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Herbs or Natural Products That Increase
Cancer Growth or Recurrence
Part Two of a Four-Part Series
Muriel J. Montbriand, PhD, RN
Key Points . . .
Purpose/Objectives: To review 32 herbs and natural products that
show potential to increase cancer growth or recurrence or to interfere
with cancer treatments.
Some herbs and natural products may increase cancer growth
Data Sources: Natural Medicines Comprehensive Database and
or recurrence.
Lawrence Review of Natural Products­Monograph System.
Patients who have or have had cancer should avoid these 32
Data Synthesis: Early evidence shows that patients who have or have
had cancer should avoid 32 herbs and natural products. Some herbs and
herbs and natural products.
natural products have estrogenic effects that enable these products to
Oncology nurses can become better resources for healthcare
compete with hormone cancer therapies, whereas others interfere with
professionals and patients regarding herbs and natural prod-
chemotherapy treatment or may induce recurrence of cancer.
ucts.
Conclusions: Healthcare professionals can be resources for patients
who have cancer, helping them to avoid or identify products that may in-
duce cancer growth or interfere with cancer treatment.
Implications for Nursing: The information in this article is designed
to provide quick access for healthcare professionals working in clinical
Montbriand (2000a, 2000b) found that 97% of 100 ran-
oncology.
domly selected physicians, pharmacists, and nurses did not
believe that their knowledge about alternative therapies was
adequate. Therefore, even preliminary research information
reliminary evidence shows that some common foods
P
can help healthcare professionals alert their patients of pos-
and beverages and some not so commonly known
sible dangers and interactions when herbs and natural products
chemicals in herbs and natural products can promote
are used with cancer or treatments.
cancer growth or recurrence or can interfere with cancer treat-
This review article is the second of a four-part series on
ments. This article provides evidence-based information about
herbs and natural products that may decrease or increase can-
32 herbs and natural products that early research has shown
cer growth. The four parts of the series are
may have the potential to increase cancer growth. Common,
· Part I: herbs and natural products that may decrease cancer
scientific, and brand names of products are given, as well as
growth in patients with cancer
the typical doses and potential adverse effects. The intent in
providing this information is to assist healthcare profession-
als to become better resources for patients with cancer.
Many publications are devoted to questioning the prevalence
Muriel J. Montbriand, PhD, RN, is an associate professor in the Col-
of using alternative or complementary therapy by patients with
lege of Nursing and a research associate in applied research/psychia-
cancer (e.g., Ernst, 2000a, 2000b; Ernst & Cassileth, 1998;
try in the College of Medicine at the University of Saskatchewan in
Perlman, Eisenberg, & Panush, 1999; "Questionable Methods
Saskatoon, Canada. During this work, the author was a recipient of
two Health Services Utilization and Research Commission, Socio-
of Cancer Management," 1993; Sparber et al., 2000; Sparber &
Health Grants, in Saskatoon. (Mention of specific products and opin-
Wootton, 2001; White, 2002). Rather than look at prevalence
ions related to those products do not indicate or imply endorsement by
of use, which seems to be abundant, this series of articles en-
the Oncology Nursing Forum or the Oncology Nursing Society.)
deavors to provide preliminary research about products that
interact with cancer, either positively or negatively.
Digital Object Identifier: 10.1188/04.ONF.E99-E115
ONCOLOGY NURSING FORUM ­ VOL 31, NO 5, 2004
E99
rice root 100 mg, wild yam root 150 mg, chaste tree berry 150
· Part II: herbs or natural products that may increase cancer
mg, dong quai root 150 mg, unicorn root 100 mg, and black
growth in patients with cancer
cohosh root 50 mg. All of these herbs or natural products have
· Part III: herbs and natural products that may protect against
the potential to increase cancer growth. Patients with hor-
cancer growth in patients who do not have cancer
mone-sensitive cancers should not take the latter five herbs.
· Part IV: herbs and natural products that may potentiate can-
Tables 1 and 2 list multiple common names for herbs and
cer growth in patients who do not have cancer.
natural products. For example, chaste tree berry is also known
Some herbs and natural products are found in more than one
as chasteberry, and unicorn root and aletris are the same prod-
part of this series. In some cases, these products can act dif-
ucts. Therefore, a scan through the various common names
ferently in the bodies of patients who have or have had can-
can identify products or herbs bearing different common
cer compared to their action in patients who never have had
names in the tables.
cancer. For example, in this article, research shows that soy
Products must be used wisely. Patients seek what they per-
products may increase cancer growth, especially for women
ceive as natural products to alleviate a discomfort, but manu-
who have breast cancer. Soy also will be covered in Part III,
facturers sell products aimed at symptoms and conditions. Be
where studies are cited that have reported that soy has a ten-
alert to all brands using names that target specific conditions,
dency to protect individuals against developing cancer. Most
such as hot flashes and menopause, among others.
of the studies reviewed are in vivo studies, performed on tis-
Some herbs and natural products have many brand names.
sues not removed from a living organism (an animal), or in
Listing them all is not possible; however, brand names with
vitro studies, performed in glass on tissues from a living or-
single components of herbs are listed where possible. If a
ganism. When a human study is cited, it is usually a prelimi-
product bears the name of a specific herb or component, it
nary clinical trial.
usually is a product with the highest amount of that herb or
When possible, typical doses are given to indicate ap-
natural product. If numerous ingredients are listed, the amount
proximately how much of a product has been used in a study
of each ingredient typically is smaller than in products with
or advised by the manufacturer. The typical dose is not to be
only one listed ingredient. When a product is composed of nu-
construed as the recommended dose. When a recommended
merous ingredients, the risk of potential side effects is in-
dose is given, it is usually a vitamin or mineral and has been
creased because each ingredient can have side effects. Notice
recommended by the U.S. Food and Drug Administration or
the concern about the safety of products made from animals.
Health Canada. Individuals who self-medicate with vitamins
The tables in this article may be used as a quick reference to
or minerals often take the products in higher doses than rec-
find a product or herb before reading additional information
ommended (Montbriand, 1994a, 1995a, 1995b, 1997, 2000a,
in the text.
2000b). Knowing the recommended dose can help health-
Neither the author nor publisher makes any medical
care professionals determine whether a patient is exceeding
claims for any of the herbs or natural products in this re-
it.
view or the tables. This is informational literature. Note
Names of herbs and natural products with potential to in-
that some of the herbs described are deadly poisons and
crease cancer growth have been found in the listings from the
that some are extremely dangerous.
Natural Medicines Comprehensive Database (2003) and the
Lawrence Review of Natural Products­Monograph System
Herbs and Natural Health Products With
(Facts and Comparisons, 2001). Information about the prod-
ucts listed in this article has been taken from the studies cited
Potential to Increase Cancer Growth
in the references. Other herbs or natural products with poten-
tial to enhance cancer growth may exist, but this review relies
Aletris, with a scientific name of Alertis farinosa, is used
only on the professionals and advisory boards of the two
in self-medication for rheumatism and female disorders. Ale-
above-named monograph and database series.
tris also is used as a tonic, sedative, laxative, antispasmodic,
Table 1 is provided as a quick reference in locating an herb,
antidiarrheal, and diuretic (Leung & Foster, 1996). Estrogenic
a natural product name, or the name of a product component.
properties of this herb make it prohibitive for women with
Notice that 25 of these 32 herbs and natural products have the
hormone-sensitive cancers (McGuffin, Hobbs, Upton, &
potential to enhance the growth of hormone-sensitive cancers,
Goldberg, 1997). Adverse effects include colic, stupefaction,
such as breast, uterine, and ovarian cancers. A quick reference
and vertigo (Facts and Comparisons, 2001). Aletris is ac-
of these 25 herbs and products is found in Table 2. Estrogenic
quired as a powdered root, a liquid extract, or an infusion
effects can compete for estrogen receptors, causing transcrip-
(Gruenwald, Brendler, & Jaenicke, 1998). Common dosages
tion activities in estrogen-responsive cells. This action can
range from 0.3­6.6 g three times a day.
interfere with hormone therapies, such as tamoxifen, taken by
Alfalfa has a scientific name of Medicago sativa. Consum-
women with breast cancer.
ers use alfalfa as a diuretic or for kidney, bladder, prostate,
Herbs and natural products have numerous names. The sci-
asthma, arthritis, and diabetes conditions (Facts and Compari-
entific name for herbs consists of the genus (scientific classi-
sons, 2001). Alfalfa is another herb with estrogenic properties
fication of a group of plants with common characteristics)
that can interfere with hormone-sensitive cancers (Leung &
followed by the species (unique plants in that genus). Com-
Foster, 1996). Photosensitivity is a potential adverse effect of
mon names and brand names also are listed in Tables 1 and 2.
this herb (Brown, 1997). Ingestion of large amounts of alfalfa
Notice on a brand name label how many herbs or natural prod-
seeds is associated with pancytopenia (Malinow, Bardana, &
ucts are listed in Table 1. Many products contain more than
Goodnight, 1981; Tyler, 1993). Newall, Anderson, and Philp-
one item with the potential to enhance cancer growth. For
son (1996) suggested a dosage of 5­10 g steeped and drained
example, a product named Menopause (Nutrivention, San An-
as a tea, three times a day. Only aboveground parts of the plant
tonio, TX) contains vitamin C 50 mg, vitamin E 100 IU, lico-
should be used.
ONCOLOGY NURSING FORUM ­ VOL 31, NO 5, 2004
E100
Table 1. Herbs and Natural Products With Potential to Increase Cancer Growth, Interfere With Cancer Treatments, or Increase
Cancer Recurrence for Patients Who Have or Have Had Cancer: Common and Brand Names
Herb or Natural Product
Brand Name and Manufacturer or Other
Aletris
See Table 2.
Alfalfa
See Table 2.
Androstenedione
See Table 2.
Anise
See Table 2.
Black tea
See Table 2.
Boron
See Table 2.
Chasteberry
See Table 2.
CDT CoQ10 (Olympian Labs)a
Coenzyme Q-10
Co Enzyme Q10 (Jamieson)a
Other names: co-enzyme Q10, coenzyme Q10, co-enzyme Q-10, co enzyme Q
Coenzyme Q10 (Source Naturals)a
10, coQ10, co Q 10, co-Q-10, co-Q10, coQ-10, Q10
Anti-Oxidant Formula #1 (Olympian Labs)b
Blue-Green Connection (HealthWatchers System)b
Cenzyme Q-10 Fields of Nature (Inverness Medical Innovations, Inc.)b
Coenzyme Q10 100 mg (Leiner Health Products)b
3-Daily (The Vitamin Shoppe)b
206 brand names found
Cohosh
· Black cohosh
See Table 2.
· Blue cohosh
See Table 2.
Deer velvet
See Table 2.
DHEA
See Table 2.
Dong quai
See Table 2.
Fennel
See Table 2.
Flaxseed
See Table 2.
Ginseng
· American ginseng
See Table 2.
· Panax ginseng
See Table 2.
· Siberian ginseng
See Table 2.
Glucosamine
ArthritiCare (Aarisse Health Care)b
· Glucosamine hydrochloride
Arth Rx (Symmetry)b, c
Other names: 2-amino-2-deoxy-beta-D-glucopyranose, amino monosaccha-
Cosamine 500 mg (Kripps Pharmacy)b, c
ride, chitosamine, glucosamine, glucosamine HCl, glucose-6-phosphate
G/C 1,000 (Progressive Labs)b, c
Gluco-Pro 900 (Thompson Nutritional Products)b, c
Glucosamine Formula (Symmetry)b, c
Glucosamine Complex (Natrol)b
Move Free, formerly called Pain Free (Schiff)b, c
36 brand names found
Glucosamine Sulfate (PhotoPharmica)a
· Glucosamine sulfate
Glucosamine Sulfate Capsules (PhytoPharmica)a
Other names: 2-amino-2-deoxy-beta-D-glucopyranose, amino monosaccha-
Glucosamine Sulfate (Swanson)a
ride, chitosamine, D-glucosamine, G6S, glucosamine, glucosamine sul-
From the Sea (Puritan's Pride)b
phate, glucose-6-phosphate, glucose-6-sulfate, glucose-6-sulphate, GS,
Glucomine (Body Wise International, Inc.)b, c
mono-sulfated saccharide, sulfated monosaccharide, sulfated saccharide,
Glucosamine Fuel (TwinLab)b, c
sulphated monosaccharide
Glucosalage SO4 Extra Strength (Olympian Labs)b
Glucosamine Formula (Symmetry)b, c
129 brand names found
(Continued on next page)
a
This herb or natural product is the only ingredient in this brand.
b
This brand name is an example of a product in which the 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 (i.e.,
mad cow disease).
ONCOLOGY NURSING FORUM ­ VOL 31, NO 5, 2004
E101
Table 1. Herbs and Natural Products With Potential to Increase Cancer Growth, Interfere With Cancer Treatments, or Increase
Cancer Recurrence for Patients Who Have or Have Had Cancer: Common and Brand Names (Continued)
Brand Name and Manufacturer or Other
Herb or Natural Product
Arthro-Glucosamine (Nutri-Quest)b, c
· N-acetyl glucosamine
Glucosamine Complex (Natrol)b
Other names: acetylglucosamine, glucosamine N-acetyl, N-acetyl d-glu-
Glucosa-Plex (Progressive Labs)b, c
cosamine, N-acetyl-D glucosamine, NAG, N-A-G, poly-NAG
Intestinal Fortitude (Nutri-Quest)b
Osteo Formula Quest (Pangeo Health Brands, Inc.)b
XTEND-LIFE Total Balance (Xtend-Life Nutraceuticals Inc.)b, c
19 brand names found
Hydrazine sulfate
No brand names found. However, an Internet source sells hydrazine sulfate
Other names: hydrazine, sehydrin
from Abbotsford, Canada.
Kefir
Kefir is milk that has been fermented for 18­48 hours following addition of kefir
Other names: fermented dairy product, fermented milk, kefir cheese, kefir
grain. Kefir grain is made up of a mixture of lactic acid bacteria, acetic acid
grains, kefir yogurt
bacteria, and yeast held together in lumps by polysaccharides.
Probiata (Wakunaga of America Co., Ltd.)a
Lactobacillus
Acidophilus E.C. (Progressive Labs)a
Other names: acidophilus, L. acidophilus, L. amylovorus, L. brevis, L.
Acidophilase (Wakunaga of America Co., Ltd.)b
bulgaricus, L. casei, L. crispatus, L. delbrueckii, L. fermentum, L. gallinarum,
Acidophilus Super Strain (Jamieson)b
L. johnsonii, LC-1, L. plantarum, L. reuteri, L. sporogenes, LC-1, Laco bacillus,
Probiotic (Enzymes, Inc.)b
Lactobacilli, Lactobacillus GG, Lactobacillus rhamnosus GG, probiotics
Probiotica (McNeil Consumer Healthcare)b
92 brand names found
VSL #3 (Questcor Pharmaceuticals)a
· Yogurt other names: acidophilus milk, Bulgarian yogurt, live culture yogurt,
Daily 3 Complete (The Vitamin Shoppe)b
probiotics, yoghurt, yougurt
Glycobar: Peanut Butter and Jelly (Pharmanex)b
Low-Carb Apple Autumn Frost--Revival (Physicians Laboratories)b
Rhino Actalin Bars (Nutrition Now)b
Yogurt-Covered Soynuts--Revival (Physicians Laboratories)b
6 brand names found
Note. The above are products found in health-food stores.
See Table 2.
Licorice
Milk thistle
See Table 2.
Pregnenolone
See Table 2.
Progesterone
See Table 2.
Raspberry leaf
See Table 2.
Red clover
See Table 2.
Resveratrol
See Table 2.
Scarlet pimpernel
See Table 2.
Soy
See Table 2.
Star anise
See Table 2.
Vitamin C 1,000 mg (Jamieson)a
Vitamin C
Vitamin C 1,000 mg Time Release (Jamieson)a
Other names: ascorbate, ascorbic acid, antiscorbutic vitamin, calcium ascor-
Vitamin C 500 mg Time Release Capsules (Jamieson)a
bate, cevitamic acid, sodium ascorbate
Vitamin C Crystals (Puritan's Pride)a
Vitamin C (Nutraceutical Sciences Institute)a
Vitamin C 200 mg (The Vitamin Shoppe)b
Vitamin C (Leiner Health Products)b
Vitamin C 1,000 mg (Olympian Labs)b
1,324 brand names found
(Continued on next page)
a
This herb or natural product is the only ingredient in this brand.
b
This brand name is an example of a product in which the 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 (i.e.,
mad cow disease).
ONCOLOGY NURSING FORUM ­ VOL 31, NO 5, 2004
E102
Table 1. Herbs and Natural Products With Potential to Increase Cancer Growth, Interfere With Cancer Treatments, or Increase
Cancer Recurrence for Patients Who Have or Have Had Cancer: Common and Brand Names (Continued)
Herb or Natural Product
Brand Name and Manufacturer or Other
Vitamin E (Drugstore.com)a
Vitamin E
Vitamin E 1,000 IU Basic Nutrition (GNC)a
Other names: all rac-alpha-tocopherol, d-alpha-tocopherol, d-alpha-tocopheryl
Vitamin E (Nature's Way)a
acetate, d-alpha-tocopheryl succinate, dl-alpha-tocopherol, di-alpha-tocopheryl,
Vitamin E 1,000 IU, GNC A-Z (GNC)a
di-alpha-tocopheryl acetate, d-tocopherol, di-tocopherol, d-beta-tocopherol, d-
Vitamin E (Health Smart Vitamins)a
delta-tocopherol, d-gamma-tocopherol, mixed tocopheryl succinate,
Vitamin E 400 IU (Jamieson)a
tocotrienol, tocotrienol concentrate from vitamin E
Vitamin E 800 IU (Leiner Health Products)a
Vitamin E Oil 28,000 IU (Jamieson)a
Vita E Complex (Shaklee)b
Vita E (Shaklee)b
These products contain only vitamin E in soy oil. See text for soy.
Vitamin E 100 IU (Jamieson)a
Vitamin E 200 IU (Jamieson)a
Vitamin E (Olympian Labs)a
1,034 brand names found
Wild yam
See Table 2.
a
This herb or natural product is the only ingredient in this brand.
b
This brand name is an example of a product in which the 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 (i.e.,
mad cow disease).
has carcinogenic tendencies. A typical dose is 0.5­1 g of dried
Androstenedione has a scientific name of 4-androstene-3,
anise fruit or 50­200 ml of anise oil (Newall et al.). In consid-
17-dione. This product has been used to enhance athletic per-
eration of the adverse effects, consumers might be wise to
formance by increasing endogenous testosterone. It also has
revise and lower this dosage or avoid this herb completely.
been known to increase energy and keep red blood cells
See Table 3 for herbs and natural products with toxic or nega-
healthy (Natural Medicines Comprehensive Database, 2003).
tive side effects.
Androstenedione normally is produced by the adrenal glands,
Black tea has a scientific name of Camillia sinensis, which
testes, and ovaries (Leder et al., 2000) and consistently in-
is synonymous with Camellia thea. Black tea is used in self-
creases estrogen levels (Broeder et al., 2000; Brown et al.,
medication for many ailments. Of particular interest is black
2000; King et al., 1999; Leder et al.; Rasmussen, Volpi, Gore,
tea's use in reducing the risk of gastrointestinal, ovarian, or
& Wolfe, 2000). Women with hormone-sensitive cancers
breast cancer. This herb has estrogenic properties; therefore,
should avoid this product (Brown et al.). Adverse effects of
women with hormone-sensitive cancers should avoid high
this hormone are different for men and women. In men, it
doses (Hegarty, May, & Khaw, 2000). Second only to water,
decreases spermatogenesis, acne, and testicular atrophy and
tea is the most common beverage in the world (Schulz, Han-
increases the risk of pancreatic and prostate cancers (King et
sel, & Tyler, 1998). Black tea, the most ingested tea, under-
al.; van Weerden et al., 1992). In women, androstenedione can
goes a fermentation process that causes enzymic changes.
cause masculinization, acne, menorrhea, male pattern bald-
Green tea, which comes from the same plant, is prepared di-
ness, and coarseness of skin. Androstenedione also may
rectly after harvest, limiting its enzymic changes. Therefore,
worsen depression (Weber, Lewicka, Deuschle, Colla, &
the chemical constituents in black and green tea are different.
Heuser, 2000). According to Broeder et al., Brown et al., King
Tyler (1993) indicated that one 6 oz cup of black tea contains
et al., and Leder et al., weight trainers using doses of 50­150
approximately 10­50 mg of caffeine and suggested no more
mg did not improve their muscle strength or size.
than four or five cups per day. Some research has reported that
Anise, scientific name Pimpinella anisum, is used in self-
caffeine (in tea and other beverages) is associated with fibro-
medication as an antiflatulent and expectorant (Facts and
cystic breast disease, but this evidence is controversial (Mc-
Comparisons, 2001). Women with hormone-sensitive cancers
should avoid using anise because of its estrogenic properties
Kevoy, 1998; Micromedex Inc., 2002).
Boron, with the same scientific name, is used in self-medi-
(Leung & Foster, 1996; Newall et al., 1996). Newall et al.
cation to enhance healthy bones and treat osteoarthritis
indicated that excessive doses of anise can interfere with an-
ticoagulants, monoamine oxidase inhibitors, and estrogen.
(Newnham, 1994). Boron is used to build muscle and increase
testosterone levels (Green & Ferrando, 1994). Women with
This herb is associated with allergic reactions of the skin and
hormone-sensitive cancers and conditions should avoid
the respiratory and gastrointestinal tracts. Anise has been re-
supplemental boron or excessive use of foods known to con-
lated to photosensitivity and other adverse reactions, includ-
tain this trace element (Shils, Olson, & Shilke, 1994). Cow's
ing nausea, vomiting, seizures, and pulmonary edema with
milk and all food of plant origin contain this element in trace
ingestion of 1­5 ml of anise oil (Newall et al.). Facts and
amounts (Health and Welfare Canada, 1990). Large doses of
Comparisons reported that bergapten, a component of anise,
ONCOLOGY NURSING FORUM ­ VOL 31, NO 5, 2004
E103
Table 2. Herbs, Natural Products, and Components of Products That Enhance Growth of Hormone-Sensitive Cancers, Such
as Breast, Uterine, or Ovarian Cancers: Common and Brand Names
Herb or Natural Product
Brand Name and Manufacturer or Other
Menopause (Nutrivention)c
Aletris
1 brand name found
Other names: ague grass, ague root, aloerot, blazing star, colic root, crow corn,
devil's-bit, stargrass, starwort, unicorn root, whitetube stargrass
Alfalfa (Puritan's Pride)c
Alfalfa
Alfalfa Complex (Shaklee)c
Other names: feuille de luzerne, Lucerne, Medicago, phytoestrogen, purple
50+ (Futurebiotics)c
medick
Alfalfa Quest (PanGeo Health Brands, Inc.)c
194 brand names found
Androstenedionea
Andro-Stack 850 (Optimum Nutrition)c
Androstenedione With Yohimbe (Puritan's Pride)c
Other names: andro, androstene
Anotesten (Muscletech)c
19-Nor-3-Andro (AST Sports Science)c
Pinnacle Androstat 100 (Bodyonics, Ltd.)c
25 brand names found
Bitter Virtue (Blessed Herbs)c
Anise
Enzymes (Nutrivention)c, d
Other names: aniseed, anisi fructus, phytoestrogen, semen anisi, sweet cumin
Menopause Nutritional System 2 (Schiff)c
Mother's Milk (Traditional Medicinals)c
35 brand names found
Black tea
EB5 Body Formula (Pharmacist Heldfond's eb5 Formulas for Younger Looking
Skin)c
Other names: Chinese tea, tea
Guarana Chai (Traditional Medicinals)c
Red Wine Formula (Health Smart Vitamins)c
Thermojetics Herbal Concentrate (Herbalife)c
Note. Some of the above are in capsule form, and others are in tea packages
for brewing.
10 brands for medicinal use found
Centrum (Wyeth)c (has 150 mcg of potassium borate in comparison to most
Boron
other products with 3 mcg or 3 mg of boron)
#120 CAL Calcium Plus (Systemic Formulas)c
30 Day Beauty Secret (Futurebiotics)c
Breast Health Formula (Great American Nutrition)c
XTEND-LIFE Total Balance (Xtend-Life Nutraceuticals Inc.)c, d
246 brand names found
Vitex (Puritan's Pride)b
Chasteberry
Vitex Chaste Berry (Jamieson)b
Other names: Agnolyt, agnus castus, agnus-castus, chaste berry, chaste tree,
Chaste Tree MediHerb (Standard Process, Inc.)c
chaste tree berry, castetree, gattilier, hemp tree, monk's pepper, vitex, vitex
Femfocus Herbal Female Complex (Solgar)c
agnus castus
Chaste Tree Siberian Ginseng Virtue (Blessed Herbs)c
Zotin (AlphaGen Biotech)c
71 brand names found
Cohosh
Amazon Menopause Support (Raintree Nutrition, Inc.)c
· Black cohosh
Black Cohosh (Jamieson)b
Other names: baneberry, black snakeroot, bugbane, bugwort, Cimicifuga,
Black Cohosh (Leiner Health Products)c
phytoestrogen, rattle root, rattle snakeroot, rattlesnake root, rattleweed,
Black Cohosh (Nature's Way)c
squawroot (Blue and black cohosh are not the same.)
Concentrated Black Cohosh, GNC Herbal Plus (GNC)c
Daily Balance Hot Flash (Doctor's Preferred, Inc.)c
Hot Flashex (Natrol)c
140 brand names found
(Continued on next page)
a
Androstenedione is a product banned by the International Olympics Committee, National Collegiate Athletic Association, National Basketball Association, National
Football League, and World Natural Body Building Federation ("NBA Bans Androstenedione," 2000; Pheatt, 1999).
b
This herb or natural product is the only ingredient in this brand.
c
This brand name is an example of a product in which the herb or natural product is included along with other herbs and products. Monitor for all possible side
effects of all ingredients in these products.
d
Safety of this product is a concern. The product contains animal material, possibly diseased animals that may harbor bovine spongiform encephalopathy (i.e.,
mad cow disease).
ONCOLOGY NURSING FORUM ­ VOL 31, NO 5, 2004
E104
Table 2. Herbs, Natural Products, and Components of Products That Enhance Growth of Hormone-Sensitive Cancers, Such
as Breast, Uterine, or Ovarian Cancers: Common and Brand Names (Continued)
Herb or Natural Product
Brand Names and Manufacturer or Other
Alertis Compound (The Herbalist)c
· Blue cohosh
Black Cohosh-Blue Cohosh Virtue (Blessed Herbs)c
Other names: blue ginseng, Caulophyllum, papoose root, squaw root, yel-
Monthly Comfort (Source Naturals)c
low ginseng
Natural Quit (JBS Natural Products)c
15 brand names found
Brave Hart Deer Velvet Capsules (Hart Products)b
Deer velvet
Male Power (Futurebiotics)c, d
Other names: Cornu cervi parvum, deer antler, deer antler velvet, horns of gold,
Male Drive (Dial Herbs)c
lu rong, nokyong, rokujo, velvet antler, velvet of young deer horn
Super Nutrition Power (Mascot Enterprise)  c, d
4 brand names found
7-Keto (Enzymatic Therapy/PhytoPharmica)b
DHEA
DHEA 50 mg (Olympian Labs)b
Other names: dehydroepiandrosterone, GL 701, prasterone
DHEA (Leiner Health Products)c
DHEA Ultra (Free Life International)c
Andro-Xtreme (New Hope Health Products)c
39 brand names found
Dong Quai (Olympian Labs)b
Dong quai
Dong Quai Extract (Montana Naturals, Inc.)b
Dong Quai Extract in Vegetable Glycerin (Nature's Herbs)b
Dong Quai Fingerprint Botanicals (GNC)b
Dong Quai Root, GNC Herbal Plus (GNC)b
Dong Quai (Leiner Health Products)c
Dong Quai (Nature's Way)c
Hot Mommies Essential 3 (Changes International, Inc.)c
136 brand names found
Bone Builder (Schiff)c
Fennel
Catnip and Fennel (Dial Herbs)c
Other names: bitter fennel, carosella, common fennel, finnochio, Florence fen-
Detox Formula (Gary Nulls)c
nel, garden fennel, large fennel, phytoestrogen, sweet fennel, wild fennel
GBLVR (Nutri-Quest)c
Female Sage (Traditional Medicinals)c
Fennel-Yam (Atrium Inc.)c
104 brand names found
Female Advantage (Body Wise International, Inc.)c
Flaxseed
Golden Flax Meal (Nature's Life)c
Other names: fax seed, graine de lin, leinsamen, lini semen, linseed, lint bells,
Male Advantage (Body Wise International, Inc.)c
linum, phytoestrogen, winterlien
Complete Cleanse (PhysioLogics)c
59 brand names found
Ginseng
American Ginseng (Nature's Way)c
· American ginseng
American Ginzing (Traditional Medicinals)c
Other names: Anchi ginseng, Canadian ginseng, ginseng, North American
Canadian Ginseng (Jamieson)c
ginseng, Ontario ginseng, red berry, ren shen, sang, tienchi ginseng, Wis-
PMS Forte (Futurebiotics)c
consin ginseng
2nd Wind (Sports Nutrition Source, Inc.)c
132 brand names found
Ginseng Extract (The Vitamin Shoppe)b
· Panax ginseng
Ginseng-Go! (Wakunaga of America Co., Ltd.)b
Other names: Asian ginseng, Asiatic ginseng, Chinese ginseng, ginseng, gin-
Ginseng (Source Naturals)b
seng Asiatique, ginseng radix, ginseng root, Japanese ginseng, Jintsam, Ko-
Ginsana (PanGeo Health Brands, Inc.)c
rean ginseng, Korean panax, ginseng Korean red, Korean red ginseng, ninjin,
Ginseng Complex (Puritan's Pride)c
Oriental ginseng, red ginseng, ren shen, sang, seng
Ginseng Energy (Celestial Seasonings)c
(Continued on next page)
a
Androstenedione is a product banned by the International Olympics Committee, National Collegiate Athletic Association, National Basketball Association, National
Football League, and World Natural Body Building Federation ("NBA Bans Androstenedione," 2000; Pheatt, 1999).
b
This herb or natural product is the only ingredient in this brand.
c
This brand name is an example of a product in which the herb or natural product is included along with other herbs and products. Monitor for all possible side
effects of all ingredients in these products.
d
Safety of this product is a concern. The product contains animal material, possibly diseased animals that may harbor bovine spongiform encephalopathy (i.e.,
mad cow disease).
ONCOLOGY NURSING FORUM ­ VOL 31, NO 5, 2004
E105
Table 2. Herbs, Natural Products, and Components of Products That Enhance Growth of Hormone-Sensitive Cancers, Such
as Breast, Uterine, or Ovarian Cancers: Common and Brand Names (Continued)
Herb or Natural Product
Brand Names and Manufacturer or Other
Ginseng (Leiner Health Products)c
· Panax ginseng continued
Ginseng Phytosome (PhytoPharmica)c
Red Dragon Imperial Ginseng (Jamieson)c
2nd Wind (Resource Wellness)c
Vigor-Max (Shenlong Natural International, Inc.)c (A drug similar to sildenafil
citrate has been found in this product. Health Canada [2002] advised the pub-
lic not to use this product.)
282 brand names found
Siberian Ginseng (Gaia Herbs)b
· Siberian ginseng
Siberian Ginseng (Olympian Labs)b
Other names: ci wu jia, ciwujia, devil's bush, devil's shrub, eleuthera,
Siberian Ginseng Quest (PanGeo Health Brands, Inc.)b
eleuthero, Eleuthero ginseng, Eleutherococ, Eleutherococc, Eleutherococci
Siberian Ginseng Extract (PhytoPharmica)b
radix, Eleutherococcus, ginseng, phytoestrogen, prickly Eleutherococc, Rus-
Aqueous Liver Extract With Siberian Ginseng (PhytoPharmica)c, d
sian root, Shigoka, thorny bearer of free berries, touch-me-not, untouchable,
Ginseng Complex (Puritan's Pride)c
Ussuri, Ussurian thorny pepperbush, wild pepper, wu jia pi, wu-jia
Ginseng (Leiner Health Products)c
Ginseng Energy (Celestial Seasonings)c
Olympian Energy (Olympian Labs)c
Panax Ginseng (Pharmanex)c
Siberian Ginseng (Nature's Way)c
Siberian Ginseng (Pharmanex)c
355 brand names found
Licorice (Nature's Way)b
Licorice
7 Day Smoke Away Lung Saver (The Quit Smoking Co.)c (homeopathic product)
Other names: alcacus, alcazuz, Chinese licorice, gan cao, gan zao, clycyrrhiza,
#14 COLON (Systemic Formulas)c
isoflavones, lakritze, licorice root, liquiritiae radix, liquirizia, liquorice, orozuz,
Flash Fighters (Puritan's Pride)c
phytoestrogen, reglisse, regliz, Russian licorice, Spanish licorice, subholz,
GastroSoothe (Enzymatic Therapy)c
sweet root
Licorice Garlic (Atrium Inc.)c
Respiratory Support Formula (PhysioLogics)c
Women's PM Multi (Clinician's Choice)c
Women's Guardian (Clinician's Choice)c
342 brand names found
Milk Thistle (BioDynamax)b
Milk thistle
Milk Thistle (Jamieson)b
Other names: Cardui mariae fructus, Cardui mariae herba, holy thistle, lady's
Milk Thistle Extract (Nutraceutical Sciences Institute)b
thistle, Legalon, Marian thistle, Mariendistel, Mary thistle, milk thistle above
Milk Thistle Seed (Gaia Herbs)b
ground parts, milk thistle fruit, milk thistle seed, our lady's thistle, St. Mary
Milk Thistle Basic Nutrition (GNC)c
thistle, silybin, Silybum, silymarin (This is not the same as blessed thistle.)
Milk Thistle (Pharmanex)c
Milk Thistle (Leiner Health Products)c
XTEND-LIFE Total Balance (Xtend-Life Nutraceuticals Inc.)c, d
134 brand names found
Pregnenolone (Metabolic Response Modifiers)b
Pregnenolone
Pregnenolone-15 (PhytoPharmica)b
No other names except above. Pregnenolone is the precursor for all steroid
ArthritiCare (Aarisse Health Care)c
hormones in the body, including estrogen and progesterone. Pregnenolone is
Brain Lightning (Novus Research)c
produced in the body from cholesterol.
Intimate Response (Source Naturals)c
Youth-Assure (Nature's Plus)c, d
12 brand names found
Emerita (Transitions for Health, Inc.)c
Progesterone
Her Stuff (Blue Stuff, Inc.)c
Other names: corpus luteum hormone, luteal hormone, luteohormone, lutine,
Testatropinol (Advanced Sports Nutrition)c (homeopathic product)
N SC-9704, pregnancy hormone, pregnanedione, progestational hormone,
Progensa (Life-Flo)c
progesteronum
14 brand names found
(Continued on next page)
a
Androstenedione is a product banned by the International Olympics Committee, National Collegiate Athletic Association, National Basketball Association, National
Football League, and World Natural Body Building Federation ("NBA Bans Androstenedione," 2000; Pheatt, 1999).
b
This herb or natural product is the only ingredient in this brand.
c
This brand name is an example of a product in which the herb or natural product is included along with other herbs and products. Monitor for all possible side
effects of all ingredients in these products.
d
Safety of this product is a concern. The product contains animal material, possibly diseased animals that may harbor bovine spongiform encephalopathy (i.e.,
mad cow disease).
ONCOLOGY NURSING FORUM ­ VOL 31, NO 5, 2004
E106
Table 2. Herbs, Natural Products, and Components of Products That Enhance Growth of Hormone-Sensitive Cancers, Such
as Breast, Uterine, or Ovarian Cancers: Common and Brand Names (Continued)
Brand Names and Manufacturer or Other
Herb or Natural Product
Fem-Mend Formula (Nature's Way)c
Raspberry leaf
Menopause Formula (Natrol)c
Other names: red raspberry, Rubi idaei folium, rubus
Purist Cleanse (Abbott Industries)c
Raspberry (Natrol)c
Raspberry Drinkable Yogurt (Stonyfield Farm)c
T-DREA (Dial Herbs)c
74 brand names found
Red Clover (Nature's Way)b
Red clover
Red Clover Extract (Source Naturals)c
Other names: beebread, cow clover, daidzein, genistein, isoflavones, meadow
Red Clover Combination (Nature's Way)c
clover, phytoestrogen, purple clover, trefoil, trifolium, wild clover
Chaparral and Red Clover (Dial Herbs)c
FEMFOCUS Red Clover (Solgar)c
#481 OXAA Cell Organizer (Systemic Formulas)c
Hoxsey Formula (The Herbalist)c
113 brand names found
Resveratrol is found in red wine, red grape skins, purple grape juice, mulber-
Resveratrol
ries, and small amounts in peanuts.
Other names: cis-resveratrol, kojo-kon, phytoestrogen, trans-resveratrol
Actilife Super Antioxidant (Crystal Springs)c
Red Wine Formula (Health Smart Vitamins)c
Protykin/Resveratrol (Natrol)c
8 brand names found
Scarlet pimpernel
No brand names found. Therefore, expect that patients using this herb will be
Other names: adder's eyes, phytoestrogen, poor man's weatherglass, red chick-
identifying it in the wild and using the dried plant to prepare tea.
weed, red pimpernel, shepherd's barometer
Soy Extract (PhytoPharmica)b
Soy
Cayenne (Now)c
Other names: daidzein, edamame, frijol de soya, genistein, haba soy, hydro-
Soy Essentials (Health From the Sun)c
lyzed soy protein, isoflavone, isoflavones, legume, miso, natto, phytoestrogen,
Soy Preventive (GNC)c
plant estrogen, shoyu, soja, sojabohne, soy fiber, soy milk, soy protein, soy
protein extract, soy-protein, soya, soybean, soybean curd, tempeh, texturized
362 brand names found
vegetable protein, tofu
Everyday Detox (Traditional Medicinals)c
Star anise
Weightless Cinnamon-Spice (Traditional Medicinals)c
Other names: aniseed stars, Anisi stellati fructus, badiana, Chinese anise, Chi-
nese star anise, eight-horned anise, eight horns, illicium
2 brand names found
Wild Yam Root (Nature's Bounty)c
Wild yam
Wild Yam (Alvin Last)c
Other names: Atlantic yam, barbasco, China root, devil's bones, Mexican yam,
Wild Yam Extract (PhytoPharmica)c
natural DHEA, phytoestrogen, rheumatism root, wild Mexican yam, yuma
Female Balance (Olympia Nutrition)c
Menopause (Nutrivention)c
102 brand names found
a
Androstenedione is a product banned by the International Olympics Committee, National Collegiate Athletic Association, National Basketball Association, National
Football League, and World Natural Body Building Federation ("NBA Bans Androstenedione," 2000; Pheatt, 1999).
b
This herb or natural product is the only ingredient in this brand.
c
This brand name is an example of a product in which the herb or natural product is included along with other herbs and products. Monitor for all possible side
effects of all ingredients in these products.
d
Safety of this product is a concern. The product contains animal material, possibly diseased animals that may harbor bovine spongiform encephalopathy (i.e.,
mad cow disease).
boron can cause poisoning, with nausea, vomiting, diarrhea,
Chasteberry has a scientific name of Vitex agnus-castus.
epigastric pain, hematemesis, discolored feces, and blue- to
Chasteberry is used to self-medicate for symptoms associated
green-colored vomit (Ellenhorn & Barceloux, 1997). A diet
with menstrual and menopausal conditions. Consumers also use
high in boron consists of 3.25 mg of boron per 2,000 kcal per
chasteberry for acne, female infertility, fibrocystic breasts, and
miscarriage prevention. Daily doses of 120 mg of chasteberry
day, whereas a diet low in boron consists of 0.25 mg of boron
per 2,000 kcal per day (Penland, 1994). A safe dietary limit is
can diminish the release of follicle-stimulating hormone and
10 mg per day (Shils et al.). Individuals who eat a regular
increase luteinizing hormone, which, in turn, decreases the
body's estrogen levels and increases progesterone and prolac-
North American diet (Office of Nutrition Policy and Promo-
tion, 2004; U.S. Department of Agriculture, 1995) should not
tin levels (Brown, 1994; Merz et al., 1996; Mills & Bone, 2000;
be concerned about boron.
Newall et al., 1996). Women with hormone-sensitive cancers
ONCOLOGY NURSING FORUM ­ VOL 31, NO 5, 2004
E107
Table 3. Herbs or Natural Products That Have Toxic or
Permanetter et al., 1992; Portakal et al.). Clinical studies have
Negative Side Effects Along With Properties to Enhance the
demonstrated no other significant adverse reactions (Lang-
Growth of Cancer
sjoen, Langsjoen, & Folkers, 1990). Micromedex Inc. (2002)
indicated that 50 mg per day has been used for treating car-
Herb or Natural Product
Major Adverse Reaction or Toxicity
diotoxicity related to doxorubicin chemotherapy treatment.
Cohosh comes in two colors, black and blue. Black cohosh
Anise
Nausea, vomiting, seizures, and pulmonary
has a scientific name of Cimicifuga racemosa, and blue co-
edema can be caused by ingestion of 1­5 ml of
hosh has a scientific name of Caulophyllum thalictroides.
anise in oil.
Both are used as natural hormone replacement therapy. Tyler
Blue cohosh
Poisoning has resulted from ingestion of leaves
(1993) noted the self-medication of these herbs for inducing
and seeds.
menstruation, for stimulating the uterus, and as a laxative.
Boron
Acute poisoning can result from ingestion of
Black cohosh is used to manage menopause symptoms such
doses of more than 10 mg per day.
Adverse effects include acne, hair loss, hirsutism,
DHEA
as hot flashes. Although laboratory tests have shown that
voice deepening, insulin resistance, changes in
black cohosh does not stimulate proliferation of estrogen re-
menstrual pattern, hepatic dysfunction, ab-
ceptor-positive breast cancer cells (Foster, 1999; Gruenwald,
dominal pain, and hypertension.
1998; Liske, 1998), large-scale epidemiologic studies have not
Flaxseed
When doses greater than 45 g per day are com-
been performed on humans (Natural Medicines Comprehen-
bined with inadequate fluid intake, intestinal
sive Database, 2003). Both blue and black cohosh have estro-
blockage is possible.
genic properties; therefore, Eagon et al. (2000) reported that
Hydrazine sulfate
Regular use can cause irregular breathing, con-
women with hormone-sensitive cancers should avoid these
fusion, hypoglycemia, hyperglycemia, lethargy,
herbs. In addition, black cohosh may interfere with tamoxifen
violent behavior, restlessness, seizures, coma,
(Natural Medicines Comprehensive Database).
renal toxicity, and hepatotoxicity.
Licorice
Chronic consumption can cause a variety of
Common adverse effects of black cohosh are gastrointesti-
symptoms, including lethargy, headache,
nal disturbances (Liske, 1998; Pepping, 1999), headache
edema, congestive heart failure, lower extrem-
(Eagon et al., 2000), heaviness in the legs, and weight gain
ity weakness, hypertensive encephalopathy,
(Gruenwald, 1998). High doses cause nausea, vomiting, diz-
and quadriplegia.
ziness, nervous system and visual disturbances, perspiration,
Panax ginseng
Adverse effects include insomnia, mastalgia,
and reduced heart rate (Newall et al., 1996). Most studies re-
vaginal bleeding, tachycardia, and mania.
ported using a dose of 40­80 mg twice daily, which is much
Pregnenolone
Overuse side effects are insomnia, irritability,
lower than the 300­2,000 mg that manufacturers recommend
anger, anxiety, acne, headache, negative mood
(Natural Medicines Comprehensive Database, 2003).
changes, facial hair growth, and hair loss.
Blue cohosh can irritate gastrointestinal conditions (Newall
This herb interacts with anticoagulant drugs and
Red clover
herbs, leading to a risk of hemorrhage.
et al., 1996). Although the typical dose of a dried rhizome or
Regular and high doses of vitamin C are associ-
Vitamin C
root is 0.3­1 g or tea taken three times daily, self-medication
ated with deep vein thrombosis.
with this herb is considered unsafe because of potential poison-
This vitamin interacts with anticoagulant and
Vitamin E
ing from leaves and seeds (Newall et al.; Tyler, 1993).
antiplatelet drugs and herbs, resulting in a risk
Deer velvet has scientific names of Cervus nippon and
of hemorrhage.
Cervus elaphus. Individuals use deer velvet for what they be-
lieve are its anticancer and anti-inflammatory properties (Natu-
ral Medicines Comprehensive Database, 2003). Women with
should avoid chasteberry because of its effects on estrogen lev-
hormone-sensitive cancers should avoid deer velvet because
els (Eagon, Elm, & Hunter, 2000). Side effects for this herb are
of its estrogenic properties (Huang, 1999). Reliable informa-
relatively rare, but minor changes in menstrual flow can result
tion is insufficient about the safety, effectiveness, or adverse
from chasteberry ingestion (McCaleb, Leigh, & Morien, 2000;
reactions of deer velvet. A typical dose of powdered deer vel-
Newall et al.). Typically, crude herb extracts are taken in doses
vet is 400­600 mg (Natural Medicines Comprehensive Data-
of 20­240 mg per day (Mills & Bone).
base).
Coenzyme Q-10 has scientific names of ubiquinone,
DHEA has a scientific name of dehydroepiandrosterone.
ubidecarenone, and mitoquinone. Patients with cancer use
People use DHEA believing it will prevent heart disease, breast
coenzyme Q-10 to prevent cardiotoxicity related to doxorubi-
cancer, and diabetes (Kuritzky, 1998; Skolnick, 1996). DHEA
cin chemotherapy, and some patients with breast cancer also
is involved in the metabolism of androstenedione, the major
self-prescribe this product. The human body produces coen-
human precursor to androgens and estrogens (Oelkers, 1999;
zyme Q-10 naturally, but preliminary evidence has shown that
van Vollenhoven, 2000); therefore, women with hormone-sen-
concentrations of this enzyme are lower in cancerous breast
sitive cancers should avoid this product. DHEA is produced
tissue than in healthy tissue, leading researchers to speculate
from wild yam extract. Although the medicinal component of
that very low levels may indicate poor prognosis (Jolliet et al.,
wild yam is converted to DHEA in laboratories, when wild yam
1998; Portakal et al., 2000). Researchers are concerned that
extract is ingested, the body cannot accomplish this conversion.
ingesting antioxidants such as coenzyme Q-10 may interfere
Therefore, ingestion of wild yam is not the same as ingestion of
with chemotherapeutic agents, but this effect has not been
DHEA (Skolnick). Products labeled "natural DHEA" are, in
verified. Researchers have speculated that coenzyme Q-10,
fact, wild yam and do not contain DHEA (Natural Medicines
when used concomitantly with alkylating agents such as cy-
Comprehensive Database, 2003). Adverse effects of DHEA
clophosphamide, protects cancer cells from the chemotherapy
include acne, hair loss, hirsutism, voice deepening, insulin re-
agent (Lund, Quistorff, Spang-Thomsen, & Kristjansen, 1998;
sistance, changes in menstrual pattern, hepatic dysfunction,
ONCOLOGY NURSING FORUM ­ VOL 31, NO 5, 2004
E108
senticosus). All three ginseng species are used as self-medi-
abdominal pain, and hypertension ("Dehydroepiandrosterone
cation for conditions such as atherosclerosis, blood and bleed-
[DHEA]," 1996; Kroboth, Salek, Pittenger, Fabian, & Frye,
ing disorders, cancer, colitis, rheumatism, and memory loss
1999; Kuritzky). A typical dose ranges from 20­200 mg (Natu-
(Leung & Foster, 1996; Newall et al., 1996; Robbers, Speedie,
ral Medicines Comprehensive Database).
& Tyler, 1996). Patients on chemotherapy may take Siberian
Dong quai has the scientific name of Angelica sinensis,
ginseng to reduce what they perceive is the toxicity of treat-
which is synonymous with Angelica polymorpha sinensis.
ment.
People self-medicate with dong quai for gynecologic symp-
Differences and similarities exist among the three types of
toms of menstrual or menopausal disorders. Some believe
ginseng. In studies of female rats whose ovaries were re-
dong quai is a blood purifier (Natural Medicines Comprehen-
moved, Siberian ginseng increased serum ceruloplasmin oxi-
sive Database, 2003). The estrogenic effect of dong quai in-
dase activity (i.e., a measurement of estrogenic activity in the
dicates that women with hormone-sensitive cancers should
liver). Duda et al. (1999) found that extracts from American
avoid this herb (Eagon et al., 2000). This herb is potentially
ginseng may reduce breast cancer growth and may be useful
carcinogenic and mutagenic (Facts and Comparisons, 2001).
when taken with some anticancer drugs. Conversely, Ameri-
It also can cause photosensitivity and photodermatitis. Suppli-
can, Panax, and Siberian ginseng all have estrogenic effects;
ers have suggested three daily doses of 520 mg for individu-
therefore, women with hormone-sensitive cancers should
als weighing less than 100 pounds, 1,040 mg for patients rang-
avoid these herbs (Eagon et al., 2000).
ing from 100­175 pounds, and 1,560 mg for patients weighing
American ginseng can lower blood sugar, thereby interfer-
more than 175 pounds (Natural Medicines Comprehensive Da-
ing with antidiabetic drugs (Vuksan, Sievenpiper, et al., 2000;
tabase). These are neither recommended nor known safe doses.
Vuksan, Stavro, et al., 2000). For patients on warfarin therapy,
Fennel has a scientific name of Foeniculum vulgare, which
American, Panax, and Siberian ginseng can potentiate the an-
is synonymous with Foeniculum officinale. Fennel is used in
ticoagulant effects (Brinker, 1998; Cheng, 2000; Janetzky &
self-medication for initiating menstruation (Facts and Com-
Morreale, 1997; Newall et al., 1996; Sotaniemi, Haapakoski,
parisons, 2001) and managing respiratory and gastrointestinal
& Rautio, 1995). Concomitant use of the ginsengs with other
problems (Blumenthal et al., 1998). Estrogenic effects of this
herbs with anticoagulant-antiplatelet properties (e.g., angelica,
herb may interfere with hormone-sensitive cancers (Leung &
anise, chamomile, cloves, feverfew, garlic, ginkgo, licorice,
Foster, 1996). Although a fennel constituent, estrogole, is a
red clover, willow) should be avoided (Brinker; Newall et al.).
procarcinogen, the risk of its inducing cancer is minimal.
Adverse effects of Panax ginseng include insomnia (Hopkins,
Estrogole requires activation by the liver enzymes to reach
Androff, & Benninghoff, 1988), mastalgia (Palmer, Mont-
toxicity, and liver enzymes are capable of inactivating carci-
gomery, & Monteiro, 1978), vaginal bleeding (Greenspan,
nogenic metabolites, thus protecting the liver (McGuffin et al.,
1983; Hopkins et al.), tachycardia (Schulz et al., 1998), and
1997). Individuals using fennel should avoid excessive sun-
mania (Natural Medicines Comprehensive Database, 2003).
light or ultraviolet light exposure because of its photoder-
Apart from anticoagulant-antiplatelet properties, adverse ef-
matitis potential (Brinker, 1998). Cross-sensitivity is possible
fects for American and Siberian ginsengs are rare (Natural
for people who are allergic to other Apiaceae family plants
Medicines Comprehensive Database).
such as carrot, celery, or mugwort (Gruenwald et al., 1998).
According to the Natural Medicines Comprehensive Data-
A typical dose is 5­7 g of dried fruit or seed or one cup of tea
base (2003), a safe dose of American ginseng is 0.25­0.5 g for
three times daily (Blumenthal et al., 1998; Gruenwald et al.).
young, healthy adults or 0.4­0.8 g for older adults and debili-
Flaxseed has a scientific name of Linum usitatissimum. In-
tated individuals. For Panax ginseng, the usual dose is 0.6­3
dividuals use flaxseed for numerous conditions, such as consti-
g of cut or powdered root taken one to three times daily. Tea
pation or bladder inflammations, but they also use it to protect
bags typically contain 1,500 mg of Panax ginseng root and are
against cancer (Haggans et al., 1999; Lampe, Martini, Kurzer,
consumed three to four times daily (Facts and Comparisons,
Adlercreutz, & Slavin, 1994). The antiestrogen effect, caused
2001; McGuffin et al., 1997). A typical dose for the dry root
by flaxseed lignans competing for estrogen receptors, may in-
of Siberian ginseng is 0.6­3 g daily for up to one month
hibit the growth of hormone-dependent cancer cells (Lampe et
(Newall et al., 1996).
al.). Furthermore, using flaxseed may protect postmenopausal
Glucosamine is another natural product that consumers use
women against breast cancer because it increases urinary excre-
in self-medication without considering that the name refers to
tion of estrogen metabolites (Haggans et al.). On the other hand,
three distinct products. These products are glucosamine hydro-
estrogenic effects of flaxseed contraindicate its use by women
chloride (scientific name: 2-amino-2-deoxyglucose hydrochlo-
who have hormone-sensitive cancers. Flaxseed may impair
ride), glucosamine sulfate (scientific name: 2-amino-2-
absorption of all oral drugs (Brinker, 1998). When inadequate
deoxyglucose sulfate), and N-acetyl glucosamine (scientific
fluids are consumed with flaxseed, intestinal blockage is pos-
name: 2-acetamido-2-deoxyglucose). All three products usually
sible (Gruenwald et al., 1998). This also may occur with doses
are self-prescribed for osteoarthritis and sometimes weight loss
greater than 45 g per day. A typical dose is one tablespoon of
(Natural Medicines Comprehensive Database, 2003). N-acetyl
whole or bruised seed with 6 oz of fluid, two to three times a
glucosamine also is used in self-medication for inflammatory
day (Blumenthal et al., 1998; McGuffin et al., 1997).
bowel disease (i.e., ulcerative colitis or Crohn's disease) (Natu-
Ginseng is the common name for three important species of
ral Medicines Comprehensive Database).
herbs, but many use it without recognition or concern about
Yun, Tomida, Nagata, and Tsuruo's (1995) findings indicate
the differences among the plants. The three species of ginseng
that glucosamine hydrochloride, glucosamine sulfate, and N-
are American ginseng (scientific name: Panax quinquefolius),
acetyl glucosamine induce resistance to etoposide and doxoru-
Panax ginseng (scientific name: Panax ginseng, synonymous
bicin by reducing inhibition of topoisomerase II (an enzyme
with Panax schinseng), and Siberian ginseng (scientific name:
needed for DNA replication in tumor cells). This induced
Eleutheroccus senticosus, synonymous with Acanthopanax
ONCOLOGY NURSING FORUM ­ VOL 31, NO 5, 2004
E109
(Goldin, 1998; Kalima, Masterton, Roddie, & Thomas, 1996;
resistance occurred in colon, human ovarian, and breast cancer
Saxelin et al., 1996; Tynkkynen, Singh, & Varmanen, 1998).
cells. Therefore, patients on chemotherapy agents should avoid
However, patients taking immunosuppressant drugs and some
all glucosamine products. Typical doses of glucosamine hydro-
chemotherapy agents, such as cyclophosphamide and cisplatin,
chloride in self-prescription are 1­2 g daily (Natural Medicines
should avoid this product (Goldin; Kalima et al.; Saxelin et al.).
Comprehensive Database, 2003). For glucosamine sulfate and
Typical oral doses range from 1­10 billion viable organisms
N-acetyl glucosamine, the typical dose is 1,500 mg (Drovanti,
daily (Fetrow & Avila, 1999). Yogurt is a natural product con-
Bignamini, & Rovati, 1980; Lopes Vaz, 1982).
taining lactobacillus. Eaten as a food and chosen as an alterna-
Hydrazine sulfate has no scientific name. Patients with can-
tive to cow's milk products (Pelto, Isolauri, Lilius, Nuutila, &
cer may use hydrazine sulfate to treat the general weight loss
Salminen, 1998), yogurt also is used to self-medicate for nu-
and wasting associated with cancer (Loprinzi, Goldberg, &
merous gastrointestinal disorders and to reduce colorectal can-
Burnham, 1992; Micromedex Inc., 2002). Hydrazine sulfate is
cer. Yogurt is one of the lactobacillus products with properties
an organic compound, a sulfate salt that inhibits phospho-
that interfere with immunosuppressive therapies and cancer
enolpyruvate kinase, an enzyme involved in gluconeogenesis.
chemotherapy, as tested by Goldin, Kalima et al., and Saxelin
Researchers believe that gluconeogenesis may be partially re-
et al. Typical doses for yogurt range from 125­450 ml daily
sponsible for cachexia (Loprinzi et al.). Chlebowski et al.
(Natural Medicines Comprehensive Database).
(1987) found that people with diverse cancers who were treated
The Natural Medicines Comprehensive Database (2003)
with varied chemotherapy regimens and prone to cachexia
warned that some lactobacillus products contain little or no
might gain weight when using hydrazine sulfate. However,
Lactobacillus acidophilus even though they are labeled with
hydrazine sulfate was associated with poorer quality of life for
this name. Products also may contain different strains of lac-
patients with non-small cell lung cancer, especially those being
tobacillus or be contaminated with other bacteria (Facts and
treated concomitantly with cisplatin or vinblastine (Kosty et al.,
Comparisons, 2001).
1994). Adverse effects recorded for hydrazine sulfate include
Licorice has a scientific name of Glycyrrhiza glabra. Pa-
nausea, vomiting, dizziness, drowsiness, peripheral neuropa-
tients self-medicate with licorice for upper respiratory tract
thies (Kaegi, 1998), weakness, irregular breathing, confusion,
and gastrointestinal conditions (Blumenthal et al., 1998). In
hypo- or hyperglycemia, lethargy, violent behavior, restless-
vitro, licorice extract enhances binding of estradiol to estro-
ness, seizures, coma, renal toxicity, and hepatotoxicity (Mic-
gen receptors. This, in turn, enhances the estradiol-induced
romedex Inc.). A typical dose for cachectic patients undergoing
transcription activity in estrogen-responsive cells. Then, ac-
chemotherapy for cancer is 60 mg three times daily for 30­45
cording to studies that have measured the liver of rats with
days, followed by a break of two to six weeks (Chlebowski et
ovaries removed, serum ceruloplasmin oxidase activity in-
al.; Kaegi).
creases (Natural Medicines Comprehensive Database, 2003).
Kefir has no scientific name but is found in fermented dairy
These estrogenic effects suggest that women with hormone-
products. The Natural Medicines Comprehensive Database
sensitive cancers should avoid this herb. Fifty grams per day
(2003) reported that self-medication with kefir is for improv-
or chronic use up to six weeks can cause pseudoaldosteronism
ing digestion, hyperlipidemia, and lactose intolerance. Kefir
with symptoms that include hypertension, lethargy, headache,
contains growing bacteria and yeast (De Vrese, Keller, &
and sodium and water retention. This can lead to other symp-
Barth, 1992; Murofushi, Mizuguchi, Aibara, & Matuhasi,
toms such as hypokalemia, heart failure, pulmonary edema,
1986; Rimada & Abraham, 2001; Shiomi, Sasaki, Murofushi,
and quadriplegia (Blumenthal et al., 1998; Facts and Compari-
& Aibara, 1982); therefore, patients receiving chemotherapy
sons, 2001; Foster & Tyler, 1999; Newall et al., 1996; Sigur-
such as cisplatin, fluorouracil, cyclophosphamide, and other
jonsdottir, Ragnarsson, Franzson, & Sigurdsson, 1995; Tyler,
agents that suppress the immune system should avoid kefir.
1994). Excessive and chronic use should be avoided because
Oral doses of 125­500 ml have been used daily for up to six
of its potential toxicity. One brand-named licorice is a homeo-
months (Agerbaek, Gerdes, & Richelsen, 1995; Richelsen,
pathic product. As mentioned in Part I of this series (Mont-
Kristensen, & Pedersen, 1996; Schaafsma, Meuling, van Dok-
briand, 2004), homeopathic products have been through many
kum, & Bouley, 1998).
dilutions with water or another liquid. Most homeopathic
Lactobacillus has numerous scientific names, including
products have little or no active ingredients and therefore no
Lactobacillus acidophilus, Lactobacillus brevis, Lactobacillus
pharmacologic effects, drug interactions, or toxic effects.
bulgaricus, Lactobacillus casei sp. rhamnosus, Lactobacillus
Milk thistle has a scientific name of Silybum marianum,
delbrueckii, Lactobacillus fermentum, Lactobacillus plantarum,
which is synonymous with Carduus marianum. Individuals self-
and Lactobacillus rhamnosus. Self-medication with lactobacil-
medicate with milk thistle for gastrointestinal and hepatic con-
lus is for diarrhea or digestive and irritable bowel conditions or
ditions in addition to prostate cancer and numerous other ail-
for preventing cancer and stimulating the immune system
ments (Natural Medicines Comprehensive Database, 2003).
(Natural Medicines Comprehensive Database, 2003). Lactoba-
Parts of milk thistle enhance estradiol binding to estrogen recep-
cillus, a group of lactic acid-producing bacteria found in the
tors. This activity enhances the estradiol-induced transcription
normal flora of human gastrointestinal and genitourinary tracts,
activity in estrogen-responsive cells. Therefore, milk thistle is
may protect against cancer. In animal models, lactobacillus has
another herb that women with hormone-sensitive cancers should
shown a tendency to bind dietary carcinogens (El-Nezami,
avoid (Eagon et al., 2000). Milk thistle has an antiproliferative
Kankaanpaa, Salminen, & Ahokas, 1998) and has decreased
effect on androgen-responsive prostate cancer cells (Zhu, Zhang,
colon tumor growth (Goldin, Gualtieri, & Moore, 1996; McIn-
& Young, 2001). Allergic reactions have been reported and in-
tosh, Royle, & Playne, 1999). Lactobacillus usually is well tol-
clude pruritus, rash, urticaria, eczema, and anaphylaxis (Natu-
erated when taken orally or inserted intravaginally (McKevoy,
ral Medicines Comprehensive Database). Individuals sensitive
1998). For healthy patients with intact immune systems, patho-
to other plants from the Asteraceae (Compositae) family (e.g.,
genic colonization of lactobacillus has not been reported
ONCOLOGY NURSING FORUM ­ VOL 31, NO 5, 2004
E110
al., 1996). Red clover can cause rash-like reactions. It also
ragweed, chrysanthemums, daisies) also may expect allergic
interacts with drugs or herbs with anticoagulant properties
reactions. Milk thistle is considered possibly safe by the Natu-
(Brinker, 1998; Newall et al.), including angelica, chamomile,
ral Medicines Comprehensive Database; however, reliable infor-
feverfew, garlic, ginkgo, and licorice. This herb is a compo-
mation is insufficient. Doses of up to 420 mg per day have been
nent of Jason Winters Tea, an alternative therapy for cancer.
used (Ferenci et al., 1989). Tea is made from milk thistle, but the
A typical dose is 4 g of flower tops three times daily or one
active ingredients are not water soluble (Foster & Tyler, 1999).
cup of tea three times daily (Newall et al.).
Pregnenolone has a scientific name of (3beta)-3-hydroxy-
Resveratrol has a scientific name of 3,4',5-stillbenetriol.
pregn-5-en-20-one. Self-medication with pregnenolone often is
Individuals self-prescribe resveratrol products for atheroscle-
intended to slow or reverse aging, for arthritis, for gynecologic
rosis, to lower cholesterol levels, or to prevent cancer. Al-
problems, or to increase energy (Natural Medicines Compre-
though evidence appears to exist that the resveratrol in red
hensive Database, 2003). Produced in the body from cholesterol,
wine, red grape skins, purple grape juice, and mulberries re-
pregnenolone is a precursor for all steroid hormones: progest-
duces the risk of cancer, caution is advised because testing in
erone, aldosterone, cortisol, dehydroepiandrosterone, testoster-
humans has not been conducted (Carbo, Costelli, Baccino,
one, and estrogens (Devlin, 1992). Its estrogenic properties in-
Lopez-Soriano, & Argiles, 1999; Jang et al., 1997; Soleas,
dicate that women with hormone-sensitive cancers should avoid
Diamandis, & Goldberg, 1997). White wines are low in trans-
this herb. In addition, this product can cause steroid-related ad-
resveratrol concentrations. In red wines, pinot noir is consis-
verse effects. Symptoms of overuse include insomnia, irritabil-
tently high in concentrations, regardless of climate. Cabernet
ity, anger, anxiety, acne, headache, negative mood changes,
sauvignon from colder climates (Bordeaux or Canada) has
facial hair growth, and hair loss (Natural Medicines Comprehen-
higher concentrations than wines from hot, dry climates
sive Database). No typical dosages for pregnenolone are avail-
(Natural Medicines Comprehensive Database, 2003). Women
able, and the Natural Medicines Comprehensive Database found
who already have hormone-sensitive cancers should avoid
little reliable information about this product.
large amounts of products with resveratrol because of its es-
Progesterone has a scientific name of 4-pregnene-3. Indi-
trogenic activity (Gehm, McAndrews, Chien, & Jameson,
viduals self-medicate with this product for gynecologic con-
1997). No adverse effects of resveratrol have been docu-
ditions. It also has an estrogenic effect; therefore, women with
mented. Other products such as grape seed extracts frequently
breast cancer are advised to avoid progesterone. This hormone
are combined with resveratrol. A safe dose of resveratrol is
also should be avoided unless it is part of the management of
200­ 600 mcg per day (Carbo et al.). One glass of red wine has
breast cancer (Martindale, 1999). Some adverse reactions are
about 640 mcg of resveratrol, and a handful of peanuts con-
weight gain, fatigue (Freeman, Weinstock, Rickels, Sond-
tains approximately 73 mcg of resveratrol (Natural Medicines
heimer, & Coutifaris, 1992; Micromedex Inc., 2002), acne,
Comprehensive Database).
allergic skin rashes, symptoms similar to premenstrual syn-
Scarlet pimpernel has a scientific name of Anagallis
drome, and irregular menstrual cycles (Micromedex Inc.).
arvensis. Individuals self-medicate with scarlet pimpernel to
Products labeled natural progesterone, derived from natural
treat depression, cancer, and liver and kidney disorders. Estro-
sources only, are misleading because progesterone is prepared
genic effects of this herb make it inadvisable for women with
in a laboratory and is identical to endogenous progesterone.
hormone-sensitive cancers. Gruenwald et al. (1998) reported
Progesterone is not found naturally in plants; as a result, pre-
that chronic use or large doses of scarlet pimpernel causes
scription progesterone is synthesized from a constituent found
gastroenteritis and nephritis. Although no typical dose exists,
in wild yam. The human body is incapable of synthesizing
Gruenwald et al. suggested drinking one cup of tea through-
progesterone directly from wild yam (Foster & Tyler, 1999).
out the day.
The dosage of progesterone varies with the condition for
Soy has a scientific name of Glycine max, which is synony-
which it is prescribed. The usual dosage is 200 mg of micron-
mous with Glycine soja. Although some people use soy prod-
ized progesterone. Notice the brand names in Table 2 that
ucts as a substitution for cow's milk, soy also is taken for nu-
contain nonprescription progesterone.
merous conditions and for the prevention of breast or prostate
Raspberry leaf has a scientific name of Rubus idaeus,
cancer. Soy commonly is used to alleviate hot flashes caused by
which is synonymous with Rubus strigosus. People self-medi-
breast cancer treatments. Diets high in soy products appear to
cate with raspberry leaf for cardiovascular, gastrointestinal,
reduce the risk of prostatic disease and cancer (Evans, Griffiths,
and respiratory conditions (Blumenthal et al., 1998). Animal
& Morton, 1995). However, the action of soy is controversial.
studies have revealed that raspberry leaf increases serum ceru-
Some scientists have suggested that soy increases the risk of
loplasmin oxidase activity, a measure of estrogenic activity in
breast cancer, whereas others have reported that soy may have
the liver; therefore, women with hormone-sensitive cancers
some protective effect for breast cancer (Hakkak et al., 2000;
should avoid it (Eagon et al., 2000). No adverse effects have
McMichael-Phillips et al., 1998; Petrakis et al., 1996). Women
been reported. Midwives typically have given this herb to
with breast cancer or a history of breast cancer should avoid
their patients to facilitate labor. Usually taken as tea, 2 g of
therapeutic doses of soy products, especially if they are taking
dried leaf steeped in 240 ml of water for five minutes is the
tamoxifen (Facts and Comparisons, 2001; Massey, Palmer, &
typical dose (McFarlin, Gibson, O'Rear, & Harman, 1999).
Horner, 2001; Smolinske, 1999). Two or more glasses of soy
Red clover has a scientific name of Trifolium pratense.
milk daily have been suggested to reduce the risk of prostate
Self-medication with red clover is for bronchial conditions
cancer (Jacobsen, Knutsen, & Fraser, 1998). Safe therapeutic
(Leung & Foster, 1996), sexually transmitted disease (Tyler,
doses of soy vary from 20­60 g per day for adults (Natural
1993), cancer, or menopause (Kurzer & Xu, 1997). Red clo-
Medicines Comprehensive Database, 2003).
ver is another herb with estrogenic properties that women with
Star anise has a scientific name of Illicium verum. People
hormone-sensitive cancers should avoid (Le Bail, Cham-
self-medicate with star anise for gastrointestinal and respiratory
pavier, Chulia, & Habrioux, 2000; Leung & Foster; Newall et
ONCOLOGY NURSING FORUM ­ VOL 31, NO 5, 2004
E111
natural alternative to estrogen. Wild yam has estrogenic prop-
conditions. Women with hormone-sensitive cancers should
erties that women with hormone-sensitive cancers should
avoid this herb because of its estrogenic properties (Leung &
avoid (Eagon et al., 2000). Ingestion of large amounts of wild
Foster, 1996). Adverse reactions are rare for this herb. A typi-
yam has caused emesis (McGuffin et al., 1997). The Natural
cal dose is 3 g or 0.3 g of essential oil (Bisset & Wichtl, 1994).
Medicines Comprehensive Database (2003) indicated that no
Vitamin C has a scientific name of ascorbic acid. A very
typical dose is known (see also DHEA and progesterone).
popular self-medication, vitamin C often is used to treat the
common cold. Findings show that high concentrations of de-
hydroascorbic acid, the oxidized form of vitamin C, accumu-
Conclusion and Implications
late in cancerous cells. After oxidation and concentration in
This review provides information about 32 herbs and natu-
cells, the dehydroascorbic acid is converted back to vitamin
ral products with the potential to increase the growth of can-
C (Agus, Vera, & Golde, 1999; Spielholz, Golde, Houghton,
cer. It also denotes that 25 of these 32 herbs and products may
Nualart, & Vera, 1997; Vera, Rivas, & Zhang, 1998; Vera,
enhance the growth of hormone-sensitive cancers, such as
Rivas, Zhang, Furber, & Golde, 1994). Benefit or detriment to
breast, uterine, or ovarian cancer. Awareness of the negative
cancer cell growth has not been determined when oxidization
potentials of these products can alert patients with cancer and
and conversion occur. In view of this, patients with cancer
healthcare professionals about interactions with cancer thera-
should avoid high doses of vitamin C.
pies or the potential to increase cancer growth.
Several medications can increase the elimination of vitamin
In addition to the practice implications discussed in Part I
C, including aspirin and other salicylates (Hansten & Horn,
of this series of articles, certain other concerns are warranted.
1997; McKevoy, 1998), barbiturates, estrogen and oral con-
Notably, some herbs and natural products were discussed
traceptives, smoking and nicotine, and tetracyclines (Brinker,
under one heading in this article; they are (a) cohosh (black
1998; McKevoy). Vitamin C in high doses is associated with
and blue), (b) ginseng (American, Panax, and Siberian), and
deep vein thrombosis. Prolonged use establishes a high me-
(c) glucosamine (hydrochloride, sulfate, and N-acetyl). Pa-
tabolism of vitamin C, and rebound scurvy can result with an
tients often look for a product or an herb without knowing that
abrupt dosage reduction. Individuals prone to renal calculus
more than one plant or product exists that uses the same name.
are at greater risk of developing stones when they take high
This grouping makes this article succinct and alerts patients
doses of this vitamin (Health and Welfare Canada, 1990;
and healthcare professionals to the subtle differences among
McKevoy; Montbriand, 1994b). The recommended daily dose
the plants and products in these categories.
of vitamin C is 30­40 mg (Health and Welfare Canada). The
Tables 1 and 2 include advisories that some brand names
Natural Medicines Comprehensive Database (2003) recom-
contain glandular or organ material taken from animals. If this
mended a dose as high as 90 mg per day. The American Can-
material was taken from diseased animals, the product itself
cer Society stated that no substantial evidence exists that
may be harboring bovine spongiform encephalopathy (i.e.,
supplements can reduce cancer risk; however, the intake of
mad cow disease). Although the risk of transferring this dis-
fruits and vegetables containing vitamin C or other antioxi-
ease to humans is considered to be rare, patients should avoid
dants (vitamin E, selenium, and carotenoids) seems to lower
these products. This advisory also is applicable to products
risk of cancer (American Cancer Society 1996 Advisory Com-
such as deer velvet. Chronic-wasting disease among North
mittee on Diet, Nutrition, and Cancer Prevention, 1996).
American elk and deer is related closely to bovine spongiform
Vitamin E has a scientific name of alpha-tocopherol, among
encephalopathy; therefore, patients should consider this risk
others. This vitamin is a popular self-medication for cardiovas-
before self-medicating.
cular and cancer conditions. Antioxidants, such as vitamin E, are
Some research evidence seems positive about products con-
connected to minimizing the effects of normal oxidative dam-
taining lactobacillus bacteria, or fermented products (e.g.,
age, which is associated with cancer development (Blumenthal
kefer), but patients with cancer should use extreme caution. The
et al., 2000). Furthermore, RRR-alpha-tocopheryl succinate,
literature recommends avoiding the concomitant use of bacte-
also known as vitamin E succinate, is being studied for its che-
ria products with chemotherapy agents. Patients with cancer
motherapeutic and chemopreventive potential (Israel, Yu, Sand-
should refrain from overtaxing their bodies, which are fighting
ers, & Kline, 2000). However, efficacy of chemotherapy can be
cancer, with additional bacteria.
reduced when antioxidants such as vitamins C and E are used
In conclusion, this article emphasizes the herbs and natural
concomitantly. Patients undergoing chemotherapy should avoid
products that have the potential to interact with hormone-sen-
the use of vitamin C and E, except under their oncologists' su-
sitive cancers. These 25 herbs and products provide strong
pervision (Watanabe, Kakihana, Ohtsuka, & Sugishita, 1997).
evidence that women with breast, ovarian, or uterine cancers
Use of vitamin E, along with anticoagulant and antiplatelet
are in vulnerable positions and should exercise extreme care
agents, increases the risk of bleeding through inhibition of
in taking any additional natural products whether they are
platelet aggregation and antagonism of vitamin K-dependent
characterized as healing agents or not. Healthcare profession-
clotting factors (Liede, Haukka, Saxen, & Heinonen, 1998).
als are in a unique position for being resources for women
The risk of bleeding is increased when vitamin E is used with
who will benefit greatly from this information.
anticoagulant or antiplatelet herbs such as anise, chamomile,
feverfew, garlic, and Panax ginseng (Brinker, 1998; Newall et
The author acknowledges the continuing support of Carl D'Arcy, MD, the
al., 1996). According to Health and Welfare Canada (1990),
director of applied research/psychiatry at the University of Saskatchewan in
the recommended daily dose for adults 19 years and older is
Saskatoon, Canada.
10 mg. Vitamin E is naturally present in significant amounts
in cereal grains such as wheat, oats, and barley.
Author Contact: Muriel J. Montbriand, PhD, RN, can be reached at
Wild yam has a scientific name of Discorea villosa, among
montbriand@skyway.usask.ca, with copy to editor at rose_mary@
others. Individuals self-prescribe wild yam believing it is a
earthlink.net.
ONCOLOGY NURSING FORUM ­ VOL 31, NO 5, 2004
E112
References
Agerbaek, M., Gerdes, L.U., & Richelsen, B. (1995). Hypocholesterolaemic
of dairy strains of lactic acid bacteria to bind a common food carcinogen,
effects of a new fermented milk product in healthy middle-aged men.
aftatoxin B1. Food and Chemical Toxicology, 36, 321­326.
European Journal of Clinical Nutrition, 49, 346­352.
Ernst, E. (2000a). Prevalence of use of complementary/alternative medicine: A
Agus, D.B., Vera, J.C., & Golde, D.W. (1999). Stromal cell oxidation: A
systematic review. Bulletin of the World Health Organization, 78, 252­257.
mechanism by which tumors obtain vitamin C. Cancer Research, 59,
Ernst, E. (2000b). The role of complementary and alternative medicine in
4555­4558.
cancer. Lancet Oncology, 1(3), 176­180.
American Cancer Society 1996 Advisory Committee on Diet, Nutrition, and
Ernst, E., & Cassileth, B.R. (1998). The prevalence of complementary/alter-
Cancer Prevention. (1996). Guidelines on diet, nutrition, and cancer pre-
native medicine in cancer: A systematic review. Cancer, 83, 777­782.
vention: Reducing the risk of cancer with healthy food choices and physi-
Evans, B.A., Griffiths, K., & Morton, M.S. (1995). Inhibition of 5 alpha-re-
cal activity. CA: A Cancer Journal for Clinicians, 46, 325­341.
ductase in genital skin fibroblasts and prostate tissue by dietary lignans and
Bisset, N.G., & Wichtl, M. (Eds.). (1994). Herbal drugs and phytopharma-
isoflavonoids. Journal of Endocrinology, 147, 295­302.
ceuticals. A handbook for practice on a scientific basis. London: Medpharm.
Facts and Comparisons. (2001). The Lawrence review of natural products­
Blumenthal, M., Busse, W.R., Goldberg, A., Gruenwald, J., Hall, T., Riggins,
monograph system. St. Louis, MO: Walter Kluwer.
C.W., et al. (Eds.). (1998). The complete German commission E mono-
Ferenci, P., Dragosics, B., Dittrich, H., Frank, H., Benda, L., Lochs, H., et al.
graphs: Therapeutic guide to herbal medicines (S. Klein, Trans.). Boston:
(1989). Randomized controlled trial of silymarin treatment in patients with
American Botanical Council.
cirrhosis of the liver. Journal of Hepatology, 9, 105­113.
Blumenthal, R.D., Lew, W., Reising, A., Soyne, D., Osorio, L., Ying, Z., et
Fetrow, C.W., & Avila, J.R. (1999). Professional's handbook of complemen-
al. (2000). Anti-oxidant vitamins reduce normal tissue toxicity induced by
tary and alternative medicines. Springhouse, PA: Springhouse.
radio-immunotherapy. International Journal of Cancer, 86, 276­280.
Foster, S. (1999). Black cohosh (Cimicifuga racemosa): A literature review.
Brinker, F. (1998). Herb contraindications and drug interactions (2nd ed.).
Herbalgram, 45(Winter), 35­49.
Sandy, OR: Eclectic Medical.
Foster, S., & Tyler, V.E. (1999). Tyler's honest herbal: A sensible guide to
Broeder, C.E., Quindry, J., Brittingham, K., Panton, L., Thomson, J.,
the use of herbs and related remedies (4th ed.). Binghamton, NY: Haworth
Appakondu, S., et al. (2000). The Andro project: Physiological and hor-
Herbal Press.
monal influences of androstenedione supplementation in men 35 to 65
Freeman, E.W., Weinstock, L., Rickels, K., Sondheimer, S.J., & Coutifaris,
years old participating in a high-intensity resistance training program.
C. (1992). A placebo-controlled study of effects of oral progesterone on
Archives of Internal Medicine, 160, 3093­3104.
performance and mood. British Journal of Clinical Pharmacology, 33,
Brown, D. (1994). Vitex agnus castus clinical monograph. Quarterly Review
293­298.
of Natural Medicine, 2(2), 111­129.
Gehm, B.D., McAndrews, J.M., Chien, P.Y., & Jameson, J.L. (1997). Res-
Brown, G.A., Vukovich, M.D., Martini, E.R., Kohut, M.L., Franke, W.D.,
veratrol, a polyphenolic compound found in grapes and wine, is an agonist
Jackson, D.A., et al. (2000). Endocrine responses to chronic androstene-
for the estrogen receptor. Proceedings of the National Academy of Science,
dione intake in 30- to 56-year-old men. Journal of Clinical Endocrinology
94, 14138­14143.
and Metabolism, 85, 4074­4080.
Goldin, B.R. (1998). Health benefits of probiotics. British Journal of Nutri-
Brown, R. (1997). Potential interactions of herbal medicines with anti-
tion, 80, S203­S207.
psychotics, antidepressants and hypnotics. European Journal of Herbal
Goldin, B.R., Gualtieri, L.J., & Moore, R.P. (1996). The effect of lactobacillus
Medicine, 3, 25­28.
GG on the initiation and promotion of DMH-induced intestinal tumors in
Carbo, N., Costelli, P., Baccino, F.M., Lopez-Soriano, F.J., & Argiles, J.M.
the rat. Nutrition and Cancer, 25, 197­204.
(1999). Resveratrol, a natural product in wine, decreases tumor growth in
Green, N.R., & Ferrando, A.A. (1994). Plasma boron and the effects of bo-
a rat tumour model. Biochemical and Biophysical Research Communica-
ron supplementation in males. Environmental Health Perspectives,
tions, 254, 739­743.
102(Suppl. 7), 73­77.
Cheng, T.O. (2000). Ginseng-warfarin interaction. ACC Current Journal
Greenspan, E.M. (1983). Ginseng and vaginal bleeding. JAMA, 249, 2018.
Review, 9, 84.
Gruenwald, J. (1998). Standardized black cohosh (Cimicifuga) extract clinical
Chlebowski, R.T., Bulcavage, L., Grosvenor, M., Tsunokai, R., Block, J.B.,
monograph. Quarterly Review of Natural Medicine, 3, 117­125.
Gruenwald, J., Brendler, T., & Jaenicke, C. (Eds.). (1998). PDR® for herbal
Heber, D., et al. (1987). Hydrazine sulfate in cancer patients with weight
loss. A placebo-controlled clinical experience. Cancer, 59, 406­410.
medicines. Montvale, NJ: Medical Economics.
Dehydroepiandrosterone (DHEA). (1996). Medical Letter on Drugs and
Haggans, C.J., Hutchins, A.M., Olson, B.A., Thomas, W., Martini, M.C., &
Therapeutics, 38, 91­92.
Slavin, J.L. (1999). Effect of flaxseed consumption on urinary estrogen
Devlin, T.M. (Ed.). (1992). Textbook of biochemistry with clinical correla-
metabolites in postmenopasual women. Nutrition and Cancer, 33, 188­
tions (3rd ed.). New York: Wiley-Liss.
195.
De Vrese, M., Keller, B., & Barth, C.A. (1992). Enhancement of intestinal
Hakkak, R., Korourian, S., Shelnutt, S.R., Lensing, S., Ronis, M.J., & Bad-
hydrolysis of lactose by microbial beta-galactosidase (EC 3.2.1.23) of
ger, T.M. (2000). Diets containing whey proteins or soy protein isolate
kefir. British Journal of Nutrition, 67(1), 67­75.
protect against 7,12­dimethylbenz(a)anthracene-induced mammary tu-
Drovanti, A., Bignamini, A.A., & Rovati, A.A. (1980). Therapeutic activity
mors in female rats. Cancer Epidemiology, Biomarkers and Prevention, 9,
of oral glucosamine sulfate in osteoarthrosis: A placebo-controlled, double-
113­117.
blind investigation. Clinical Therapeutics, 3, 260­272.
Hansten, P.D., & Horn, J.R. (1997). Drug interactions: Analysis and manage-
Duda, R.B., Zhong, Y., Navas, V., Li, M.Z., Toy, B.R., & Alavarez, J.G.
ment. Vancouver, WA: Applied Therapeutics.
(1999). American ginseng and breast cancer therapeutic agents synergis-
Health and Welfare Canada. (1990). Nutrition recommendations. Ottawa,
tically inhibit MCF-7 breast cancer growth. Journal of Surgical Oncology,
Canada: Canadian Government Publishing Centre.
72, 230­239.
Health Canada, Part II: Regulation and Regulatory Structure. (2002). Health
Eagon, P.K., Elm, M.S., & Hunter, D.S. (2000, June). Medicinal herbs:
Canada site on natural health products. Retrieved April 4, 2002, from http://
Modulation of estrogen action. Paper presented at the Era of Hope Meet-
www.hc-sc.gc.ca/hpb/onhp/welcome_e.html
ing for the Department of Defense Breast Cancer Research Program, At-
Hegarty, V.M., May, H.M., & Khaw, K. (2000). Tea drinking and bone den-
lanta, GA.
sity in older women. American Journal of Clinical Nutrition, 71, 1003­
Ellenhorn, M.J., & Barceloux, D.G. (1997). Ellenhorn's medical toxicology:
1007.
Diagnoses and treatment of human poisoning (2nd ed.). Baltimore: Will-
Hopkins, M.P., Androff, L., & Benninghoff, H.S. (1988). Ginseng face cream
and unexplained vaginal bleeding. American Journal of Obstetrics and
iams and Wilkins.
Gynecology, 159, 1121­1122.
El-Nezami, H., Kankaanpaa, P., Salminen, S., & Ahokas, J. (1998). Ability
ONCOLOGY NURSING FORUM ­ VOL 31, NO 5, 2004
E113
Huang, K.C. (1999). The pharmacology of Chinese herbs (2nd ed.). Boca
ated anorexia and cachexia. Implications for drug therapy. Drugs, 43,
Raton, FL: CRC Press.
499­506.
Israel, K., Yu, W., Sanders, B.G., & Kline, K. (2000). Vitamin E succinate
Lund, E.L., Quistorff, B., Spang-Thomsen, M., & Kristjansen, P.E. (1998).
induces apoptosis in human prostate cancer succinate-triggered apoptosis.
Effect of radiation therapy on small-cell lung cancer is reduced by ubi-
Nutrition and Cancer, 36, 90­100.
quinone intake. Folia Microbiologica, 43, 505­506.
Jacobsen, B.K., Knutsen, S.F., & Fraser, G.E. (1998). Does high soy milk
Malinow, M.R., Bardana, E.J., & Goodnight, S.H., Jr. (1981). Pancytopenia
intake reduce prostate cancer incidence? Cancer Causes and Control, 9,
during ingestion of alfalfa seeds. Lancet, 1(8220, Pt. 1), 615.
553­557.
Martindale, W. (1999). Martindale: The extra pharmacopoeia. London:
Janetzky, K., & Morreale, A.P. (1997). Probable interaction between war-
Royal Pharmaceutical Society, Pharmaceutical Press.
farin and ginseng. American Journal of Health-System Pharmacy, 54,
Massey, L.K., Palmer, R.G., & Horner, H.T. (2001). Oxalate content of soy-
692­693.
bean seeds (Glycine max: Leguminosae), soyfoods, and other edible le-
Jang, M., Cai, L., Udeani, G.O., Slowing, K.V., Thomas, C.F., Beecher,
gumes. Journal of Agricultural and Food Chemistry, 49, 4262­4266.
C.W., et al. (1997). Cancer chemopreventive activity of resveratrol, a natu-
McCaleb, R.S., Leigh, E., & Morien, K. (2000). The encyclopedia of popu-
ral product derived from grapes. Science, 275, 218­220.
lar herbs. Roseville, CA: Prima Health.
Jolliet, P., Simon, N., Barre, J., Pons, J.Y., Boukef, M., Paniel, B.J., et al.
McFarlin, B.L., Gibson, M.H., O'Rear, J., & Harman, P. (1999). A national
(1998). Plasma coenzyme Q10 concentrations in breast cancer: Prognosis
survey of herbal preparation use by nurse-midwives for labor stimulation.
and therapeutic consequences. International Journal of Clinical Pharma-
Review of the literature and recommendations for practice. Journal of
cology Therapy, 36, 506­509.
Nurse Midwifery, 44, 205­216.
Kaegi, E. (1998). Unconventional therapies for cancer: 4. Hydrazine sulfate.
McGuffin, M., Hobbs, C., Upton, R., & Goldberg, A. (1997). American
Task force on alternative therapies of the Canadian Breast Cancer Research
Herbal Products Association's botanical safety handbook. Boca Raton,
Initiative. Journal of the Canadian Medical Association, 158, 1327­1330.
FL: CRC Press.
McIntosh, G.H., Royle, P.J., & Playne, M.J. (1999). A probiotic strain of L
Kalima, P., Masterton, R.G., Roddie, P.H., & Thomas, A.E. (1996). Lacto-
acidophilus reduces DMH-induced large intestinal tumors in male
bacillus rhamnosus infection in a child following bone marrow transplant.
Sprague-Dawley rats. Nutrition and Cancer, 25, 197­204.
Journal of Infectious Diseases, 32, 165­167.
McKevoy, G.K. (Ed.). (1998). AHFS drug information. Bethesda, MD:
King, D.S., Sharp, R.L., Vukovich, M.D., Brown, G.A., Reifenrath, T.A.,
American Society of Health-System Pharmacists.
Uhl, N.L., et al. (1999). Effect of oral androstenedione on serum testoster-
McMichael-Phillips, D.F., Harding, C., Morton, M., Roberts, S.A., Howell,
one and adaptations to resistance training in young men: A randomized
A., Potten, C.S., et al. (1998). Effects of soy-protein supplementation on
controlled trial. JAMA, 281, 2020­2028.
epithelial proliferation in the histologically normal human breast. Ameri-
Kosty, M.P., Fleishman, S.B., Herndon, J.E., II, Coughlin, K., Kornblith,
can Journal of Clinical Nutrition, 68(6, Suppl.), 1431S­1435S.
A.B., Scalzo, A., et al. (1994). Cisplatin, vinblastine, and hydrazine sulfate
Merz, P.G., Gorkow, C., Schrodter, A., Rietbrock, S., Sieder, C., Loew, D.,
in advanced, non-small-cell lung cancer: A randomized, placebo-con-
et al. (1996). The effects of a special agnus castus extract (BP1095E1) on
trolled, double-blind phase III study of the cancer and leukemia group B.
prolactin secretion in healthy male subjects. Experimental and Clinical
Journal of Clinical Oncology, 12, 1113­1120.
Endocrinology and Diabetes, 104, 447­453.
Kroboth, P.D., Salek, F.S., Pittenger, A.L., Fabian, T.J., & Frye, R.F. (1999).
Micromedex Inc. (2002). Micromedex healthcare series. Englewood, CO:
DHEA and DHEA-S: A review. Journal of Clinical Pharmacology, 39,
Author.
327­348.
Mills, S., & Bone, K. (2000). Principles and practice of phytotherapy. Lon-
Kuritzky, L. (1998). DHEA: Science or wishful thinking? Hospital Practice,
don: Churchill Livingstone.
33, 85­86.
Montbriand, M.J. (1994a). Decision heuristics of patients with cancer: Alter-
Kurzer, M.S., & Xu, X. (1997). Dietary phytoestrogens. Annual Review of
nate and biomedical choices. Unpublished doctoral dissertation, Univer-
Nutrition, 17, 353­381.
sity of Saskatchewan, Saskatoon, Canada.
Lampe, J.W., Martini, M.C., Kurzer, M.S., Adlercreutz, H., & Slavin, J.L.
Montbriand, M.J. (1994b). An overview of alternate therapies chosen by pa-
(1994). Urinary lignan and isoflavonoid excretion in premenopausal
tients with cancer. Oncology Nursing Forum, 21, 1547­1554.
women consuming flaxseed powder. American Journal of Clinical Nutri-
Montbriand, M.J. (1995a). Alternative therapies as control behaviors used by
tion, 60, 122­128.
cancer patients. Journal of Advanced Nursing, 22, 646­654.
Langsjoen, P.H., Langsjoen, P.H., & Folkers, K. (1990). Long-term efficacy
Montbriand, M.J. (1995b). Decision tree model describing alternate health
and safety of coenzyme Q10 therapy for idiopathic dilated cardiomyopa-
care choices made by oncology patients. Cancer Nursing, 18, 104­117.
thy. American Journal of Cardiology, 15, 521­523.
Montbriand, M.J. (1997). Empowerment of seniors through improved com-
Le Bail, J.C., Champavier, Y., Chulia, A.J., & Habrioux, G. (2000). Effects
munication about medication. In L.F. Heumann (Ed.), Proceedings of the
of phytoestrogens on aromatase, 3beta and 17beta-hydroxysteroid dehy-
Sixth International Conference on Systems Science in Health-Social Ser-
drogenase activities and human breast cancer cells. Life Science, 66, 1281­
vices for the Elderly and the Disabled (pp. 258­264). Chicago, IL: Univer-
1291.
sity of Illinois at Urbana-Champaign.
Leder, B.Z., Longcope, C., Catlin, D.H., Ahrens, B., Schoenfeld, D.A., &
Montbriand, M.J. (2000a). Health professionals' attitudes about alternative
Finkelstein, J.S. (2000). Oral androstenedione administration and serum
therapies. Canadian Nurse, 96, 22­26.
testosterone concentrations in young men. JAMA, 283, 779­782.
Montbriand, M.J. (2000b). Senior and health-professionals' mismatched per-
Leung, A.Y., & Foster, S. (1996). Encyclopedia of common natural ingredi-
ceptions and communication about prescription and non-prescription medi-
ents used in food, drugs, and cosmetics (2nd ed.). New York: John Wiley
cation. Canadian Journal on Aging, 19, 35­56.
and Sons.
Montbriand, M.J. (2004). Herbs or natural products that decrease cancer growth.
Liede, K.E., Haukka, J.K., Saxen, L.M., & Heinonen, O.P. (1998). Increased
Part one of a four-part series. Oncology Nursing Forum, 31, E75­E90.
tendency towards gingival bleeding caused by joint effect of alpha-toco-
Murofushi, M., Mizuguchi, J., Aibara, K., & Matuhasi, T. (1986). Immuno-
pherol supplementation and acetylsalicylic acid. Annals of Medicine, 30,
potentiative effect of polysaccharide from kefir grain, KGF-C, adminis-
542­546.
tered orally in mice. Immunopharmacology, 12(1), 29­35.
Liske, E. (1998). Therapeutic efficacy and safety of Cimicifuga racemosa for
Natural Medicines Comprehensive Database. (2003). Therapeutic Research
gynecologic disorders. Advanced Therapy, 15(1), 45­53.
Faculty National Database [Data file]. Available at http://www.natural
Lopes Vaz, A.L. (1982). Double-blind, clinical evaluation of the relative ef-
database.com
ficacy of ibuprofen and glucosamine sulphate in the management of
NBA bans androstenedione. (2000). Retrieved March 31, 2000, from http://
osteoarthrosis of the knee in out-patients. Current Medical Research and
nba.com/news/nba_androban_000330.html
Opinion, 8, 145­149.
Newall, C.A., Anderson, L.A., & Philpson, J.D. (1996). Herbal medicine: A
Loprinzi, C.L., Goldberg, R.M., & Burnham, N.L. (1992). Cancer-associ-
ONCOLOGY NURSING FORUM ­ VOL 31, NO 5, 2004
E114
guide for health care professionals. London: Pharmaceutical Press.
Smolinske, S.C. (1999). Dietary supplement-drug interactions. Journal of
Newnham, R.E. (1994). Essentiality of boron for healthy bones and joints.
American Medical Women's Association, 54, 191­192, 195.
Environmental Health Perspectives, 102(Suppl. 7), 83­85.
Soleas, G.J., Diamandis, E.P., & Goldberg, D.M. (1997). Resveratrol: A mol-
Oelkers, W. (1999). Dehydroepiandosterone for adrenal insufficiency [Edi-
ecule whose time has come? And gone? Clinical Biochemistry, 30, 91­113.
torial]. New England Journal of Medicine, 341, 1073­1074.
Sotaniemi, E.A., Haapakoski, E., & Rautio, A. (1995). Ginseng therapy in
Office of Nutrition Policy and Promotion. (2004). Canada's food guide to
non-insulin dependent diabetic patients. Diabetes Care, 18, 1373­1375.
healthy eating. Retrieved July 20, 2004, from http://www.hc-sc.gc.ca/hpfb-
Sparber, A., Bauer, L., Curt, G., Eisenberg, D., Levin, T., Parks, S., et al.
dgpsa/onpp-bppn/food_guide_rainbow_e.html
(2000). Use of complementary medicine by adult patients participating in
Palmer, B.V., Montgomery, A.C., & Monteiro, J.C. (1978). Gin seng and
cancer clinical trials. Oncology Nursing Forum, 27, 623­630.
mastalgia. BMJ, 1, 1284.
Sparber, A., & Wootton, J.C. (2001). Surveys of complementary and alterna-
Pelto, L., Isolauri, E., Lilius, E.M., Nuutila, J., & Salminen, S. (1998). Pro-
tive medicine: Part II. Use of alternative and complementary cancer thera-
biotic bacteria down-regulate the milk-induced inflammatory response in
pies. Journal of Alternative and Complementary Medicine, 7, 281­287.
milk-hypersensitive subjects but have an immunostimulatory effect in
Spielholz, C., Golde, D.W., Houghton, A.N., Nualart, F., & Vera, J.C. (1997).
healthy subjects. Clinical and Experimental Allergy: Journal of the Brit-
Increased facilitated transport of dehydroascorbic acid without changes in
ish Society for Allergy and Clinical Immunology, 12, 1473­1479.
sodium-dependent ascorbate transport in human melanoma cells. Cancer
Penland, J.G. (1994). Dietary boron, brain function, and cognitive perfor-
Research, 57, 2529­2537.
mance. Environmental Health Perspectives, 102(Suppl. 7), 65­72.
Tyler, V.E. (1993). The honest herbal: A sensible guide to the use of herbs
Pepping, J. (1999). Black cohosh: Cimicifuga racemosa. American Journal
and related remedies (3rd ed.). Binghamton, NY: Pharmaceutical Products
of System Pharmacists, 56, 1400­1402.
Press.
Perlman, A.I., Eisenberg, D.M., & Panush, R.S. (1999). Talking with patients
Tyler, V.E. (1994). Herbs of choice: The therapeutic use of phytomedicinals.
about alternative and complementary medicine. Rheumatic Disease Clin-
Binghamton, NY: Pharmaceutical Products Press.
ics of North America, 25, 815­822.
Tynkkynen, S., Singh, K.V., & Varmanen, P. (1998). Vancomycin resistance
Permanetter, B., Rossy, W., Klein, G., Weingartner, F., Seidl, K.F., & Blo-
factor of Lactobacillus rhamnosus GG in relation to enterococcal vanco-
mer, H. (1992). Ubiguinone (coenzyme Q10) in the long-term treatment of
mycin resistance (van) genes. International Journal of Food Microbiology,
idiopathic dilated cardiomyopathy. European Heart Journal, 13, 1528­
41, 195­204.
1533.
U.S. Department of Agriculture. (1995). Nutrition and your health: Dietary
Petrakis, N.L., Barnes, S., King, E.B., Lowenstein, J., Wiencke, J., Lee, M.M.,
guidelines for Americans (4th ed.). Washington, DC: U.S. Government
et al. (1996). Stimulatory influence of soy protein isolate on breast secre-
Printing Office.
tion in pre- and postmenopausal women. Cancer Epidemiology, Bio-
van Vollenhoven, R.F. (2000). Dehydroepiandrosterone in systemic lupus
markers and Prevention, 5, 785­794.
erythematosus. Rheumatic Disease Clinics of North America, 26, 349­362.
Pheatt, N. (Ed.). (1999). Sport's Supplements. Pharmacist's Letter Continu-
van Weerden, W.M., van Kreuningen, A., Elissen, N.M., de Jong, F.H., van
ing Education Booklet, 99, 1­56.
Steenbrugge, G.J., & Schroder, F.H. (1992). Effects of adrenal androgens
Portakal, O., Ozkaya, O., Erden Inal, M., Bozan, B., Kosan, M., & Sayek, I.
on the transplantable human prostate tumor PC-82. Endocrinology, 131,
(2000). Coenzyme Q10 concentrations and antioxidant status in tissues of
2909­2913.
breast cancer patients. Clinical Biochemistry, 33, 279­284.
Vera, J.C., Rivas, C.I., & Zhang, R.H. (1998). Colony-stimulating factors
Questionable methods of cancer management: Nutritional therapies. (1993).
signal for increased transport of vitamin C in human host defense cells.
Blood, 91, 2536­2546.
CA: A Cancer Journal for Clinicians, 43, 309­319.
Vera, J.C., Rivas, C.I., Zhang, R.H., Furber, C.M., & Golde, D.W. (1994).
Rasmussen, B.B., Volpi, E., Gore, D.C., & Wolfe, R.R. (2000). Androstene-
Human HL-60 myeloid leukemia cells transport dehydroascorbic acid via
dione does not stimulate muscle anabolism in young healthy men. Journal
the glucose transporters and accumulate reduced ascorbic acid. Blood, 84,
of Clinical Endocrinology and Metabolism, 85(1), 55­59.
1628­1634.
Richelsen, B., Kristensen, K., & Pedersen, S.B. (1996). Long-term (6 months)
effect of a new fermented milk product on the level of plasma lipopro-
Vuksan, V., Sievenpiper, J.L., Koo, V.Y., Francis, T., Beljan-Zdravkovic, U.,
Xu, Z., et al. (2000). American ginseng (Panax quinquefolius L) reduces
teins--A placebo-controlled and double-blind study. European Journal of
postprandial glycemia in nondiabetic subjects and subjects with type 2
Clinical Nutrition, 50, 811­815.
diabetes mellitus. Archives of Internal Medicine, 160, 1009­1013.
Rimada, P.S., & Abraham, A.G. (2001). Polysaccharide production by kefir
Vuksan, V., Stavro, M.P., Sievenpiper, J.L., Beljan-Zdravkovic, U., Leiter,
grains during whey fermentation. Journal of Dairy Research, 68, 653­661.
L.A., Josse, R.G., et al. (2000). Similar postprandial glycemic reductions
Robbers, J.E., Speedie, M.K., & Tyler, V.E. (1996). Pharmacognosy and
with escalation of dose and administration time of American ginseng in
pharmacobiotechnology. Baltimore: Williams and Wilkins.
type 2 diabetes. Diabetes Care, 23, 1221­1226.
Saxelin, M., Chuang, N.H., Chassy, B., Rautelin, H., Makela, P.H., Salminen,
Watanabe, H., Kakihana, M., Ohtsuka, S., & Sugishita, Y. (1997). Random-
S., et al. (1996). Lactobacilli and bacteremia in southern Finland. Clinical
ized, double-blind, placebo-controlled study of supplemental vitamin E on
Infectious Diseases, 22, 564­566.
attenuation of the development of nitrate tolerance. Circulation, 96, 2545­
Schaafsma, G., Meuling, W.J., van Dokkum, W., & Bouley, C. (1998). Ef-
2550.
fects of a milk product, fermented by Lactobacillus acidophilus and with
Weber, B., Lewicka, S., Deuschle, M., Colla, M., & Heuser, I. (2000). Tes-
fructo-oligosaccharides added, on blood lipids in male volunteers. Euro-
tosterone, androstenedione and dihydrotestosterone concentrations are el-
pean Journal of Clinical Nutrition, 52, 436­440.
evated in female patients with major depression. Psychoneuroendocrinol-
Schulz, V., Hansel, R., & Tyler, V.E. (1998). Rational phytotherapy: A phy-
ogy, 25, 765­771.
sician's guide to herbal medicine (3rd ed.) (T.C. Telger, Trans.). Berlin,
White, J.D. (2002). Complementary and alternative medicine research: A
Germany: Springer.
National Cancer Institute perspective. Seminars in Oncology, 29, 546­
Shils, M., Olson, A., & Shilke, M. (1994). Modern nutrition in health and
551.
disease (8th ed.). Philadelphia: Lea and Febiger.
Yun, J., Tomida, A., Nagata, K., & Tsuruo, T. (1995). Glucose-regulated
Shiomi, M., Sasaki, K., Murofushi, M., & Aibara, K. (1982). Antitumor ac-
stresses confer resistance to VP-16 in human cancer cells through a de-
tivity in mice of orally administered polysaccharide from kefir grain. Japa-
creased expression of DNA topoisomerase II. Oncology Research, 7, 583­
nese Journal of Medical Science and Biology, 35(2), 75­80.
590.
Sigurjonsdottir, H.A., Ragnarsson, J., Franzson, L., & Sigurdsson, G. (1995).
Zhu, W., Zhang, J.S., & Young, C.Y. (2001). Silymarin inhibits function of
Is blood pressure commonly raised by moderate consumption of licorice?
the androgen receptor by reducing nuclear localization of the receptor in
Journal of Human Hypertension, 9, 345­348.
the human prostate cancer cell line LNCaP. Carcinogenesis, 22, 1399­
Skolnick, A.A. (1996). Scientific verdict still out on DHEA. JAMA, 276,
1403.
1365­1367.
ONCOLOGY NURSING FORUM ­ VOL 31, NO 5, 2004
E115