unfortunately, the investigations were looking for reductions in cancer rates as a result of aspirin and NSAID use.

While the correlation between aspirin and reductions in cancer risk was clearly demonstrated in the two studies that I’ve most recently reviewed, it is a fact that the correlation between acetaminophen use and increased cancer risk was just as clearly demonstrated.

However, this correlation was either ignored or downplayed and rationalized away by the authors.

I don’t find this particularly unusual. By now everyone knows that aspirin (and sometimes NSAIDs) are strongly associated with serious reductions in cancer occurences and progression. In fact, this information has become so well known within the academic communities that it is now starting to spill over into the awareness of the general public. It is the norm for there to be an avalanche of data supporting discoveries like this once the fundamental claim has become accepted by the mainstream scientific community and researchers.

As Arthur Schopenhauer (1788-1860) is said to have prophetically written – ‘All truth passes through three stages: First, it is ridiculed; second, it is violently opposed; and third, it is accepted as self-evident.’

Along those lines, it simply isn’t acetaminophen’s turn to be reported on. But it will be. Correlations as strong as the ones shown in these two reports simply cannot be ignored forever.

I have seen similar information in other publications, but – like most - I have been so focused on reading the data that supports the publication’s research focus that I totally missed the acetaminophen correlation. But the studies I just reviewed were done so well and had been statistically analyzed so intensely that I just couldn’t ignore the point that acetaminophen and cancer occurence was strongly correlated for the studied conditions.

I encourage you to check this info out for yourself.

The first article is titled ‘Aspirin and the Risk of Hodgkin’s Lymphoma in a Population-Based Case-Control Study’ and its reference information is Chang ET, Zheng T, Weir EG, Borowitz M, Mann RB, Spiegelman D and Mueller NE. Aspirin and the Risk of Hodgkin’s Lymphoma in a Population-Based Case-Control Study. Journal of the National Cancer Institute February 18, 2004 Vol 96, N0 4, pp 305-315. You can get a free copy of it at http://jnci.oxfordjournals.org/content/96/4/305.full .

You can find a free copy of the second article at http://jama.ama-assn.org/cgi/reprint/291/20/2433 . It’s titled ‘Association of Frequency and Duration of Aspirin Use and Hormone Receptor Status With Breast Cancer Risk’. It’s reference is Terry MB, Gammon MD, Zhang FF, et. al. Association of Frequency and Duration of Aspirin Use and Hormone Receptor Status With Breast Cancer Risk. JAMA, 2004;291(20);2433-2440.

Although I don’t use acetaminophen, I intend to make sure my kids know about these studies and their findings… Hopefully they’ll limit their acetaminophen intake.

Oh yeah, in case you’re wondering… both studies noted above found strong correlations between daily aspirin intake and reductions in cancer occurence. Imagine that.

Remember – you must talk to your physician before starting any new medication regimen. Pharmacists Pharmacist – Doctors Doctor, as it should be.

The Gerson Therapy – Was Doctor Gerson A Quack?

Written by Steve on 02 August 2010

Max Gerson, M.D. was a physician who claimed to have developed a protocol that could cure cancer. He is dead now, but his legacy lives on in alternative cancer treatment centers around the world – with the most famous one being located in Mexico.

Mainstream healthcare providers frequently react with extreme skepticism and/or claims of quackery when asked their opinion of Dr Gerson’s theories and protocols.

I reacted the same way when I heard of this physician’s claims and beliefs. Some of his proposals sounded completely nutty to me.

But there is nothing like knowing that a loved one has an advanced cancer that most people die from to make you reexamine your assumptions and what you accept as fact.

You see, I know that the treatments we currently subject patients to almost always have poor outcomes if the patients’ cancers are not discovered early and cut out.

So… as part of my study of options that might be useful to extend my family member’s life… I forced myself to put aside dogma and my biases and pre-conceptions so that I wouldn’t miss something that might work.

Thus, it was inevitible that I would end up reading Dr Gerson’s book – ‘A Cancer Therapy: Results of Fifty Cases and the Cure of Advanced Cancer’. In fact, I read it several times.

It was a difficult read. The first time I read it I had to re-read the chapters several times because it was extremely difficult to get my mind wrapped around the ideas presented by this physician. Every time I progressed to a new idea my subconscious mind told me it was nuts and I was wasting my time. It was a tortuous process.

Pharmacists are extremely conventional in their perspectives, and – as a group – we tend to have been strongly indoctrinated to the status quo. But, slowly it dawned on me that I had to interpret Dr Gerson’s writings and theories based on the state of scientific knowledge when he was practicing - to look for what I call ‘convergence’ of the data and ideas and the assumptions behind them with new knowledge that originates from other sources.

Then, the pieces started to fall into place. I won’t detail Dr Gerson’s theories in this post. If you need the information there are many books out there that will explain in much more detail than I can. But I will say this – I can point out case after case of convergence between his claims and protocols and information that is documented in journal articles that have been published in the recent past.

I do not know whether the people who are running his clinics are curing cancers or not. I have seen documentaries where patients claim they are. I do not know if Dr Gerson actually cured cancers or not, although there are many claims that he did. I do not know if Dr Gerson was a good man or not, but I have heard recordings of interviews that seem to show a physician who believed with all his heart that he was helping people.

I haven’t drug my loved one to the Gerson clinic in Mexico – things happened too fast and my learning curve limited my ability to assimilate enough data soon enough to even consider whether or not that trip should have been made. But….  as my learning has progressed I find myself implementing things into her day-to-day activities that could easily qualify as spin offs of therapies proposed by Dr Gerson.

And every day I find evidence that Dr Gerson may have been correct in many of his actions.

So, I find that I must say that I do NOT believe that Max Gerson, M.D. was a quack.

You can find more information about clinics that practice the Gerson Therapy if you’re interested in learnng more about his protocols at http://www.gerson.org/ .

Again – I’m a pharmacist, not a doctor. I’m providing information I think you might want to talk to your doctor about. Good luck.

Gerson Again – Convergence With Others’ Claims and Theories

Written by Steve on 16 August 2010

The recent post about Doctor Gerson and his theories about treating cancer has generated quite a few enquiries.

In that post I talked about what I believed to be a convergence – or coming together – of more recent claims and findings with the protocols detailed by Doctor Gerson.

People want to know more details about these convergences.

I’ll attempt to explain the most significant ones.

An oversimplified summary of Doctor Gerson’s protocol and the reasons behind the various elements of his therapies includes:

1. Increase the patient’s immune response by stimulating the person’s organs and systems to a state of increased vigilence – with an emphasis on the function of the liver and the system of organs that your food flows through from your mouth to your you-know-what. Included in this stimulation are the organs that are associated with this system. Eventually, a majority of the patient’s organs would be involved in this effort to improve immune function.

2. To achieve this stimulation of the immune system and the body’s ability to recognize and kill cancer cells various substances were delivered into the digestive system and to the liver. These substances were given by mouth and via enemas of various types.  The most famous enemas were the infamous ‘coffee’ enemas, and the primary stimulatory substance taken by mouth was castor oil.

3. Doctor Gerson also strongly believed that it was possible to increase the body’s ability to mount an immune response by changing the concentration of mineral ions in the body – most notably potassium and sodium. He believed that it was important to drive the body’s potassium level up and the sodium level down. The goal of this effort to change ion concentrations was the alteration of the voltages that exist across the membranes and structures of the body’s cells.

4. To achive these changes in the body’s potassium and sodium levels Doctor Gerson administered a solution that contained a specific combination of potassium compounds along with a regimen of fruit and vegetable greens juice. These extracts were made from fruits and greens that are known to be high in potassium.

5. To further rev up the body’s metabolic and immune systems Doctor Gerson gave patients doses of iodine and potassium iodide (Lugol’s Solution – 5%), dessicated thyroid (aka ‘Armour Thyroid’), and niacin.

6. In additon to the fruit and vegetable greens juices patients were given a raw liver drink. The purpose of this drink was the provision of nutrients to the patient – and particularly to his/her liver.

7. Without explanation – and despite a ban on ‘fats and oils’ – Doctor Gerson’s protocols called for the administration of flax seed oil every day.

Although there are many other details, the list above is pretty representative of the strategies Doctor Gerson was trying to implement to save his patients’ lives.

So, now we go forward to today.

Because of contamination problems that make it hard to get safe liver for making the liver drink the people controlling the Gerson Protocol switched to dessicated liver tablets. Then it appears that they switched from the liver tablets to Coenzyme Q10 supplements.

This switch to CoQ10 converges with current theories about CoQ10′s ability to re-energize cell’s mitochondria, especially when combined with doses of niacinamide.

Niacinamide is what niacin is converted to by patients’ livers. Another convergence.

Fruit juices and garden greens contain a multitude of vitamins and minerals. Maybe more importantly, they contain bioflavanoids. In general, flavanoids are the molecules that often give a plant’s fruit its color. They are known to frequently survive the digestive system and their trip through the liver. Most importantly, flavanoids are widely believed to be able to suppress cancer cells’ growth and metastasis. Convergence.

There is a growing body of evidence that indicates that we need more iodine than we are currently getting in our diets. If you don’t have enough of the right forms of iodine your thyroid gland can’t make thyroid hormone that works right. Without thyroid hormone your body’s metabolism – and everything else – slows down. A patient’s immune response and ability to mount a counterattack can also be expected to be depressed. This has been named Type 2 Hypothyroidism by doctor Mark Starr in the recent past, and there are those who strongly believe that the administration of dessicated thyroid and iodine supplements are necessary to correct this problem and make the body’s systems work as they’re supposed to. Convergence once again.

The people who talk of iodine and thyroid supplementation explain that the goal of their supplementation is an increase of the body’s electric potentials. Integral to that discussion is the increase in potassium levels to alter the electrical gradients across cell and structure membranes. Convergence, convergence, convergence.

And, finally, it is becoming well known that the oils that one eats can have a very significant impact on your body’s metabolism and well being. One of the oils that is recommended to reduce global inflammation and promote proper immune response is flax seed oil. It is the richest source of Omega-3 fatty acids generally available as a food oil. Convergence.

So, short as this post is, I hope it helps you understand where convergences appear to be occuring with Doctor Gerson’s teachings.. Sorry for not going into even more detail, but this topic could fill a book.

If you want more info on some of the topics I touched on above feel free to click on any of the books listed on the right edge of this blog to get yourself taken to BarnesAndNoble.com to see more details.

Neulasta and gCSF Receptor Stimulation

Written by Steve on 02 August 2010

In a previous post I talked about whether an alcohol/water extract of raw ginger root could positively impact the kill rate of cancers – particularly ovarian cancer.

In that post I pasted a couple of charts that showed a change in slope of lines that model an actual patient’s CA125 levels as her therapy progressed. This change in slope suggests that something increased the kill rate for this patient’s tumors, and a review of changes in this patient’s treatment regimen indicated that the change in slope occured around the time that the patient started taking the ginger supplement.

HOWEVER, in that post I also mentioned the fact that another event that might correlate with the change was the starting of Neulasta injections 24 hours after each chemo session.

I can make what I believe to be a convincing case for either the ginger supplement or Neulasta. Or, perhaps both interact with each other. I simply don’t know because no further studies have been performed.

Neulasta’s product insert clearly cautions that there is a possibility of stimulation of gCSF receptors and increased tumor growth. However, the consensus in the literature in the USA is that Neulasta does NOT cause ovarian tumors to grow. And I can accept that finding. However, studies that have been published elsewhere in the world have shown that about 50% of ovarian tumors have gCSF receptors.

IF Neulasta was involved in the change observed for the patient I referenced earlier I would hypothesize that the gCSF receptors are activated, and in some way this forced the tumors to try to reproduce and/or blocked cell cycle pauses that allow tumor cells to repair the damage done by chemo agents like carboplatin.

If I was being treated for ovarian cancer – and maybe other solid tumor cancers – I would seriously consider taking the ginger supplement that I posted the recipe for previously and Neulasta injections 24 hours after chemo administration.

Of course, I’m a pharmacist – not a physician. You must talk to your physician before starting any new supplements or medications. And, if your doctor and you decide to try the ginger supplement you must follow the rules laid out in the posts associated with it. Do NOT assume ginger is not a powerful substance.

CoEnzyme Q10 – Should You Be Taking It?

Written by Steve on 01 August 2010

Well, I’ve wrestled with this post for quite awhile trying to decide what to say and how to say it.

Actually, I’ve been checking and double checking my references and info – and debating the topic with other pharamacists I respect to make sure I knew what I wanted to tell you.

I believe you should be taking CoEnzyme Q10 because there is significant evidence that it is useful for the prevention of problems that find their roots in your cells’ mitochondrias’ ability to do their job.

The mitochondria are your cells’ power plants. If they don’t have enough CoQ10 they can’t work right. If they don’t work right you’re more likely to suffer from chronic diseases, heart muscle problems (e.g. heart failure), etc… – maybe even cancer.

This may be particularly true if you are taking a statin drug to reduce your cholesterol levels. Statins block the production of cholesterol. They also block your body’s ability to manufacture its own CoQ10. Compounding the problem is the theory that you need cholesterol to properly absorb and transport the CoQ10 your body gets from your diet.

So, what version of CoQ10 should you take? Let’s talk about that.

There are two types of CoQ10 being sold on the market. One (ubiquiNONE) is what your body normally gets from your diet. It is not easily absorbed by your body, so most of what you take in when you take a supplement that delivers ubiquiNONE doesn’t get absorbed. The other type that’s available out there – ubiquiNOL – is the form that your body converts ubiquiNONE to. It’s absorbed into the body more easily, and more of what you take in supplement form gets absorbed. But, it’s not as stable and requires special chemical environments in the capsules it comes in to ensure it will benefit you when you take it.

The bottom line is that you take smaller doses of ubiquiNOL than you do ubiquiNONE, and ubiquiNOL tends to cost more.

How much smaller is the uniquiNOL dose? Well, a 50mg ubiquiNOL dose is equal to somewhere between what a 150 and 300 mg dose of ubiquiNONE would get into your system when you take the run-of-the-mill CoQ10 capsules you find most often in the stores. Those capsules cost less too.. but you get less into your system.

However, there are forms of ubiquiNONE that are absorbed 3 times better than what you usually get at the store. One brand name is Q-Gel. Another is made available by Jarrow under the name Q-absorb CoQ10. These formulations are mixed in a special oil base that makes them more absorbable. They cost more too. But this is the form I just switched to.

I was taking 60mg of the CoQ10 (ubiquiNONE) three times a day. I figure that 100mg of the more absorbable version will be roughly equivalent. Or, you could take 30mg three times a day – which is probably the right way to take it. (I’m lazy)

Or, you could take 50mg of ubiquiNOL daily. Jarrow’s ubiquiNOL version is QH-absorb. There are many others that are probably equal in absorbtion – or close enough.

Stick with major brand names… although all the ubiquinone and ubiquinol is being manufactured by Japanese companies as far as I can tell. And, if you decide to go with the ubiquiNONE route look for lecithin and medium chain glycerides (MCGs) in the ingredient list. These seem to be associated with the more absorbable brands.

AND – based on some other journal articles I’ve read – I think you should add a niacinamide capsule to your daily supplement intake if you’re adding CoQ10. There are reports that the two work together – and that high dose CoQ10 might not be good for you without niacinamide.

Niacinamide is what niacin gets converted to after you take it. It will NOT make you flush and it will NOT lower your cholesterol levels.

I’ve added a 500mg capsule to my daily regimen.

The article I’ve linked to below was actually in a book I bought that cost me a lot of cash. The authors propose that CoQ10 is needed to fight off infections, and may be useful for keeping cancer patients in remission. You should read it. They have it posted for free at this site in New Zealand – along with quite a few other interesting articles about CoQ10 supplementation.

http://www.coq10.co.nz/cms/uploads/File/CoQ10-cancer.pdf

Hope this info is useful for you and catalyzes thought about adding CoQ10 and Niacinamide to your diet.

As always…. I’m a pharmacist – not a doctor. I’m not telling that you have to start taking CoQ10 and/or nicacinamide. I am recommending that you ask your Doc what he/she thinks and whether this would be worth a try.

An Aspirin a Day Can Improve Non-Metastatic Colorectal Cancer Survival Rates by 30%

Written by Steve on 22 June 2010

In January of 2009 Andrew T Chan, Shuji Ogino, and Charles S Fuchs published Aspirin Use and Survival After Diagnosis of Colorectal Cancer in JAMA (The Journal of the American Medical Association). (A. T. Chang, S. Ogino, C. S. Fuchs 2009. Aspirin Use and Survival After Diagnosis of Colorectal Cancer. JAMA 302:6 649-658)

The authors are associated with world class institutions including Harvard Medical School, Brigham and Women’s Hospital, Dana-Farber Cancer Institute, and Massachusetts General Hospital. You will have to look very hard and for a very long time to find a better structured and thorough study.

You can get a copy of this article on its final form at http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2848289/pdf/nihms-185802.pdf

I’ve pasted excerpts from this paper below -

‘Conclusion Regular aspirin use after the diagnosis of coloractal cancer is associated with lower risk of coloractal cancer-specific and overall mortality, especially among individuals with tumors that overexpress COX-2.’

‘COX-2 promotes inflammation and cell proliferation, and is overexpressed in the majority of human colorectal cancers.’

‘Overexpression of COX-2 in tumor tissue has been associated with a poorer prognosis among colorectal cancer patients in some but not all studies.’

‘Nonetheless, because our data are observational, routine use of aspirin or related agents as cancer therapy cannot be recommended, especially in light of concerns over their related toxicities, such as gastrointestinal bleeding. Further studies among patients with colorectal cancer, including placebo-controlled trials of aspirin or related agents as adjuncts to other routine therapies, are required.’

The bottom line on this article is that patients with diagnosed colorectal cancer had about a 30% increase in survival rate when they took one 325mg aspirin daily. Further analysis of the results indicates that the patients who were benefiting were the ones whose tumors overexpressed an enzyme called COX-2.

When you consider that the authors themselves say that overexpression of COX-2 probably leads to worse outcomes I would have to say that the results of this study are quite impressive.

But, because there is a chance these patients could get what is called a GI Bleed – which can be fatal – it’s better to let them die from their cancers?

Come on… what the heck is going on here…? With all due respect to these physicians, they’re talking like someone who has never sat in a physician’s office and heard the words ‘you have cancer’ or sat in a cancer infusion center’s waiting room while a loved one gets his/her chemotherapy administered.

It’s up to you… but I’d be talking very seriously to my Doc about the findings of this study if I had colorectal cancer – or cancer of the colon of any kind.

Me? I have researched the risks. I’m taking my aspirin.

As always…. I’m a pharmacist – not a doctor. I’m not recommending that you start taking an aspirin a day. I am recommending that you ask your Doc whether this would be worth a try.

The BEST Natural Compounds for Cancer Therapy Book I’ve Found

Written by Steve on 23 May 2010

The world is full of people telling you everything natural can cure or prevent cancer.

You know much of it is hogwash, but don’t know where to go to get reliable information about different natural products’ usefulness.

If this describes your current situation you should take a look at the pdf file for this book.

NCCT2005

It’s the best book that I’ve found for providing evidence based information on the usefulness of different natural compounds for the prevention and treatment of cancer.

It provides the information in a readable format and is balanced in its presentation. It is also well indexed and easy to look up particular substances in without having to read the whole book.

It is no longer in print, but used copies can be found at Amazon.com. I bought my copy there.

However, the author has made the book available as a pdf file at this location.

http://www.ompress.com/

The author has asked for a donation of $25 if you like and use the book. It’s well worth the price, and I hope you’ll think so too after you’ve taken a look at it. You can donate to the book;s author online at the website listed above, or by sending your donation to an address listed in the pdf file.

Aspirin and Breast Cancer

Written by Steve on 21 May 2010

Potentially Life Saving Information for Breast Cancer Patients:

Can taking one regular strength (325mg) aspirin tablet per day save your life?

Maybe.

Two articles that have been recently published say that some women can cut their risk of getting breast cancer or dying after being diagnosed with breast cancer by taking an aspirin a day. Both of these articles were published in the magazines that doctors read. So, you have to believe that they might be telling the truth.

The first article was published in THE JOURNAL OF CLINICAL ONCOLOGY. It’s title is ‘Aspirin Intake and Survival After Breast Cancer’, and it was written by a team of researches from Brigham and Women’s Hospital, Harvard, and the Dana-Farber Cancer Institute. 

OK, they have my attention. These are places where very smart people work.

In their article they say that their studies show them that women who have  been diagnosed with Stage I, II, or III Breast Cancer – and who have lived a year after diagnosis – can cut their risk of dying and the risk of their cancers spreading to other sites by more than 50%.  And – it didn’t seem to matter what stage the cancer was, whether the woman had gone through menopause or not, how thin or heavy set they were, or whether their tumors were estrogen receptor sensitive or not.

That’s HUGE information!!!

The article is not available for free, but I’m sure your local librarian or a librarian at a major hospital or university library will  be able to help you get a copy that you can read and give to your Doctor without your having to pay for it. Just tell them you’re looking for the journal article titled ‘Aspirin Intake and Survival After Breast Cancer’ written by Michelle D. Holmes et. al. and published in the Journal of Clinical Oncology. Tell them it was published ahead of print on Feb 16, 2010. They will know how to find it.

The second article was published in JAMA – The Journal of the American Medical Association – in May of 2004. It’s available free of charge from the JAMA website at http://jama.ama-assn.org/cgi/content/full/291/20/2433 . The website will probably tell you you’re not a subscriber. I just clicked on my back arrow and the article showed up. If that doesn’t work for you do a google search for ‘ mary beth terry jama breast cancer ‘. Or, you can get a copy from one of the librarian sources I listed above for the other article.

ANYWAY – The title of this article is ‘Association of Frequency and Duration of Aspirin Use and Hormone Receptor Status With Breast Cancer Risk’ and – as I said above – it was published in JAMA. The authors are Mary Beth Terry et. al. and they come from Columbia University, the University of North Carolina – Chapel Hill, Mt. Sinai School of Medicine, Cornell University, and the Strang Cancer Prevention Center. (hope I didn’t miss anyone) Ditto on the smart people comment above.

The authors of this article say that they saw around a 20% reduction in cancer cases when patients were taking aspirin every day. They also saw around a 15% reduction in risk with daily ibuprofen (Motrin, Advil, and other brand names) use. This study did not find a reduction in cancer prevention rates unless the breast cancer was estrogen receptor positive.

Please get copies of these articles – or print out a copy of this blog note – and talk to your Physician about them and whether you should be taking an aspirin a day or not.

As always, Do NOT start taking aspirin or any other medication without talking to your Physician and getting his OK.

I’m a pharmacist – not a doctor – and am providing information that I think is important for you to talk to your doctor about.

I am NOT recommending that you take these medications without your physicians’ OK!!!

There are some people who absolutely should not be taking Aspirin, Ibuprofen, or any other NSAID medication – So make sure your Doctor agrees it is safe before you start.

oh yeah…. in case you didn’t know – et. al. is used by geeks who read journal articles when they’re too lazy to write out the names of all the authors who were listed for the article they’re referencing. don’t be intimidated. you have all the information you need to get a copy of the article so that your doctor or other health care provider can read it. and, when you get a copy don’t let the techno-jargon intimidate you. you don’t have to know it. your doctor will know how to read and interpret it. the most important information is usually contained in a summary section at the first of the article anyway

DCA (Dichloroacetate) and Cancer – Thoughts and Update

Written by Steve on 18 August 2010

In December of 2007 I worked graveyard shift at a local hospital and gave little thought to alternative therapies, nutrition and/or cancer therapies.

But I did read an article that New Scientist magazine had published about a Canadian professor who worked at the University of Alberta in Edmonton, Canada and the theories proposed by him and a team of unusual depth and breadth about the causes of some cancers and a substance that might be used to cure them. You can find a copy of that article here – http://www.newscientist.com/article/dn10971-cheap-safe-drug-kills-most-cancers.html .

That professor – Evangelos Michelakis – and his team had published the results of laboratory studies that indicated that a substance called dichloroacetate (DCA) could be used to cause upregulation of cancer cells’ mitochondrial activity, and that this could cause cancer cells to kill themselves - while normal cells remained unaffected.

You can find a copy of that article here - http://www.cell.com/cancer-cell/retrieve/pii/S1535610806003722 .

After reading the article I felt compelled to understand this claim more fully, so I devoted significant time and energy to following up on the information that had been presented and the substance called DCA.

Then, once I thought I had a handle on the fundamental information, I promptly got busy with other things and forgot about it. After all, I was NOT an oncology pharmacist. In fact, I worked hard to stay as far away from that work as I could.

But pharmacists never know what people will ask them to help them with, and while I was walking through one of the wards one night a nurse stopped me and started telling me about her dad and asking me if I had any alternative ‘ideas’ he could try.

You see, her dad was a doctor and he had terminal lung cancer. I told her – with as much compassion as I could muster at 3AM – that I didn’t know anything more than the docs already did, but I would keep my eyes open.

As I worked my way back to the pharmacy that little voice that nags at you when you’ve done less than your best started whispering in my ear about dichloroacetate.

By the end of the shift I had printed out the article and some other information I’d previously tracked down, and I gave it – along with caveats and a summary of my understanding of the information – to the nurse who had stopped me. She told me she’d get it to her dad right away. I promptly got back to my work and forgot about it.

A week or so later that same nurse stopped me again and told me that her dad sent his thanks, and he was so appreciative for the information. In fact, she told me, he’d already gotten access to some DCA through a pharmacist somewhere and was taking it. He wasn’t sure how it was supposed to be mixed or the dose, but the pharmacist had helped him, and he thought he was on the right track. But, she told me, it was ‘fearsome stuff’ to take. I told her I was glad I could help and got back to work.

The next time I saw that nurse she stopped me again. She told me that her dad had stopped taking the DCA because he’d developed some severe neuropathy and it didn’t seem to be working.

As I walked away from that conversation I felt frustrated and angry. Angry that I didn’t have enough information to answer her questions about the toxicity, dosing, and side effect causes for this ‘drug’, and angry that it wasn’t working.

So, I took another look at DCA. A REAL look, from a pharmacist’s point of view.

In the meantime, things had really heated up on the mainstream media side. New Scientist magazine had published a couple more articles about DCA and this professor’s work, all the while emphasizing that it was all so preliminary and speculative and nobody should be trying to use it. The University of Alberta had also published a disclaimer on its website that basically said that they supported their research team to the fullest, but what they were saying shouldn’t really be listened to. It was, after all, only theory and lab results.

But the genie was out of the bottle, and the public was clamoring for access to this substance. The U.S. regulatory folk had put on a full press to keep people from getting DCA, but websites had sprung up with DCA being the only topic. Despite it being banned, people were somehow getting access to DCA. But they were getting the neuropathy problems and problems with formulation too.

Eventually, the public pressure and support for this substance reached such a fevered pitch that people were making donations to the University of Alberta to fund a clinical trial to figure out whether DCA worked as claimed or not. Maybe then – they thought – they would be able to get access to DCA.

You can get info on that trial’s progress and the university’s position on the topic at http://www.dca.med.ualberta.ca/Home/index.cfm .

And - as I started to say above – I got a lot smarter about DCA and its use in other clinical trials to treat hereditary diseases that had at their roots mitochondrial dysfunction, misregulation and failure to produce energy properly.

It quickly became apparent that dosing DCA could not be done as we usually dosed medications. It had a unique characteristic by which the body adapted to it and stopped metabolizing it as quickly after awhile. This would lead to blood levels that were higher than intended and the appearance of a multitude of side effects – including neuropathy. It was also noted that mixing this caustic material into a drink that could be safely consumed was tricky – and I noted that most people wouldn’t know enough to get it mixed up right.

Mixed improperly DCA would indeed be something that would be ‘fearsome’ to take. But, I had tracked down the title of an article that detailed how they had mixed the DCA for the mitochondrial disease trials.

Obviously one would need a sharp pharmacist and the information in the article to get this one right.

I studied this information as fast as I could, as I knew the nurse would be stopping me again to talk about her dad, his disease, and DCA. I wanted to be prepared. Then the word was circulating around the wards that this nurse’s dad had died. Everyone was sad. I wished I’d have been smarter and studied harder sooner.

So, I put all my data into a binder and continued to follow the clinical trial that was finally beginning to recruit patients. But trials take forever to get going and completed …. so I got busy with other things and forgot about it.

A couple of months ago I read an update on those trials – I truthfully don’t remember where – but the bottom line is that they studied a limited number of patients who had the deadly brain cancer glioblastoma, and the results seem to indicate that the DCA was capable of positively impacting those patient’s outcomes. You can find a copy of the journal article that details the trial’s results here – http://dca-information.pbworks.com/f/Metabolic%20Modulation%20of%20Glioblastoma%20with%20Dichloroacetate.pdf.

Notice – if you would – that the mainstream press did NOT hype this trial’s results. In fact, it wasn’t covered at all – as far as I can tell – except for the one article I blundered across while looking for alternatives for my family member. (Just in case the protocol she’s currently following fails. You know.)

Anyway – back to topic – there is something just wrong about that. It’s major news, I think.

And I find myself wanting to make sure I don’t come up short again on my support of those trying to keep themselves alive.

So… I’m listing the info about the article that contains what your doc and pharmacist would need to mix and dose DCA safely below.

The article that details how to mix DCA right is titled ‘Development of an Oral Drug Formulation for Dichloroacetate and Thamine‘, and its reference is:

Henderson GN, Whalen PO, Darr RA, Curry SH, Darendorf H, Baumgartner TG and Stacpoole PW. ‘Development of a Drug Formulation for Dichloroacetate and Thiamine‘. Drug Development and Industrial Pharmacy. 20(15), 2425-2437 (1994).

You can find the article at http://www.informaworld.com/smpp/content~db=all~content=a785358792~frm=titlelink .

I’m giving you this address to help your librarian find you a copy – either through their contracted online providers or interlibrary loan. Or you can try the librarian at a major hospital or cancer center. If you don’t want to wait you can buy access to the article. But it’s not cheap. If all else fails or you are out of time drop me an e-mail using the links on this website and I’ll try to get you access to a copy.

It is my understanding that some cancer centers in Canada are already making this substance available to their patients. There are a plethora of websites that have information about it. I am sure there are many who can fill in the blanks much better than I can, and saying more seems to border on advocating you take this substance. A good starting point might be this site: http://www.thedcasite.com/index.html.

Let me be clear – I am NOT advocating this substance for the treatment of cancer.

I am also NOT saying that I think it has no chance of working.

(In fact, please note that I have devoted a lot of time that I should have been dedicating to sleep to getting this info posted for your review and consideration.)

I AM trying to stay true to my goal of providing you with unbiased and balanced information that I believe hasn’t been properly delivered to the public so that you can have a discussion with your physicians about whether it might be an option or not.

I know people are trying DCA – and I also know it is a dangerous substance if not properly dosed and formulated. So – to try to keep people from getting hurt and/or improperly treated – I’ve provided the reference to the article that contains the information that your doctor and pharmacist will need to properly dose and compound it for you if your physician wants to try it.

Most of what you need to know is in the article I referenced above, and your physician and pharmacist will know how to get a copy of it – or if they can’t – your university’s library or hospital librarian will know how to get you a copy.

This is NOT a substance you should tackle on your own without medical support!

Again – I’m a Pharmacist, not a Physician. Pharmacists Pharmacist. Physicians Physician. Talk to your physician and get his/her buyin before trying this or any other drug.

Flu Shots – Set Up For Pandemic Death? Try FluMist™ Instead.

Written by Steve on 22 August 2010

It’s that time again.

The CDC and other organizations have started publishing their influenza (aka ‘The Flu’) data and recommendations again in preparation for the upcoming flu season. To sarcastically oversimplify their guidelines, they basically recommend that everyone who can breath or has a pulse needs to get a flu shot.

Who knows – they might be right. That many people may need flu protection this year.

But – in case you haven’t figured it out already, I do NOT like Flu shots. In fact, I am VERY anti-flu shot.

Instead, I propose you seriously consider getting the nasal vaccine – FluMist.

Not because of conspiracy theory debates about whether sinister forces are working to kill us all or not, or rumored links to autism, or any other reason along these lines.

Pharmacists hear these objections and get questioned about these topics all the time.

They are not the reasons that I am so anti-flu shot.

So, you might ask, then what the heck is your main hangup?

It’s simple. I think flu shots block you from building up long lasting antibodies that your body can rely upon to protect you from similar flu strains in the future.

All pharmacists know that the conventional flu shot that you get in your arm only gives you immunity for a time period measured in months. Then the immune response goes away and the body forgets it ever saw that strain of flu before.

If there is one thing you can guarantee, it’s that the flu viruses are going to mutate. Quickly. And, it is inevitable that one of these days we’re going to end up with a killer flu circulating aroud the world.

If your body has seen one of the earlier versions of a flu it may protect you to some degree from the currently circulating flu virus. You hear about this happening all the time for people who didn’t get as sick as others because they’d seen a relative of the current flu sometime in the past.

This phenomenom will be mentioned in passing in articles in the newspapers, on the radio, on TV -even on the internet. But few people are aware of the fact that they will not be getting that kind of protection from the flu shots they got this season unless they end up getting the flu anyway.

So…. you ask…. what do you recommend we do instead, Mr Smartie-pants? Take our chances and get the flu?

Well, I guess that’s exactly what I recommend – unless you have a serious medical problem that would make the flu life threatening. At least what I recommend is equivalent to getting the flu.

Taking the FluMist vaccine is the same as getting the flu from an immune system point of view.

I’m a huge fan of FluMist – the influenza vaccine that is squirted up your nose.

FluMist actually infects your nose with the flu, and after your body fights it off you will have an immunity to the flu strains that were included into the vaccine that will last for many years. At least this has been the case for as long as FluMist has been on the market.

And – it has been reported, and I believe it to be true – that FluMist gives you better protection if the flu strain changes a little from what was predicted.

Think of it this way.

Visualize the flu strain you’re being immunized against as a 7 foot tall troll with a hunched back, a bad attitude, blonde hair, one blue eye and one grey eye. The shots only identify the virus as having a grey eye. That’s all the information they’re capable of communicating to your immune system. FluMist – on the other hand – handcuffed and hog tied the sucker and let your immune system get a good picture of its every physical attribute as it beat the snot out of him. Later, if a relative comes through with a disguise – but having a bad attitude and showing a hunched back and a blue eye – your immune system is likely to beat the snot out of it because it has enough information to know that there’s a family resemblance.

A pandemic or killer flu might just be that relative with the disguise. different enough to avoid the info your immune system got from the shot, but not different enough to bluff its way through if you had FluMist.

You could actually take your chances with the flu. But, I do not think this is a good strategy, especially right now. I am quite concerned that this year’s flu season could be a very challenging one.

So, that’s what I’m going to do. I’m going to march my butt into my doctor’s office and get that darned FluMist vaccine squirted up my nose. I’m past the 49 year old cutoff for getting FluMist. Doesn’t matter. I’m going to twist my Doc’s arm till he/she gives it to me. It’s my understanding that the reason it’s not approved by the FDA for people who are older than 49 is that the company that invented it ran out of money and couldn’t finish the clinical trials. Think about it. You’re OK when you’re 49 and you turn into a pumpkin at 50? I got it last year, and I’m going to get it again this year. And so did and so are all the other members of my family.

(To share a kind of funny story with you, my daughter got FluMist a couple of years ago. She works for a drug development company, and – of course – all the people she worked with got the shot her company paid for. She called me up in the midst of the flu season and told me she was never going to get FluMist again. Concerned, I asked her why. She explained with a laugh that she was the only person who didn’t have the flu and everyone had been out for going on a week – and she was being expected to keep the projects on schedule all by herself. True story.)

Anyway -

One last note – FluMist does contain weakened live flu viruses. Not everyone can take it. As with all medicines – there are risks that are uniquely associated with it. But, I think it’s a WHOLE lot safer than getting the flu for most.

As always, these decisions must be made in consultation with your physician. Pharmacists Pharmacist, Doctors Doctor. Ask him/her if you’re healthy enough to get FluMist… Seriously consider getting yourself protected this year. Stay safe.

A ‘Crazy’ Theory – Use CoQ10 and Niacinamide Instead of Dichloroacetate (DCA)?

Written by Steve on 14 September 2010

Most cancer patients are searching for something else they can do in addition to what their doctors are prescribing to increase their odds of survival.  Some are looking for something to try instead of what their doctors have proposed. This is because they know that the therapies their doctors are prescribing frequently fail. For these patients this search is a matter of life and death.

I understand this mindset completely, and search night and day for the same thing for a family member who is trying to survive cancer.

And, every once in awhile the information I plow through comes together in my mind to form an idea that I think might really work to buy time for some cancer patients.

What I’m about to tell you is one of those ideas.

I emphasize that this is only a theory. I have no hard data that says it will work. You won’t find it written about anywhere else. You won’t find clinical trial data for it. People will undoubtedly question it and tell you it won’t work.

If you decide to try it you’ll truly be running what I call a ‘Clinical Trial of One’, and you’ll be assuming responsibility for the outcomes – good or bad.

But, I’ve checked, double checked, and rechecked the information that this theory is based upon – and if I had cancer and was trying to buy time for myself I would absolutely be adding this idea to my treatment plan. I’d try it as an adjunct to traditional treatments to help get me into remission, I’d try it on its own to see if I could get myself into remission, I’d definately use it to try to keep myself in remission. In other words, I believe.

I say this with the caveat that – as always – you MUST let your physician know what you’re doing. The goal is to present options and the supporting information and to recruit his/her assistance and support – not to do things behind her/his back.

Please note – having given you the caveat above – I feel strongly enough about this one that I will tell you that – unless the docs can point out something I’ve missed and convince me that they know what they’re talking about – I’d try this even if my doc didn’t approve. I’m not telling you you should. I’m telling you that’s what I would do. But, keep in mind - we KNOW I’m ‘Crazy’.

We’ve talked previously about the Canadian physician (Evangelos D Michelakis, MD) and the team at the University of Alberta that believes DCA (dichlroacetate) can cause many cancer cells to die because it can return the cancer cells’ mitochondria to proper function, which then enables the cells to recognize they’re supposed to kill themselves.

A search of the literature for dichloroacetate’s use to return mitochondria to proper function will bring you to many references of its use for the treatment of children with a hereditary disease that results in mitochondria that don’t work right.

If you take a look at who the pioneering researcher was for many of those studies you’ll find a man named Peter Stacpoole, MD PhD.

I submit for your consideration that Doctor Stacpoole’s research and the research being done in Canada relative to using DCA to improve the function of mitochondria converge with each other. Different diseases, but the same goal – get the mitochondria working again.

So, what is Doctor Stacpoole involved with now? Same thing. Trying to get the mitochondria to work – only this time he’s involved in a Phase III clinical trial of the use of CoEnzyme Q10 to upregulate the mitochondria and reverse these kids’ disease. You can find a copy of the clinical trial info at http://clinicaltrials.gov/ct2/show/NCT00432744?term=coenzyme+q10&rank=34. The dose they’re using is 10 mg/kg (or 10mg/2.2 pounds) up to a maximum dose of 400mg.

(It’s critical to note that – as far as I can tell – the form of CoQ10 that they’re using for Doctor Stacpoole’s stucy is ubiquiNOL, not the more commonly available ubiquiNONE. UbiquiNOL is absorbed from your gut much better than ubiquiNONE – with reports indicating that ubiquiNOL is absorbed from 6 to 8 times better. Regardless of which form you use, split the daily doses up so you’re taking a dose multiple times per day. I think the product they’re using for the study is LiQ-NOL™. Another product that you could use is Liquid QH™. Both are highly concentrated formulations of ubiquiNOL. Both are available online.)

Anyway, I think this information is extremely interesting.

We already know that CoQ10 is associated with mitochondrial function, and that deficiencies of CoQ10 cause reduced mitochondrial function. We also know – if you believe the data coming out of the Canadian labs and clinical trial – that increasing mitochondrial function with DCA improves cancer treatment outcomes. You can find info on the completed clinical trial at http://clinicaltrials.gov/ct2/show/NCT00540176?term=dichloroacetate&rank=4.

Now that a team has had the courage to push forward with this idea you’ll find a lot of other clinical trials recruiting patients. (http://clinicaltrials.gov/ct2/results?term=dichloroacetate) Funny how that works, isn’t it?

Anyway, you’ll also find – if you do a literature search on PubMed and Google around a bit – that CoQ10 is being tried for several disease states, and has been approved by the FDA on an orphan drug basis for the treatment of a few.

However, reading through the trials data you will find that sometimes it works well, and other times it doesn’t work well at all.

This indicates to me that CoEnzyme Q10 is not the whole story. There must be something else that is needed for the CoQ10 to work right.

This brings us to niacinamide.

Remember, Dr Gerson put his patients on high doses of Niacin when he started treating their cancers – and remember that niacin is converted in the human body to niacinamide. So, high doses of niacin = high doses of niacinamide. 

And niacinamide is noted in several studies to be able to upregulate mitochondrial function and protect mitochondria from chemical attack. In fact, some studies suggest that it works better than CoQ10 in some ways.

More interesting data, but what we’re looking for is more than upregulation of mitochondria and/or protection from poisons. We’re looking for significant increases in the production of ATP.

Which brings us to a study that I found referenced in a book written by Russell L. Blaylock, M.D. titled ‘Excitotoxins – The Taste That Kills’. On pages 236-237 Doctor Blaylock tells us that this study found that combining CoQ10 and niaciniamide caused a ‘significant increase in brain cell ATP levels’. The reference for this study is listed as Beal MF, et al. Coenzyme Q10 and niacinamide are neuroprotective against mitochondrial toxins in vivo. Neurology (supplement 2) A177, 1994.

I’d give you the link to this document, but there’s a problem. I can’t find it. I’ve looked really hard. I’ve had reference librarians at two medical libraries look for it. I’ve had my daughter – who works for a drug development company – look for it. It can’t be found. I can find similar work by Doctor Beal. I just can’t find this article.

This brings us to a judgement call. I can believe Dr Blaylock really has read this paper and is smart enough to summarize its findings, or I can throw the reference and associated information out. In my searches for this article I’ve found it referenced by several other authors. Maybe they didn’t read it either. I simply can’t explain it – and I have moved on to other searches. But I will tell you that – based on my review of other work by this professor and the documents that have referenced the article in question – I believe.

Which finally brings me to propose that if I had cancer I would add CoEnzyme Q10 and niacinamide to my daily regimen. EXCEPT from 5 days before to 3 days after a chemotherapy or radiation session. During that time period I would not take either CoEnzyme Q10 or niacinamide unless my physician told me it was ok.

Since no one has tried this before as far as I can tell, the doses are going to be completely pulled out of my you-know-what. But, I suspect high doses are good doses for this application.

For Dr Stacpoole’s study they’re using a maximum dose of 400mg of CoQ10 (ubiquiNOL)per day. I’d spread it out over two or three doses (e.g. 200mg twice a day), but – based on human trials data that I’ve reviewed – I don’t think it really matters. I’ve read abstracts and summaries of studies that used 300 mg of CoQ10 (ubiquiNONE) per day to positively impact breast cancer outcomes (see the article link it my previous post on CoEnzyme Q10). There are references for the use of doses of a German brand of nano-particular CoQ10 (ubiquiNONE) all the way up to 1200 mg/day (for the treatment of Parkinson’s disease – http://altmedicine.about.com/cs/supplements/a/CoenzymeQ10.htm). At that dose I’d definately spread the doses out.

Niacinamide dosing is something I’m still studying. But, I’m currently taking 1000 mg/day with no ill effects. I found reference to using up to 5000 mg/day to treat joint problems (http://www.doctoryourself.com/kaufman5.html). I’d start at 500 mg twice a day and slowly increase my dose – while watching out for bad side effects/reactions – till I got near 4000 – 5000 mg/day. Bigger doses might be OK. I will have to research more. Anyway, keep your physician in the loop and rely on him/her to make sure you’re tolerating the niacinamide well. Oh yeah, in the reference they state that they got better results if they broke the doses into several smaller doses per day. I’d try to take partial doses every 4-6 hours.

So, I’ll close by reminding you that Pharmacists Pharmacist, Physicians Physician. Keep your doc in the loop and make sure you’re being properly monitored. Again, I remind you… I’m telling you what I would do, not what you should do. Talk it over with your doc. Print out the references and provide them to your doc. And DON’T take either niacinamide or CoQ10 within the pre and post chemo/radiation timeframes I talked about above unless your physician specifically says it’s OK.