Dear Readers,

Welcome to the Spring and the April 2017 issue of TotalHealth Online.

We begin with an article by Hannah Hunt, Senior Analyst, American Wind Energy Association on, "Wind Power Grows America's Economy And Keeps Our Air Clean." Letting us know the value of the wind industry in employment numbers, its reach across 50 states, and the environmental impact.

For a short summary we quote from Dallas Clouatre's, PhD, article, "Aging And The Mitochondria,"—"Although the importance of the mitochondria as a central point of health has been accepted for decades, over the last few years the understanding of the mechanisms involved has changed significantly. Twenty or ten years ago, antioxidants and the free radical theory of aging largely dominated thinking. Today, the importance of mitochondrial biology linking basic aspects of aging and the pathogenesis of agerelated diseases remains strong, yet the emphasis has changed. The focus has moved to mitochondrial biogenesis and turnover, energy sensing, apoptosis, senescence, and calcium dynamics."

Jacob Teitelbaum, MD, states in, "The Food—Mood Connection" that the Standard American Diet is causing widespread nutritional deficiencies, along with an epidemic of anxiety and depression. In addition to a diet including fish, meats, and fruits and vegetables, he shares with readers the key nutrients, "which I take myself each day to turbocharge energy and optimize health, while also leaving me being a calm, happy soul."

Elson Haas, MD, presents, "Ten Tips For A Healthy Spring." The Five Keys to Staying Healthy—your Nutrition, Exercise, Stress, Sleep and Attitude. He suggests focusing on those five keys—those areas of your life that need improvement. Haas is also an advocate of Detoxification and through his books has addressed this topic.

Gene Bruno, MS, MHS, RH(AHG), in "Heartburn & Indigestion," addresses the frequently occurring symptoms of diarrhea, heartburn, abdominal cramps and pain, gas distress, and nausea. Included is a list of primary and secondary supplements, which may offer relief if you suffer from the symptoms mentioned above.

Gloria Gilbère, CDP, DAHom, PhD, shares her recipe for "Green Banana Soup (Repe Lojano)." She explains being located in Ecuador they use plantains but if they are unavailable bananas will do. Gilbère includes all the health benefits of the ingredients and we hope all this information will give you the motivation to try her recipes.

Charles Bens, PhD, in "The Early Diagnosis And Treatment of Alzheimer's," contributes information on things for Prevention, Detection and a New Treatment. It's engaging.

In Pet Care, Shawn Messonnier, DVM, contributes Part 4 of the four part series on cancer. This month's article focuses on, "Antioxidants and Conventional Therapies." Pet owners will find this information helpful.

Best in health,

TWIP The Wellness Imperative People

Click here to read the full April issue.

• Environmental News:
  Wind Power Grows America's Economy And Keeps Our Air Clean
  Hannah Hunt
• Aging And The Mitochondria
  Dallas Clouatre, PhD
• The Food—Mood Connection
  Jacob Teitelbaum, MD
• 10 Tips For A Healthy Spring
  Elson Haas, MD
• Heartburn & Indigestion
  Gene Bruno, MS, MHS
• Green Banana Soup (Repe Lojano)
  Gloria Gilbère, CDP, DAHom, PhD
• The Early Diagnosis And Treatment of Alzheimer's
  Charles K. Bens, PhD
• Cancer In Pets, Antioxidants And Conventional Therapies
  Shawn Messonnier, DVM

Click here to read the full April issue.

The n/d diet—Hill's Pet Food Company introduced the first cancer diet for dogs called n/d. The diet contains increased protein and fat, decreased carbohydrates, increased omega-3 fatty acids, and increased arginine. The composition of the diet is: protein, 37 percent; fat, 32 percent; carbohydrates, 21 percent; arginine, 3.1 percent (647 mg/100 kcal); omega-3 fatty acids from fish oil, 7.3 percent (1518 mg/100 kcal). In controlled studies dogs with lymphoma (lymphosarcoma) that were being treated with chemotherapy and being fed n/d had increased survival times when compared with dogs being treated with the same chemotherapy medications and eating a controlled diet.

Similar findings were found for dogs with nasal and oral cancer that were treated with radiation therapy and eating n/d. The conclusions from this study showed that: survival time increased 56 percent; quality of life improved due to decreased pain from dogs treated with radiation; remission periods were longer; and metabolic changes seen in pets with cancer were reversed.

While these findings are quite impressive, there is no evidence this diet helps dogs or cats with other forms of cancer. Despite this need for additional research, it is likely any pet with any type of cancer could benefit from this or similar diets. However, there are three potential problems with diet n/d:

1. It is an expensive diet, especially for owners of large breed dogs.
2. It is only available in a canned variety, most likely due to the high fat content.
3. The protein source is an animal by-product, beef lung. (Owners who desire the most holistic and natural diet possible might object to this protein source.)

A homemade diet that approximates n/d can be attempted. However, due to the high level of omega-3 fatty acids in the food it is difficult (if not impossible) and expensive to prepare a similar diet at home.

Tofu (soy protein) protects the intestinal tract from damage that could occur with certain chemotherapy drugs and result in diarrhea. While not proven, tofu diets might be preferred for pets with cancer, especially those whose treatment regimen includes chemotherapy.

The homemade anticancer diet for dogs should have the following nutrient levels: protein, 35 to 40 percent; fat, 30 percent; carbohydrates, 20 percent. Cats can have higher protein and fat levels and minimal or no carbohydrates (cats do not have a strict dietary carbohydrate requirement). Antioxidants can be added to the diet. However, high doses might interfere with any chemotherapy medications, such as doxorubicin (Adriamycin), that work to kill cancer cells by oxidation. Several studies indicate high levels of antioxidants may help cancer cells grow and spread. For example, one study showed that cancer cells contain high levels of vitamin C, probably serving as an antioxidant to protect the cancer cell from oxidation. Because of the possibility of high levels of antioxidants interfering with treatment or cure, you should discuss this topic with your pet's oncologist prior to using increased levels of antioxidants.

Arginine decreases tumor growth and spread (metastasis); supplemental arginine is useful for pets with cancer. Glutamine may retard the cachexia (wasting) seen in many pets with cancer and may help protect against intestinal injury. However, some experimental studies have shown no benefit and occasionally increased vomiting or diarrhea in pets supplemented with glutamine. At this time, there is no clear-cut evidence for or against glutamine supplementation. The need for glutamine will vary from case to case.

Other recommendations include adding 60 to 100 mg of Coenzyme Q10 and 500 mg of vitamin E /450 kcals of food. The precaution mentioned above concerning antioxidants should be heeded.

Finally, many holistic veterinarians will add fresh vegetables (especially those high in indoles and antioxidants), such as broccoli, kale, cabbage, and fresh garlic. Other supplements can be used as needed. Your veterinarian can decide which additional supplements might be helpful after consultation with you and a thorough examination of your pet.

Diet For Dogs With Cancer

Note: Before you start to feed your dog or cat a home-prepared diet, it is strongly recommended you discuss your decision with your veterinarian or a holistic veterinarian in you area. It is essential you follow any diet's recommendations closely, including all ingredients and supplements. Failure to do so may result in serious health consequences for your pet.

• 1/2 cup raw tofu
• 1 cup boiled lentils
• 2 cups potatoes boiled with skins
• 2 teaspoons chicken fat or canola oil
• 1/10 teaspoon salt

Multivitamin/mineral supplement

This diet provides 775 kcal and supports the daily needs of a 25-pound dog. It also provides 43.9 gm of protein and 22 gm of fat. Adding 2 tablespoons canned sardines increases the protein content by 6.2 gm and fat content by 4.6 gm.

Variations

1. 1. Add arginine at 647 mg/100 kcal of food.
2. 2. Add omega-3 fatty acids (fish oil) at 1518 mg/100 kcal. This is very difficult to do, as the average omega-3 fatty acid capsule contains 180 mg. Work with your doctor to increase the fatty acid content as much as possible (adding fish such as salmon to the diet can help achieve this goal.)
3. 3. Occasionally substitute 1/3 pound of cooked chicken, turkey, or lowfat beef for the tofu (in which case the lentils can be eliminated).
4. 4. Occasionally substitute 2 cups rice or macaroni for the potatoes.
5. 5. Add fresh, raw or steamed vegetables to increase the level of natural vitamins and minerals, as well as add flavor. Most vegetables provide approximately 25 kcal per 1/2 cup.
6. 6. Add 4 bonemeal tablets (10-grain or equivalent) or 1 teaspoon of bonemeal powder to supply calcium and phosphorus with a multivitamin/mineral supplement. Follow the label instructions. Alternatively, use a natural product from Standard Process (1 Calcifood Wafer or 2 Calcium Lactate tablets) for each 2 bonemeal tablets.
7. 7. When possible, use natural vitamins made from raw whole foods, rather than synthetic vitamins (although both can be used in combination), as the natural vitamins also supply plant phytochemicals, enzymes, and other nutrients not found in chemically synthesized vitamins. Use either Catalyn from Standard Process (at a dose of 1 Catalyn per 25 pounds) or Canine Plus from VetriScience (following label dosages) as the natural vitamin in this recipe.

Diet For Cats With Cancer

• 1/2 pound chicken
• 1/2 large hard-boiled egg
• 1/2 ounce clams, chopped in juice
• 4 teaspoons chicken fat or canola oil
• 1/8 teaspoon potassium chloride
• 100 mg taurine

Multivitamin/mineral supplement

This diet provides 471 kcal, 53.1 gm of protein, and 27.4 gm of fat and provides the daily needs for a 15-pound cat.

Variations

1. Add arginine at 647 mg/100 kcal of food. This is a recommendation for dogs and has not been proven in cats.
2. Add omega-3 fatty acids (fish oil) at 1518 mg/100 kcal. This is very difficult to do, as the average omega-3 fatty acid capsule contains 180 mg. Work with your doctor to increase the fatty acid content as much as possible (adding fish such as salmon to the diet can help achieve this goal). This is a recommendation for dogs and has not been proven in cats.
3. Occasionally add . cup rice, macaroni or potatoes. However, cats do not have a proven need for dietary carbohydrates, and adding additional carbohydrates supplies substrate (food) for cancer cell.
4. Add fresh, raw or steamed vegetables to increase the level of natural vitamins and minerals, as well as add flavor. Most vegetables provide approximately 25 kcal per . cup. Many cats, however, will not eat vegetables.
5. Add 3 bonemeal tablets (10-grain or equivalent or 3/4 teaspoon of bonemeal powder to supply calcium and phosphorus with a multivitamin/mineral supplement, following the label instructions. Alternatively, use a natural product from Standard Process (1 Calcifood Wafer or 2 Calcium Lactate tablets for each 2 bonemeal tablets) as the natural vitamin in this recipe.
6. When possible, use natural vitamins made from raw whole foods, rather than synthetic vitamins (although both can be used in combination), as the natural vitamins also supply plant phytochemicals, enzymes, and other nutrients not found in chemically synthesized vitamins. Use either Catalyn from Standard Process (at a dose of 1 Catalyn per 10 pounds) or NuCat from VetriScience (following label dosages) as the natural vitamin in this recipe.

Omega-3 Fatty Acids

Omega-3 fatty acids-eicosapentaenoic acid (EPA) and docosahexaenoic acid (DHA)-are derived from fish oils of cold water fish (salmon, trout, or most commonly menhaden fish) and flaxseed. Omega-6 fatty acids-linoleic acid (LA) and gamma-linolenic acid (GLA)-are derived from the oils of seeds such as evening primrose, black currant, and borage. Often, fatty acids are added to the diet with other supplements to attain an additive effect.

In transplanted tumor models, omega-3 fatty acids reduced tumor development while omega-6 fatty acids stimulated tumor development. Omega-3 fatty acids have been shown to inhibit tumor growth as well as the spread of cancer. Reduced radiation damage in the skin was also seen following supplementation with omega-3 fatty acids.

The use of omega-3 fatty acids can promote weight gain and may have anticancer effects, and warrants special mention. In people, the use of omega-3 fatty acids, such as those found in fish oils, improves the immune status, metabolic status, and clinical outcomes of cancer patients. These supplements also decrease the duration of hospitalization and complication rates in people with gastrointestinal cancer. In animal models, the omega-3s inhibit the formation of tumors and metastasis. Finally, omega-3 supplementation shows anticachetic (anti-wasting) effects.

Note: Flaxseed oil is a popular source of alpha-linoleic acid (ALA), and omega-3 that is ultimately converted to EPA and DHA. However, many species of pets (probably including dogs) cannot convert ALA to these other more active non-inflammatory omega-3s. Also, flaxseed oil contains omega-6, which are not recommended in pets with cancer. In one study in people, flaxseed oil was ineffective in reducing symptoms or raising levels of EPA and DHA. While flaxseed oil has been suggested as a less smelly substitute for fish oil, there is no evidence that it is effective when used for the same therapeutic purposes as fish oil. Therefore, supplementation with EPA and DHA is important, and this is the reason flaxseed oil is not recommended as the sole fatty acid supplement for pets.

While many doctors use fatty acids for a variety of medical problems, there is considerable debate about the use of fatty acids. The debate concerns several areas.

Dosages
What is the "best" dose to use in the treatment of pets? Most doctors use anywhere from two to ten times the label dose. The recommended dosage for pets with cancer is approximately 1500 mg/100 kcal of food. In order to get this dose, depending upon the product selected, you would need to feed your dog about five capsules per 100 kcal of diet. This is a LOT of fatty acid capsules!

Is supplementation with fatty acid capsules or liquids the best approach, or is dietary manipulation preferred for treatment of cancer? There is one diet, Prescription Diet n/d, made for dogs with cancer. This diet contains the "proper" amount of omega-3 fatty acids, and it is impossible to add enough fatty acids in the form of supplements to equal the amount found in this diet. However, the protein source, beef lung, is not the most wholesome protein source, which is a concern for holistic pet owners. Many owners use some of the n/d with a homemade diet plus additional fatty acids to achieve a compromise.

Studies done in dogs with lymphoma and nasal tumors have shown that dogs eating the n/d showed increased disease-free intervals and survival times when compared with similarly treated dogs not eating this diet. While research has not been reported in dogs with other cancers or in cats with cancers, it is recommended to use fatty acid supplementation in pets with any kind of cancer due to the potential benefit.

Fish Oils For Pets

Since fish oils can easily oxidize and become rancid, some manufacturers add vitamin E to fish oil capsules and liquid products to keep the oil from spoiling. (Others remove oxygen from the capsule.)

The bottom line is there are many questions regarding the use of fatty acid therapy. More research is needed, as well as the proper dosage needed to achieve clinical results. Until definitive answers are obtained, you will need to work with your doctors to determine the use of these supplements for your pet.

Fish oil appears to be safe. The most common side effect is a fish odor to the breath or the skin.

Because fish oil has a mild "blood-thinning" effect, it should not be combined with powerful blood-thinning medications, such as Coumadin (warfarin) or Heparin, except on a veterinarian's advice. Fish oil does not seem to cause bleeding problems when it is taken by itself at commonly recommended dosages. Also, it does not appear to raise blood sugar levels in people or pets with diabetes.

Flaxseed Oil For Pets

Flaxseed oil is derived from the seeds of the flax plant and has been proposed as a less smelling alternative to fish oil. Flaxseed oil contains alpha-linolenic acid (ALA), an omega-3 fatty acid that is ultimately converted to EPA and DHA. In fact, flaxseed oil contains higher levels of omega-3 fatty acids (ALA) than fish oil. It also contains omega-6 fatty acids.

As mentioned, many species of pets (probably including dogs and cats) cannot convert ALA to these other more active non-inflammatory omega-3 fatty acids. In one study in people, flaxseed oil was ineffective in reducing symptoms or raising levels of EPA and DHA. While flaxseed oil has been suggested as a substitute for fish oil, there is no evidence that it is effective when used for the same therapeutic purposes as fish oil. Unlike the case for fish oil, there is little evidence that flaxseed oil is effective for any specific therapeutic purpose.

Therefore, supplementation with EPA and DHA is important, and this is the reason flaxseed oil is not recommended as the sole fatty acid supplement for pets. Flaxseed oil can be used to provide ALA and as a coat conditioner.

Flaxseed oil also contains lignans, which are currently being studied for use in preventing cancer in people. To date, we have no information to recommend their use in pets with cancer.

The essential fatty acids in flax can be damaged by exposure to heat, light, and oxygen. For this reason, you shouldn't cook with flaxseed oil. A good product should be sold in an opaque container, and the manufacturing process should keep the temperature under 100 degrees F. Some manufacturers combine the product with vitamin E because it helps prevent rancidity.

The best use of flaxseed oil is as a general nutritional supplement to provide essential fatty acids. It appears to be a safe nutritional supplement when used as recommended.

Glycoproteins
Glycoproteins are protein molecules bound to carbohydrate molecules. Glycoprotein molecules coat the surface of every cell with a nucleus in the human body. The body uses the glycoproteins on cell surface glycoconjugates as communication or recognition molecules. These communications may then result in other cellular events, including secretion of bioactive substances (interferon, interleukin-1, complement), ingestion of bacteria and cell debris, inhibition of adherence necessary for bacterial infection, and the spread of cancer cell metastasis.

Scientists have identified eight sugars, glycoforms, found on human cell surfaces that are involved in cellular recognition processes. Of the 200 such sugars occurring naturally in plants, to date only these eight have been identified as components of cellular glycoproteins. These eight sugars that are essential for glycoconjugate synthesis (mannose, galactose, fucose, xylose, glucose, sialic acid, N-acetylglucosamine, N-acetylgalactosamine) can be readily absorbed and directly incorporated into glycoproteins and glycolipids.

Research has found specific cell surface glycoforms to be characteristic of many disease conditions. In some people with rheumatoid arthritis, some of these patients' defense cells (IgG antibody) bear malformed glycoproteins. These cells are missing required galactose molecules; the extent to which the galactose molecules are missing correlates with disease severity and reverses in disease remission. In people with cancer, more than 20 different malignancies are known to be associated with characteristic glycoproteins.

Glyconutritional supplements are designed to provide substrates for the body to use in building part of the glycoconjugates on cell surfaces. These supplements, most commonly acemannan and mannose, are designed to make the necessary sugars available to the cells quicker and in greater quantity.

Acemannan is a glycoprotein (a long chain of mannan polymers with random o-acetyl groups) derived from the aloe vera plant that has been shown to increase the body's production of immune-modulating chemicals, including interleukins 1 and 6, and Prostaglandin E2 and tumor necrosis factor alpha by macrophages. Acemannan also enhances macrophage phagocytosis and nonspecific cytotoxicity, which increases the ability of white blood cells (macrophages) to destroy infectious organisms. Glycoproteins such as acemannan also offer antiviral activity as well as bone marrow stimulating activity.

Scientific Evidence
Acemannan has been approved as an adjunct therapy for solid tumors called fibrosarcomas. Intralesional injection into the tumor (2 mg weekly for up to six weeks), combined with intraperitoneal injections (1 mg/kg of body weight given weekly for six weeks, followed by monthly injections for one year), has been shown to be effective in shrinking tumors (via necrosis and inflammation).

All eight of the glycoconjugate sugars are readily absorbed from the intestines when taken orally. Studies has shown intact mannose molecules are rapidly absorbed from the intestine of rats into the blood, elevate the blood mannose levels by 3-to 10-fold, and is cleared from the blood within hours. The conclusion reached was that mannose was absorbed from the intestinal tract into the blood and from the blood into the cells. These studies suggest that dietary mannose may make a significant contribution to glycoforms synthesis in mammals.

Other human and animal ingestion studies show mannose is readily absorbed, and is cleared from the blood over several hours; some of the mannose was incorporated into glycoproteins. After absorption into the blood, glycoconjugate sugars generally become distributed (usually as glycoproteins and glycolipids) into body fluids, organs, and various body tissues.

In one study, healthy humans were given radiolabeled galactose, mannose, or glucose. This study showed galactose and mannose were directly incorporated into human glycoproteins without first being broken down into glucose. The conclusion was specific dietary sugars could represent a new class of nutrients and the use of these nutrients could have important consequences. Therapy with mannose offers a treatment that is easy to administer and is nontoxic.

Most of the essential glycoconjugate sugars have demonstrated an ability to inhibit cancer growth and the spread of tumor cells both in vitro and in vivo (in experiments in pets and people). The ability of the glycoproteins to inhibit tumor growth may be related to their ability to alter the activities of the immune system. Glycoconjugate sugars stimulate white blood cells (macrophages), which secrete interferons. The interferons activate natural killer cells that help eliminate cancer cells. The glycoproteins may inhibit the spread of tumor cells by preventing them from adhering to each other as a result of competitive inhibition of glycoconjugate receptor binding.

Adverse effects caused by glycoconjugate sugars are rare and usually occur when they are injected or when doses greatly exceed levels that would be expected in normal diets. For pets being treated with the most commonly used glycoproteins (acemannan and mannose), side effects would not be expected.

The final part of our cancer in pets series concludes next month. We will discuss the use of antioxidants, and conventional therapies such as surgery, radiation and chemotherapy.

Cancer is among the most feared diseases by pet owner. For many owners, the diagnosis brings grief, uncertainty, fear, and a general feeling of hopelessness.

While it is true that cancers can result in the untimely death of our pets, not all cancers carry a poor prognosis. For example, many solid tumors, if diagnosed early, respond quite well to surgical removal before they have spread. In these instances, early surgery is curative.

Other cancers may not be diagnosed until they have already spread. In these instances, treatment may not cure the pet but instead will provide a comfortable, extended life. In this latter case, the goal is to prolong life, but also ensure the pet is comfortable and has a good quality of life in whatever time remains. For most pets, the diagnosis of cancer is not an immediate death sentence, but rather the chance to begin therapy. Few cancers truly spread quickly. By keeping up with regular veterinary examinations and laboratory tests, early diagnosis of cancer is possible in most dogs and cats.

WHAT CAUSES CANCER IN PETS?

There are actually several recognized causes of cancers in pets.

VIRUSES. In cats, the feline leukemia virus, feline sarcoma virus, and feline immunodeficiency virus directly or indirectly through suppression of the immune system cause cancer.

TOXINS. In dogs, exposure to certain chemicals including 2,4-D can cause cancer. Various food additives have also demonstrated carcinogenic activity in laboratory animals, prompting many owners to prepare food at home or select diets that do not contain these synthetic additives and preservatives.

VACCINATIONS. Doctors are now beginning to realize that in a very small percentage of cats, frequent immunizations may cause certain solid tumors to develop. This is a very controversial topic, and the exact reason why a very rare number of cats that receive vaccinations, or other injectable medications, develop cancer is not known. Current evidence suggests that in genetically susceptible pets, some component of the vaccine, or injection, may cause a local reaction that becomes cancer.

GENETICS. Some pets are genetically prone to cancers. For example, among dogs, the Boxer is well known to develop cancers at a much higher rate than other breeds. Large breed dogs such as Retrievers have a higher incidence of malignant tumors of the spleen and liver. These examples may be a result of the inheritability of certain types of cancers, similar to the situation that occurs with some types of cancers in people (retinoblastoma) that occur as a result of genetic defects.

AGING. Most cancers occur in older pets. The exact reason is not known, but it seems that these older pets may have decreased functioning of the immune system.

Normally, as cells divide, mutations arise. In most pets, these abnormal, mutated cells are killed by their immune systems. Cancers arise when the immune system fails to kill these mutated cells. This seems to occur at a higher frequency in older pets. On a cellular level, here is how cancer forms and spreads.

It is know that malignant cellular transformation is associated with a series of genetic changes occurring within the cell. Cells contain proto-oncogenes, normal sequences of DNA, which regulate cellular responses to external signals that stimulate cell growth and reproduction. Proto-oncogenes are called simply oncogenes if their level of expression is altered so that the cell gains the potential for malignant transformation. Oncogenes may be activated in an aberrant manner in several ways, including:

• Point mutations can occur as a result of cell damage, altering the behavior of normal genes.
• Amplification of oncogenes can occur, altering the processing of cellular signals.
• Tumor suppressor genes, normally acting to restrict cell proliferation, can be diminished, allowing the formation and spread of cancer.

Once these cellular defects occur, mutated (cancerous) cells can reproduce and spread, causing what is called "cancer."

PRINCIPAL NATURAL TREATMENTS FOR PETS
The main natural treatments are designed to boost the immune system and reduce the spread of cancer. These can be used in conjunction with conventional therapies, as they are unlikely to be effective by themselves in most patients. The natural treatments are widely used with variable success but have not been thoroughly investigated and proven.

NATURAL DIETS FOR PETS
While there are few controlled studies showing the value of diet in supporting the pet with every type of cancer, there are studies showing the benefits of dietary therapy when combined with conventional therapies in dogs with lymphoma and nasal tumors. Since this diet is designed to reduce the growth and spread of cancer, it is often recommended for dogs and cats with any type of cancerous disease.

Studies demonstrate that both people and pets with inadequate nutrition cannot metabolize chemotherapy drugs adequately, which predisposes them to toxicity and poor therapeutic response. This makes proper diet and nutritional supplementation an important part of cancer therapy. There are several metabolic derangements common in the cancer patient. First, cancer patients often have hyperlactatemia (increased lactic acid in the blood). Additionally, since metabolism of simple carbohydrates produces lactate, a diet with a minimum of these carbohydrates might be preferred.

Research has shown a pronounced decrease in certain amino acids such as arginine in the plasma of cancer patients. If left uncorrected, these amino acid deficiencies could result in serious health risks to the patient. Supplementation with the deficient amino acids might improve immune function and positively affect treatment and survival rates.

Weight loss often occurs in cancer patients as a result of cachexia (wasting). Most of the weight loss seen in cancer patients experiencing cancer cachexia occurs as a result of depleted body fat stores. Tumor cells, unlike normal healthy cells, have difficulty utilizing lipids for energy. Dogs with lymphoma fed diets high in fat had longer remission periods than dogs fed high carbohydrate diets.

While there are often many treatment options for the various malignancies experienced by our patients, we often overlook the simple aspect of nutrition. Prevention and treatment will in the future most likely focus on nutrition in veterinary medicine, just as our counterparts are now doing in the human medical field. The research is out there: There is no doubt that cancer patients have deranged nutrient metabolism that can negatively affect the outcome of conventional therapies. Additions of omega-3 fatty acids and antioxidant vitamins and minerals to the diet of cancer patients may help improve survival and possibly decrease the chances of pets contracting cancer in those who are currently cancer-free.

Next month we will talk about the different diets available for pets with cancer.

ANTIOXIDANTS FOR PETS

Certain vitamins and minerals function in the body to reduce oxidation. Oxidation is a chemical process that occurs within the body's cells. After oxidation occurs, certain by-products such as peroxides and "free radicals" accumulate. These cellular byproducts are toxic to the cells and surrounding tissue. The body removes these by-products by producing additional chemicals called antioxidants that combat these oxidizing chemicals.

In disease, excess oxidation can occur and the body's normal antioxidant abilities are overwhelmed. This is where supplying antioxidants can help. By giving your pet's body extra antioxidants, you may find it possible to neutralize the harmful by-products of cellular oxidation.

Several antioxidants can be used to supplement pets. Most commonly, the antioxidant vitamins A, C and E, and the minerals selenium, manganese and zinc are prescribed. Other antioxidants, including N-acetylcysteine, Coenzyme Q10, Gingko biloba, bilberry, grape seed extract, and pycnogenol may also be helpful for a number of disorders. There is no "correct" antioxidant to use. Dosage varies with the specific antioxidant chosen.

Following is a brief discussion of a commonly used group of antioxidants called bioflavonoids/proanthocyanidins.

Proanthocyanidins are naturally occurring polyphenolic compounds found in plants; most often products containing proanthocyanidins are made from grape seed or pine bark. Proanthocyanidins are also called pycnogenols or bioflavonoids, a class of water-soluble plant coloring agents. While they don't seem to be essential to life, it's likely that people and pets need them for optimal health. These compounds are used for their antioxidant effects against lipid (fat) peroxidation. Proanthocyanidins also inhibit the enzyme cyclooxygenase (the same enzyme inhibited by aspirin and other nonsteroidal medications); cyclooxygenase converts arachidonic acid into chemicals (leukotrienes and prostaglandins), which contribute to inflammation and allergic reactions. Proanthocyanidins also decrease histamine release from cells by inhibiting several enzymes.

Proanthocyanidins, by potentiating the immune system (via enhancement of T-lymphocyte activity and modulation of neutrophil and macrophage responses), are often recommended for use in the treatment of pets with cancer.

Some research suggests pycnogenol seems to work by enhancing the effects of another antioxidant, vitamin C. Other research suggests the bioflavonoids can work independently of other antioxidants; as is the case with many supplements, there probably is an additive effect when multiple antioxidants are combined. People taking pycnogenol often report feeling better and having more energy. This "side-effect" may possibly occur in our pets as well.

Quercetin is a natural antioxidant bioflavonoid found in red wine, grapefruit, onions, apples, black tea, and in lesser amounts, in leafy green vegetables and beans. Quercetin protects cells in the body from damage by free radicals and stabilizes collagen in blood vessels. Test-tube and animal research also suggests quercetin might be able to help prevent tumors in hamsters or enhance the effects of cancer-fighting drugs.

Quercetin appears to be quite safe. Maximum safe dosages for young children, women who are pregnant or nursing, or those with serious liver or kidney disease have not been established; similar precautions are probably warranted in pets.

In people, a typical dosage of proanthocyanidins is 200 to 400 mg three times daily. Quercetin may be better absorbed if taken on an empty stomach. The suggested dosage of proanthocyanidins complex in pets is 10 to 200 mg given daily and divided into two or three doses. The suggested dosage of bioflavonoid complex in pets is 200 to 1500 mg per day, divided into two to three doses. The actual dosage of each product will vary with the product and the pet's weight and disease condition.

Because some types of chemotherapy and radiation therapy may rely on cellular oxidation for their effects, antioxidants should not be used without veterinary supervision in pets with cancer undergoing chemotherapy or radiation therapy.

CONVENTIONAL THERAPY

Conventional therapies for pets with cancer make use of a combination of surgery, chemotherapy, and radiation therapy.

Surgery For Pets
Surgery is the treatment of choice for solid tumors. Surgery can be curative if the entire solid tumor can be removed before it has metastasized (spread throughout the body by way of blood or lymphatic vessels). In the case of most small skin tumors, surgery is curative. When the entire tumor cannot be removed, surgery can be used to "debulk" the tumor (debulking removes as much of the tumor as possible). After debulking, additional therapy (chemotherapy or radiation) is used in an attempt to kill any remaining cells, as well as any cells that may have already spread from the original cancer site.

But does every tumor need to be removed? Of course not! Many of the pets seen for cancer consultations have benign fatty tumors, cysts, or warts that usually do not require surgical removal. With rare exception (an obvious wart), the only way to determine whether the lump is a benign lesion or a malignant cancer is through a biopsy.

Fortunately, most lumps are easily biopsied in the office with a small needle, in a procedure called aspiration cytology. In this procedure, a small needle, typically a 23 to 25-gauge needle, is gently inserted into the lump. The doctor aspirates a few cells or small amount of fluid, which are placed on a microscope slide, stained, and examined in the office.

Within minutes the doctor can usually tell whether the lump is benign or malignant. Most benign lumps grow slowly if at all and don't usually need removal. Malignant masses should be removed as soon as feasible after additional testing (x-rays, blood tests) has been done to determine if the cancer has spread.

It is vital that all lumps be biopsied! Some doctors diagnose tumors as "cysts" or "fatty tumors" by only looking or feeling the lumps; some of these in fact turn out to be malignant tumors when biopsied. The only mass that can be correctly diagnosed by visual inspection is the common papilloma or wart. All other masses, both benign lumps and cancerous tumors, look and feel the same. If your doctor says the lump doesn't need to be biopsied, get a second opinion!

Some tumors are so large by the time of diagnosis, or are in a location making surgery difficult if not impossible, that surgery is not an option. In these cases, some other form of treatment must be performed. To make the surgery as safe as possible, a thorough diagnostic workup including blood tests must be done prior to anesthesia.

Radiation For Pets
Radiation involves the use of radioactive materials, usually some type of x-ray, to kill the tumor cells. It can be used alone or in combination with surgery or chemotherapy. Radiation is not effective against every type of cancer, so it's necessary to work closely with a radiation specialist to determine which tumors are radiosensitive and are most likely to respond to this form of therapy.

Most pets tolerate radiation therapy quite well, but treatments usually require full anesthesia to administer the radiation. Common side effects of treating tumors with radiation include hair loss, burning of the skin, and discoloration of the skin. A new form of therapy for dogs with lymphosarcoma is whole body irradiation. In this procedure, the dog is anesthetized and half of the body is irradiated. Several weeks later, the procedure is repeated and the other half of the body is irradiated. The procedure has been reported to give dogs with lymphosarcoma a longer life expectancy (two to three years) than with conventional chemotherapy (12 to 18 months). The most common side effects, which last one to two weeks, are nausea, vomiting, diarrhea, and lethargy. Nutritional support and herbal therapies can be useful to minimize side effects of whole body irradiation, as well as any other radiation therapies for the pet with radiosensitive cancers.

Chemotherapy For Pets
Chemotherapy is effective against many but not all tumors. As is the case with radiation therapy, some cancers are sensitive to chemotherapy whereas others are not. Usually the goal of chemotherapy is not to cure but rather to prolong life before the cancer returns. Unlike the case with people, side effects of chemotherapy, such as vomiting and hair loss, are rare. However, pets must be monitored closely for other, more serious side effects. These side effects vary with the actual drug used, but include kidney disease, heart disease, and bone marrow suppression. Working with a knowledgeable cancer specialist is critical. Most pets do quite well with chemotherapy and suffer few side effects. Nutritional support and herbal therapies can be useful to minimize side effects of chemotherapy.