Rapid Evolution: More Than COVID-19

One of the biggest concerns with the coronavirus vaccines has been how effective they will be against variants.  Invariably a spokesperson makes the claim that the vaccine will be effective, albeit probably requiring a booster shot.  Given that we are less than 60% full vaccinated in the US. and much less internationally, “booster” shots are hypothetical as none have been tested or are available.  The term “variant” may conjure up some mutation has taken place modifying the virus over the past year.  More likely, variants represent hardier coronaviruses better able to adapt to ill humans who are incapable of mounting a triumphant defense against infection.  While we think of animals adapting over generations taking relatively long time periods, viruses evolve far more quickly.  The variant plaguing India will undoubtedly predominate the COVID-19 disease-scape in the months ahead. 

In the June 5^th Wall Street Journal a review of Cal Flyn’s new book, Islands of Abandonment: Nature Rebounding in the Post-Human Landscape talks about current and past incidents of rapid floral and faunal evolution. The area surrounding Chernobyl that has been closed off to humans for more than three decades is now replete with wildlife, vegetation, and trees that had been extinguished in the aftermath of the meltdown.  Closer to home, Flyn marvels at the return of certain fish in Newark Bay in New Jersey.  For centuries the tanneries defiled its waters with sulfuric acid, arsenic, and chromium.  Hatters discarded unused mercury there.  In the 1950s polychlorinated biphenyls (PCBS) used as insulators and coolants were dumped in the bay. Herbicides such as Agent Orange and its more lethal byproduct, dioxin, were also discharged there.  Needless to say, the bay waters were so toxic that all fish and oysters died off. 

Flyn writes about the return of the leopard-spotted Atlantic killfish to the Newark Bay in the 1990s.  The killfish perished along with most other fish there in the 1950s.  For the killfish to return meant that some killfish on the Atlantic seaboard had genes capable of adapting to a very toxic brew.  In fact, when scientists compared in 2016 the killfish living in Newark Bay to killfish from non-contaminated waters, they were astounded to find an 8,000% difference in capability of handling toxic chemicals.  For the killfish to survive Newark Bay, those variants needed to evolve over three decades—a rapid transformation for fish. 

Rapid evolution is hardly a 20^th century phenomenon.  In Manchester, England, in the 1840s a butterfly naturalist observed that the peppered moth, typically light and pale colored, was increasingly observed as brown toned.  Apparently, the lichen on trees that the moth favored was increasingly denuded by the toxic smoke and acid rain of the surrounding mills.  The dark color of the moth afforded it safety in blending in with the bark.  When Manchester’s acrid smoke dissipated with improved industrialization the peppered moth resumed its lighter coloration.

An article in Nature in 2011 reported how the tawny owl in Finland changed its primary coloration from a light gray to a dark brown.  Finland has seen a diminishing snow level over the past two decades.  With a lesser amount of snow, the owl’s coloration has changed from gray to brown to better blend in with the trees.  The author suggested that this rapid evolution is the first to be directly attributable to climate change. 

Animals and plants are adapting to the world impacted by our pollution—in certain cases rapidly.  We may not be so adaptable.

Low Dose Naltrexone:  The Simple Drug Ignored by Oncology (and Neurology, Rheumatology, Gastroenterology, Dermatology, Psychiatry, and Pain Medicine)

It’s been well over 30 years since Bernard Bihari, MD, discovered the dramatic effect of low dose naltrexone for stabilizing the immune system in patients with HIV/AIDS.  And it must be emphasized that low dose naltrexone is a very different pharmaceutical from the full dose naltrexone used in treatment of opiate dependency disorders and alcoholism.  Bihari’s work was disseminated slowly in the days before the internet.  One patient with multiple sclerosis, Linda Elsegood, who resided in the UK heard through small patient groups about his work in the US.  After suffering with progressive multiple sclerosis with no effective therapy, she heard about low dose naltrexone.  A general practitioner agreed to prescribe LDN for her; within weeks Elsegood experienced notable improvements.  It is now more than 20 years, and not only is Elsegood’s MS in remission but she has been the primary force and advocate of LDN in the international educational resource group, LDNresearchtrust.org.  LDN has a growing list of clinicians who prescribe it, researchers who study it, and patients using it.  Still low dose naltrexone is being prescribed as an off-label drug, not recognized by the FDA, and largely unknown to doctors and the scientific community.  How can a drug that is beneficial for many medical conditions with minimal adverse effects be so grossly ignored?

This June the LDNresearchtrust.org held its annual meeting virtually.  (While some may miss the getting together of the in-person meeting, there is something to be said about being able to attend a very informative meeting from one’s kitchen table.)  For those who missed the meeting, one can purchase the full presentation and have access to it throughout the year.  LDNresearchtrust.org is also offering a master class to certify LDN prescribers.  CME credit is available for those purchasing and listening to the 2021 meeting. 

This issue we focus on cancer.  While we are well acquainted with the role that LDN plays in treating autoimmune disease and modulating the immune system, using LDN in the treatment of cancer has not been greatly appreciated in its off-label applications.  At the 2021 conference Andrew McCall, MD, a Glascow, Scotland practitioner discussed his experience prescribing LDN.  He discussed a case of a 47-year-old male who presented to him with metastatic melanoma who had undergone six surgical procedures and was given a one-year prognosis.  The patient was treated with immunotherapy, which did provide some benefit in controlling his disease.  Ultimately it proved to be too painful and needed to be discontinued.  Dr. McCall prescribed LDN slowly increasing it to a nightly dose of 4.5 mg.  Gradually the patient’s pain subsided, and he experienced overall wellness.  Dr. McCall has continued to follow him for seven years; the patient shows no sign of recurrence or progressive metastasis.

At the conference Akbar Khan, MD, in Toronto, Canada, discussed several of his 650 patients that he treated with LDN.  His first case was an example of how LDN treatment can directly treat cancer as reported in OHDM in September 2014.¹  A 60-year-old male presented with tongue cancer.  He was advised to undergo radical surgery, including glossectomy, laryngectomy, radiation treatment, and chemotherapy; he refused all of these recommendations.  Instead, he sought Dr. Khan’s care who agreed to initiated LDN.  In addition, he was prescribed high-dose vitamin D3.  The patient responded well to the LDN and vitamin D3; the tongue cancer resolved as documented on MRI and has remained in remission over nine years.  LDN enabled this patient to avoid radical surgery that would have taken away his tongue and voice box.  He had excellent quality of life and did not experience adverse effects.  Why is this treatment being ignored by oncologists?

Khan thinks that LDN is capable of exerting anti-cancer activity by its capability of increasing endogenous opiate methione enkephalin and blocade of opiod growth factor based on the work of Ian Zagon, MD.² However, Khan is more impressed with LDN’s role as an adjuvant treatment in cancer—its ability to act synergistically with other therapies to improve cancer patient outcomes.  As an example, he cites a 63-year-old female who had Stage 2A non-Hodgkin’s lymphoma.  She was initially treated with chemotherapy and targeted immune treatment.  After this treatment was completed, she initiated LDN together with other integrative cancer treatments.  She is alive now seven years later. 

Prof. Angus Dalgleish, professor of oncology at St. George’s, University of London, explains that LDN has both direct anti-cancer effects targeting cancer cells and indirect anti-cancer activity “reeducating” the immune system.  His research has demonstrated that anti-cancer activity is not carried out entirely by increasing endogenous opiate activity.  Instead LDN modulates the “toll-like receptor” (TLR) system acting independently on the immune, endocrine, and neurologic system.  Experimentation has demonstrated that LDN is capable of exerting differing effects on TLR receptors.  The activation of TLR 9 has an inhibitory effect on IL-6.  Because IL-6 drives cancer cell cancer proliferation and growth, its inhibition by TLR 9 exerts a profound anti-cancer effect.³  Prof. Dalgleish’s work should provide ample reason for academicians to research LDN’s activity in cancer treatment.

Cancer:  The Journey from Diagnosis to Empowerment by Dr. Paul Anderson

Most naturopathic physicians and integrative doctors are familiar with Paul Anderson, ND, who lectures extensively.  Anderson has worked closely with cancer patients and their families over the past 20 years.  He and Dr. Mark Stengler are the authors of Outside the Box Cancer Therapies.  Paul’s clinical work has focused on supporting patients who have undergone conventional cancer care, providing supportive strategies and treatment to maintain cancer remission, improve quality of life, and optimize palliative care when cure is not possible.  Anderson’s work was recognized by the National Institutes of Health when he headed a clinical trial.  Beyond the “outside the box” cancer therapies constituting much of Anderson’s work, he has focused on the emotional and mental aspects of the cancer patient’s survival journey.  Such study has led to the publication of his newest book:  Cancer:  The Journey from Diagnosis to Empowerment.

While different cancer diagnosis offers a better or worse prognosis, each patient faces a different cancer course dependent not only on cancer care but on patient mindset, mental wellbeing, and ability to emotionally deal with cancer.  Of course, all patients cringe when confronted with a cancer diagnosis, but how the patient approaches his/her life and treatment depends to a greater degree on acceptance of the diagnosis and an openness to explore mental and emotional impediments to healing.  Those patients who remain angry and convinced of their doom experience more treatment failure than those who are willing to open up to face their fears and past traumas.  We all recognize that mindfulness is an important tool for healing, but how do we get patients and their families to bring this into the healing process?  Anderson points out how not only is this invaluable in the adult with cancer, but it is even more important in the family with a child having cancer.

Dr. Anderson’s shares with us in this issue how we get from diagnosis to empowerment.

Jonathan Collin, M.D.

References

1.  Khan A. Long-term remission of adenoid cystic tongue carcinoma with low dose naltrexone and Vitamin D3 – A case report. OHDM. 2014;13,3.

2.  Donahue R, Zagon I. The opioid growth factor (OGF) and low dose naltrexone (LDN) suppress human ovarian cancer progression in mice.  Gynec Oncol. 2011; 122,2,382-88.

3.  Liu W, Dalgleish A.  Naltrexone at low doses upregulates a unique gene expression not seen with normal doses: implications for its use in cancer therapy.  Int J Oncol.  2016; 49, 2, 793-802.