Traditional Arabic and Islamic Medicine, a Re-emerging Health Aid

Hassan Azaizeh1, Bashar Saad1,2,3, Edwin Cooper4 and Omar Said1,5

1The Galilee Society R&D Center, P.O. Box 437, Shefa-Amr 20200, 2Qasemi Research Center, Al-Qasemi

Academic College, Baga Algharbiya, Israel, 3Faculty of Allied Medical Sciences, Arab American University Jenin,

P.O. Box 240, Jenin, Palestine, 4Laboratory of Comparative Neuroimmunology, Department of Neurobiology,

David Geffen School of Medicine at UCLA, Los Angeles, CA, USA and 5Antaki Center for Herbal Medicine Ltd,

Kufur Kanna (Cana of Galilee), Israel

Complementary medicine is a formal method of health care in most countries of the ancient

world. It is expected to become more widely integrated into the modern medical system,

including the medical curriculum. Despite the perception of modern medicine as more efficacious,

traditional medicine continues to be practiced. More than 70% of the developing world’s

population still depends primarily on the complementary and alternative systems of medicine

(CAM). In rural areas, cultural beliefs and practices often lead to self-care, home remedies or

consultation with traditional healers. Herbal medicine can be broadly classified into four basic

systems as follows: Traditional Chinese Herbalism, Ayurvedic Herbalism, Western Herbalism—

which originally came from Greece and Rome to Europe and then spread to North and South

America and Traditional Arabic and Islamic Medicine (TAIM). There is no doubt that today

the concept of Arabic traditional herbal medicine is a part of modern life in the Middle East,

and it is acquiring worldwide respect, with growing interest among traditional herbalists

and the scientific community. TAIM therapies have shown remarkable success in healing acute

as well as chronic diseases and have been utilized by people in most countries of the

Mediterranean who have faith in spiritual healers. TAIM is the first choice for many in dealing

with ailments such as infertility, epilepsy, psychosomatic troubles and depression. In parallel,

issues of efficacy and safety of complementary medicine have become increasingly important

and supervision of the techniques and procedures used is required for commercial as well as

traditional uses. More research is therefore needed to understand this type of medicine and

ensure its safe usage. The present review will discuss the status of traditional Arab medicine

(particularly herbal medicine), including the efficacy and toxicity of specific medicinal preparations,

with an emphasis on the modern in vitro and in vivo techniques.

Keywords: Arab herbal medicine – efficacy – toxicity

Traditional Arabic and Islamic Medicine Joins TCM, CAM, Kampo and Ayurveda.There are several well-known and established medicinal plant heritages worldwide including the Kampo,TCM,TIM and Ayurveda. There has been increased global interest in traditional medicine and there are efforts underway to monitor and regulate herbal drugs and traditional

medicine. China has been successful in promoting its therapies with more research and a science-based approach, while Ayurveda still needs more extensive scientific research and evidence bases. Kampo medicine is widely practiced in Japan, where it is fully integrated into the modern health care system. Kampo is based on traditional Chinese medicine but adapted to Japanese

culture.

For reprints and all correspondence:

Dr Hassan Azaizeh or Prof.

Bashar Saad, The Galilee Society R&D Center, P.O. Box 437, Shefa

Amr 20200, Israel. Tel: +972-4-9504523/4; Fax: +972-4-9504525;

E-mail: bsaad@gal-soc.org or hazaizi@gal-soc.org

2008 The Author(s).

eCAM Advance Access published June 13, 2008 adopted also in Taiwan and exported from Taiwan to the West. Kampo spread rapidly during the period 1985–95; after that, the number of practitioners stabilized at a nearconstant level (1,2). By 1985, it was reported that about 20–25% of the medical doctors in Japan were prescribing some herbal medicines in their practice. However, as pointed out by Terasawa Katsutoshi, only about 100 or so doctors were routinely prescribing Kampo medicines to their patients. The proportion of doctors that provide some Kampo medicines has risen to about 50% or more by some estimates, with a proportional increase in Kampo specialists by more than 200.

In addition, there are about 10 000 pharmacies in Japan that dispense herbal formulas. In Japan, unlike Western countries, some part of Kampo remedies and acupuncture are covered by

public health insurance (1,2).

Therefore, Japanese practitioners of Kampo and acupuncture would object to their inclusion in Complementary and Alternative Medicine (CAM) and would rather regard themselves as belonging to the authentic traditional medicine. Ayurveda, traditional Indian medicine (TIM) and traditional Chinese medicine (TCM) remain the most ancient yet living traditions.

The history and development of TCM in Taiwan started during the end of the Ming dynasty when largescale migration from Mainland China took place (3).

The migrants brought with them a 2000 year old knowledge of TCM, complemented by the rich flora and fauna of Taiwan and the local knowledge of the aboriginal people. TCM has now become the highest priority in the Taiwan’s blueprint for the development of biotechnology. With thousands of years of accumulated knowledge and experience in herbal medicine, there is a will to preserve it at any cost, although in early communist China it was discouraged. A utilization pattern for herbal medicine is just emerging in Taiwan.

Uninformed patients,unscrupulous traders, adulterated preparations, unlicensed practitioners

and illegal sources for herbal medicines have been blamed for creating a bad image of herbal medicine use in Taiwan (4,5).

The decision to cover Chinese Herbal Medicine (CHM) treatment under Taiwan’s National Health Insurance (NHI) in 1992 had a big impact on the pattern of CHM unitization in Taiwan.

Some researchers tried to find some link between the TCM and Ayurveda from the Indian subcontinent and their integration with other systems of medicine, including Western medicine, to realize the concept of sustainable medicine (6).

In this aspect, several herbal medicines for potential steroidogenic activity have been screened

both in vivo and in vitro to analyze their effect on steroid hormones.

Traditional Chinese herbal therapy can be characterized by the use of a large number of multi-herb formulae. To provide modern and Western scientists who do not possess background knowledge of Chinese literature and culture easy access to information, a database with more

than 11 000 traditional Chinese herbal formulae was constructed (6).

All information was then translated into understandable scientific terms in English. Traditional

Arabic and Islamic Medicine Joins (TAIM), on the other hand, is based on single plant species or a mixture of a small number of local plant species. According to Olalde Rangel et al. (7), recent past and current naturalists and phytotherapeutic practitioners share a long and impressive tradition of knowledge and pride in curing illnesses. These qualities have been substantiated

by the success of Chinese, Kampo, Ayurvedic, Chumash or Mayan among many other traditional

medicines. From these traditional medicines it has been demonstrated that every culture is capable of understanding and ‘inventing’ the meaning of disease and finding probable cures (7).

They may even be different from our modern medical views. The variety and extent of cultures to provide answers to traditional medicines and to unsolved pathologies are firmly grounded in

the curiosity and observational capabilities of humans. To ensure this culture, there are collective factors, ‘a background of extensive family practice in traditional medicine’ crucial in the transmission and survival of medicinal plant knowledge among ethnic groups. However, there is a possible curtailment of the wisdom and therapies of traditional medicines that comes with geographical and ethnic boundaries. In addition, the number of plants, potential formulations or properties is a formidable concern for individual caregivers or groups to understand, store and transmit (7).

TAIM started hundreds of years ago and were used until recently in many of the primary books in libraries throughout Europe. Research into the TAIM herbs has been conducted in many Arab countries such as Syria, Morocco, Yemen, Egypt and others. The most recent surveys conducted on the potential uses of plant species in the Mediterranean region by ethnopharmacologists recorded 250–290 plant species belonging to different families still in use (8,9).

The remedies are administered by practitioners in forms of standard decoction prepared by boiling plant parts in hot water, infusion in water or oil or inhalation of essential oils. It is also taken as juice, syrup, roasted material, fresh salad or fruit, macerated plant parts, oil, milky sap, poultice and paste. In recent years, remedies based on TAIM herbs have been tested in cooperation with physicians and started to be routinely prescribed in Europe and in Mediterranean countries to their patients.

According to the World Health Organization (WHO),more than three-quarters of the world’s population rely upon traditional medicine, mainly herbs (medicinal plants), for health care. Phytotherapy existed in oneway or another in different cultures/civilizations, but the systematic and comprehensive works of Ibn Sina(Avicena in the West) in the form of Al-Qanun-fil-Tib(Canon of Medicine) occupies an eminent place in the

2 of 6 TAIM, a re-emerging health aid history of medicine. This book has remained relevant over 600 years. During the 15th and 16th centuries alone it was published more than 35 times.

In addition to the use of plants in their crude form for health care, they have been the main source for chemical drugs. Today there is a revival of interest in the use of medicinal plants in the form of standardized extracts/botanicals partly due to the high cost involved in the development of patentable chemical drugs and their multiple side effects. Botanicals such as Ispaghol, Garlic, Ginseng, Ginger,Ginkgo, St John’s Wort, Mucuna prureins and Saw palmetto are gaining popularity for the purpose of health care. The impact of journals publishing data on medicinal plants is increasing and there is a rising trend to include phytotherapy in the curriculum of medical schools in North America and Europe. Over 70% of German physicians prescribe herbs, and St. John’s Wort is more commonly used than any chemical medicine to treat mild to moderate depression. Phytotherapy is considered relatively safe as it contains multiple chemicals with a specific composition acting as ‘effect-enhancing and/or side-effects neutralizing’, though there is limited scientific evidence for this assumption. Multidisciplinary team work including ethnobotanists, pharmacologists, physicians and phytochemists is essential for the fruitful outcome of medicinal plants research, and such international symposia as the aforementioned conference help to achieve this goal.

Revival and Preservation of TAIM Knowledge Parallel to the increasing interest in ‘modern’ CAM therapies and the historical importance of TAIM, there is a similar trend in research activities dealing with the efficacy and safety of medicinal plants in the Middle East. Historical and current studies indicate that the Eastern region of the Mediterranean has been distinguished

for long periods with a rich inventory of natural medicinal herbs. It is well documented that TAIM has contributed greatly to the development of modern medicine in Europe and remains one of the closest forms of original European medicine. In recent years researchers at the Galilee Society Research and Development Center, in cooperation with different institutes, have published more than 20 articles and review papers in peer reviewed Journals on this subject (8–16).

These articles demonstrate the importance of traditional Arabic medicine and indicate that the Eastern region of the Mediterranean has been distinguished from other regions by a rich inventory of complementary alternative medicine, in particular herbal medicine. The data collected during these studies indicated that 200–250 herbs are still used in treating human diseases and are sold or traded in market places in the Mediterranean region or internationally. Some of these plant species have been investigated and bioactive ingredients extracted to treat various human diseases and as botanical pesticides (17–20).

The modern use of Arab botanical medicines has historical roots in ancient Arabic medicine. Arab herbalists, pharmacologists, chemists and physicians in the middle ages adopted the ancient medicinal practices of Mesopotamia, Greece, Rome, Persia and India. Medical innovations introduced by Arab physicians included:the discovery of the immune system, the introduction ofmicrobiological science and the separation of medicine from pharmacological science. Recent ethnopharmacologicalsurveys conducted by different groups in the Middle East support the necessity of proper handling ofherbal medicine used in TAIM which requires suitable regulation and licensing in order to ensure supply of

appropriate and safe products (8,9).

Fortunately, today there is a countertrend underway to preserve natural botanical resources through an increasing emphasis on conservation by way of botanical gardens, greenhouses,

herbariums, tissue cultures, propagation and seed banks. In an effort to help revive and preserve the knowledgeof TAIM, an international conference on the current state of research and practice in the field was organized in 2007. This three-day conference took place in Amman,

Jordan during August 8–10, and included an exhibition and poster session.

The conference intended to:

(i) establish an institution to serve as a network for all stakeholders

in TAIM, as a prerequisite to revitalizing this

important subject and to coordinate research and

different activities in this field;

(ii) revive the heritage of TAIM in order to present it in its normal environment,

in order to release it from the political restrictions of the

Middle East,

(iii) revitalize this heritage as a scientific

discipline and raise awareness of TAIM;

(iv) explore the economic and sustainability aspects of this heritage and

encourage investment to develop pharmaceutical products

based on this culture and

(v) increase the number of practitioners and quality of the practice of TAIM

by training new and existing practitioners (21).

The conference was designed for research scientists, local and regional traditional healers, international pharmaceutical and medical research companies, medical doctors, ethnopharmacologists and other parties interested in the study of traditional Arabic and Islamic medicine. All bodies and institutions, research centers and interested parties working in the field of Arab medicinal plants were invited to participate in the conference, which was structured

into six sessions. Discussions touched on the historical and cultural aspects of Arabic Islamic medicine and its contribution to modern medicine and to human wellbeing.

The global scientific research on medicinal and aromatic plants, pharmaceutical research, clinical trials, as well as international legislation and intellectual property rights on Arabic and Islamic medicinal plants of the region were also reviewed. Each of the six sections eCAM 2008 3 of 6 discussed a different issue related to TAIM. Their main points are delineated as described subsequently.

Ethnopharmacology of Medicinal Plants used in TAIM Historical and current studies indicate that the Eastern region of the Mediterranean has been distinguished from other regions by a rich inventory of CAM, in particular herbal medicine. Data also indicate that there is a flourishing

and well-developed trade of herbs, some of which are rare or endangered species. Unfortunately, with regard to the status of the herbalists’ knowledge, herbal medicine in our region is mostly prescribed symptomatically by ethnopharmacologists; that is, based on signs and symptoms alone, rather than on a full understanding of the underlying disease. In other cases, herbs used

today may not even correspond to the plants described originally in the old literature, as the former are cultivated from herbs that went through different breeding procedures over several centuries (10).

TAIM Heritage

During the 8th until the 11th centuries, Arab physicians upgraded the existing knowledge about herbs and their potential medical efficacy and safety. Their greatest contributions to modern medicine were the immune system and introduction of microbiological science [(22), for

more details, see review in Ref. (12)].

The Eastern region of the Mediterranean has been distinguished throughout generations by a rich inventory of natural medicinal herbs (8,22–24).

The Middle Eastern region was covered with >2600 plant species of which >700 were noted for their use as medicinal herbs or botanical pesticides. Unfortunately, recent ethnopharmacological surveys reveal that 200–250 plant species are still in use in Arab traditional medicine for the treatment of various diseases (8,25–28).

There are several factors endangering plant diversity or even causing eradication of these herbs,

including habitat loss, habitat degradation and overharvesting (29).

Recent ethnopharmacological surveys conducted by different groups in the Middle East support

the necessity of proper handling of herbal medicine which requires suitable regulation and licensing in order to ensure supply of suitable and safe products (13,25).

Medicinal plants in the Middle Eastern region and worldwide are becoming increasingly rare due to the ongoing destruction of their natural habitat and detrimental climatic and environmental changes. As a result, it is predicted that in semi-arid regions such as the Middle East, a number of species will disappear within the next 10 years, particularly in desert or dry areas. This gives an added sense of urgency to initiate preservation programs of regional medicinal plant genetic resources (15).

Al-Maissam

Al-Maissam, the Galilee Society’s Medicinal Plants Center, was established based on in-depth study of TAIM and intended to provide an efficient model for preserving and developing traditional knowledge on Arabic medicinal plants. A comprehensive survey of traditional Palestinian herbal medicine practitioners was conducted in order to assess the current status of theherbal medicinal practice (8,10).

Results demonstrated that, unfortunately, most practitioners have very limited knowledge about herbal medicine and younger practitioners had even poorer knowledge than their older

counterparts, while many practitioners are turning to ‘mystical’ or ‘magical’ methods of healing. In addition, plants used in certain regions are not used in others, the education level of practitioners is in decline, some medicinal plant species are endangered and plant mixtures are

of poorer quality and less variety in comparison to the past (8,10).

As a result of this survey, it became clear that indigenous plant knowledge is disappearing across recent generations. The conclusion to be drawn was clear—that traditional Palestinian medicinal practice is suffering and that in time, if action is not taken to ensure its survival, important parts of this heritage may disappear completely and a wide variety of methods of treating various

diseases may be lost to humanity. The first effort made by the Galilee Society to revive the Palestinian traditional medicinal heritage was the establishment of Al-Maissam.

Al-Maissam, the Galilee Society’s Medicinal Plants Center, was founded in 1999 with main objectives of preserving and rediscovering the ancient Arab legacy of herbal medicine. Its activities include preserving native medicinal plants, preserving and advancing ethnobotany

of the native flora, and spreading this knowledge to all levels of society (especially among the younger generation). It is a unique biotechnology center and the first in our region where modern advanced research is used with traditional Arab herbal medicine, rendering it compatible with modern phytotherapy.

In vitro Studies

In general, in vitro test systems represent the first phase of the evaluation procedure. The in vitro cell culture methods have the advantage of relatively well-controlled variables and are generally accepted as a very effective method for safety testing. Advantages of these systems

over classical methods (such as long term studies on experimental animals) include relatively well-controlled variables, decreased costs, a reduced time to completion, and reduced numbers of animals necessary to complete the study. The fact that cells and tissues in vivo do not exist in isolation but communicate with and are interdependent of neighboring tissue makes it essential to simulate the in vivo situation (13,14).

4 of 6 TAIM, a re-emerging health aid Some studies on this subject were presented during the conference, (21) including anti-colon-cancer effects of Thymoquinone, a natural drug with pro-oxidant activities. Also, promising data was shown about Salograviolide A isolated from the indigenous Lebanese plant Centaurea ainetensis. Salograviolide A causes growth inhibition and cell death in skin cancer cells.

In vivo and Clinical Trials The use of in vivo experimentation and clinical trials are important methods, and despite the limitations of animal experimentation, they are still crucial in herbal

drug development. Developing a therapeutic remedy from herbal origins is a complex process that has to pass through various important preclinical steps. These steps include standardization of the herbal extract, providing evidence of pharmacological activity, and providing evidence of safety.

Pharmacological screening has to be carried out ultimately on laboratory animals and this has many ethical considerations regarding the proper conduct of such screening and the expected value of its outcomes. The use of laboratory animals is unavoidable but should be rationalized through careful planning. Preliminary in vitro testing should give some idea of the possible mechanisms of action and potential therapeutic usefulness of an herbal extract, but obviously has its shortcomings. Such tests provide no information regarding biotransformation of the extract in the body, pharmacokinetic aspects of absorption and fate. To determine potential therapeutic usefulness in a certain disease state, however, appropriate animal models have been developed that mimic the human condition to some extent. Animal models have been developed for many conditions, including hypertension, myocardial infarction, atherosclerosis, ischemia,

bronchial asthma, arthritis, diabetes, Parkinsonism, depression, epilepsy, gastric ulcers, reflux oesophagitis, inflammatory bowel disease, cancer, etc. Extrapolation of results from animal to human should be carried out with great caution. Animal models only mimic the symptoms

in humans, but not the etiology or the overall clinical picture. Thus, it is not possible to say that an extract, which lowers blood pressure in rats rendered hypertensive by L-NAME, where the hypertension is due to endothelial dysfunction, would function as well in a patient whose hypertension is due to any other cause. Streptozotocin induced diabetes in rat is not exactly the same as diabetes in humans: not only is the condition different in etiology, but the human response may be quite different from that of the rat, particularly since diabetes in humans

is normally associated with a number of events that may not be seen in the rat.

The metabolism and pharmacokinetic behavior of active constituents may differ from species to species, and accordingly the interpretation of animal findings may not necessarily be applicable to humans. In general, therefore, animal models are artificially induced conditions said to be analogous to the human diseases they are intended to simulate, but they differ substantially from their human ‘counterparts’ in both cause and clinical course. This also holds true for toxicological studies. Such studies should always be performed according to international guidelines and are a prerequisite for evaluating the safety of potentially useful therapeutic agents.

Market Authorization Regulations for Herbal Products

Regulations are needed to ensure safety, quality and efficacy of herbal medicines. Countries define herbal medicines differently and have adopted various approaches to licensing, dispensing, manufacturing and trading these products. The main differences in the regulations governing herbal medicines in different countries were discussed at the conference. Within Europe, and according to the country using them, herbal medicines are either fully licensed as medicines with efficacy proven by clinical trials, or have a more simplified approach toward proof

of efficacy. In the USA, most herbal products are considered dietary supplements and thus are not required to meet the more stringent standards for drugs specified in the Federal Food, Drugs and Cosmetic Act. These different approaches have resulted in differences in the availability of some herbal medicines.

Acknowledgements

The authors would like to thank Ms Arisha Ashraf and

Ms Jamie Mandell from the Galilee Society, Shefa-Amr,

Israel for their constructive comments.

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An Analytic study of Cancer and Nutrition

Dr. Bhaskar K.S. & Dr. Shweta M.

Cancer is a major health problem, being the second leading cause of death in United States. Recently there has been surge of interest in relationships between Cancer and Diet. Concerns fall in two categories:-

1. Relationship between nutrition and etiology of Cancer.

2.Relationship between diet and progression of Cancer in the host. (1)

In comparison to the number of people who might never develop Cancer if a few changes are made in lifestyle and dietary habits. Diet and environmental factors might be related to 80% of all Cancers. (2,3)

The most common fatal Cancers, Lung, Large intestine and Breast are directly related to either Cigarette smoke or diet. Smoking is the cause of more cancers than any other known substances. A high fat, low fiber diet is linked to Cancer of Bowel and Breast.(4,5)

Additionally, the health of immune system-the body’s defense against infection and disease might be important in protecting the body from the development and growth of abnormal cells. (6)

Nutritional deficiencies, as well as dietary excesses, exert an influence on Cancer growth. It is estimated that diet accounts for up to 70% of all Cancers and is the most influential environmental cause of Cancer in addition to smoking. (7)

The National Academy of Sciences states that “Cancer of most major sites is influenced by dietary patterns”. (8)

Nutrition and Carcinogenesis
Of all the forms of Cancer known, a handful have been associated with diet and nutrition. This is not to say that diet causes Cancer but that under some circumstances diet may influence development of Cancer.

Dietary fat in relation with Breast and other hormone dependent Cancers
Total fat intake has been called an indicator of the risk of Breast Cancer in post-menopausal woman. (9,10)

A mechanism that has been suggested to explain relationship between high fat intake and breast is an altered hormonal environment in which ratio of Prolactin to Estrogen is increased. (10,11)

Woman with Ovarian Cancer consume more fat from whole milk butter and other animal sources and less non-fat milk, margarine and fish than healthy woman.(12,13)
A change in the body’s hormonal state as a result of diet may also be involved in development of other endocrine dependent Cancers, including Cancers of the Prostate and Endometrium, although the relationship is not clear cut. (9,14,15)

Ideal body weight

People who maintain an ideal body weight live longer and are less likely to develop Cancer. (16,17)
Low calorie diets also might reduce the incidence of tumour formation, although this might be caused more by the reduction in total calories. People who are 20% or more above their ideal body weight are more likely to develop Cancers such as of Uterus (16,18), gall bladder, kidney, prostate, cervix, stomach, colon and breast.

Dietary fat
All forms of dietary fat are linked to Cancers. The saturated fats found in foods from animal sources and unsaturated polyunsaturated fats in foods from plant sources and vegetable oils both increase the risk of developing Cancer. (19)

Vegetable oils cannot replace butter in diet, so that the total fat intake should be reduced.
When people consume a diet high in fatty meat and low in fruits and vegetables the risk of cancer increases 8 fold as compared to people who eat a low fat, high fiber diet. (20)

The poly unsaturated fats in vegetables oils are as likely to cause Cancer as saturated fats. Dietary polyunsaturated fats are incorporated into cell membranes in the body. The fats are susceptible to damage, called Oxidation, by highly reactive compounds called free radicals. Free radicals are formed from air pollution, radiation and natural metabolism of proteins. This in-turn can trigger a chain reaction that cause damage to fat and destroys cells and tissues. This process might cause Cancer. (21)

Another type of fat that is linked to Cancer is trans fatty acid found in margarine and shartenig. These fats are found sparingly in nature, but levels can be high in hydrogenated vegetable oils. (22)

Trans fatty acids might impair cell function and they could be involved in development of Cancer. (23,24)

Smokers, a group at high risk for lung cancer might increase this risk by consuming a diet high in Cholesterol .(25)

Colon Cancer
Compounds that act as tumor promoters might be produced when dietary fats turn rancid. The consumption of vegetable oils and other dietary fats that contain same rancid fats can expose the intestine to Cancer causing substances.(26)

Since Cancer patients have altered metabolism, the benefit of nutrition is not as much as in non-Cancer patients. Factors other than poor nutrition are responsible for their low serum albumin; total parenteral nutrition may not increase the serum albumin.(27)

For these reasons, routine intravenous feeding is discouraged. (28)

Experienced clinicians prefer oral feeding or peripheral vein nutrition and resort to central parenteral nutrition only when if absolutely essential.

Incidences of Colon Cancer appears to rise with increasing fat intake of populations; however, the correlation of colon cancer with calories from animal foods is slightly higher than that for fat.(29)

High fat diets increase the release of bile acids from gal bladder. It has been suggested, though not supported by research, that bile acids that have been modified by bacteria within the intestine may contribute to CARCINOGENESIS.

Colon cancer rates are lower in members of certain religious groups who consume a low fat, high fibre vegetable diet than American population.(19)

Meat
Nitrosamines, food additives that are found in processed meat are initiative of Cancer(21).

Meat intake may be related to incidence of Colon cancer for reasons other than its fat content. Frying or broiling meat can result in the formation of PYROGENS, which are mutagenic substances(30).

It is unknown whether methods of cooking meat have a significant effect on colon cancer rates.


Alcohol
It is clear that incidence of specific types of Cancer (Cancer of oral cavity, pharynx, larynx, colon and oesophagus ) is greatly increased in person who both drink alcoholic beverages and use tobacco. Risk of pancreatic cancer may be increased by heavy use of alcoholic beverages, particularly beer (31).

Certain types of alcoholic beverages may increase the risk of specific Cancers because they contain other compounds ,Congeners which increase cancer risk (32).

Evidence is lacking that high alcohol intake contributes to the development of Liver Cancer (33).
One substance known to convert substances in body to Carcinogens is CYTOCHROME P-450,found in the liver. Alcohol increases the level of Cytochrome P-450 and is believed to be linked in to the risk of certain cancers in alcoholics (34).
Beer consumption, but not alcohol consumption, is directly correlated with colon cancer ; the greater the intake of beer the greater the likelihood of colon cancer (35,36).
Alcohol abuse is also associated with a suppression of the immune system, a factor that may make person susceptible to Cancer (35,37).
Alcoholics are known for their poor food intake and poor nutritional status. Alcohol interferes with the absorption of some nutrients and raises requirement for other nutrients. Alcoholics often have low levels of Vitamin-A and Vitamin-C, Folic acid, many B-Vitamins, Zinc and Selenium (38).
Deficiencies of these vitamins and minerals are associated with an increased risk of Cancer.

OTHER SUBSTANCES
Food additives
The general public trends to feel comfortable using food additives which they are familiar such as Salt, Herbs, Spices and Vitamins. Some purpose of food additives are to improve the appearance , texture, storage life of convenience food.

Nitrites and Nitrates
Nitrites and Nitrates are food additives used to preserve and color processed meat. These compounds also occur in nature, especially in beats, celery, lettuce, spinach, radishes and rhubarb. Nitrates can be converted to Nitrites by bacteria in saliva. Nitrites then combine with other substances found in stomach and form cancer causing substances called Nitrosamines. In the areas of World where exposure to these substances is great, there is an increased incidence of cancers of the stomach and oesophagus (8,40).

Cigarettes are high in nitrosamines and the use of nitrogen fertilizers has increased the amount of nitrosamines in water supply. A diet high in Vitamin-C and Vitamin-E can reduce the formation in the stomach of nitrosamines from nitrites (37).

Sugar
A diet high in Sugar is linked to increased risk for developing cancer of breast and bowel. Although these diets also are associated with reduced fibre intake, increased fat consumption and excess Calorie intake, the sugar might exert an independent effect on the incidence of Cancer. (40,41)

Artificial Sweeteners
Many people turn to artificial sweeteners to satisfy their sweet tooth while reducing their calories. Experimental studies on animals show that SACHHARIN, given at high dosages, produce Urinary tract tumors.(37)
This sweetener promotes the action of other carcinogens in the bladder. Saccharine use has increased since Cyclamates were banned in 1970, after studies showed that an increase in bladder tumors. (8)

Saccharine might increase a person’s risk for bladder cancer and as saccharine use increase so does the risk of cancer. The concern over the safety of saccharine has led to an increase in the use of aspartame. It does not appear to have negative effects on human health. (8,37)

Other food additives
More than 3000 chemicals are intentionally added to foods during processing. Another 12000 additives are added unintentionally to foods. These additives such as Vinyl chloride, migrate into foods during the growing , harvesting, packaging or storage of food.

Butylated hydroxyl toluene(BHT) and Butylated hydroxyl anisole(BHA) are preservatives used to prolong the shelf-life of foods.BHT might promote the formation of tumors (37).

No cancer promoting action has been found for BHA.

Natural Carcinogens-
Aflatoxin- A naturally occurring carcinogen is aflatoxin. Aflatoxin is a mold that forms on Corn, Cotton seed, Peanut and Peanut butter when these foods are not well preserved (42).

This substance is believed to be a potent carcinogen that increase risk of liver cancer.
Coffee-The statement that coffee or its caffeine content are linked to cancer has not been supported by research. Excess coffee consumption might be linked to a slight increase in bladder cancer incidence, but these results are not substantiated by studies (37).
The link between coffee consumption and pancreatic cancer also is weak and inconclusive (43,44).

Carcinogens formed during cooking-While a food might not be carcinogenic, the method used to prepare it might cause changes in the food that might make carcinogenic. Frying, Barbecuing or broiling meat or fish at high temperatures can produce cancer promoting substances from the fat and proteins in these foods. Smoked foods, such as ham, sausage, fish or oysters absorb the tars that are produced from the incomplete combustion of fuel. These tars contain several cancer causing substances that are similar to the carcinogenic tars in tobacco smoke. The liquid smoke sold commercially is less hazardous.

Cancer causing substance also have been found in other foods that are browned such as toast and fried potatoes. Dark roasted coffee contains some potential carcinogens (8).

Potentially protective effects of food components
Dietary fibers-The combination of a high fat diet with a low intake of fiber is linked to cancer of the colon (45).

It has been suggested that fiber can provide protection against development of the colon cancer by
1) Decreasing length of time that feces.

2) Diluting the intestinal contents.

3) Absorbing and /or affecting the metabolism of pro-carcinogens or cancer promoting substances, thus retarding the formation of carcinogens. (1)


Fiber also might affect the incidence of breast cancer. Woman who are vegetarians and consume a fiber-rich diet, 28 grams daily, excrete more estrogen than woman who consume the typical American diet containing 12 gram fiber daily. The increased removal of Oestrogen suggests that less Estrogen is reabsorbed (46).
Vegetarian woman also have lower blood levels of other hormones (47).
Vegetarian woman consume a diet containing 30% of fat and thus have a low incidence of breast cancer, compared to woman who eat meat and consume 40% of their calories as fat.

There are many types of fiber and different fibers are found .Hemicelluloses found in whole grain cereals. Gums such as Guar gum, are found in beans, oats, fruits and vegetables. The insoluble fibers, such as cellulose or wheat bran, appear to be the best protectors against cancer. Cellulose and other insoluble fibers might alter the type and activity of bacteria in the intestine and reduce their ability to produce cancer causing compounds. Finally, some cancer causing compounds are formed from bile. Fiber binds to bile and discourages its conversion to harmful substances (48).

Other types of cancer prevention have been attributed to fiber. Pectin decreases the production of certain fatty acids that are known to accelerate the growth of cancer cells in the bowel (49).

Lignin, a fiber in some vegetables has antioxidant properties. Lignin might protect a cell from damage by free radicals and might protect against some forms of cancer. (3, 50)

Vitamin-A—A diet that contains ample amounts of Vitamin-A and its form found in plant sources, Beta carotene, is associated with a reduced risk for developing some cancer including cancer of mouth, larynx, oesophagus, breast, cervix , bladder and lungs (51,52).
Diets that are low in Vitamin-A or Beta carotene increase a person’s risk for cancer (52).

The 2 step process in the development of cancer includes an initiation and a promotion phase. Vitamin-A and Beta carotene play an inhibiting role in both of these phases. Vitamin-A or Beta carotene might—
a)inhibit the growth of abnormal cells so that cancer tissue is unable to form
b)alter immune function and improve the body’s defense against abnormal cell growth
c)strengthen cell membranes and make them less vulnerable to attack or damage
d)or alter cell production so that abnormal cells are less likely to form (52).

Beta carotene might reduce the risk of developing lung cancer. Lung cancer rates are lower in smokers who consume a diet high in fruits and vegetables. When the intake of Beta carotene is low, the incidence of lung cancer in smokers increases (53).

The RDA for Vitamin-A might not be adequate to reduce a person’s risk of cancer (54).
The adult RDA of 4000IU-5000IU is designed to protect against the development of night blindness, which is the classic Vitamin-A deficiency disease. Large dosage for this fat soluble vitamin between 10,000 IU and 25,000 IU, have been suggested to decrease the risk of cancer (54).Because Vit-A can be toxic, large dosage on a routine basis are discouraged.

Vitamin-C-Use of high dosage of Vitamin-C has been promoted for prevention and treatment of Cancer (55,56,57). But these recommendation are based on very shaky evidence (58.59).

It does appear that Vitamin-C may serve to reduce the risk of cancer of Stomach and Oesophagus (59,60,61).

If a source of ascorbic acid is taken with a meal that includes a source of nitrites (e.g. Pickled fish) the production of nitrosamines in stomach is reduced (62).
This is advantageous because nitrosamines are known to be potent mutagens and animal carcinogens.

Vitamin-E- Vit-E’s function as an antioxidant is its primary link in the prevention of cancer. Vit-E might inhibit the the growth of cancer(63).
This fat soluble vitamin reduces the formation of Nitrosamine from dietary nitrites and might reduce the risk for development of stomach cancer (64).
Vit-E also might assist selenium, a mineral that inhibits the development of cancer, when it is present in the diets(65).
The vit-E content of vegetable oils also declines when they are refined and bleached(66).

Folic acid- A folic acid deficiency causes damage to cells that resembles the initial stage of cancer(67).
Preliminary evidence shows that folic acid might prevent the conversion of abnormal cells to cancer cells and might convert damaged cells back to normal ones(68).

Vitamin-B6-Helps strengthen the immune system.The body might have more resistance to cancer when Vit-B6 is present in ample amount(69).
Vit-B6 also might protect against the initiation of cancer(70).

Iron-An iron deficiency might increase a person’s risk for cancer.Adequate iron intake is necessary for the proper function of the immune system, which might explain the link between this mineral and cancer. Iron deficiency also might increase the risk for stomach cancer(64).

Selenium-It’s a trace mineral that might be important in prevention of cancer. People who live in areas where the selenium content of the soil is poor have higher rates for cancer of digestive tract, lung, breast, lymph system than people who live in areas where the soil is selenium rich(71).
Blood levels of selenium are low in people with cancer and people with very low selenium levels have twice the risk for cancer as those with high selenium levels(72,73).
Selenium might protect against cancer in several ways, it is an antioxidant nutrient and apparently prevents cancer by protecting cell membranes from damage by free radicals(73-74).
In addition to its effectiveness as an antioxidant, selenium also might stimulate the immune system and strengthen the body’s defence against disease(75).

Selenium detoxifies Cadmium and mercury, two minerals known to cause cancer(8).
Selenium is available in supplements as the organic forms, such as Selenanethionine or Selenocysteine and the the inorganic form, which is sodium selenite.The organic form of selenium might be toxic and might promote cancer when taken in large doses (76-77).

Zinc-is required
1) for normal formation and regulation of genetic code within each cell.
2)maintenance of healthy immune system.
3) healing of tissues (78).
Whereas adequate intake of Zinc might be important in the prevention of cancer, large doses of zinc might inhibit the immune system and increase the risk for infection and disease(79).
Best dietary source of zinc are whole grain bread and cereals, low fat milk.

NUTRITIONAL CARE & GUIDELINES FOR PREVENTION OF CANCER
Good news about cancer is there is something each person can do to prevent it. Cancer may have several adverse effects on nutritional status for a variety of reasons. Helping the patient to comfortably maintain adequate nutrient intake may help him retain a sense of wellbeing and ability to carry-out activities of daily living. Impaired nutritional status can contribute to impaired function and feelings of depression (80)

CHANGED NUTRIENT REQUIREMENT:
Changes in nutrient, requirements resulting from cancer are unpredictable. Increase in metabolism that may be caused by tumor might be offset by decreased physical activity. If a person’s defense mechanism are impaired and he develops an infection, accompanying fever significantly increases resting metabolic requirement. Considerable variation is seen in resting caloric expenditure of people with cancer, with higher values found in those who are progressively losing weight. No definitive studies of changed micronutrient requirements have been reported for cancer.
It is clear that quality care of person with cancer requires careful assessment of their food intake, eating problems and special emotional and physical needs. Treatment of cancer can have profound effect on a patients nutritional and emotional status. Patient benefits from regular monitoring of changes and continuing support from healthcare providers and family.

DELETERIOUS NUTRITIONAL EFFECTS OF ANTICANCER THERAPY:
Antineoplastic (anticancer) therapy includes radiation therapy, chemotherapy and surgery. All of these lead to malnutrition (82).

Since cancer has come to be viewed as a systematic disease, even when it appears to be localized (83) attempts to cure it are now likely to include treatment with drugs that act systematically as a form of adjunctive therapy.

VALUE OF ADEQUATE NUTRITIONAL STATUS:
Because antineoplastic therapy has many side effects that may interfere with adequate food intake or utilization, a person who is malnourished at the start of therapy is susceptible to developing serious nutritional problems as a result of treatment. Some studies show that person who have lost 6% or more of their usual body weight prior to treatment have significantly reduced response to chemotherapy and decreased survival (83).
It is not known whether weight gain prior to antineoplastic therapy improves a person’s response to treatment. It is hoped that maintaining satisfactory nutritional status during therapy improves a person’s response to treatment and will reduce symptoms of fatigue, weakness and depression that are associated with under nutrition. Thus, intensive nutritional support can be an important aspect of care.

DIETARY PATTERN THAT REDUCE RISK FOR DEVELOPING CANCER:
a)Maintaining ideal body weight:
The best method of weight control, besides exercise is to eat less fat and fatty food. A person can eat more food and lose weight if low fat foods are included in diet to replace the fatty foods. Maintenance of normal body weight is associated with a reduced risk for developing cancer (8).

b)Reducing dietary fat:
Fat consumption must not be more than 30% of total calorie intake if risk for developing cancer and other disease is to be reduced (8, 9).

i)Two third to three quarter of the food in the diet should come from foods from the plant sources such as fresh fruits & vegetables, whole grain breads & cereals, and dried beans & peas. These foods are high in fiber and low in fat & sugar.
Fruit and vegetable are good dietary source of Vit. A and Vit. C. A rule of thumb is three out of every four food or three quarter food on the plate should be foods from the plant sources.

ii) Low- fat and non- fat dairy foods should be emphasized rather than fatty dairy food to reduce the intake of saturated fat & cholesterol. The change from whole milk dairy food to low-fat or non-fat should be gradual

iii)Vegetable oil, butter. And other fats should be used sparingly. In cooking bake, steam or broil the foods.

c)Increasing the dietary fiber:
Recommendation for reducing fat in the diet will increase fiber intake. Not all the grains in the diet have to be whole grain, however at least half of the grain in the diet should be from the whole grain variety to guarantee adequate fiber intake.
Fresh fruits and green vegetables to be consumed adequately. Excessive consumption of fiber might reduce the absorption of some mineral and irritate the intestinal tract. The estimated safe and adequate amount of fiber that can be consumed daily is between 35-45 gm (84).

Example:
*6 serving of whole grain bread/roti, cereals & pasta.
1 serving=1 slice of bread, ½ cup cooked cereal or pasta, 1 cup whole grain cereal= 13 gm fiber.

*4 serving of fresh fruits and vegetables.
1 serving=1 piece of fruit or vegetable, 1 cup raw or ½ cup cooked = 15-23gm fiber.

*1 serving dried beans or peas.
1 serving =1/2 cup cooked =9 gm fiber

TOTAL == 37-45gm Fiber




d)Increasing intake of food high in Vit A & Vit C.
Vit A comes in two major form :

Retinol- animal source / origin.

Carotene- (B- Carotene) found in fruits and vegetables.

The Vit C content of food is easily destroyed. To protect this, store food at temperature below 40 degree, cook in a minimal amount of water, use cooking water to make gravies or soup, do not leave food out in air or under heat lamps.

1)Add a salad to daily menu.
2)Drink fruit and vegetable juices.
3)Select snacks of raw vegetable and fruit.
4)Serve fruit for dessert.
5)Include atleast one dark green leafy vegetable in the daily menu.


e)Increased intake of cruciferous vegetables.
The cruciferous vegetables including cabbage, broccoli, cauliflower contain more than just fiber, VitA, Vit C. Cruciferous vegetables contain cancer fighting substance called Indoles.
Therefore include several servings of these vegetables in the weekly menu.

f)Avoid salt-cured and smoked foods & foods that might cause cancer.
No diet is completely free of cancer –promoting substances.It is possible , however to minimize these substances while increasing the nutrients that protect against cancer, such as fiber, Vit A , Vit C.

Avoid cooking methods that promote the formation of cancer causing substance.

Examine nuts in their shell for freshness before eating; old peanuts &other nuts might contain aflatoxin, a potent carcinogen. Some non nutritive sweetener such as saccharine might increase the risk for developing cancer. These should be avoided.


THE ANTI-CANCER DIET:

* A high fiber low fat diet will provide ample amount of nutrients that fight cancer, such as Vit A & Vit C, as well other nutrients such as Vit D, Vit E, folic acid, VitB6, iron,selenium, zinc.
* This diet has only minimal amount of dietary component that encourage cancer.
* A reduction in fat is good way to reduce unnecessary calories and maintain a healthy weight.



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Quit Smoking with Acupuncture

By: Diane Joswick, L.Ac., MSOM

Each year, people across the globe vow to finally quit smoking for good only to watch their resolution go up in smoke. If you have tried to quit smoking, you know how difficult it can be. It is hard because nicotine is a powerful addiction. For some people, it can be as addictive as heroin or cocaine.

Acupuncture as an alternative approach to smoking cessation has a growing number of converts. In fact, acupuncture is often a court mandated treatment for drug addicts because of its ability to curb withdrawal symptoms and manage cravings.

It is estimated that most smokers will attempt to quit 2 or 3 times, or more, before finally kicking the habit. When conventional methods to quit smoking, such as nicotine gum or patches, have failed, smokers often look outside the mainstream and turn to alternative medicine.

Acupuncture is not a panacea or a magic cure in the treatment of any addiction, including smoking. But, acupuncture is effective in making it easier to quit and remain smoke-free. If you are highly motivated and ready to quit, acupuncture can empower you to take control and begin a healthy and smoke-free life!

A Formidable Addiction

More than 50 million Americans smoke, and nearly 7 million more use smokeless tobacco. The numbers are even higher in other parts of the globe, with worldwide statistics showing that one out of three men and women over the age of 18 are smokers.

The reasons to quit smoking are endless. Cigarettes have 4000 known poisons, any of which can kill in high enough doses. One drop of pure nicotinic acid can kill a man. According to the CDC, tobacco kills more than 440,000 people each year, in the US alone. Not to mention the chronic illnesses and diseases that are associated with smoking. Emphysema, lung cancer, high blood pressure, shortness of breath, chronic cough, an increased frequency of colds and flu; these are just a few of the widely known risks associated with smoking.

Many people decide to quit because of the enormous expense of a cigarette habit or are just plain tired of being dependant on a substance. There is also considerable social pressure not to smoke. I am sure that most smokers can recall a dirty look or rude comment from someone that was nearby when they lit up.

How Does Acupuncture Help Break the Cigarette Habit?

Acupuncture has turned a growing number of cigarette cravers into permanent ex-smokers. As said before, acupuncture is not a panacea or a magic cure in the treatment of smoking. It can, however, reduce the cravings and lessen the withdrawal symptoms associated with quitting.

Oriental Medicine aims to treat the specific symptoms that are unique to each individual using a variety of techniques such as acupuncture, Chinese herbs, bodywork, lifestyle/dietary recommendations and energetic exercises to restore imbalances found in the body.

Your acupuncturist may do an interview to learn about your unique smoking habits and perform a physical examination including blood pressure, taking the pulse and observing the tongue. The emotional and physical symptoms that you are experiencing will help create a clear picture on which your practitioners can create a treatment plan specifically for you.

The acupuncture treatments will focus on the jitters, the cravings, the irritability, and the restlessness that people commonly complain about when they quit. It will also aid in relaxation and detoxification.

What Points Are Used?

Each patient is custom-treated according to his or her specific and unique diagnosis. Usually a combination of body acupuncture points and points on the ear are used that are believed to influence the organs and energetic pathways associated with smoking.

Commonly Used Points for Smoking Cessation include:

Ear points:

Shenmen
Kidney
Sympathetic
Lung Upper and Lung Lower
Hunger or Mouth

Body points:

Tim Mee- an extra-meridian point located on the wrist between LU-7 (Lieque) and LI-5 (Yangxi), a specific point to quit smoking.
The Four Gate Points (LI-4, LV-3)- would be used to circulate energy (Qi) throughout the body and calm the nervous system.
Typical treatments last from five to 30 minutes, with the patient being treated one or two times a week. After removing the needles, ear press needles or silver pellets are often applied to stimulate the points between treatments and reduce cravings.

Are There Herbs To Help Me Quit Smoking?

Often you are prescribed herbs or supplements to control cravings or withdrawal symptoms.
There are three areas to address for herbal support; dryness and tissue repair, irritability and cravings.

A Lung Yin Tonic such as Ophiopogonis Combination (Mai Men Dong Tang) is often used to moisten the lungs and mouth which can prevent cravings and repair tissue damage caused by smoking.

A Chinese herbal formula to calm the spirit may be used for irritability. Bupleurum plus Dragon Bone and Oyster Shell (Chai Hu Jia Long Gu Mu Li Tang) can help relieve irritability and anxiety associated with detox. Many people use this formula to help them through stressful situations and prevent relapses.

Lobelia Tea (Ban Bian Lian) or Green Tea can be sipped daily during the detox period to keep tissues flooded with elements that discourage nicotine cravings. (Lobelia is traditionally used to rid the body of a strong toxin such as a snake bite.)
NOTE: The improper use of Chinese Herbs can be dangerous. Please consult with a licensed acupuncturist and herbologist before taking any herbal products.

What Lifestyle and Dietary Changes Should I Make?

Exercise is encouraged and dietary and support systems are recommended to rid the body of toxins and avoid relapses:

Get plenty of fresh fruit and vegetable juices and miso soup to neutralize and clear the blood of nicotinic acid and to fortify blood sugar.
Carrots, Carrot juice, celery, leafy green salads and citrus fruits promote body alkalinity and decrease cravings.

Avoid junk food, sugar, chocolate, coffee and cooked spinach. They can upset blood sugar levels and increase blood acidity which can aggravate smoking-withdrawal symptoms.


Lobelia Tea (Ban Bian Lian) or Green Tea can be sipped daily during the detox period to keep tissues flooded with elements that discourage nicotine cravings. (Lobelia is traditionally used to rid the body of a strong toxin such as a snake bite.)
Drink water - Research shows that dryness causes cravings. Sip water frequently throughout the day.

Deep Breathing Exercises – to increase body oxygen

How Many Treatments Will I Need and How Long Do they Take?

The length, number and frequency of treatments will vary. Typical treatments last from five to 30 minutes, with the patient being treated one or two times a week. Some symptoms are relieved after the first treatment, while more severe or chronic ailments often require multiple treatments.

A stop smoking program will often consist of 4-6 initial treatments scheduled in the first few weeks followed by monthly treatments for four to six months.