Healing -From the Inside Out

Wound healing is a stepwise process involving hemostasis, inflammation, and remodeling. During hemostasis, blood platelets release clotting factors and growth factors to help the body create a protective wound scab. This barrier provides a surface beneath which cell movement can occur. Then the process of inflammation brings nutrients to the area, removes debris and bacteria, and provides chemical signals for wound repair. Healing proceeds only after inflammation is controlled. The repair process can then begin to build new skin, fibrous tissue and blood vessels. 

Deficiencies of proteins, vitamins, minerals and fluids may significantly impair the healing process.  Vitamin C (ascorbic acid) found in citrus fruits, tomatoes, green peppers is required for the formation of the connective tissue protein collagen.  The precursor to Vitamin A  (retinol) is found in carrots, cantaloupe, tomatoes, eggs, butter and cheese.  It is essential for cell growth, skin and bone formation and immunity.  The body uses glucosamine to build connective tissue.   Adequate dietary protein is necessary to build new tissue.  Surgical trauma produces a sharp decrease in serum zinc concentration.  Zinc is an important cofactor for enzymes that control the collagen matrix. It has demonstrated anti-infective action, inhibits formation of reactive oxygen species and promotes skin formation.

Healing- From the Outside In

Topical vitamin E and ascorbic acid, calcium D-pantothenate and fibronectin can speed wound healing.  Other novel approaches involve topical application of a mixture of various growth factors (PDGF, TGF-beta, PDAF, PF4, PDEGF) to slow healing wounds. Skin graft donor site healing time has been reduced by 1 day using topically applied epidermal growth factor (EGF).  Zinc oxide in paste bandages (

Pressure is thought to decrease tissue metabolism and increase collagen breakdown within the wound. Silicon gel sheets (applied for 12 hours/day) add pressure and are also thought to work by hydrating the scar tissue. Rehydration softens the scar, thereby making it more flexible and improving the natural repair and flattening process. The newer the scar, the better the result.   Onion extract (Mederma) has shown improvement for hypertrophic and keloids scars.   However, it was ineffective in improving scar height and itching. For this reason, onion extract therapy should be used in combination with a silicon dressing to achieve a desirable decrease in scar height.  Aquaphor is a petroleum based product that has been shown to speed healing of damaged skin.

In summary, each phase of tissue repair can be influenced by nutritional, biological, botanical factors and mechanical approaches.

*Avoid factors that inhibit blood clotting prior to surgery

Cancer is a significant factor in slowing wound repair.  Processes intrinsic to cancer, such as hormonal disregulation, chronic inflammation, nutritional deficits, etc. work against the repair process.  However, addressing these clinical issues and integrating the above approaches  can improve the wound repair process.

References 

Brown, SA. Plast Reconstr Surg. 2004 Jul;114(1):237-44  Oral nutritional supplementation accelerates skin wound healing: a randomized, placebo-controlled, double-arm, crossover study.

Chithra, P.  Mol Cell Biochem. 1998 Apr;181(1-2):71-6.  Influence of Aloe vera on collagen characteristics in healing dermal wounds in rats.

Chung, V. Dermatol Surg. 2006 Feb;32(2):193-7  Onion extract gel versus petrolatum emollient on new surgical scars: prospective double-blinded study.

Diegelmann, R. Front Biosci. 2004 Jan 1;9:283-9.   Wound healing: an overview of acute, fibrotic and delayed healing.

Hosnuter, M.  J. Wound Care. 2007 Jun;16(6):251-4.  The effects of onion extract on hypertrophic and keloid scars. 

Komarcevic , A. Med Pregl. 2000 Jul-Aug;53(7-8):363-8. The modern approach to wound treatment.

Lansdown, A.  Wound Repair Regen. 2007 Jan-Feb;15(1):2-16. Zinc in wound healing: theoretical, experimental, and clinical aspects.

MacKay, D.  Altern Med Rev. 2003 Nov;8(4):359-77  Nutritional support for wound healing.

Mandal, A. J Wound Care. 2006 Jun;15(6):254-7. Do malnutrition and nutritional supplementation have an effect on the wound healing process?

McCarty, M. Med Hypotheses. 1996 Oct;47(4):273-5. Glucosamine for wound healing.

Russell, L. Br J Nurs. 2001 Mar;10(6 Suppl):S42, S44-9.  The importance of patients’ nutritional status in wound healing

Phillips, S.  ASAIO J. 2000 Nov-Dec;46(6):S2-5. Physiology of wound healing and surgical wound care.

Wound Care Links 

http://www.southwestmedical.com/Woundcare_Products/Specialty_Woundcare/CollagenSilicone/574c0

Cancerous tumors are more sensitive to heat damage because they lack efficient ways to dissipate the heat.  Heat also increases oxygen levels within tumors and oxygen in turn helps to naturally suppress tumor growth through a master gene switch called HIF-1 alpha.   Used alone, hyperthermia is effective in shrinking tumors located close to the skin. One such study published in the Annals of Surgical Oncology showed significant tumor size reduction and tumor cell kill in 8 (80%) of 10 breast cancer patients.

Numerous clinical trials have studied hyperthermia in combination with radiation therapy and/or chemotherapy. Many of these studies, but not all, have shown a significant reduction in tumor size when hyperthermia is combined with other treatments (National Cancer Institute website, accessed July 2007).  “Hyperthermia boosts the killing power of radiation and chemotherapy by up to 10 times greater than without heat,” says researcher Mark Dewhirst in a Duke University press release.  Heating tumors before radiation treatment has been shown to shrink the tumors completely in more patients than radiation treatment alone, according to a study by Duke

Most normal tissues are not damaged during hyperthermia if the temperature remains under 111°F. However, due to differences in tissue density, higher temperatures may occur in various spots. This can result in burns, blisters, discomfort, or pain.  Most side effects are temporary. Whole-body hyperthermia can cause more serious side effects, including cardiac and vascular disorders, but these effects are uncommon. Nausea, diarrhea and vomiting are commonly observed after whole-body hyperthermia.

Although hyperthermia is clearly an effective treatment option, variations in instrumentation and clinical study techniques has slowed hyperthermia’s  widespread use as a stand alone method of care. 

Hyperthermia Glossary:  Whole Body Hyperthermia raises body temperature above normal.  Though it does not directly kill tumor cells, it can be used along with chemotherapy to increase its effectiveness. External heat treatment uses applicators positioned around or near the appropriate region, and energy is focused on the tumor to raise its temperature.  Intraluminal or endocavitary methods may be used to treat tumors within or near body cavities, such as the esophagus or rectum. Probes are placed inside the cavity and inserted into the tumor to deliver energy and directly heat the area. Interstitial techniques are used to treat tumors deep within the body, such as brain tumors. This technique allows the tumor to be heated to higher temperatures than external techniques. Under  anesthesia, probes or needles are inserted into the tumor while imaging, such as ultrasound, CT or MRI, may be used for proper probe positioning inside the tumor. The heat source may then be inserted into the probe.

Radiofrequency ablation (RFA) is a type of interstitial hyperthermia that uses radio waves to heat and kill cancer cells.Magnetic thermal ablation uses metallic nanoparticles (biocompatible superparamagnetic nanoparticles) which are excited to produce heat by an external magnetic source. 

Links:

CNBC video on hyperthermia and cancer. 

Directory of International Hyperthermia Treatment Centers 

References:Annals of Surgical Oncology, 2002. 9(4):326-332.Cell Cycle. 2004. 3(8):1027-9.Int J Hyperthermia 2007 May;23(3):315-23.J Clin Oncol. 2005 May 1;23(13):3079-85J Natl Compr Canc Netw 2007 Mar;5(3):345-8.Prostate 2005; 64: 283–292The Oncologist. 2004. 9(suppl 5): 10 – 17. Harnessing Fat to Attack Cancer  1/2/2007  Duke Press release.4/28/05.  Duke Press release

A new study in published in Nature Medicine (June 2007) this week, showed that increasing omega-3 fatty acids by dietary means could reduce the pathological effects of these diseases in an experimental model.  This study supports the clinical trials done in humans that show a connection between improved eye health and dietary micronutrients.

We only have one set of eyes.  They’re not one of those body parts that can be functionally replaced.  To help protect your eyesight here is what you need right now…

Magnesium

Vascular regulation can be improved systemically with magnesium.

Omega-3-fatty acids

Omega-3-fatty acids can improve blood flow regulation in the eye.  Higher intake of omega-3 long chain poly unsaturated fatty acids is associated with decreased likelihood of having AMD and cataract as well as with delaying the progression of intermediate AMD to advanced AMD.  Flax seed oil is an excellent source of omega-3’s and it avoids the concern of mercury toxicity from improperly processed fish oils.

Antioxidants

A formulation composed of vitamins C, E, beta-carotene and zinc used in the Age-Related Eye Disease Study (AREDS) was shown to prevent the development of advanced age-related macular degeneration by 25%.   Antioxidants should be from whole food sources not synthetic chemicals for proper absorption.  I have found one company that produces an antioxidant/multivitamin formula from organic whole foods.  It’s called ‘Complete Life’ . 

Sodium

Reduce your sodium intake.  A high-salt diet may increase the risk of posterior cataract.

Look on the bright side.  A healthy diet and supplementation where necessary can improve your eyesight.  That’s good news for your eyes.

Arch Ophthalmol. 2007 May;125(5):671-9.Am J Ophthalmol. 2007 Jun;143(6):932-939. Curr Opin Ophthalmol. 2003 Jun;14(3):159-62Curr Opin Ophthalmol. 2007 May;18(3):220-3Expert Opin Emerg Drugs. 2007 May;12(2):195-8Nature Medicine 13, 868 - 873 (2007)

In the most basic terms, cancer is defined as the occurrence of heritable mutations in a cell’s DNA that provide growth advantages to the affected cell.  When we look at cancer this way, we can see that the first logical steps in cancer prevention are protecting our DNA from damage, and helping our bodies to repair the damage done.  Factors that can damage DNA include reactive oxygen species (ROS) that are created during the body’s normal metabolic processes, ultraviolet (UV) radiation, x-rays, and certain environmental chemicals such as vinyl chloride, hydrogen peroxide, and polycyclic hydrocarbons from tar and soot.  The damage caused may occur as breaks, mutations or adducts to the DNA.   

Much of the damage that occurs to DNA is quickly recognized and repaired in a healthy body.  Normal p53, p21 and BRCA1 complexes play an integral role in detecting DNA damage, and inducing repair mechanisms.  However, when the damage becomes too severe, or nutritional deficiencies weaken the body’s repair systems, DNA mutations can lead to tumor formation.  One study of middle-aged men suggested that blood selenium levels lower than 100 ng/ml were inadequate for surveillance or repair of oxidative (and other) DNA damage (

 Because damage can occur anywhere in the DNA sequence, the proteins and processes that are affected vary widely.  Some cancers may result from mutations in surveillance proteins, while others may involve disrupted pathways for programmed cell death (apoptosis).  Therefore, preventative approaches to cancer control must bring into play a wide range of complementary  protective mechanisms.   

 Nutrition 

Epidemiologic studies consistently show a correlation between increased fruit and vegetable intake and reduction in the incidence of various cancer types.  The EPIC study followed this association in more than 500,000 men and women (Gonzalez).  This study demonstrated that regular intake of fiber, fruits and vegetables produced a protective effect against colon and rectal cancer, and regular fruit consumption reduced the incidence of lung cancer.   

Many of the benefits of a diet rich in fruits and vegetables are attributed to the complex additive and synergistic effects of phytochemicals that are present in whole foods.  In contrast, research has demonstrated substantial risks in the use of mega-dose, isolated nutrient/vitamin supplements.  Allium and cruciferous vegetables are especially beneficial, with broccoli sprouts providing the densest source of sulforophane.  Protective elements included in a cancer prevention diet should include selenium, folic acid, vitamin B-12, vitamin D, chlorophyll, and antioxidants such as the carotenoids (alpha-carotene, beta-carotene, lycopene, lutein, cryptoxanthin).  Dietary fiber provided by fruit and vegetable intake also plays a crucial role in processing potentially harmful compounds.  For example, estrogen is a potent growth signal for some cancer cells, and in the lumen of the intestines, it is bound by dietary fiber for removal from the body (Goldin).     

Anti-cancer nutrients exert their influence through induction of programmed cell death, competition for estrogen receptors, antioxidant/free radical scavenging, proteasome and aromatase inhibition, anti HIF-1 alpha activity, proliferation/cell cycle inhibition, angiogenesis inhibition, etc.  Certain nutrients can benefit specific organs; for example, the effect of the red pigment lycopene, found in foods such as tomatoes and watermelon, is localized to the prostate gland (Heber).  Recent data clearly demonstrates that specific nutrients can produce effects even at the genetic level.  Indole-3-carbinol is a phytochemical from cruciferous vegetables that has been shown to induce BRCA1 expression, and thereby to inhibit estrogen activity in human cells (Fan).    

Calorie Restriction  

Calorie restriction with adequate nutrient intake contributes to reduction of cancer risk through nutrient sensing pathways and decreased metabolic rate (Heilbronn 2006).  Though the details of these processes have yet to be discovered, the behavior of many genes involved in DNA repair seems to be altered during caloric restriction.  A decrease in metabolic rate reduces the frequency of biochemical reactions in general, and thus the opportunities for DNA damage to occur. 

Physical Activity 

Exercise appears to produce a dose-response reduction in the incidence of colon and breast cancer.  The

 Another important benefit of exercise is in combating the effects of stress.  Excessive stress negatively influences resistance to tumor growth, and some stress-reducing hormones released during exercise, such as corticosteroids or catecholamines, can modulate the ability of immune cells to kill tumor cells.   

Seven Steps Toward Cancer Prevention 

The following simple lifestyle changes can help to protect you and your loved ones from cancer:   

1. Avoid tobacco and side stream smoke.
2. Get regular sun exposure, but avoid excessive UV exposure and sunburn.
3. Consume a variety of phytonutrients/antioxidants from whole food sources.
4. Avoid cured meats with nitrate additives.
5. Be sure that your diet includes adequate amounts of folate and selenium.
6. Stay active, and maintain your proper body mass.
7. Enjoy at least 8 hours of sleep each night.

It is not possible for us to understand all the mechanisms by which lifestyle interventions function for cancer prevention and control.  However, it is good to know that we can supplement our body’s natural health maintenance processes to produce significant and lasting benefits in the years to come.   

Additional

 Chen, S.  Prevention and treatment of breast cancer by suppressing aromatase activity and expression. 

Dallal, CM.  Arch Intern Med. 2007 Feb 26;167(4):408-15.  Long-term recreational physical activity and risk of invasive and in situ breast cancer: the

 Fan, S., et al.  British Journal of Cancer (2006) 94, 407-426.  BRCA1 and BRCA2 as molecular targets for phytochemicals indole-3-carbinol and genistein in breast and prostate cancer cells. Feskanich, D.  J Natl Cancer Inst.  2000 Nov 15;92(22):1812-23.  Prospective study of fruit and vegetable consumption and risk of lung cancer among men and women.  

 Giovannucci, E.  Archives of Internal Medicine.  2005 May 9: vol 165; pp 1005-1010. 

 Goldin, BR.  Cancer.  1994 Aug 1;74(3 Suppl):1125-31.  The effect of dietary fat and fiber on serum estrogen concentrations in premenopausal women under controlled dietary conditions.

 Heber, D.  J Postgrad Med.  2004 Apr-Jun;50(2):145-9.  Vegetables, fruits and phytoestrogens in the prevention of diseases. 

 Holmes, M.  Journal of the American Medical Association (Vol. 293, No. 20: 2479-2486). 

Michaud, DS.   J Natl Cancer Inst.  1999 Apr 7;91(7):605-13.  Fruit and vegetable intake and incidence of bladder cancer in a male prospective cohort. 

A Brief History

“Alternative medicine” was probably the first ‘other medicine’ term to gain popularity in the

By early 2000, larger medical centers began offering complementary medicine programs.  Patients receive the same type of care as before but have the opportunity to receive services such as acupuncture, yoga classes, art and music therapy programs under the guidance of the medical center.  But the evolution was not at an end.  Americans wondered whether these complementary approaches could benefit them not just as an add-on to the standard medical care, but as an integral part of their care.

There was a ‘great divide’ between the two medical systems due to the difference in approach and methodology.  Western trained physicians are not required to study botanical pharmacology or mind-body influences and Western medical schools do not offer alternative medicine certification.  For those practicing in either camp, the possibility that either medical practice has the ability to influence the effects of the other within the body, and the fact that practitioners are often unaware of each other was disturbing.  There was a need to better understand the interplay but more importantly, understand if/how it can benefit the patient. The communication gap needed to be closed. Naturopathic physicians are stepping in to fill this void. Naturopaths are trained in one of four accredited medical colleges in the

From a global point of view, integrative medicine is not new. Other developed nations such as

What to expect in a complementary treatment program.Current complementary medicine programs at institutional treatment centers provide complementary approaches as an option.  Surgery, radiation and chemotherapy are the standard of care for cancer.  Optional treatments may include nutritional support, naturopathic medicine, mind-body medicine, physical therapy, pain management and others.  Clinical trials investigating new treatments may be available (http://nccam.nih.gov/clinicaltrials/alltrials.htm) but these studies cannot accommodate customization. 

What to expect from an integrative medicine program.In the integrative setting, practitioners collaborate in patient care- the team is fully aware of all treatment protocols.  Nutritional therapy, botanical preparations, mind-body medicine and physical therapies are coordinated into a single treatment plan. Examples of current integrative treatments include MRI-guided hyperthermia (heat treatment) in conjunction with radiation therapy of breast cancer,  and botanical adjuvants in standard chemotherapy.    For future and current physicians, the

 Note: Advanced cancer presents special medical challenges.  Therefore, it should be addressed in a facility that has the capacity to diagnose and address complications that may arise. This is essential when considering a treatment center.   

Resources:

Clinical Trials involving Complementary Medicine. 

http://nccam.nih.gov/clinicaltrials/alltrials.htm

Video Clips: Physicians and Scientists from

http://thenewmedicine.org/professionals_and_educators

American Association of Naturopathic Physicians.    http://www.natruopathic.org

Directory of Integrative Cancer Treatment Centers. 

http://www.DrDonnaDouglas.com/consultation.html