The A4M meeting held each December in Las Vegas is a great show and wonderful prelude to the holidays. Last year's convention held at the Venetian Hotel offered a plush ambience for the medical lectures. One aspect of the A4M meeting that excited me was the nice mix in the exhibition hall of aesthetic-medicine firms with nutritional-supplement companies and diagnostic labs. On display were skin creams that combined nutraceutical ingredients with stem cell therapy support, aesthetic medicine approaches that offered advances in laser and ultrasound technologies, and diagnostic laboratory testing that refined abilities to assess epigenetic functioning with genomic testing. Nutritional supplement companies offered products that ensure improved quality control and whole-food content. It is invigorating for these different medical approaches to be brought under one roof; there is a growing collaboration to utilize aesthetics and functional medicine together in managing the patient.
One innovation on display at the A4M meeting was the vibration exercise machine. The technology is not new – it has been used by Russian cosmonauts as an exercise support to counter the effects of weightlessness in space. Confined to a limited space and reduced gravitational force, muscles will atrophy and bones decalcify. Subjecting the cosmonaut to "vibrational exercise" lessens the risk of muscle wasting and osteoporosis. Of course, these are the observations in healthy, robust individuals who are disciplined to eat well, exercise conscientiously, and perform under stress. How would this technology work for the average public?
In the last few years, a number of manufacturers have designed a variety of vibrational exercise machines. A machine will vibrate rapidly and the vibrational force is translated from the feet throughout the body. One can simply stand or sit while on the machine or hold a variety of positions to work out specific muscle groups. An exercise session is not long – one need only exercise 10 minutes, several times weekly. Theoretically, there are no downsides to using the device, although some manufacturers caution against its use in those with severe disease and recent surgery.
Will vibrational exercise replace regular exercise? Probably not. But it may augment the outcome of regular fitness and prudent dieting in losing weight and building physique. I have opted to buy a device – so I'll do my own personal test!
Hyperbaric Oxygen for Cancer
Another device prominently on display at the A4M meeting was the hyperbaric oxygen chamber. Chambers can be quite large suitable for treating many individuals; at the meeting, the units were for one-person use. Hyperbaric chambers typically deliver 100% oxygen at 1.3 to 2.7 atmospheric pressure. Approved medical use for hyperbaric oxygen includes treatment for the bends; decompression illness; carbon monoxide poisoning; and poorly healing wounds, infections, and burns. In the alternative medical community, hyperbaric oxygen has been widely used for treatment of neurological disorders, including stroke. Many clinics also offer hyperbaric oxygen for treating chronic medical conditions, including cardiovascular disorders and autism. However, conventional medicine has disputed these claims, limiting hyperbaric oxygen use to only those conditions listed previously. Cancer is not an approved use. But is there evidence that cancer care may be supported by hyperbaric oxygen?
At the A4M meeting, Mark Rosenberg, MD, chairman of A4M's cancer fellowship program, reviewed the evidence for hyperbaric oxygen use in treating cancer. Otto H. Warburg observed that cancer cells are capable of high rates of energy production through glycolysis. Estimated to be 200 times faster than normal glucose metabolism, glycolysis is greatly accelerated in an oxygen-depleted environment. While no cell can survive without oxygen, tumor cells flourish when oxygen content is minimized. In 1997, Bruce Fenton, MD, at the University of Rochester investigated the effect of increased oxygen on tumors treated with radiation.1 Fenton's examination of mice implanted with sarcoma cells demonstrated that the oxygen content of a tumor varies depending on location; those cells closest to the surface have the highest oxygen content, tumor cells nearest the core have lowest oxygen content. Radiation therapy tends to increase oxygen content within tumor cells, primarily in those closest to the surface but not so well with the core tumor cells. Increasing the oxygen delivery using carbogen (95% oxygen, 5% carbon dioxide) also increases the oxygen content of tumor cells; however, this effect was observed both at the surface and core. When radiation and carbogen were administered together, oxygen content increased throughout the tumor, but most noticeably at the surface. Of particular note was that when radiation alone was administered, the oxygen content increased in a small tumor; however, in a larger tumor, oxygen content was not increased with radiation alone. When radiation and carbogen were combined, the oxygen content increased significantly in larger tumors. Hence, Fenton's work demonstrated that increased oxygen delivery to tumor cells will augment the effect of radiation treatment.
Louis Harrison, MD, at the Beth Israel Medical Center (New York) reviewed the effect of hypoxia when treating tumors with radiation therapy.2 Harrison's review confirmed that many solid cancers, including head and neck, lung, prostate, and cervical cancers, have intratumor hypoxia. The combination of a decreased oxygen concentration and a slight-ly acid environment increases tumor metabolic activity, accelerating new cancer cell formation. Experimentation with cell cultures has demonstrated a lower rate of new tumor cell formation and higher cellular repair following ultraviolet irradiation if the intratumor oxygen concentration (pO2) was greater than 10 mm Hg. When patients with metastatic cervical cancer underwent pelvic irradiation, there was significant improvement in outcomes at 19 months if the intratumor pO2 was greater than 10 mm Hg. Harrison's review indicated that some early studies done with hyperbaric oxygen did indicate improved outcomes when treating patients with radiotherapy. However, a number of subsequent published reports did not show similar benefit. Further, Harrison suggested that carbogen administration could potentially offer the same benefit more conveniently and with less expense.
This past summer J. Paul Duic, MD, of the Long Island Brain Tumor Center announced a plan to study the effect of hyperbaric oxygen as an adjunctive treatment for glioblastoma. Preliminary observational work in Japan has demonstrated shrinkage of the brain tumor when hyperbaric oxygen was added to treatment regimens. There was evidence of improved survival rates with less toxicity.
Dr. Rosenberg concluded his A4M lecture by commenting that hyperbaric oxygen may play a more important role in the future in treating cancer. Physicians interested in additional training and specialization in managing cancer with nutrition and alternative medicine should consider enrolling in A4M's cancer fellowship program.
Barbara MacDonald on Treating Breast Cancer
In my early days of medical practice, I recall having the simplistic sense that the program which I would offer women with breast cancer would make a big difference. It was a kitchen-sink approach, throwing everything at the patient: restrictive diet, cleansing, exercise, supplementation such as high-dose vitamin C and proteolytic enzymes, IV therapies, and treatment protocols developed by the great cancer healers. In spite of my hubris, there was the occasional success. But as Dr. MacDonald points out, 82% of women with breast cancer survive more than 10 years. Most of my patients would have survived without my 2 cents.
How should the naturopathic or alternative physician counsel a patient with breast cancer? First, Dr. MacDonald would advise that the usual medical diagnostics should be undertaken to determine the course of conventional treatment. Once those modalities have been completed, naturopathic care would be implemented, including complementary care, "basic naturopathic care," followed by "individualized, constitutional treatment." MacDonald divides constitutional treatment into three areas: detoxification, inflammation care, and stress support. She emphasizes that if drug treatment is employed such as an estrogen-receptor modulator like tamoxifen or an aromatase inhibitor, it is critical that botanical and nutrient therapies not interfere with the drug effect. Botanicals that act synergistically with the drugs should be emphasized. Diet and lifestyle modification are also essential for healing.
Dr. MacDonald's review is a cogent and concise guideline for treating and educating the breast cancer patient. Her book, The Breast Cancer Companion: A Complementary Care Manual, is an important read for those wanting a more complete review.
Jonathan Collin, MD
1. Fenton BF. Effects of carbogen plus fractionated irradiation on KHT tumor oxygenation. Radiother Oncol. 1997;44:183–190.
2. Harrison LB, Impact of tumor hypoxia and anemia on radiation therapy outcomes. Oncologist. 2002;7(6):492–508.