Bowel Colon Cancer Symptoms

my name is abraham. i'm a pharmacy residentat stanford right now. together with eun, we'veworked on this presentation about the potential benefits ofherbal and dietary supplements. so first, i'll givean overview about what the definition of an herbalor dietary supplement is. we'll review some of thecommon misconceptions about these supplementsand then review some of the commonlyused supplements.

there's thousands of supplementsavailable on the market, but i'll just reviewsome of the top 15 that are commonly usedin cancer patients, including what therecommended doses are, what they can beused for, and what are situations that you shouldavoid using those supplements. we'll quickly goover some other forms of alternative orcomplimentary medicine and then have a summary.

and at the end, i'll havesome other resources online where you can go and learn aboutsome of the other supplements. so what are dietary supplements? they are defined asvitamins, minerals, herbs, products made from plants,animal parts, and yeasts and extracts. the fda regulates themdifferently from food and drug. so drugs have to getfda approval before they get put on the market.

however, withdietary supplements, they get put on the marketbefore fda approval, and the fda only really stepsin when a problem is reported. they're sold over thecounter, however, differently than over-the-countermedications. they also don'tget regulated like over-the-counter medications. so drugs are usuallyconsidered unsafe until they're provensafe to the fda,

while dietary supplements areconsidered safe until they're proven unsafe to the fda. and this can make thingsa little difficult. so while most supplementshave clean, safe histories, there have been somereports that there has some contamination insome of the herbal and dietary supplements. for example, recently theyfound some supplements have been found to be taintedwith pesticides, heavy metals,

and prescription medicines. for example, a fewyears ago, there was this a maleenhancer that was sold at your local pharmacy, andthey found that they actually contained viagra or cialis. this is dangerous because itdoesn't state that it actually has those medications in it. so patients may havetaken it unknowingly and have someother side effects.

so the fda eventually steppedin and took those supplements off the market. in 2013, there was astudy done in toronto that found that out of the 44herbal supplements, including supplements from canada andthe united states, about half of them didn't actuallycontain the herb on the label. they contained someother substitution, or they just contained filler. so the best way toavoid this is probably

to avoid products that claim towork like prescription drugs, because they might actuallycontain some prescription drugs. also you can avoid productsthat are advertised through mass emails,products that are marketed in aforeign language, and products that promiseweight loss, bodybuilding, enhanced sexual performance,and other products that say they're a legalalternative to steroids.

some of the commonmisconceptions of herbal anddietary supplements is that it's natural,so it must be safe. well, not necessarily. so the first example onthe left is a mushroom. it looks very similarto the mushrooms that you buy at wholefoods or safeway, however, it's actuallyquite poisonous, and there's been many reports ofpeople going out and collecting

these mushrooms andcooking them and then ending up in the hospitalbecause of toxicity. tobacco we all know is avery natural substance, but used in smoking, and weknow all the harmful effects from cigarette smoking,including heart disease, lung disease, also cancer. the third one isthe castor bean. so it looks prettyharmless, it's just a bean. but it actually contains achemical called ricin in it,

and about 5 to 20 of thesebeans can kill an adult human. so in the 1970s,the kgb actually used the extract from thesebeans and assassinated people. so it's natural, butit's also dangerous. and then the last oneis ephedra sinica. it's also knownas ephedra, and it used to be sold as a dietarysupplement in the united states. it's a performance enhancement,gives a stimulant effect,

and many athletesused to use it. however, in 2003, afamous baseball player actually died from usingthis herbal supplement. and then the fdawent through the data and found that it wasbecause 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 usedin leukemias and lymphomas, and it can cause nerve pain. cytarabine territoryis from the sea sponge, and it can really decreasea patient's blood counts. and paclitaxel is usedin many chemotherapies, like for breast cancer, andit comes from the pacific yew

tree. so even though theseare natural substances, you know that the chemotherapyhas a lot of toxicity. so while they maybe safe as a plant, once they become concentrated,it can become dangerous. another common misconceptionis that more is better, and this is also notnecessarily true. for example, somepeople recommend taking a lot ofvitamin c. however,

they found that actuallytaking too much vitamin c can interfere withabsorption of copper, and copper is important formaking red blood cells and also for nerves. they've also found thattaking too much phosphorus can interfere withabsorption of calcium. and calcium is importantfor having strong bones and also to stabilizingthe heart rhythm. so what's important is thatthe safety and dose of whatever

you're taking are related. so when you're taking theleaves and root of a plant, it may be safe in smallamounts as an herb, but now they sell all theseconcentrated pills as extracts, and they may contain veryhigh concentrations, which may not always be safe. in 2012, the fda did receive2,800 reports of dietary supplement adverseeffects, so they're not necessarily side effect free.

in 2011, the uspoison control centers received over 35,000 callsregarding dietary supplements. so what i want tomake sure you all understand is theappropriate use of these herbal and dietarysupplements are important, and that the dose is alsoimportant for your own safety. so this is a list of some ofthe common supplements that are often used, and i'll go overthe uses of each one of these. there's many thousandsof supplements,

but through theliterature these seem to be the most popularones that i'll go over. the first supplement i'lltalk about is glutamine. this is an amino acidthat's found in our bodies, and they sell it as anover-the-counter powder. and this has beenstudied to decreased the security andrate of mucositis from chemotherapy and radiation. mucositis is basicallyall the sores

in the mouth, all theway through the gi tract, due to chemotherapy. glutamine has also beenfound to decrease neuropathy from chemotherapy. it's mostly studied withtaxanes, like paclitaxel and also oxaliplatin. so those are usually breastcancer and colon cancer patients, but sometimesthey extrapolate that data to other cancers.

the common dose for glutamineis 10 grams three times a day, and it can be taken with food. the taste is not verygood, apparently. so some patients canmix it with yogurt, and that makes itmore palatable. some side effectsfrom glutamine are that it can cause stomachupset and headache. and then there's apossible interaction with anti-seizure medications.

so if you are on ananti-seizure medication, it's probably bestto avoid glutamine. next i'll talk about vitamin d,also known as ergocalciferol, or cholecalciferol. vitamin d is basicallya vitamin that controls the calcium,phosphorus, and also bone metabolism. it's often used tohelp form strong bones, and usually incombination with calcium.

a deficiency invitamin d has also been originally foundto have an increased risk in certain cancers. however, the reverse isnot well cleared yet, so boosting yourvitamin d levels does not necessarilyreduce the risk for cancer. that's still being investigatedin studies right now. the common doses forvitamin d are usually a dose based on vitamin d levels.

so some physicians may actuallydraw your vitamin d level, and if it's toolow, they can set up a plan to replace thatto a regular level. usually it's dosedaround 1,000 iu, or international units a day. the over-the-counter tabletsare usually 1,000 or 2,000 ius. there are some side effectsfrom vitamin d. sometimes it can cause stomachupset, and also if you take toomuch vitamin d, it

can also increasethe calcium levels in the blood, which canlead to kidney stones. next topic i'll talk aboutis fish oil, also known as omega-3 fatty acids. these are usually extractedfrom cod, krill, salmon, or sardines. the potential uses of thisis to reduce inflammation, and then somephysicians actually prescribe it to helpreduce triglycerides,

if you have hightriglycerides in your blood. there's been some studieslooking at it as a way to prevent cancerprogression, but there is very mixed resultsright now, so it's not recommended for that. common doses are about twoto three grams per day. and the side effects is thatit can cause loose stools, because it is greasy. so it makes you goto the restroom.

and then it also hasa fishy aftertaste, because it is sourced from fish. fish oil does increasebleeding risk and interacts with some anticoagulants. so if you're onanticoagulants like warfarin, it may increaseyour bleeding risk, so it's important to talkto your physician, whoever monitors your warfarin. next, green tea.

green tea is from theunfermented leaves of camellia sinensis. it's often used as anantioxidant and to help improve cholesterol. and then people drink itbecause it also tastes good. it's commonly consumedthrough dietary consumption, and now they do sellextracts of green tea. however, the dosesof those supplements is not very clear yet.

some side effectsof green tea is that it can causecaffeine-related side effects, because it doescontain caffeine. so it can causeinsomnia at night and cause some jitteriness. it can also increasestomach acid, which can be a problem ifyou have some reflux issues. green tea doesinteract with warfarin, so it can affect the inr andthe bleeding with warfarin.

green tea also hassome interactions with some chemotherapyagents, including bortezomib, irinotecan,sunitinib, and tamoxifen. so in the case ofbortezomib and sunitinib, the green tea actuallyinactivates them and reduces their efficacy. while in irinotecanand tamoxifen, it raises the amountthat's in the body, which can lead to more side effects.

milk thistle is formed from theextract of the silybum marianum flower. the active ingredient inmilk thistle is silymarin, and it's often usedto protect the liver from chemotherapy damage orother insults to the liver. the common dose is about 200 to400 milligrams of the silybum marianum, and that canincrease to about a max of 13 grams per day. however, if you do goabove 13 grams per day,

what usually protects your livercan actually harm the liver. so this is an example wheremore is not always better. milk thistle can alsocause some stomach upset. next i'll talk aboutastragalus or huang qi. this is the root of theastragalus membranaceus. this is a chineseherbal medicine that's used veryoften, and it's thought to strengthen qi or energy. it's often used to reducethe 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 boosttheir immune system. there's been somestudies, mostly in china, looking at astragalus as ananti-cancer agent, however, it's not very well established. all the studies combineit with chemotherapy, so you don't really knowif it's adding much.

the common dose isabout 10 to 90 grams per day of the raw herb. you can grind it up and andmake it a tea or a soup. and because it booststhe immune system, it interacts withimmunosuppressant medications like tacrolimusand cyclosporine. and they foundthat astragalus can alter the levels ofestrogen in the body, which can be dangerousif patients have

an estrogen-driven cancersuch as breast cancer, ovarian cancer, or uterine cancer. the next one is dong quai. this is the root fromthe angelica sinensis. and it's often used tohelp with mental symptoms or menopausal symptoms,like hot flashes. the common doseis 1 to 15 grams. you can divide it oneto three times a day. the main side effectsfrom dong quai

is that it cancause stomach upset, and it does also increasethe risk of bleeding and has interactionwith anticoagulants. so if you do have low plateletsor you're on an anticoagulant, it's probably best toavoid this medication. dong quai also has estrogenactivity like astragalus before. so again, it shouldbe avoided if there's breast cancer, ovariancancer, or cervical cancer.

next i'll talk about melatonin. this is a natural hormone that'ssecreted from the pineal gland, but now we can concentrateit into a pill. melatonin's involvedwith the circadian rhythm to help with thesleep/wake cycle. so it's often used to helpimprove sleep and reduce fatigue. there's also been somestudies looking at it as an anti-cancer agent, but itsrole is not well-defined right

now. the common doses are about0.5 to 3 milligrams a day, but this cansometimes be increased to about 10 milligrams a day. some side effectsyou can expect are to have drowsiness orconfusion, because it's helping you go to sleep. some patients do reportthat it causes some itching, and it can also causea fast heart rate.

melatonin also affectsthe levels of estrogen, so again, in breastcancer, ovarian cancer, and uterine cancer,it should be avoided. and then probioticsare a hot topic now. so it's basicallylive microorganisms, usually either lactobacillus,bifidobacterium, or saccharomyces. and they can be used to improvediarrhea due to chemotherapy or radiation.

so the idea behindthis is that you can take these microorganismsthat are naturally found in yourintestines and replace that to help block out anydangerous other bacteria. the common doses ofprobiotics-- it really depends on the brand-- butfor example, culturelle is a commonly used brand. the dose that isrecommend is about 10 to 20 billion cells a day,and each capsule or culturelle

contains 10 billion cells. and another way toconsume probiotics is to eat yogurt,because yogurt does have lots of probiotics in it. some side effectsfrom probiotics is that it can cause gas. and then it should be usedcautiously in patients that are immunosuppressed,or if they're neutropenic. so while these bacteriaare natural flora

in your intestines,they are live organisms. so it can cause an infectionif your immune system is low. ginger. well, a lot of culturesuse ginger in cooking. and basically, it's theroot of the ginger plant. it's been found that it's prettyeffective in mild to moderate nausea and vomiting. the common doses are about250 to 1,000 milligrams a day. it can cause heartburn,and it can also

increase bleeding risk. so use cautiously ifyou have low platelets or if you are on anticoagulants. ginger also antagonizes someof the immunosuppressants, such as cyclosporineand tacrolimus. ginseng is commonlyused as an asian herb. there's two maintypes of ginseng, panax ginseng, whichis the asian ginseng, and panax quinquefolius,which is american ginseng.

the asian ginseng is more potentthan the american ginseng, and they do have differentproperties that herbalists could tell you more about. most often, they're usedto help with fatigue due to chemotherapyand also disease. and it's been found to alsohelp with some diabetes. the common dosethat's usually taken is about one to two gramsper day of the raw herb. and now they dosell the extract,

the usual dose is about200 milligrams a day. some side effectsfrom ginseng is that it can increase the heartrate, which can be dangerous if you have a history ofcardiovascular issues, such as a prior heart attackor if you have coronary artery disease. it can also cause insomnia, andit does decrease blood sugar. so if you have low blood sugar,it might make it too low. ginseng also doesincrease bleeding time,

and it does havesome interactions with anticoagulants. and they found that ginseng alsohas increased estrogen effects. so again, it shouldbe use cautiously in those three cancers. next, we'll talk aboutsaint john's wort. this is made from the flowerof the hypericum perforatum. it's been found to befairly effective in mild to moderate depression.

in germany, this herb isactually a prescription only drug, and somephysicians actually prescribe this more than prozac. the usual dose is about 300milligrams three times a day. it can cause some dry mouth,dizziness, and stomach upset. however, the mostimportant thing is that does reducethe effectiveness of many medications,including chemotherapy and immunosuppressants.

so saint john's wort increasesyour metabolism of chemotherapy and clears it fromyour body faster, so it doesn't have a chanceto work on the tumor. so we highly recommend againstusing saint john's wort, especially whileyou're on treatment. and if you do havesymptoms of depression, it's always best totalk to your physician so that they can work withyou to set up a plan for that. next is the antioxidants.

this is a very broadclass of compounds that counteract free radicals. this includes vitamin c,vitamin e, beta-carotene, a-lipoic acid. it's thought that thesehave anti-cancer properties, or that they can protectthe body from damage due to chemotherapyor radiation. so some free radical sourcesare from ultraviolet rays from the sun, frompollution, stress, poor diet,

chemotherapy, and thesefree radicals damage cells and create mutations. so the idea, they thought, wasthat maybe using antioxidants can prevent them fromdamaging the cells. so they've donemany studies looking at using antioxidant supplementsas a way to prevent cancer. and with vitamin e, theyfound that it actually increased prostate cancer risk. with beta-carotene, they foundthat it increased lung cancer

risk, and withvitamin c, they found it has no effect oncancer incidence. so it looks like it's not veryhelpful to prevent cancer. and then later on they didmore studies looking at it, looking at supplement useduring cancer treatment, to see if it could helpreduce side effects. so they looked at vitamin euse in head and neck cancer, and they found that it actuallyincreased the mortality in those patients.

and they think that thisis because it decreases the effectiveness of theradiation and possibly the chemotherapy. so when you're givingradiation or chemotherapy, you're giving a lot of theseradicals to kill the tumor. but with theantioxidants, it actually helps protect the tumoras well as your own body. so as a result, theamerican cancer society does recommend consumptionthrough food sources

rather than as a dietarysupplement because of the high dose that's foundin the dietary supplement. so those are theones i'll go over, and then there's a quicksummary at the end. and the summary isalso in your handout. so the first one i talkedabout was glutamine. and it can help withmucositis and neuropathy. however, it should be avoidedwith anti-seizure medications. with vitamin d, it'suseful for bone health,

for bone formation. however, it should be avoidedif you have a high calcium level or if you have kidney stones. fish oil can be helpfulfor reducing inflammation, and it should be avoided ifyou're on anticoagulants. green tea can beused as antioxidant and it's also used tohelp reduce cholesterol. but it should be avoided ifyou're on warfarin, and then some of these chemotherapies,bortezomib, irinotecan,

sunitinib, and tamoxifen. milk thistle is often usedto help protect the liver from variousinsults, and there's no real absolutecontraindication to anything. astragalus, oralso known as huang qi is good for fatigueand kidney protection. and it should be avoided ifyou're on immunosuppressants. or if you have ahormone-sensitive cancer. dong quai can be used to helpwith menstrual or menopausal

symptoms. it should be avoided ifyou're on anticoagulants or hormone-sensitive cancers. melatonin is effective for sleepand to help reduce fatigue. it should be avoided if you'reon hormone-sensitive cancers. probiotics can be usedto help with the diarrhea from chemotherapy andradiation, however, should be avoided if youhave low white blood cells, like with neutropenia, orif you're immunosuppressed.

ginger is very helpful formild to moderate nausea and vomiting, and itshould be avoided if you're on immunosuppressants. ginseng can be used forfatigue and diabetes, but avoided if you'reon anticoagulants, if you have heartconditions, or if you have a hormone-sensitive cancer. and then the two we dorecommend against using are saint john'swort, because it

does reduce the effectivenessof many chemotherapies, and antioxidants asa supplement form, because its role in cancertreatment and prevention is very unclear,but it does show that it can reducethe effectiveness of some chemotherapyand radiation. and then there arealso other forms of complimentary medicine,such as meditation, yoga, guided imagery, or acupuncture.

and many of these are availablethrough stanford's cancer supportive care program. so if you're interestedin any of these, you can talk to holly, and shecan help set you up with this. so the summary, it'salways important to ask your doctor or pharmacistor health care professional if you're consideringusing a dietary supplement, because there are some unknowninteractions that may possibly be found.

there's no supplementthat has been conclusively shown to treat cancer. so there's no miraclepill, unfortunately. supplements may be helpfulas a supportive care agent during chemotherapyand radiation, however, with every supplementthere still are some risks that must be considered. and then these are someother online resources from some verycredible societies.

so they're are alsolisted on your handout, but i'll quickly go overeach of these websites. so you can't reallysee it very clear, but the americancancer society website has a section on complementaryand alternative medicine. it has a section that talksabout these different modes of treatment. and at the bottom, there's asection on herbs, vitamins, and minerals.

and that hasdetailed information about specificherbs and minerals. the national cancerinstitute, or the nci, has this booklet that you candownload from their website, and it talks about not onlyherbal and dietary supplements, but also other complementaryand alternative medicines. and it's a pretty goodread, so if you have time, you can download it and read it. the nih has a sectioncalled the national

center for complementaryand integrative health, and it has a section with manytopics, research-based info from acupunctureto zinc, so a to z. it has many different topics. and then the last one ismemorial sloan kettering has a very large integrativemedicine department. memorial sloan kettering is oneof the major cancer hospitals in new york city,and they set up this database where basically,if you're interested

in about any herb orbotanical or other product, you can find it in the index. and then within eachproduct, it talks about what they thinkit can be used for, or how they think it might work. what are possibleside effects, and when you should avoid using them. and that's all ofmy presentation. i can take any questions.

[applause] oh, thank you. is there synthetic fish oil? synthetic? no. i don't-- no. yeah, they do sourcethem from like krill, which is kind of like ashrimp, but they're all usually from the sea.

say you want to take calcium. i heard if you take too muchof it, you don't absorb it, you excrete it. so is it-- for any ofthese, or for calcium, do you recommend smallerdoses several times a day? it really depends on some drugs. most things havea saturable level of how much you can absorb. and with theseherbal supplements,

they probably haven'tdone enough studies to actually knowwhat 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 probioticsdo to patients who neutropenic and immunesystem are compromised?

there's a theoretical risk thatbecause your immune system is low, if the probioticsdo become mean, they can cause an infection. and there is thattheoretical risk. actually, we had onepatient, neutropenic, that we found infection sourceis sort of similar to lactose. so we had one case thatactually caused infection. but it's relatively safe. supplements, we promotethe patient to use it

if they want to use it. especially when you have lotsof issues with digestion, and when they have loadsof-- they're on antibiotics, and may kill the bacteriathat are good for your gi. is there a reasonthat you separated green tea, which can beused as an antioxidant, and supplementsthat you can use. on the back page, yousaid supplements to avoid, and it lists antioxidants.

yeah. so i think theyprobably recommend not using the actual green teacapsules as an antioxidant, but if you take it as atea, it's probably ok, unless you're on thosespecific chemotherapies. does that answer your question? because it's moreof a food source. because it's more--it's like a food source. it's like you can eatoranges, but you probably

shouldn't take too much vitaminc as a concentrated tablet. you said to avoid green teaif you're on irinotecan. what's the reason? irinotecan-- it's supposed toincrease the absorption, more irinotecan in your body. so it might cause moretoxicity from the irinotecan. but i mean, it's justvery small studies. can you take milk thistleif you have liver lesions? if i have what?

if you have liver lesionsthat you're being treated for? can you go on milk thistlewhile you're on treatment? i think that it's ok to take it. but i wouldn't goover too high a dose. use a low dose tosupport your liver. but i do not recommend ahigh dose milk thistle. but should you-- well, i'mon it, like one week on and one week off, sowhat i've been doing is to take milkthistle 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? so the dose isusually 200 to 400. 200 to 400? 200 to 400, yeah. you were first. what about tumors? [inaudible].

tumors? tumors. that's-- oh, what is a use for? what do you-- [inaudible]? would you supportthe immune system? i've had patients that wereinterested in supplements, but i'm not sure there is goodenough data to uphold that. so supplements like--a tumor, i would not

use it to as an alternativeto conventional treatment. oh, no. clearly. you would not recommendit as an alternative to allopathic treatment? no, but after treatment, assupporting the immune system. after treatment, if youare not immunosuppressed from previous chemotreatment, you're ok. just make sure that youtalk to herbal specialists

about good products theycan recommend for you. so you don't [inaudible]during treatment? well, there aresome patients that are taking those treatmentsinstead of recommended-- [interposing voices] i don't have any opinion on it. how about aloe vera. some people drink it, oryou may be able to get it as a pill form, i don't know.

is there any studieson that at all? its affect on chemotherapy? what [inaudible]? aloe vera? yeah, i know. but we use it forthe skin conditions. it's for skin. yeah, but you can alsoget it in liquid form, and people drink it, andit supposedly helps with--

it's good for the stomach. stomach and thecomplexion and things. i think as long as youdon't go overboard on it-- people cook with it, too. yeah, as a food source--like if you eat, consume what would benatural as a food source, it's probably ok. as long as you don't gooverboard and-- yeah. you didn't mention ortalk about cannabis.

so that's a verycontroversial topic. but a lot of physiciansare allowing their patients to use it, because itdoes help with symptoms. however, if you just smokeit, if you have lung cancer, and you're oncertain medications like tarceva or erlotinib. it does reduce the effectivenessof tarceva by smoking. so there are some certain druginteractions with cannabis. so talk to yourdoctor and see if they

have any opinion on that. it's related to nih has beendoing [inaudible] research into cannabinoids, whichis an extract of cannabis without the psychopathy. and preclinical, and they'restarting clinical trials, [inaudible] significantimpacts on tumor growth and the spread of tumors invery serious forms of cancer. i was wondering if you hadbeen looking into this at all, having knowledge intothat level of research,

and who might be gooddoctors that-- [inaudible]? so i haven't looked intothe research that deeply. but i don't know whowould be a good doctor. yeah, i'm sorry, i don't know. it is relatively recent. the preclinical trialshave been [inaudible], but they're startingclinical trials. and a very significantamount of research has been done by the nih.

if you're interested in clinicaltrials for cancer treatment, you can go a websitecalled clinicaltrial.gov. and then you can find anyclinical trails that you know. [inaudible]? yeah, clinical-- it'slike a government program where they list all theclinical trials that's being done in the united states. so you can see if there'sany centers near you. is it harmful to takehigher doses of probiotics?

i'm taking 90 billion, but yousaid between 10 and 20 million. was it million? does it-- well, itdepends on what product it is, because thecells are different. so are you usingculturelle also? it's differentbetween the products, so you can't reallycompare them. i just go by whatever's thelabeling on the product. well, it says 90 billion.

but is it way too much? too powerful for-- if it's within the productlabeling, it's fine. can you use theproduct as a starter to make your own yogurt? can you use theprobiotic as a starter to make your ownyogurt, which is easy. yeah, you can makeyour own yogurt. there's a recipe.

i do not know of that. i only mix drugs. [laughter] let me impact the onset of that. the mothers andgrandmothers, they have been doing for ancientfor millions of years, growing their own culture,and they have survived fine. one of the things that-- i havebeen actively doing research on the herbology for the last10 years, ayurveda and all that,

because i was a medicalscientist back in india, and i became asoftware scientist. the thing is that thecommon denominator is really that you want to use herbsnot as medicine, but more as a food, like [inaudible]or that we commonly grow, like the mint family. there's coriander, there'sbasil, and all these, the oregano, and all that, ifyou use in small quantities and combine all of them,as much as we can do,

as it unmollified, means nottry to concentrate them a lot, we have found manythings, that you'll be able to use many ofthese herbs simultaneously. they are helping us inmany different ways, and they will all contribute. even if they can reducediseases by 10%, that's a lot, and without any sideeffects and all that. so that's kind of theconclusion of my research. so yes, peoplehave been growing,

and they can-- i don't knowwhat 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? i'd like to know if there'sa safe source of supplements? so if you look onthe supplements, sometimes theysay usp certified.

and those actually go throughthe united states pharmacopeia, and they're probably saferthan the ones that don't have that usp label on it. usp? there's a circle with usp. so those are monitored, so-- those are-- --like half of a-- well, it's notas-- well, it's not

monitored from the fda level,but it's more monitored than the other ones. so it's more likely safe. how about taking selenium? s-e-l-e-n-i-u-m. taking what? selenium. what are you using it for? is it--

they say it's goodto prevent tumors. oh. i mean, i haven'theard any evidence that it does prevent any tumors. so if you're takingit for that purpose, it probably won't help too much. that's all i can tell. for the last one anda half or two years, there's a lot ofresearch going on all

over the world for vitamin dand how much is good and safe. and then they're comingout that more and more that the higher dose is better. how far are we doingin 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 doctorrecommends 50,000 iu. yeah, you're takingit once a week, right?

and it's one. [inaudible] he's working with. and i didn't have any sideeffects, or anything like that. but supposedly it reallyhelps the diabetic, plus also gives you lots of support inany other parts of your body. i don't know how much researchis going on here at stanford. i'm not aware that there arespecific studies going on at stanford. but vitamin d deficiency islinked to a lot of disease,

including cancer, cardiovasculardisease, and mental illness. and so the 50,000units once weekly is replacing the vitamin d. if your doctor checkedyour vitamin d level and it turned outto be low, it's the actual treatment ofvitamin d deficiency. so we do use a highdose in that case. but to my knowledge,it's not recommended to use a high dose for peoplewho are in the normal vitamin d

level. so normally, we do 1,000 to2,000 international units daily. that's the recommended dose. i have seen some patientsusing higher doses, 5,000, or even higher, but we donot recommend that high dose unless you were diagnosedfor vitamin d deficiency. because i know you can seelots 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 thatwhole foods or very good vitamin stores, where there isthe market for 40 years. so 30 years orsomething like that. so it can be got at higherand higher doses of vitamin d. and it's all over the world. it's a big research now, thevitamin d that does a lot. so you could need it.

and that's why i was wonderinghow much we [inaudible] to see the research. i would be cautious totaking high dose vitamin d. because it can be accumulated. so i would avoid[inaudible] make sure that you check the-- if youwere diagnosed low-- vitamin d deficiency, checkthe level, make sure that your supplement'sdose is adequate to keeping your vitamin d levelin the normal range.

what is the normal range? is? well, depending on the-- it's 20 to 40. 20 to 40, dependingwhat units, but 20 to 40 is a normal range, about. what about the usageof honey and olive oil to prevent tumor or cancer? you know, there are lotsof herbal supplements,

or any food asserts itis studied and claims to help the cancer. but i'm not aware of anysingle big studies that have proven that that'shelped a cancer patient or treating cancer. what do you think about soybeanand seaweed product that's been-- you know, now they saythat tofu is not good for you after all, because it's sogmo, genetically modified. so tofu is-- has a soybean.

it helps to preventbreast cancer. and it's very interesting thattofu, soy, in food source, it helps to reducebreast cancer risk. however, soybean as asupplement has been proven to increase breast cancer risk. and it's not even ahuman study, but it's been proven in animal studies. so if you're at highrisk for breast cancer, then i recommendthat you take soybean

as a food source,not as supplements. but even in thefood source, they say the beans are-- ahigh percentage of beans are growing in america thatare genetically modified, so it's not reallynatural to eat. well, if you're-- i have tosay, it's still better than just soybean powders, and youhave some soybean supplements you can buy at thehealth food store that i do not recommendthat if you wanted

to use it for breast cancer. that's the sameway with seaweed? because it's a supplement,brown seaweed from japan. and they sell for $330for 120 [inaudible]. and they recommend that ifyou are a cancer patient, you need to take from10 to 20 pills a day. i think i would be-- i'm notrecommending you spend so much money on those pills,because first of all, you don't know how--

i just wanted toexplain to this lady, if you're concernedabout tofu that has too much gmo, whatever,go to a health food store and find one that says no gmosoybeans used in this tofu. i mean, it's gottabe out there, and i'm sure you can find whatyou're looking for. i have a question abouttofu and soy products and estrogen-based cancers. the studies seem to be mixed.

some say yes, eat it, otherssay no, stay away from it. so i stay away from it becausei don't know what to do. i so women from northeastasia, so japan or people from asia, people havelower risk of breast cancer. but however, when theyintegrate to the united states, their risk is higherthan people who are living in their countries. so the speculation is thatit's probably from diet.

and so as a pharmacist,and [inaudible] have experience with herbalprescribing practice, i do think that soy-- imean, tofu in natural sources is good for breast cancer. and if you are tooconcerned about, oh, i don't wantto take any chance. but the studies have strongerevidence-- provide more, stronger evidence to thepositive in role in breast cancer risk by taking--

let's say for ovariancancer, would it increase your estrogen levels? that was my concern. will it increaseyour estrogen levels? so my understandingis some people say it's good for ovariancancer, because the estrogen in the soy product will attachto the estrogen receptor, and therefore occupying it, sothat the body's estrogen won't occupy it.

but then other people say,no, it doesn't matter. i don't have anyopinion on that. but i think that i favor thepatient to eat the good quality tofu if you have any riskfor the breast cancer. and how about the tempeh,which is fermented. is that lessestrogen, do you know? i'm not sure. ok. yes.

turmeric. what do you thinkabout that for cancer? turmeric, i don't seethat harm of taking it. but i'm not sure that there'smuch efficacy in treating or preventing cancer. yes? what about soy milk, likestore-bought soy milk with the calcium added in,versus just the soybean, like from whole foods, andmaking the soy milk out of

produce with a soy milk machine. i'm asking thisquestion because i'm trying to replace themilk with soy milk, because there'sbeen some studies, i don't know whether they'reaccurate or not, that real milk promotes cancer cells. milk promoting cancer cells? i think one thing i wouldavoid, the artificial supplement that has soy protein in it.

there's compoundscalled isoflavonoids, and it's one ofthe things that we believe that was importantfor preventing breast cancer. it's actually harmful i inpreventing breast cancer. so what are soy milk versusthe soy-- what is it you were-- soybean, like bulksoybean that you-- natural source? it's from a natural source? yes, just dry soybean.

i think-- i'm not surewhich one is better, but they any fromthe natural source is better than synthetic powder,promotes breast cancer health. do you have any commentabout 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 thereare the hormones and all that tothe cows and all. those have been injected. they definitely gothrough the milk and eventually inthe human body. so those are theissues with the milk. otherwise, the milk isnature's production. so though it's froma 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 waterand put the soybean in that, unground, without breaking it. so whatever ingredientsnature will give me, i would just drink that. and i will depend on the naturethat 99% of the things which are not good for thehealth, they will not go into the-- theywill not leach out,

or they will notgo into the water. so the water wouldn't haveany-- except the soybean. i would rather depend on that. same thing with thefenugreek and all that. for the diabetes and all that. that would definitely help. anything that one wantsto use, the best things you just put in the hot wateras a whole, wholesome substance, and just drink that water.

i think that's the safestand some effect, some help. how long do you putit in the water? just like 30 seconds. for vegetarians, would theadvice on these supplements be different? for a vegetarian diet? vegetarian diet. let me repeat it. would the recommendation bedifferent for vegetarians?

i don't think so. no, i don't think so. is there any specificconcerns you have? no. [inaudible]. so a lot of things that gointo almond milk instead of regular milk, is itbetter to eat the milk or to drink the milk? because you look on thelabel of the almond milk, there's hardly anynutrition there.

so i'm just kind of like, what? it helps if you needto drink three quarts a day of something. we don't have anystrong opinions. i do both. i drink the milk andi eat [inaudible]. so milk thistle forliver protection, how effective is it fordetoxification of the liver? i think it's more of aprophylactic type thing.

so if your liver hasalready some issues, it may not work so well. but if you're anticipatingsome chemotherapy or something, it may be helpful in that way. can you [inaudible]traditional chinese medicine? sorry, can you say that? supplements used in thetraditional chinese medicine? you said you have someexpertise in chinese medicine? chinese medicine is-- theconcept of chinese medicine

or taking dietary supplements. chinese medicinehas make sure there are different ingredients,and also the way you process ingredientsare different. so they enhance efficacy. at the same time, itminimizes side effects from all the differentherbal medicines. so i don't have anyspecific recommendation with chinese medicinethis lecture,

but the concept ofchinese medicine is very different from whatwe're taking as supplements from health food stores. any more questions? so does ginsengaffect the efficacy if you're on a lot ofprescription medication? because that's the thingthat's going around in the asian community. that if you're onprescription medication,

that when you take ginseng,you're supposed to space it out two or three hoursafter you take the medication. ginseng has stimulatory effects. so meaning that it canincrease your heart rate. it can increaseyour blood pressure. so if you're diagnosed somesort of cardiovascular disease, it may affect heartfunction and blood pressure. it might not be safeto take it, especially at the same time that you'retaking blood pressure or heart

medicine. but in general, people,when they use it, have improved energylevels and improved fatigue due to chemotherapyor due to cancer. it might be-- it'sprobably safe. but i would work withan herbal specialist, to make sure that that's theright supplement for you. [inaudible] energy level. personally, i do notrecommend buying ginseng

just number one, asabraham mentioned, the contents are not regulated. so even if you're buying--like you said 20%, and they may havelike 10%, maybe 5% of ginseng in the capsule. and second of all, those peopleworking at health food stores, they're not healthcare professionals. so when they recommendit, they may not know that it's not asafe supplement for you.

so if you want totake ginseng, i recommend that you talk toherbal specialists about that. this has everythingyou mentioned in it, and all together,74 ingredients. what is your opinion? what is that? this was given to me bya man whose daughter, who is very sick, was taking it. and she only got worse.

based on this yourprevious experience, probably it won'tbe so good, then. so my opinion that-- so chinesemedicine, that mixture of herbs and how they process,has been tested thousands of years in people. so it may not have strongscientific evidence, but it's provento be safe if you have a good herbal specialistprescribing for you. for those supplements,make sure-- maybe

it has all the goodingredients mixed together, but it has moreharms than benefits. because first ofall, the people who mix this, all theingredients, they may not know what is goingto happen after they mix all those ingredients together. being a pharmacist, weall like looking at how drugs interact with each other. sometimes one drugis 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 cautiousin buying those supplements, especially if they'revery expensive. and when i worked at thecancer center in berkeley for five years,my day to day job was i had patients askingabout, oh, is this good for me to take?

and oftentimes,i'd just give them more concerns than agreement. and i realize that alot of times people who are in a diseaselike cancer, people want to find the besttype of treatment options, including findingthe best doctor and finding the best alternativemedicine, best treatment options. and i realized that iwill [inaudible] help

them to find a better source. and i want to help them withhow to use the right medication and right timing. so i highly encourage all ofyou interested in supplements or anything, talkto your doctors, talk to your pharmacist. they may not have a strongopinion about some things, but they may tellyou they're not safe or maybe wait until yourtreatment is finished,

and then you cansafely use them. and i also want to emphasizethat the supplements that promote treating cancercan be very expensive. they're very expensive. i had some patientsthat came to me and asked me thegood supplements, it's emulsionproducts, which is used for treating gastric cancer injapan and some asian countries. yeah, it is very expensive.

but is it going to workfor him, his cancer? not sure. and so before you're spendingthat hundred dollars to buy all these expensive supplements,i would do some research and ask some people who are morehealth care professionals that may have some knowledgeon those supplements. and make sure that this firstof all, is it safe to use, or is it going to interactwith your treatments. and that's what iwanted to tell you.

since the fda doesn't testthese or what's in them, i've been told that thegerman equivalent of the fda, they have to be tested. do you know if that's true? herbal supplements ingermany is way more studied than inthe united states. and i know that theirpharmacists, in germany, they also have much moreknowledge in the supplements. so i believe that germanyhas more regulation

on these supplementsthan the united states. but do they actually--do they sample and test to see thatis has what it says. that's something i don't know. can i address that? basically, [inaudible] yeah. germany has a commissione, which they actually take the individual ingredientsand then they test them, rather than a combined formula.

if i were to use this one,i wouldn't touch that. the reason being thatanything that nature has made, you can combine. you can combine 10, 20, 30plants, leaves, barks, anything that you'll be still safer. once we have concentrated, thenwe have really, it can help, it can hurt. so i hope i haveanswered your question. have you got anythingabout how to find

a good herbalspecialist, or is there a website that printsthem out, [inaudible]? i know some cancerinstitutes, they have-- right? yeah, the nih alsohas a section that's how to find a practitioner. so if they're registered withnih, they should be on there. and then i think ucsf hasan integrative medicine program, not that i'mpromoting ucsf, but they do. stanford doesn't have any.

they're trying to developone, but as far as i know, they haven't finisheddeveloping it. you said the dose is veryimportant, for example, you showed two tothree grams per day. is that maximum, two to three? or you have to take at leasttwo to three to have effect? what if i take one? one a day. i mean, some[inaudible] too little?

well, for fish oil, becauseit-- are you taking it for triglycerides, or areyou just taking it to help-- because people said it's good. i think the most well studiedare usually about two to three, but i think one is probably ok. usually the max isabout four grams a day. is chocolate a good antioxidant? i don't know. it may be good asan antioxidant,

but it's bad foryour blood sugar. but it's good asa mood elevator. yes, yes. but it's bad for your belly. now some say five cups of coffeeis good for you [inaudible]. five cups of coffee? that's a little toomuch coffee, i think. maybe for alzheimer's symptoms. what is [inaudible]?

so green tea can increasethe levels of tamoxifen in the body. so you might get more sideeffects with the tamoxifen. so just one [inaudible]. yeah, it's just side effect. it doesn't neutralizeit, it just might cause more side effects. i think yeah. have you heard about theysay this anti-inflammatory,

it's called cat's claw,it's from the amazon. i've heard of it, but idon'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 definitelyhas some [inaudible] uses for people whohave [inaudible]. ok, sure. this doesn't haveto do with cancer,

but arthritis, i heard asa supplement, chondroitin? glucosamine and chondroitin. does it help? there's been-- as faras i know, there's been two big studies with those. one showed that it helps, oneshowed that it doesn't help. so it's really not harmful. do they come togetheror separately? they usually cometogether, yeah.

unless you have some bloodsugar-- are you diabetic? no, it's not for me. it's for my mom. so if you have any blood sugarissues, it should be safe. if you have a blood sugarproblem, it's not safe? if you don't have a blood sugar. yeah it can raise theblood sugars in diabetics. one item on the list,glutamine, can you get that in what kind of food?

you can find it inthe health food store. it only comes insupplement form? you can't get it in anykind of vegetables or fruits or anything? it's a large amount. so i don't think youcan get it in fruit. so does that helpwith neuropathy? it is shown to be helpfulto any neuropathy. but once you have neuropathyfrom cancer treatment,

i'm not sure that itwould be effective. but studies have shownit to be effective if you use it as a measureof preventing [inaudible]. so it also helps for mucositisfrom the cancer treatment? yeah, if you have a lot ofmouth sores or diarrhea. how come your oncologistnever mentions-- exactly. mine did. mouth sores?

absolutely. yeah, he gave me a strictmouth program to use. he never gave anything to me. oh, not thisparticular supplement. the supplement? he'll give you aprescription [inaudible]. no, no. i didn't get a prescription. he said, brush yourteeth regularly and rinse

with baking soda and water. and it's been working. the supplement willhelp with that. they should have told us before. i'm already developingthe neuropathy symptoms from the [inaudible]. so we can takeglucosamine during chemo to help prevent neuropathy. you can, yes.

but make sure that you take10 grams three times a day. so that's how the dose is. and after treatment, do mostneuropathies [inaudible]? that's something idon't an answer to. what is this for? neuropathy, but i mean-- --is it something that ourbodies are not absorbing [inaudible]. so what happens isthe range changed?

or our bodies arenot absorbing it? i think they're testing it. they're looking for it,so they're finding-- [inaudible] becausevitamin d is not a common test that [inaudible] can we get it from sun? well-- there's been somecontroversy about it. so i think because there'sa lot of skin cancer scare

now, so a lot of peopleare putting on sun screen, and then that kind of reducesthe amount of vitamin d that your body makes. so then now, because of that,now everyone's vitamin d deficient. but then you can'treally go in the sun, because you mightget skin cancer. and then, so-- you can't win.

you can never win. i'm going to go ahead andstop the filming right now. but you're welcome to stayand ask more questions. but thank you somuch for a wonderful and [interposing voices].