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Herbs or Natural Products
That Decrease Cancer Growth
Part One of a Four-Part Series
Muriel J. Montbriand, PhD, RN
Key Points . . .
Purpose/Objectives: To provide evidence-based research information
about 31 herbs and natural products that have shown potential in early
research to decrease cancer growth or as adjuncts with cancer treatment.
Some herbs and natural products may decrease cancer
Data Sources: Names of herbs and natural products with potential to
growth.
decrease cancer growth have been selected from listings in the Natural
Herbs and natural products may be used as adjuvants with
Medicines Comprehensive Database and Lawrence Review of Natural
cancer treatment.
Products­Monograph System. Information about these herbs has been
Oncology nurses can become better resources for healthcare
found in evidence-based studies cited in references.
Data Synthesis: In preliminary studies, 31 herbs and natural products
professionals and patients regarding herbs and natural prod-
appear to have potential for cancer treatment.
ucts.
Conclusions: This preliminary evidence may be useful to healthcare
professionals and patients with cancer.
Implications for Nursing: The information in this article is designed
to provide quick access for healthcare professionals working in clinical
secretive about alternative product use (Montbriand, 1994a,
oncology. Oncology nurses who have this information can become re-
1995a, 1995b, 1997, 2000a). Evidence shows that healthcare
sources for patients and other healthcare professionals.
consumers' main source of information is lay sources and
social groups. Lack of professional-patient communication is
a sign of patients' hesitancy to ask and professionals' lack of
reliminary evidence-based research shows that 31 herbs
P
adequate and available information (Montbriand, 2000a).
and natural products have potential to help individuals
Until recently, little evidence-based information was avail-
with cancer. Many components of these herbs and natu-
able on interactions of herbs and natural products with dis-
ral products are uncommon names of chemicals. This review
eases such as cancer or cancer treatments, prescriptions, other
of products is designed to help healthcare professionals be-
herbs, and laboratory tests. This information now is becoming
come more familiar with these names. Some products show
available. Yet a recent study showed that as many as 97% of
potential as adjuvants with conventional oncology treatments.
healthcare professionals lack evidence-based resources for
Others may be used in treating the side effects of conventional
natural products and herbs (Montbriand, 2000a, 2000b). Most
treatments. Patients already may be asking nurses about these
products. This review article provides evidence-based infor-
mation that will help healthcare professionals be better re-
sources for patients with cancer.
Muriel J. Montbriand, PhD, RN, is an associate professor in the
Herbal and natural products have enormous popularity as
College of Nursing and a research associate in applied research/psy-
self-medication products. They are perceived as natural,
chiatry in the College of Medicine at the University of Saskatchewan
green, pure, and without side effects. Furthermore, their popu-
in Canada. During this work, the author was a recipient of two
larity has resulted in more than 800 companies producing
Health Services Utilization and Research Commission, Socio-Health
Grants, Saskatchewan, Canada. (Mention of specific products and
herbal products and collecting revenues in excess of $4.5 bil-
opinions related to those products do not indicate or imply endorse-
lion (Greenwald, 1998). As many as 89% of patients with
ment by the Oncology Nursing Forum or the Oncology Nursing So-
cancer or other chronic conditions use alternative therapies,
ciety.)
often herbal or natural products (Eisenberg et al., 1993, 1998;
Montbriand, 1994a, 1995a, 1995b, 1997, 2000a), and 75% are
Digital Object Identifier: 10.1188/04.ONF.E75-E90
ONCOLOGY NURSING FORUM ­ VOL 31, NO 4, 2004
E75
For this article, names of herbs and natural products have
professionals would be better resources for patients if infor-
been selected from listings in Natural Medicines Comprehen-
mation was succinct, evidence-based, and consolidated. Pro-
sive Database (2004) and Lawrence Review of Natural Prod-
fessionals have spoken of limited time for information
ucts­Monograph System (Facts & Comparisons, 2001). Evi-
searches and, in some cases, lack of finances to procure
dence about these herbs has been found in the studies cited in
sources.
references. Other products that interact positively with cancer
This article is the first of a four-part series on herbs and
may exist; however, this review includes only herbs and natu-
natural products that may decrease or increase cancer growth.
ral products recognized by the authors, professionals, or ad-
Each article in the series covers a specific category. Some
visory boards of the citations mentioned earlier.
overlap in categories occurs because early evidence (espe-
The majority of studies cited are in vitro studies, performed
cially in vivo and in vitro evidence) often showed contrary
in glass on tissue from a living organism, or in vivo studies,
results. For example, fish oils are found in Part I of this series,
performed on tissue not removed from a living organism (ani-
which covers potential to decrease cancer, yet components of
mal studies). Most studies have not advanced to clinical trials
fish oils, vitamin A and D, are found in Part III, which is fo-
on humans. The few human studies cited are preliminary
cuses on products with potential to protect against cancer
clinical trials. Therefore, although results seem favorable or
growth. The same will be found for soy in Part II, which fo-
unfavorable, treat them with caution.
cuses on products with potential to increase cancer growth.
Neither the author nor publisher makes any medical
Conversely, soy appears again in Part III. The reason this hap-
claims for any of the herbs or natural products in this re-
pens is because this series targets two specific groups, indi-
view or the tables. This is informational literature. Note
viduals who have cancer in parts I and II, and individuals who
that some of the herbs described are deadly poisons and
do not have cancer in parts III and IV. For each target group,
extremely dangerous.
the aim is to identify herbs and natural products with poten-
Three herbs not included here are now biomedical chemo-
tial for or against cancer growth. For example, if a woman
therapy (Tyler, 1994).
with breast cancer takes soy, she increases her risk of cancer
· Catharanthus roseus, also known as Vinca rosea, common
growth. If a woman who does not have cancer takes soy, she
names periwinkle, old maid, myrtle, and others, is known as
protects herself against cancer. The four parts in this series are
chemotherapy agents vincristine sulfate (Oncovin®, Eli
· For patients who have cancer
­ Part I: herbs and natural products that may decrease can-
Lilly and Company, Indianapolis, IN) or vinblastine sulfate
(Velban®, Eli Lilly and Company).
cer growth
­ Part II: herbs and natural products that may increase can-
· Podophyllum peltatum, common name mayapple, Ameri-
cer growth
can mandrake, or American podophyllum, is known as che-
motherapy agents etoposide (VePesid®, Bristol-Myers
· For patients who do not have cancer
Squibb Oncology, Princeton, NJ), and teniposide (Vumon®,
­ Part III: herbs and natural products that may protect
against cancer growth
Bristol-Myers Squibb Oncology).
­ Part IV: herbs and natural products that may potentiate
· Taxus brevifolia, common name pacific yew, is the chemo-
therapy agent Taxol® (Bristol-Myers Squibb Oncology).
cancer growth.
Patients may wish to take or may already be taking natural
All three herbs are toxic to humans and should be avoided.
products for cancer or other illnesses. With this information,
Podophylum is lethal. References for these three herbs are
healthcare professionals can give patients opportunities to
Bisset (1994), Dial Access for Professionals (personal com-
make informed choices. These articles are an update to previ-
munication, May 1998), Duke (1987), Duke and Vasquez
ous publications about herbs and alternative therapies
(1994), Facts and Comparisons (2001), and Tyler (1993,
(Montbriand, 1993, 1994a, 1999).
1994).
Do not construe this information as a suggestion to use any
Table 1 provides names, additional common names, some
of these products. This information is provided in the spirit of
brand names, and manufacturers for all of the products re-
helping healthcare professionals to give evidence-based infor-
viewed and can be used as a quick reference to find the
mation to patients. When a recommended dose is given, it is
name of a product, component of a product, herb, other
for a vitamin or mineral, and the amount recommended for
common names, or brand names. Some herbs and natural
daily use is by either the U.S. Food and Drug Administration
products have many brand names, which makes total listing
or Health Canada. Individuals who self-medicate with a vita-
prohibitive. Check with your pharmacist if you cannot find
min or mineral usually take these products in higher doses
the brand name. The number of brand names found has been
than recommended (Montbriand, 1994a, 1995a, 1995b, 1997,
included in Table 1. Notice that some brands contain only
2000a). Danger of overdoses can be avoided when healthcare
one ingredient; for example, astragalus is the only ingredi-
professionals are aware of recommended daily doses.
ent in the brand named Astragalus (Nature's Way Boynton
This article focuses on herbs and natural products that have
Beach, FL). Other brand names, signified with a "b," indi-
shown potential in early evidence-based research to decrease
cate that the brand contains other herbs, natural products, or
cancer growth or be adjuvants with conventional cancer treat-
components of products besides the ingredient of interest.
ment for patients who have or have had cancer. Common
Products with single components or ingredients should be
names and some brand names are provided. Usual doses are
favored because each additional ingredient adds the poten-
provided when available. Scientific names are given for each
tial for additional side effects. In many cases, brands with
herb and natural product. The scientific name for an herb in-
numerous ingredients do not contain as much of the compo-
cludes the genus (classification of a group with common char-
nent desired. Notice also the safety concern with some
acteristics) followed by the species (many species can be
products, particularly those with animal material as ingre-
found in one genus).
dients.
ONCOLOGY NURSING FORUM ­ VOL 31, NO 4, 2004
E76
Table 1. Common and Brand Names of Herbs and Natural Products With Potential to Decrease Cancer Growth
or for Use as an Adjuvant With Cancer Treatments: Common and Brand Names
Herb or Natural Product
Brand Name and Manufacturer or Other
Astragalus (Nature's Way)a
Astragalus
Astragalus (Jamieson)a
Other names: astragali, beg kei, bei qi, buck qi, huang qi, huang qi, hwanggi,
C + Herbs (Jarrow Formulas)b
membranous milk vetch, milk vetch, Mongolia milk, ogli
Femfocus--Herbal Female Complex (Solgar)b
120 brand names found
Beta Glucans (Natrol)b
Beta glucan
Beta 1,3 Glucans (Solgar)b
Other names: beta glycans, gifolan (GRN), lentinan, PGG glucan, poly-(1-
Soy Essentials (Health From The Sun)b
6)_beta-D-glucopyranosyl-(1-3)-beta-D-glucopyranose, schizophyllan (SPG),
XTEND-LIFE Total Balance (Xtend-Life Nutaceuticals Inc.)b,c
SSG, yeast-derived beta glucan
17 brand names found
Earthmends Breast Health Program (Cancer Wellness Institute)b
Baikal skullcap
Earthmends Prostate Health Program (Cancer Wellness Institute)b
Other names: huang qin, huangqum, ogon, skullcap, scute, wogon
Sino-Lung Res-Q (Nutri-Quest)b
Snooze (Pacific BioLogic)b
90 brand names found
Breast Care System-3 (Natrol)b
Calcium D-glucarate
Healthy Cells Prostate (PhytoPharmica)b
Other names: calcium glucarate, D-glucarate
Total Life Care Nutrition System for Men (Rexall--Sundown)b
7 brand names found
Cat's Claw (Olympian Labs)a
Cat's claw
Cat's Claw (Nature's Way)b
Other names: griffe du chat, life-giving vine of Peru, samento, U a de gato
Cat's Claw 5000 (Now)b
Cat's Claw Caplet (Leiner Health Products)b
Cat's Claw Defense Complex (Source Naturals)b
56 brand names found
Colloidal Minerals (Progressive Labs)b
Cesium
Solu-Min (Aspen Group, Inc.)b
Other names: caesium, cesium-137, cesium chloride, CsCl, high pH therapy
Coraladvantage Coral Calcium (Advanced Nutritional Innovations)b
6 brand names found
BarleyGreen Premium (AIM USA)b
Chlorophyll
Earthrise Spirulina-Vegi-Capsules (Earthrise Nutritionals, Inc.)b
No other names
#405 BLDB Blood Builder (Systemic Formulas)b,c
#428 DSIR Digestant Internal Regenerator (Systemic Formulas)b,c
74 brand names found
Chrysin (ProLab)a
Chrysin
Chrysin--Metabolic Response Modifiers (Metabolic Response Modifiers)a
Other names: 5, 7-dihydroxyflavone, flavone X, flavnoid, galangin flavanone
17 brand names found
Cordyceps (Metabolic Response Modifiers)a
Cordyceps
Cordyceps [Caterpillar Fungus] (Olympia Nutrition)a
Other names: caterpillar fungus, Cs-4, dong chong xia cao, hsia ts'ao tung
Cordyceps Power 800mg (Planetary Formulas)b
ch'ung, vegetable caterpillar
Cordyceps With Siberian Ginseng (Natrol)b
33 brand names found
VPS Coriolus Virsicolor (JHS Natural Products)a
Coriolus mushroom
10 Mushroom Combination (Olympia Nutrition)b
Other names: boletus versicolor, coriolus, kawaratake, krestin, polyporus ver-
Reishi 5 (New Chapter, Inc.)b
sicolor, polysaccharide peptide, polysaccharide-K, polystictus vesicolor, PSK,
Immune Builder (JHS Natural Products)b
PSP, turkey tail, yun-zhi (cloud mushroom)
Ten Mushroom Combination (Smart Basics)b
5 brand names found
(Continued on next page)
a
This herb or natural product is the only ingredient in this brand.
b
This brand is an example of a product where this herb or natural product is included along with other herbs and products. Monitor for all possible side effects
of all ingredients in these products.
c
Safety of this product is a concern. The product contains animal material, possibly diseased animals that may harbor bovine spongiform encephalopathy (BSE
or mad cow disease).
ONCOLOGY NURSING FORUM ­ VOL 31, NO 4, 2004
E77
Table 1. Common and Brand Names of Herbs and Natural Products With Potential to Decrease Cancer Growth
or for Use as an Adjuvant With Cancer Treatments: Common and Brand Names (Continued)
Herb or Natural Product
Brand Name and Manufacturer or Other
Indolplex (PhytoPharmica)a
Diindolylmethane
Indole Pro (MMS Pro)b
Other names: DIM
2 brand names found
#402 Arta Arthro Support (Systemic Formulas)b,c
European mistletoe
Herbal Insomnia Tablets (Life Brand)b
Other names: all-heal, birdlime mistletoe, devil's fuge, drudenfuss, eurixor,
D-MNS (Dial Herbs)b
helixor, hexenbesen, iscador, isorel, leimmistel, mistlekraut, mistletoe, visci,
Wild Rose Nerve Formula (Dial Herbs)b
visci albi herba
6 brand names found
Atkins Essential Oils (Atkins Nutritionals, Inc.)b
Fish oils
Cod Liver Oil (A-2500, D-270) Sundown Vitamins (Rexall--Sundown)b
Other names: fish liver oil, omega fatty acids. Not the same as cod liver oil,
EFA Heart Formula (Health From The Sun)b
DHA, EPA, and shark liver oil
Ultra 30/20 Fish Oil (Health From The Sun)b
40 brand names found
Gamma linoletic acid
GLA is the active medicinal component of herbs such as evening primrose and
Other names: gamolenic acid, GLA
borage.
Arthritis Guardian (Clinicians Choice)b
Bio-EFA Borage Oil 90 (Health From The Sun)b
Borage Oil (Sundown Vitamins)b
Evening Primrose Oil (Health From The Sun)b
Holista Evening Primrose Oil (Holista)b
66 brand names found
Immune-Action (Nature's Plus)b
Glossy privet
Immune System (Nutrivention)b
Other names: Chinese privet, dongqinzi, ligustrum, nu zhen zi, nuzhenzi, privet,
Resist (Pacific BioLogic)b
tro ne de Chine, trueno, white waxtree
Green Tea Remedy (Puritan's Pride)b
Herpancacine (Diamond Formulas)b
Ying-Yang Secret of Longevity (Flora, Inc.)b
Hua Fo (Shen Long Co.) This product was recalled by Health Canada in 2002
because a drug similar to Viagra® (Pfizer, New York, NY) was discovered in
hua fo.
14 brand names found
Glutamine Fuel Capsules (TwinLab)a
Glutamine
#12 B Brain (Systemic Formulas)b,c
Other names: GLN, glutamate, glutamic acid, glutaminate, L-glutamic acid
#18 Ds Digestive Stabilizer (Systemic Formulas)b,c
Acetabolan (Muscletch)b
#17 D Digestive (Systemic Formulas)b,c
#428 DSIR Digestant Internal Regenerator (Systemic Formulas)b,c
417 brand names found
AfterFXBar--Bavarian Mint (Nutripeck)b
Gossypol
Alpha-Lipoic Acid (Sundown Vitamins)b
Other names: cottonseed oil
Chewable Calcium With Vitamin D (Nature's Bounty)b
10 brand names found
Gotu Kola (Nature's Way)a
Gotu kola
Gotu Kola (Olympian Labs)a
Other names: brahma-buti, centella, gotu cola, hydrocotyle, idrocotyle, Indian
Gotu Kola (Now)b
pennywort, Indian water navelwort, marsh penny, talepetraka, tsubo-kusa,
AM Plus (Brain 111 Formula) (Alpha Zebra)b
white rot
Brain Booster (Optimum Nutrition)b
Brain Fuel II (Futurebiotics)b
129 brand names found
(Continued on next page)
a
This herb or natural product is the only ingredient in this brand.
b
This brand is an example of a product where this herb or natural product is included along with other herbs and products. Monitor for all possible side effects
of all ingredients in these products.
c
Safety of this product is a concern. The product contains animal material, possibly diseased animals that may harbor bovine spongiform encephalopathy (BSE
or mad cow disease).
ONCOLOGY NURSING FORUM ­ VOL 31, NO 4, 2004
E78
Table 1. Common and Brand Names of Herbs and Natural Products With Potential to Decrease Cancer Growth
or for Use as an Adjuvant With Cancer Treatments: Common and Brand Names (Continued)
Herb or Natural Product
Brand Name and Manufacturer or Other
Amazon A-P (Raintree Nutrition, Inc.)b
Graviola
Amazon Prostate Support (Raintree Nutrition, Inc.)b
Other names: Brazillian cherimoya, Brazillian paw paw, corossolier, durian
Amazon Calm Support (Raintree Nutrition, Inc.)b
benggal, guanavana, soursop
6 brand names found
Honey
Pasteurized honey, any brand for external use
Other names: honig, mel, miel blanc
52 brand names found for oral use
IP6 Capsule (Jarrow Formulas)b
IP-6
Cell Forte with IP-6 (Enzymatic Therapy)b
Other names: fytic acid, insitol hexaphosphate, phytic acid
Women's Prime Multi (Swanson)b
9 brands found
Amino 1000 (Puritan's Pride)b
L-arginine
Arginine and Ornithine--Olympian Labs (Olympian Labs)b
Other names: arg, arginine, arginine HCI, arginine hydrochloride, L arginine, L-
Arginine Ultra (FreeLife International)b
arginine HCI, L-arginine-HCI, L-arginine hydrochloride
ArginMax for Women (Daily Wellness Co.)b
DHEAX (HealthWatchers System)b
XTEND-LIFE Total Balance (Xtend-Life Nutraceuticals Inc.)b,c
134 brand names found
Magnesium
Magnesium sulfate (IV used by a physician)
Other names: magnesium sulfate, magnesium asparatate, magnesium carbon-
1762 brand names found
ate, magnesium citrate, magnesium gluconate, magnesium hydroxide
Marinol® (prescription drug) (Sanofi-Synthelabo)a
Marijuana
Other names: cannabis, grass, hash, hashish, hemp, kif, mariguana, marihuana,
Medicinal marijuana (usually inhaled) is available through permission of a phy-
pot, weed
sician and government approval in Canada and some states in the United States.
No brand names found
Melatonin 3 mg (TwinLab)a,c
Malatonin
Appleheart Melatonin (Appleheart)a,c
Other names: MEL, MLT, pineal hormone
Melatonin (Olympian Labs)a,c
Superior Melatonin (Nutraceutical Sciences Institute)a
Ester-C Nighttime Formula (Natrol)b,c
Knock Out (Schiff)b
Melatonin 500 mcg (Nature's Way)b,c
Mannatonin (Mannatech)b,c
35 brand names found
Selenium (Source Naturals)a
Selenium
Selenium 100 mcg (Jamieson)a
Other names: L-selenomethionine, selenite, selenium dioxide, selenized yeast
Selenium 50 mcg (Jamieson)a
#41 GT Thymus (Systemic Formulas)b,c
#31 GA Adrenal (Systemic Formulas)b,c
50+ (Futurebiotics)b
XTEND-LIFE Total Balance (Xtend-Life Nutraceuticals Inc.)b,c
598 brand names found
Squalamine
No brand names found
Other names: spiny dogfish shark
Theanine
Theanine is the major amino acid in green tea.
Knock Out (Schiff)b
Other names: gamma-glutamylethylamide, L-theanine
Evolution 2--Element III (Viogenix Corp.)b
(Continued on next page)
a
This herb or natural product is the only ingredient in this brand.
b
This brand is an example of a product where this herb or natural product is included along with other herbs and products. Monitor for all possible side effects
of all ingredients in these products.
c
Safety of this product is a concern. The product contains animal material, possibly diseased animals that may harbor bovine spongiform encephalopathy (BSE
or mad cow disease).
ONCOLOGY NURSING FORUM ­ VOL 31, NO 4, 2004
E79
Table 1. Common and Brand Names of Herbs and Natural Products With Potential to Decrease Cancer Growth
or for Use as an Adjuvant With Cancer Treatments: Common and Brand Names (Continued)
Herb or Natural Product
Brand Name and Manufacturer or Other
Norexin (Biotech Corp.)b
3 brand names found
Green tea contains 1%­3% of theanine; therefore, green tea products may con-
tain less theanine than the above three products.
Green tea brands:
Imperial Green Tea (Jamieson)b
Green Tea Remedy (Puritan's Pride)b
#101 ACP Vitamin ACP (Systemic Formulas)b,c
Thymus extract
#39 Gf Thyroid (Systemic Formulas)b,c
Other names: predigested thymus extract, thymus acid lysate derivative, thy-
#428 DSIR Digestant Internal S Liver Stimulant (Systemic Formulas)b, c
mus-derived polyp eptides
#80 R Lung (Systemic Formulas)b (homeopathic product)
AllerPlus (PhytoPharmica)b,c
Aspen--Imun-Comp (Aspen Group, Inc.)b,c
Atri CU-Chelate (Atrium Inc.)b,c
GSC (Glandular Stress Complex) (Progressive Labs)b,c
Children Immu-C (Nutri-Quest)b,c
55 brand names found
Triax (Syntrax Innovations)b
Tiratricol
Other names: triac, triodothyroacetic acid
This brand name was the only one found. The U.S. Food and Drug Administra-
tion has issued recalls on all products containing tiratricol.
Transfer factor
Human-derived transfer factor was used for specific cases of childhood lym-
Other names: bovine dialyzable leukocyte extract, bovine transfer factor, dia-
phocytic leukemia. Bovine derived transfer factor brands:
Transfer Factor Plus (4 Life)b,c
lyzable leukocyte extract, DLE, human dialyzable leukoctyle extract, human
Formula 560 (Immunity Today, LLC.)b,c
transfer factor, TF, TFd
Wellness Cell Response (Source Naturals)a
3 brand names found
a
This herb or natural product is the only ingredient in this brand.
b
This brand is an example of a product where this herb or natural product is included along with other herbs and products. Monitor for all possible side effects
of all ingredients in these products.
c
Safety of this product is a concern. The product contains animal material, possibly diseased animals that may harbor bovine spongiform encephalopathy (BSE
or mad cow disease).
Herbs and Natural Products
1996; Penna, Dean, & Nelson, 1996; Ross, Vetvicka, Yan,
Xia, & Vetvickova, 1999). Beta glucans seems to allow ph-
With Potential to Decrease
agocytosis (of cancer cells) to occur. Yeast-derived beta
Cancer Growth or as Adjuvants
glucans seems well tolerated orally (Nicolosi et al., 1999).
Beta glucans has been used in doses of 7.5 g twice daily added
Astragalus , with a scientific name of Astragalus
to juice (Nicolosi et al.).
membranaceu, is an herb used in self-medication with con-
Balkal skullcap has a scientific name of Scutellaria
ventional therapies for breast, cervical, and lung cancer. As-
baicalensis. Self-medication of balkal skullcap often is for
tragalus seems to enhance the immune system, especially in
treatment of prostate cancer or respiratory infections (Huang,
cases of deficiency, by restoring suppressed T cell function
1999). Findings suggest that this herb inhibits tumor growth
(Chu, Wong, & Mavligit, 1988; Sun et al., 1983). Doses of 1-
and carcinoma cell proliferation (Huang). Although Huang
30 g per day seem to be typical, but Upton (1999) indicated
considers balkal skullcap to be relatively nontoxic, Bruneton
that doses greater than 28 g might cause immunosuppression.
(1999) recorded several cases that associated the herb with
See Table 2 for the alert list of herbs and natural products with
hepatotoxicity. A typical dose is 6-15 grams, toasted to mod-
toxic effects.
erate the effect (Bensky, Gamble, & Kaptchuk, 1996).
Beta glucans has scientific names of 1-3, 1-6-beta-glucan,
Calcium-D glucarate, with a scientific name of D-glucaro-
beta-1,3-D-glucan, and beta-1-6,1,3-beta-glucan. Individuals
1,4-lactone (1,4 GL), is used by individuals to prevent breast,
self-medicate with beta glucans for various conditions such as
prostate, and colon cancer and to remove body toxins. Cal-
diabetes, cancer, HIV and AIDS, the common cold, influenza,
cium-D glucarate seems to decrease circulating estrogen. Pa-
and allergies (Natural Medicines Comprehensive Database,
tients with breast or prostate cancers may benefit from this
2004). Beta glucans stimulates the body's macrophage phago-
action. In vitro studies also have shown that D-glucarate de-
cytosis of tumor cells, increases the cytotoxicity of natural
c r e a s e s tumor cell proliferation (Curley, Humphries,
killer cells, and stimulates tumor necrosis factor and the re-
Koolemans-Beynan, Abou-Isaa, & Webb, 1994). In animal
lease of interleukin-1 (Arinaga et al., 1992; Muller et al.,
studies, dietary glucarate inhibited beta-glucuronidase activi-
ONCOLOGY NURSING FORUM ­ VOL 31, NO 4, 2004
E80
Table 2. Herbs and Natural Products That Have Toxic
(Piscoya et al.). A typical dose for osteoarthritis of the knee is
100 mg of a freeze-dried aqueous extract of cat's claw
or Negative Side Effects
(Piscoya et al.).
Herb or Natural Product
Adverse Reaction or Toxicity
Cesium has the scientific names of Cesium, Cs, and atomic
number 55. Individuals self-medicate with cesium to treat
Astragalus
Doses over 28 grams might cause immunosup-
cancer and depression. In preliminary research, Sartori (1984)
pression.
found no response when cesium was given alone to 50 pa-
Balkal skullcap
Skullcap implicated as the cause in several cases of
tients over a period of three years. When cesium was given
hepatotoxicity
along with minerals such as magnesium, potassium, and sele-
Cat's claw
Adverse effects include headache, dizziness, and
nium and some vitamins and chelating agents, the patients
vomiting
experienced a 50% recovery from primary breast, colon, pros-
Cesiun
High exposure to Cesium can result in burns and
tate, pancreas, lung, and liver cancer and lymphoma, Ewing
death
European mistletoe
Mistletoe is a poisonous plant
sarcoma of the pelvis, and adenocancer of the gall bladder. As
Fish oils
Many side effects are associated with this product,
seen in Table 1, the examples of brands all contain other min-
and it may cause cancer.
erals or vitamin substances. Before taking additional products
Gamma linolenic acid
Only Borage products that are labeled with "UPA
such as vitamins and minerals with cesium, patients should be
(borage)
free" are safe.
cautioned to review all side effects. Sartori indicated that the
Gossypol
Gossypol is considered unsafe because of its po-
typical dosage is 6-9 g divided into three doses daily. High
tential toxicity.
exposure to cesium can result in burns to body tissue and
Graviola
Parkinson's disease like movements may result
death (Environmental Protection Agency, 2002). Side effects
from oral ingestion of graviola.
include nausea, diarrhea, anorexia, and tingling of the lips,
Magnesium (intrave-
Magnesium is fatal in large doses. Many interac-
hands, and feet (Neulieb, 1984).
nous)
tions with drugs, herbs and supplements, and
diseases or conditions make the oral self-medica-
Chlorophyll has scientific names of Chlorophyll a, Chlo-
tion of this mineral prohibitive. Finding suggests
rophyll b, Chlorophyll c, or Chlorophyll d. Individuals use
usefulness of only intravenous doses.
chlorophyll to reduce colostomy odor and for bad breath, con-
Marijuana
In inhaled form, marijuana damages the lung tis-
stipation, detoxification, and wound healing. Medicinal activi-
sue.
ties of chlorophyll contained in silkworm excreta have been
Melatonin
Melatonin has many side effects.
recognized by Far Eastern healthcare practitioners. Recent
Selenium
Selenium can cause acute toxicity.
research has confirmed that chlorophyll extracted from silk-
Thymus extract
Products with thymus extract may be contami-
worm excreta appears to have a cytotoxic effect on cancer
nated by bovine spongiform encephalitis (mad
cells (Dai et al., 1992; Lee, Park, Kim, Han, & Hahn, 1990).
cow disease).
Leung and Foster (1996) indicated that commercial sources of
Tiratricol
Individuals who have normal thyroid function
should not take Tiratricol.
c h l o r o p h y l l are derived from alfalfa (scientific name
Transfer factor
Bovine-derived products may be contaminated by
Medicago sativa) and silkworm excreta. None of the 74
bovine spongiform encephalitis (mad cow dis-
brands found listed chlorophyll extracted from silkworm ex-
ease). Benefits are only known in childhood leu-
creta as an ingredient. Advertisements for barley green prod-
kemia, using human-derived transfer factor.
ucts indicate that the chlorophyll is from barley plants. No ad-
verse side effects of chlorophyll or typical dose are reported.
Chrysin, also this products scientific name, is used to self-
ties, inhibiting mammary tumor development. Normally, in
medicate to prevent cancer and treat conditions such as anxiety,
the intestine the bacterial enzyme beta-glucuronidase breaks
inflammation, and impotence (Natural Medicines Comprehen-
the estrogen-glucuronide bond, allowing estrogen to be reab-
sive Database, 2004). Chrysin occurs naturally in plants such as
sorbed (Natural Medicines Comprehensive Database, 2004).
passionflower and silver linden and in bee honey and propolis
Beta-glucuronidase seems to be increased in the body systems
(Galijatovic, Otake, Walle, & Walle, 1999). Preliminary re-
of patients with hormone-dependent breast or prostate cancer.
search has shown that the presence of chrysin appears to reduce
Calcium-D glucarate inhibits beta-glucuronidase, decreasing
the bioavailability of dietary carcinogens (Galijatovic, Walle, &
the reabsorbed estrogen and decreasing circulating estrogen
Walle, 2000; Galijatovic, Otake, Walle, & Walle, 2001).
(Heerdt, Young, & Borgen, 1995; Walaszek et al., 1997). No
Chrysin also seems to act in a similar fashion as breast cancer
adverse reactions or typical doses have been reported (Natu-
drugs anastrozole and letrozole, decreasing estrogen synthesis
ral Medicines Comprehensive Database). Calcium glucarate
(Jeong, Shin, Kim, & Pezzuto, 1999; Kao, Zhou, Sherman,
is not the same substance as calcium gluconate.
Laughton, & Chen, 1998). Chrysin may have a future use in
Cat's claw has scientific names of Uncaria guianensis, or
cancer drug therapy. No toxic effects have been recorded.
Uncaria tomentosa. People self-medicate with cat's claw for
Manufacturers suggest various dosages for chrysin, but none
many conditions, including peptic ulcers, colitis, leaky bowel
has been tested on humans.
syndrome, herpes infections, and especially urinary tract can-
Cordyceps has a scientific name of Cordyceps sinensis.
cer (Natural Medicines Comprehensive Database, 2004). Al-
Cordyceps sinensis is a Chinese medicine, a fungus parasite
though cat's claw does not appear to be cytotoxic to normal
that lives on caterpillars in China's high mountain region. For
cells, in preliminary tests it appeared to induce tumor cell
commercial products, cordyceps cells are propagated in labo-
death and inhibit proliferation of leukemia and lymphoma
ratories (Robbers & Tyler, 1999). Patients self-medicate with
c e l l s (Piscoya et al., 2001; Sandoval, Charbonnet, &
cordyceps for numerous conditions, including lethargy,
Okuhama, 2000; Santa Maria et al., 1997). Adverse reactions
chronic bronchitis, kidney disorders, male sexual dysfunction,
to cat's claw include headache, dizziness, and vomiting
anemia, liver dysfunction, and dizziness, and to increase en-
ONCOLOGY NURSING FORUM ­ VOL 31, NO 4, 2004
E81
therapy and radiation. Oral use can cause vomiting, diarrhea,
ergy (Robbers & Tyler). Preliminary evidence suggests that
internal cramps, hepatitis (Harvey & Colin-Jones, 1981;
cordyceps might be cytotoxic to cancer cells (Bok, Lermer,
Micromedex Healthcare Series, 2003), hypotension, contrac-
Chilton, Klingeman, & Towers, 1999; Kuo et al., 1994; Kuo,
tion of the pupil, uncontrollable movement of the eyeball,
Tsai, Shiao, Chen, & Lin, 1996), especially lung carcinoma
s e i z u r e s , coma, and death (Blumenthal et al., 1998;
(Nakamura et al., 1999) and melanoma (Xu, Peng, Chen, &
Gruenwald, Brendler, & Jaenicke, 1998; Newall, Anderson, &
Chen, 1992). No adverse effects have been reported (Natural
Philpson, 1996). No typical dose has been reported. Avoid
Medicines Comprehensive Database, 2004). Zhu, Halpern,
using this poisonous herb.
and Jones (1998) used a dose of 3 g daily.
Fish oils have scientific names of N-3 fatty acid, N-3poly-
Coriolus mushroom has the scientific name of Coriolus
unsaturated fatty acids and others. Self-medication with fish
versicolor, synonymous with Trametes versicolor. Healthcare
oils usually is for such conditions as cancer, heart disease,
professionals may find individuals using coriolus mushroom to
Crohn disease, and lung disease. Individuals who take fish oils
alleviate side effects of chemotherapy or radiation treatments or
have high levels of the omega-3 fatty acids in their erythro-
to improve the effects of chemotherapy. The plant shows anti-
cytes. These fatty acids seem to decrease rates of prostate
tumor and immunomodulating effects (Dong, Kwan, Chen, &
cancer (Terry, Lichtenstein, Feychting, Ahlbom, & Wolk,
Yang, 1996; Dong, Yang, & Kwan, 1997; Harada et al., 1997;
2001) and prolong cancer remissions (Ogilvie et al., 2000).
Kanoh et al., 1994; Kim, Kacew, & Lee, 1999; Kobayashi,
Ogilvie et al. also found that fish oils decrease production of
Matsunaga, & Oguchi, 1995; Maehara et al., 1993; Mizutani, &
lactic acid in tumor cells. Lactic acidosis is a marker of unfa-
Yoshida, 1991; Ng, 1998; Tsukagoshi et al., 1984; Wang, NG,
vorable metabolism caused by many cancers.
Liu, Ooi, & Chang, 1996). Coriolus mushroom contains several
However, if individuals have familial adenomatous polypo-
polysaccharides, including polysaccharide-K (PSK and
sis and use fish oil extensively, they put themselves at greater
krestin), that have been used in Japan as biologic response
risk of developing cancer (Akedo et al., 1998). Fish oils con-
modifiers in cancer chemotherapy treatments (Harada et al.;
tain other well-known components such as vitamins A and D
Hayakawa et al., 1997; Maehara et al.; Morimoto et al., 1996;
and omega-3 fatty acids. Chronic or high use of vitamin A can
Nakazato, Koike, Saji, Ogawa, & Sakamoto, 1994; Nio et al.,
cause blood cell changes and liver damage; high doses of vi-
1992; Sugimachi, Maehara, Ogawa, Kakegawa, & Tomita,
tamin D can cause irreversible damage and calcification of
1997; Toi et al., 1992). Although no reports of adverse effects
soft tissues, such as the liver and kidneys (Health and Welfare
from coriolus mushroom have been noted (Mizutani &
Canada, 1990; Montbriand, 1994a; Yetiv, 1988). Although the
Yoshida; Ng), patients receiving PSK adjunctly with chemo-
mechanism is unknown, fish oils are known to reduce body
therapy have experienced nausea, leukopenia, and liver func-
vitamin E levels (Meydani & Dinarello, 1993). Fish oils used
tion impairment (Nakazato et al.). This might be from the che-
concomitantly with anticoagulant or antiplatelet herbs or
motherapy (Natural Medicines Comprehensive Database,
drugs increase the risk of bleeding (Brinker, 1998; Martindale,
2004). As an adjuvant, 3 g of PSK has been used daily
1999; Newall et al., 1996; Sirtori et al., 1998). Vitamin A and
(Morimoto et al.; Nio et al.; Toi et al.; Yokoe et al., 1997).
D (components of fish oil) will be covered in Part III of this
Diindolylmethane has a scientific name of 3,3'-
series. Part III focuses on products that protect against cancer.
Diindolylmethane. Individuals use it to prevent breast and uter-
Healthcare professionals may find individuals using fish oils
ine cancers. According to Balk (2000) and Riby, Chang,
in high doses, but doses of 3 g or less per day generally are
Firestone, and Bjeldanes (2000), the typical American diet con-
well tolerated (Natural Medicines Comprehensive Database,
tains 2-24 mg of diindolylmethane daily. Several researchers
2004). Higher doses can cause belching, halitosis, and heart-
agreed that diidolylmethane has estrogen receptor agonist and
burn (Belluzzi et al., 1994; Pheatt, 1998).
antagonistic activities, making it potentially useful against
Gamma linolenic acid (GLA) has a scientific name of
breast cancer cells (Chen, McDougal, Wang, & Safe, 1998;
(ZZZ)-Octadeca-6,9,12-trienoic acid. Self-medication with
Chen Safe, and Bjeldanes, 1996; McDougal, Sethi Gupta,
GLA often is for rheumatoid arthritis, premenstrual syndrome,
Ramamoorthy, Sun, & Safe, 2000; Riby et al.). All of the stud-
o r enhancement of hormonal breast cancer treatment
ies mentioned were very preliminary in vivo findings. Toxic
(tamoxifen). For women with estrogen-sensitive breast can-
effects and typical doses were not reported.
cers, GLA can hasten the response of tamoxifen (Kenny et al.,
European mistletoe has a scientific name of Viscum album
2000). GLA is found in two herbs: oil of primrose (Oenothera
and is grouped as American Phoradendron serotinum. Recent
biennis) and borage (Borago officinalis). According to Facts
studies have indicated that European mistletoe has a toxic
and Comparisons (2001), evening primrose oil is available in
effect on certain tumors and carcinoma (Bisset, 1994; Duke,
oil-filled capsules and tablets. Stability of the tablets is un-
1987; Schulz, Hansel, & Tyler, 1998). Other researchers, in
known. Some capsules are adulterated and biologically use-
randomized, controlled trials and one in vivo research study,
less, containing either soy or safflower oil. The FDA named
found no indication for adjuvant use of mistletoe for patients
evening primrose oil an unapproved food additive (Tyler,
with cancer (Friess et al., 1996; Steuer-Vogt et al., 2001;
1994). Some borage contains unsaturated pyrrolizidine alka-
Timoshenko, Cherenkevich, & Gabius, 1995). Yet, other re-
loids (UPAs) that are toxic in even minute amounts, accord-
searchers believe that European mistletoe has possibilities as
ing to Tyler (1994). Therefore, only borage products labeled
a biologic response modifier, stimulating the immune system
UPA-free are safe. Even when borage is used in therapeutic
and exerting cytotoxic effects (Natural Medicines Compre-
amounts, UPA can be in toxic levels (Fetrow & Avala, 1999).
hensive Database, 2004).
GLA also may prolong bleeding time (Guivernau, Meza,
Despite well-known toxicity of mistletoe, this herb continu-
Barja, & Roman, 1994). Natural Medicines Comprehensive
ally finds its way into alternative remedies (Facts and Com-
Database (2004) reported use of daily doses of 1.6 g and 360
parisons, 2001). Individuals self-medicate with European
mg.
mistletoe to treat cancer and reduce side effects of chemo-
ONCOLOGY NURSING FORUM ­ VOL 31, NO 4, 2004
E82
harmed (Babu, Kuttan, & Padikkala, 1995). In addition,
Glossy privet has a scientific name of Ligustrum lucidum.
Babu et al. found that gotu kola increased the life span of
This herb often is used to reduce side effects of chemotherapy
tumor-bearing mice. Gotu kola usually is tolerated well
and improve immune function. The Chinese use the fruit of
when used in typical doses of 600 mg of dried leaves three
glossy privet to clinically treat leukopenia (Leung & Foster,
times a day (Gruenwald et al., 1998). A side effect is photo-
1996). However, Khoo and Ang (1995) refuted this practice,
sensitivity (Newall et al., 1996); therefore, individuals using
finding that glossy privet did not induce any effects on leuko-
gotu kola are advised to wear sunscreen and clothing to pre-
penia in a study conducted on Wistar rats. Conversley, Lau,
vent sunburn.
Ruckle, Botolazzo, and Lui (1994) found that glossy privet
Graviola also is known by its scientific name, Annona
fruit had potential to inhibit growth of renal cell carcinoma.
muricata. Individuals use graviola for cancer and herpes.
No adverse reactions are reported for glossy privet, and a
Graviola also is used as an antibiotic or sedative. The impor-
common dose is 5-15 g of powdered berries per day (Natural
tant class of medicinal components found in graviola is
Medicines Comprehensive Database, 2004). Notice the warn-
acetogenins. Acetogenins are found in the fruit, seeds, leaves,
ing about the recall in Table 1.
and bark of the graviola plant. Preliminary research by
Glutamine has a scientific name of L-(+)-2-
Oberlies, Chang, and McLaughlin (1997) showed that
Aminoglutarmic acid. Self-medication with glutamine often is
acetogenins block production of adenosine triphosphate,
for reducing side effects of chemotherapy, such as mucositis,
which inhibits the pump that removes cancer drugs from the
diarrhea, and neuropathy. Other self-medication is for the
cell, allowing chemotherapy to be more effective. Further-
purpose of protecting the immune and gut barrier function in
more, Oberlies et al.'s research suggests that acetogenins may
p a t i e n t s with esophageal cancer or those undergoing
have chemotherapeutic potential, especially against cancer
radiochemotherapy.
that are resistant to multiple drugs. Parkinson disease-like
Patients with cancer are thought to have reduced glutamine
movements may result from oral ingestion of graviola
levels (Morlion et al., 1998). Normally, gastrointestinal cells
(Lannuzel et al., 2002). No typical dose is available.
divide rapidly; therefore, when receiving chemotherapy, these
Honey has a scientific name of Apis mellifera. Topically,
c e l l s are very susceptible to cytotoxic effects. Giving
honey is used to hasten healing of skin wounds, ulcerations,
glutamine along with chemotherapy and radiation seems to
and burns. During surgery, cancer cells can be seeded into
prevent gastrointestinal toxicity by maintaining viability of
the margins of incisions, resulting in tumor growth in the
gastrointestinal tissues (Morlion et al.). However, researchers
surgical wound. Hamzaoglu et al. (2000) implanted cancer
are suspicious that rapidly growing tumors may take up
cells into neck wounds of 60 BALB/c strain mice, then di-
glutamine and tumor growth may be stimulated. Preliminary
vided the mice into two groups. A marked decrease in
research does not confirm this suspicion; early findings have
wound cancer tumors were found in the group of mice that
shown a reduction in tumor growth (Bozzetti et al., 1997;
had surgical wounds coated with honey pre- and postopera-
Miller, 1999). IV glutamine was well tolerated in clinical stud-
tively. Although this finding may have some application in
ies (Natural Medicines Comprehensive Database, 2004). Vari-
human surgery, sterile technique is important. Honey is
ous swish-and-swallow regimens have been used to treat ad-
known to have antibacterial and antifungal properties (Efem,
verse symptoms of chemotherapy and radiochemotherapy; see
1988; Postmes, van den Bogaard, & Hazen, 1993), yet sur-
references for regimens (Anderson et al., 1998; Cockerham,
gical wounds need to be kept scrupulously clean. All oral,
Weinberger, & Lerchie, 2000; Noyer et al.,1998; Rubio, Cao,
brand-name products found have additional ingredients,
Hutchins, Westbrook, & Klimberg, 1998; Scolapio et al.,
making the use of liquid content from oral capsules inappro-
1997; Shabert, Winslow, Lacey, & Wilmore, 1999; Yoshida
priate for external use.
et al., 1998).
IP-6 has a scientific name of Inositol hexaphosphate. Indi-
Gossypol, also known as cottonseed oil, has a scientific
viduals self-medicate with IP-6 to prevent cancer, increase
name of Gossyplum hirsutum or Gossypium herbaceum. Used
white blood cells, prevent heart attacks, treat kidney stones,
as a male contraceptive, gossypol also is used for metastatic
and enhance the immune system (Natural Medicines Compre-
carcinoma of the endometrium or ovary and HIV. Preliminary
hensive Database, 2004). IP-6 has demonstrated anticancer
in vivo and in vitro studies have suggested that glossypol has
activities in breast, colon, liver, and prostate cancers, as well
cytotoxic and antitumor properties on many cytosolic and
as experimental tumors (Challa, Rao, & Reddy, 1997; Saied
mitochondrial enzyme systems, the very systems that are fun-
& Shamsuddin, 1998; Shamsuddin & Vucenik, 1999;
damental for tumor cell growth, including melanoma, en-
Shamsuddin & Yang, 1995; Thompson & Zhang, 1991;
dometrial, colon, lung, prostate, breast, brain, and adrenocor-
Vucenik, Zhang, & Shamsuddin, 1998). No adverse reactions
tical cancer (Coyle, Levante, Shetler, & Winfield, 1994;
have been noted. A dose of 500 mg-2 g twice daily has been
Gilbert, O'Reilly, Chang, Lin, & Brueggemeier, 1995; Liang
used to prevent cancer and 5-8 g daily to treat existing cancer;
et al., 1995; Shidaifat et al., 1996; Wu, 1989). No typical dose
however, these are not recommended or typical doses (Natu-
is available for the treatment of cancer. Self-medication with
ral Medicines Comprehensive Database).
gossypol is considered unsafe because of its potential toxic-
L-arginine has a scientific name of 2-amino-5-
ity (Facts and Comparisons, 2001).
guanidinopentacoic acid. Individuals self-prescribe this prod-
Gotu kola has a scientific name of Centella asiatica, syn-
uct as an adjunct to chemotherapy for breast cancer and for a
onymous with Hydrocotyle asiatica. Self-medication with
variety of conditions such as the common cold, cachexia (es-
gotu kola often is for improving memory or for urinary tract
pecially patients with AIDS), male infertility, and migraine
infection, jaundice, diarrhea, diabetes, and other conditions.
headaches. L-arginine is an essential amino acid necessary for
In early studies on animal tissue, gotu kola exhibited cyto-
protein synthesis. Early evidence indicates that it may modify
toxic and antitumor properties. Notably, gotu kola appears to
immune system function and potentiate tumor cell response to
be selective in toxicity, leaving normal lymphocytes un-
ONCOLOGY NURSING FORUM ­ VOL 31, NO 4, 2004
E83
anticancer drugs, thereby reducing the immunosuppressive
Healthcare Series, 2003; Lissoni et al., 1995, 1996b, 1999).
effects of chemotherapy agents (Brittenden et al., 1994). Ad-
Furthermore, melatonin is beneficial in stabilizing disease for
verse effects include abdominal pain and bloating (McKevoy,
adults with solid tumors who do not respond to treatments or
1998); diarrhea; gout (Brittenden et al.; Rector et al., 1996);
cannot receive treatments (Micromedex Healthcare Series;
decreased platelet count; elevation of blood urea nitrogen,
Lissoni et al., 1991, 1994a). When used concomitantly with
serum creatine, and creatinine (McKevoy); and allergic reac-
interleukin-2, melatonin seems to improve survival for pa-
tions or airway inflammation (McKevoy; Takano et al., 1998).
tients with advanced solid tumors of the breast, gastrointesti-
L-arginine has caused necrosis of veins and superficial phle-
nal tract, kidney, liver, and lung and melanoma (Micromedex
bitis (McKevoy; Tenebaum, Fisman, & Motro, 1998). Clini-
Healthcare Series; Lissoni et al., 1994b, 1994c). The same
cal studies have used doses ranging from 2-5 g three times a
seems to be true when melatonin is used concomitantly with
day (Hambrecht et al., 2000; Rector et al., 1996; Watanabe,
triptorelin pamoate for prostate cancer, radiotherapy for glio-
Tomiyama, & Doba, 2000).
blastoma, and interferon for renal cell cancer (Micromedex
Magnesium is a mineral with a scientific abbreviation of
Healthcare Series).
Mg and atomic number 12. This mineral is used to prevent or
Adverse effects of melatonin are headaches, transient de-
treat hypomagnesemia. Other self-medication use is for con-
pression, daytime fatigue and drowsiness, dizziness, abdomi-
stipation, asthma symptoms, heart conditions, premenstrual
nal cramps, and irritability (Micromedex Healthcare Series,
syndrome, leg cramps, and other conditions. Crosby, Wilcock,
2003; Wagner, Wagner, & Hening, 1998). Melatonin also
and Corcoran (2000) studied the safety, tolerability, and effi-
reduces alertness (Dollins et al., 1993, Micromedex Health-
cacy of IV doses of magnesium sulfate when given to 12 pa-
care Series). Commercially available melatonin usually is
tients with cancer who responded poorly to morphine for their
synthesized in laboratories. Avery, Lenz, and Landis (1998)
neuropathic pain. A single dose of 500 mg-1 gram seemed to
cautioned against use of animal sources of melatonin because
relieve neuropathic pain for a period of at least four hours.
of possible contamination. A clinical study under way in
This finding may be of use to clinicians. However, oral self-
France is investigating sleep properties of Circadin (melato-
medication with magnesium for pain is not advisable because
nin), and Neurim Pharmaceutical Labs [Montreal, Canada] is
this mineral is fatal in large doses. Magnesium also interacts
applying for prescription drug approval of Circadin in Canada
with numerous drugs, herbs, supplements, and diseases or
and Europe (Natural Medicines Comprehensive Database,
conditions, making self-medication with this mineral prohibi-
2004). Although an optimal safe dose has not been estab-
tive.
lished, 20-50 mg along with radiation or chemotherapy has
Marijuana has a scientific name of Cannabis sativa. In
b e e n used for cancer treatment (Brzezinski, 1997;
vitro studies of components of marijuana indicate a potential
Micromedex Healthcare Series, 2003).
to inhibit human breast cancer cells and produce tumor eradi-
Selenium also is known by its scientific names: selenium,
cations (Galve-Roperh et al., 2000). In experiments introduc-
Se, and atomic number 34. Individuals use selenium to treat
ing marijuana to malignant brain tumors, Galve-Roperh et al.
HIV and AIDS and prevent cancer, heart disease, osteoarthri-
also found that survival of animals was increased signifi-
tis, infertility, and gray hair. The actions of enzymes, regu-
cantly. Medicinal use of marijuana (inhalation, usually three
lated by selenium (an antioxidant), are hypothesized to protect
or four "joints" [cigarettes] per day) for cancer and AIDS is
against cancers (Natural Medicines Comprehensive Database,
reported to decrease pain, relieve nausea and vomiting in-
2004). Dietary deficiency of selenium has been linked to can-
duced by chemotherapy, and stimulate appetite; however, no
cer, and epidemiologic evidence now is showing the benefits
research substantiates the efficacy of these claims. Regular
to patients with prostate cancer when they use selenium
smoking of three to four joints of marijuana per day is re-
supplements (Aaseth, Haugen, & Forre, 1998; Nelson, Reid,
ported to cause as much histologic damage as smoking 20-22
Duffield-Lillico, & Marshall, 2002). Good food sources of
tobacco cigarettes per day (Johnson, Smith, Morrison, Laszlo,
selenium are crab, liver, fish, poultry, and wheat. Natural se-
& White, 2000). The cannabinoid in marijuana considered
lenium levels are in soil, although they vary throughout the
potentially useful is tetrahydrocannabinol (THC). Delta-9-
world (Rayman, 2000). Health and Welfare Canada (1990)
TCH (chemical name) Marinol® (Sanofi-Synthelabo Canada
indicated that North American diets have adequate amounts of
this trace metal and that further supplementation is not only
Inc., Markham, Ontario) and nabilone (a synthetic creation of
THC) (Cesamet®, ICN Canada Ltd., Montreal, Quebec) are
unnecessary but also risky because of the potential for toxic-
ity. Adverse effects of selenium include nausea, vomiting,
the prescription products used in treatment of cancer chemo-
fatigue, hair loss, white horizontal streaks on fingernails, and
therapy-induced nausea and vomiting; typical dosage is 5-15
a metallic taste (Ellenhorn, 1997). A typical dose taken for
mg every 2-4 hours (Micromedex Healthcare Series, 2003).
cancer prevention is 200 mcg per day (Clark et al., 1996;
Melatonin has a scientific name of N-acetyl-5-
Rayman).
methoxytryptamine. Individuals use melatonin for cancer of
Squalamine has a scientific name of Squalus acanthias.
the breast, brain, lung, prostate, head, neck, and gastrointes-
Healthcare professionals may find patients using squalamine as
tinal tract. Melatonin is also used for jet lag, insomnia, nico-
an antibiotic or a treatment for solid tumors. Squalamine shows
tine withdrawal, headache, hypertension, and other condi-
promise for possible treatment of pediatric solid tumors (Sills
t i o n s . Melatonin can decrease the incidence of
et al., 1998), as well as potential benefit when used concomi-
cytokine-induced hypotension for patients with cancer.
tantly with chemotherapy (Williams et al., 2001). Originally
Interleukin-2 and tumor necrosis factor are examples of cyto-
isolated from shiny dogfish shark liver and stomach tissue,
kines (Lissoni et al., 1996a). Quick-release melatonin may be
squalamine now is made synthetically. This product is not the
beneficial in decreasing potential sleep disorders associated
same as shark cartilage from hammerhead shark, shiny dogfish
with conditions such as thrombocytopenia induced by chemo-
shark, and other shark species. Neither adverse reactions nor
therapy or interleukin-2 (Bregani et al., 1995; Micromedex
ONCOLOGY NURSING FORUM ­ VOL 31, NO 4, 2004
E84
with differentiated thyroid cancer who are interested in
typical doses are reported for squalamine (Natural Medicines
tiratricol should discuss the product with an oncologist.
Comprehensive Database, 2004).
Transfer factor is the most common and the only scientific
Theanine has a scientific name of 5-N-ethylglutamine.
name of this natural product. Individuals use this product for
People self-medicate with theanine because they believe it
infectious diseases, whether they are immunocompetent or
enhances the effect of chemotherapy. Interest in using
immunocompromised. When prepared and derived from hu-
theanine as an adjuvant with cancer treatment was initiated
man donors with varicellazoster antibodies, transfer factor
because theanine increases doxorubicin and adriamycin in
seems to protect children who have acute lymphocytic leuke-
tumors that block cancer drug efflux from tumor cells. This is
mia and no immunity to varicellazoster (Steele, Myers, &
especially important in drug-sensitive and multidrug-resistant
Vincent, 1980). Steele et al.'s study was a double-blind trial
tumors (Sadzuka, Sugiyama, Miyagishima, Nozawa, &
with 31 patients. Although the use of transfer factor from
H i r o t a , 1996; Sadzuka, Sugiyama, & Sonobe, 2000;
bovine sources seems to be safe (Fudenberg, 1989), concern
Sugiyama, Sadzuka, Tanaka, & Sonobe, 2001; Sugiyama &
exists that bovine-derived transfer factor may contain BSE
Sadzuka, 1998). Theanine is a major amino acid found in
when it is collected from cows originating from countries
green tea (Natural Medicines Comprehensive Database,
where BSE has been reported. However, considering bovine
2004). Green tea also appears in Part III of this series of ar-
derivatives for treatments seems useless because only human-
ticles because it has properties that seem to protect humans
derived transfer factor was found useful in protecting patients
against cancer. Here, the discussion focuses on theanine (one
with childhood lymphocytic leukemia. For Steele et al.'s
component of the tea), which appears to have potential in can-
study, a single subcutaneous dose of human-derived transfer
cer treatment. Side effects and typical doses for theanine are
factor, specific for varicella, 100 million lymphocyte equiva-
not available.
lents per 7 kg of body weight was used.
Thymus extract has no scientific name, but this product
goes under many names such as thymomodulin, thymosin,
thymus complex, thymus-derived polypeptides, and others.
Conclusion and Implications
Individuals may self-medicate with this product to maintain
This review paper provides information on 31 herbs and
their white cells while receiving chemotherapy or radiation.
natural products with potential to decrease growth of cancers
Limited human studies suggest that thymus extract may pre-
or be used adjunctly with cancer treatments for patients who
v e n t cystitis, conjunctivitis, stomatomucositis, and
already have or have had cancer. Through awareness of herb
myelotoxicity for patients with breast cancer who are under-
and natural product properties, healthcare professionals, es-
going chemotherapy (Iaffaioli et al., 1988­89). No adverse
pecially nurses, can play significant clinical roles as re-
effects have been reported, but concerns have been expressed
sources. Nurses are often liaisons between patients and doc-
about possible contamination of thymus products derived
tors or pharmacists, especially when patients discretely
from sick animals when collecting raw bovine thymus glands
inquire whether a nurse knows about an herb or natural prod-
in slaughterhouses. Some thymus glands may harbor bovine
uct. With information from this series, nurses can initiate
spongiform encephalopathy (BSE) and mad cow disease
discussion with healthcare colleagues to determine whether
(Murray, 1996). Almost all brands for thymus in Table 1 have
patients may benefit from taking a specific herb or natural
this warning. According to Murray, a typical daily dose is 750
product.
mg of crude thymus polypeptide fraction.
First, scientific names of natural products and herbs have
One brand of thymus extract is a homeopathic product. This
been included in this article along with common names. Ac-
means that the thymus extract has been through many dilu-
cording to Tyler (1996), healthcare professionals and consum-
tions with water or another liquid. Most homeopathic products
ers should be encouraged to check products for the correct sci-
have little or no active ingredients and, therefore, no pharma-
entific name and spelling. Some contaminants have been
cologic effects, drug interactions, or toxic effects.
found in consumer products; therefore, careful spelling and in-
Tiratricol has a scientific name of 3,3',5-triiodothyroaceic
clusion of the scientific name may indicate some degree of
acid. Individuals with thyroid cancer may self-medicate with
manufacturer integrity in including only the ingredients speci-
this product, and some may use it as a thyroid supplement.
fied.
Two research groups found positive results with supplemen-
Typical dosages have been included in this article when
tary use of tiratricol for differentiated thyroid cancer, effective
possible, allowing healthcare professionals to critically as-
in minimizing serum thyrotrophin concentration (Jaffiol et al.,
sess amounts taken by patients. These doses are not recom-
1995; Mueller-Gaertner & Schneider, 1988). On the other
mended doses. Keep in mind that herbs (capsules or tablets)
hand, Mechelany, Schlumberger, Challeton, Comoy, and
are powder or crushed forms of whole plants. The quality
Parmentier (1991) determined that no justification existed for
and quantity of any medicinal components in an herbal prod-
using tiratricol as a supplement in treatment of patients with
uct can vary considerably according to the growing condi-
thyroid cancer. The former studies performed tests with 127
tions; quality of the soil, seed, bulb, plant, or product; and
and 25 patients with differentiated thyroid cancer, respec-
reputability of the manufacturer. The FDA (2003) has
tively, and the latter study did tests on 22 patients. In clinical
grappled with the issues of labeling supplement products.
trials, doses of 10-24 mcg twice daily were used initially. This
Although consumers now find amounts of ingredients on
dose then was titrated to less then 0.1 mU/l (Sherman &
product labels, the issue of how much medicinal component
Ladenson, 1992). The FDA (2000) indicated that tiratricol is
contained in an herbal product remains the same. For ex-
not a dietary or thyroid supplement. Individuals with normal
ample, when a product lists an amount of borage, the medici-
thyroid function should not use tiratricol. The state of Mis-
nal element named gamma-linolenic acid is only one chemi-
souri has embargoed tiratricol by distributors, and the FDA
cal in the whole borage plant; therefore, the amount of
(2000) has issued recalls on other tiratricol products. Patients
ONCOLOGY NURSING FORUM ­ VOL 31, NO 4, 2004
E85
gamma linolenic acid is shared with numerous other chemi-
extremely poisonous. Consumers also make their own con-
cals in the total weight or volume given for borage on the
coctions from scavenged herbs without realizing the potential
label. On the other hand, if an amount of gamma-linolenic
dangers. Plants are a conglomeration of many chemicals,
acid is given, the amount can be considered a specific
some medicinal, others poisonous. For example, Native
amount of gamma-linolenic acid in the product. All prescrip-
Americans have used the inner bark of elderberry as a medici-
tions and some herbal or natural products have drug identi-
nal tea; however, the stems and berries of the same plant con-
fication numbers (DINs), guaranteeing that the specified
tain cyanide (Facts and Comparisons, 2001). Encourage pa-
medicinal components will be present. For example, Tanacet
tients to disclose their innovative experiments. Mention these
125® (Ashbury Biologicals/Herbal Laboratories, Toronto,
potential dangers to patients.
Many consumers choose to take natural preparations, re-
Ontario, Canada) contains the medicinal part (tanacet) of the
gardless of the source of information. Even though healthcare
herb feverfew (scientific name Tanacetum partheniu) that
professionals may indicate that information about a certain
has been used for headaches. Tanacet 125 has a DIN, mean-
product is from evidence-based studies, consumers may say
ing it is quality-controlled and the product will contain an
their lay information also is from reliable studies. The alter-
exact amount of tanacet. If a consumer buys the herb fever-
native system often indicates that their herbs and healthcare
few, the amount of tanacet in the crushed plant is not known.
products are endorsed by "cutting edge research"; however,
Healthcare professionals should encourage consumers to ex-
the research is not in published or refereed medical, pharmacy,
amine all health products to determine if a DIN is provided,
or nursing journals. Professionals should not feel disheartened
if the scientific name is given and spelled correctly, and if
if patients seem to pay little or no attention to their well-mean-
the manufacturer gives an address and expiration date.
ing efforts. When information is given in a nonbiased manner
Second, all herbs and natural products mentioned in this
by sincere professionals, patients tend to respect their opin-
article interact positively with cancer or cancer treatments.
ions. If they initially disregard that information, later ponder-
Some also can interact with other herbs or prescriptions such
ing often initiates second thoughts about their self-medication
as anticoagulants. The latter interactions, negative or positive,
efforts. The author's experience has been that consumers and
must be passed on to patients and other healthcare profession-
patients appreciate information from healthcare professionals.
als.
They also want professionals to treat them as partners in
Third, some of the herbs and natural products mentioned in
health care. Patients with cancer have made special efforts to
this article have no adverse effects, such as coriolus mush-
tell the author how they appreciate information, no matter how
room, whereas others in high doses are considered unsafe,
technical, because they often wonder whether professionals
such as cesiun, or toxic, such as European mistletoe. Still oth-
are keeping information from them. Providing patients with
ers, such as thymus extract and transfer factor, may be con-
technical information demonstrates that they are not receiving
taminated by BSE. Most patients would appreciate having
just a vernacular version. Patients and consumers want oppor-
information of this type, allowing them to make decisions
tunities for informed choices. Healthcare professionals can be
about decreasing or discontinuing their doses. Table 2 pro-
the informed resources.
vides an alert to readers about risks in using herbs and natu-
ral products in this article.
Fourth, some patients experiment with identifying and us-
The author acknowledges with thanks the continuing support of Carl
D'Arcy, MD, director of applied research/psychiatry at the University of
ing herbs found in the wild. This can be dangerous. For ex-
Saskatchewan in Canada.
ample, mistaken identification of mushrooms can lead to le-
thal outcomes because many mushrooms are poisonous yet
appear similar to benign species. Herbs also are difficult to
Author Contact: Muriel J. Montbriand, PhD, RN, can be reached at
identify. For example, wild parsley is very similar in appear-
montbriand@skyway.usak.ca, with copy to editor at rose_mary@
ance to water hemlock. The former is benign, but the latter is
earthlink.net.
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