This paper is part of NMJ's 2017 Oncology Special Issue. Read the paper or download the full issue here.
There is growing interest among integrative practitioners about the use of intravenous therapies in their practice. In this interview Paul Anderson, NMD, describes the types of therapies being used in oncology and also discusses treatment considerations, contraindications, and research associated with this area of medicine.
Approximate listening time: 26 minutes
In this podcast interview, Paul Anderson, NMD, discusses the use of intravenous (IV) therapies in integrative practice. He offers information and guidance on the most widespread natural IV therapy—vitamin C—as well as some lesser-known ones, based on his 3 decades of experience using them.
Vitamin C IV Therapy
For regulatory reasons and reasons of availability, not all the IV therapies we read about are available in the United States. But vitamin C IV therapy is widely available and used in a lot of integrative practices.
Anderson told Natural Medicine Journal’s publisher, Karolyn Gazella, about the research and clinical evidence behind the use of IV vitamin C.
Vitamin C is unlike many drugs or nutrients in that it has a very different mechanism at different doses. Taken orally or even injected at lower doses, vitamin C is an antioxidant. But when you cross a certain dose threshold intravenously—somewhere around 25 grams—it becomes pro-oxidant. It creates a peroxide burst on the outside of the cells. Normal cells have catalase and other enzymes that can reduce the peroxide. Abnormal cells are often, but not always, catalase-deficient. So the peroxide gets transported into the cell and becomes damaging. Vitamin C administration is partly a cytotoxic—or at least a primer for a cytotoxic event—by being oxidated at those high doses.
Asked whether certain cancers respond better to IV vitamin C than others, Anderson said that in his research he sees more of a difference between individual people than between individual cancer types. If a person is going to respond to IV vitamin C therapy, a change is usually observed within 8 weeks. For people who haven’t seen improvement at that point, Anderson ceases the treatment and looks to other options.
Other IV Therapies
Anderson discussed other IV therapies that are currently being researched and used—some as standalone therapies and some to work synergistically with vitamin C. “In the natural world, just like in the drug world, if you have synergy and you can use it in a safe manner, you get further—especially with advanced cancer,” he said.
Some of the IV therapies showing promise in integrative oncology are the antimalarial medication Artesunate, curcumin, and mistletoe.
The Future of IV Therapies
Looking toward the future, Anderson is encouraged to see more research on IV therapies coming out of even conventional institutions. He sees both clinical observations and research into the mechanisms as essential to the success of integrative IV therapies.
“I think that the future is bright in the respect that people are interested in looking at [IV therapies]. People are interested in some of the positives that natural therapies can do such as decreasing side effects from standard therapy, improving the effect of standard therapy in some cases, and then sometimes in patients where they've exhausted all standard therapies, sometimes a lot of the IV natural therapies are at least improving of their quality if not length of life,” Anderson said.
“If you go back as short as 20 years ago there were so few of us—certainly in North America, but probably the whole world—doing these things. It's exciting to see more people doing it and more people in the traditional research centers looking in.”
And that trend will only be positive for clinicians and patients.
About the Expert
Paul Anderson, NMD, is CEO of the Anderson Medical Group which includes the clinic Advanced Medical Therapies, a state-of-the-art medical center providing fully compliant IV, hyperbaric, and mild hyperthermia therapies. He brings over 4 decades of medical training and experience together to allow his clinical and educational presence to grow and serve patients and physicians in the best way possible. Anderson is a well-known continuing education presenter in allopathic, naturopathic, acupuncture, and nursing CME arenas. His areas of specialty are in complex clinical medicine, intravenous and injection medicine, oncology, and genomics.
Anderson is former chief of IV services for Bastyr Oncology Research Center and a past professor at Bastyr University, where he continues to consult in research design and holds the rank of full professor. He is a graduate of the National University of Natural Medicine in Portland, Oregon, and began instructing classes at naturopathic medical schools in the early 1990s. Additionally he is a medical author and speaks in many continuing medical education courses and events. He is extending his medical education mission through the Anderson Medical Group CE site ConsultDrA.com, a web-based educational platform.
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Transcript
Karolyn Gazella: Hello. I'm Karolyn Gazella, the publisher of the Natural Medicine Journal. Before we begin, I'd like to thank the sponsor of this podcast, who is Allergy Research Group. Today our topic is intravenous therapies in oncology practice, and my guest is naturopathic oncologist Dr. Paul Anderson. Dr. Anderson, thank you for joining me.
Paul Anderson, NMD: Thank you very much for having me.
Gazella: What are some of the challenges that integrative practitioners may face when it comes to using IV therapies in clinical practice?
Anderson: I think that there's a grouping of them. I've been involved in IV therapy in integrative medicine for going on three decades now, so I've seen a lot of it. I think there's a few things. One is availability, meaning pharmaceutically, what can and can we not get ahold of at different times. Because we're doing, in especially integrative oncology we're often doing things beyond hydration and some of the basic types of IVs, so occasionally there are for regulatory reasons or because we have to have things compounded we may have availability issues with product.
Another really is, and this is I believe because I am an educator in this area and also have done research in this area, that I think the last 5 to 10 years we've seen a lot more evolution with technology and protocols and things of that nature, so sometimes what I see when I'm helping physicians and other practitioners troubleshoot is they're just a little behind the learning curve, which we all are. We've had a lot of changes in the way we do things in IV therapy in the last 5 to 10 years, and so keeping up is another challenge.
Other than that, the challenges can be technical or other things, but those are common to all infusion therapies, not just what we do.
Gazella: What types of IV therapies are presently available to practitioners, and which ones do you use in clinical practice?
Anderson: The variety is what I was alluding to in that last part of the last answer, and I figured there'd be a good follow-up question, so I'll go into that now. To some degree, because of the ability to communicate in different countries around the world, we get information about IV products that may not have been available in North America before and now they are. Additionally, in the last about 10 years we've been involved in some government funded research with respect to integrative oncology, and part of that was looking into unique and novel IV therapies from the natural medicine world. It allowed us to develop a number of things we really didn't have a lot of access to before. Those include some of the more common therapies in oncology, which would be nutrient support and hydration for quality of life or recovering from side effects from another therapy. A very common therapy we'll probably get to later would be high-dose and low-dose IV vitamin C therapy. Those are very common in our practice.
Then you move into other types of therapies. Again, either they weren't or weren't very available, say, 10, 15 years ago, things that may from other countries have been available a long time, but things from, say, the botanical or similar world, the use of an Artemsia compound called Artesunate, which is used in integrative oncology quite a bit really around the world now. Other types of things that you think of normally as oral products, such as quercetin, can be made in an IV format. Curcumin can be made that way. Then a number of other agents like alpha lipoic acid or Poly-MVA or we even sometimes use metabolic therapy, such as dichloroacetate (DCA), so there is really a large number that we are able to use now. As I said, we try to improve upon the techniques of administration over the years in that research. We have a lot available.
Gazella: Yeah, it sounds like it. I would like to stick with IV vitamin C because it seems that many practice shares are familiar with IV vitamin C, so lets spend little time there. What is the mechanism of action for IV vitamin C?
Anderson: That's probably the best place to start because vitamin C, there is a few things that are like this actually but not very many in the world of pharmacology. Most of the time we think of, say a drug or even most nutrients and they pretty much do one thing. Whether you take it orally or you inject it or do a different dose, it pretty much still does that one thing.
What vitamin C has the ability to do between the oral type of administration, which most of us are familiar with and then an IV administration. In an IV administration has the ability to given at a high enough dose where it changes its mechanism. If you take it orally or if you inject it at lower doses, intravenously or intramuscularly, you get the traditionally known version of vitamin C, which is as an antioxidant. When you cross certain dose intravenously, which you can't do by taking it by mouth, that's why the IV setting is required for the pharmacology to work. When you cross a certain dose, it starts to become a pro-oxidant. We think of vitamin C as an antioxidant but actually at certain doses, the higher doses it turns into a pro-oxidant and the down stream effect, really, is that it creates a peroxide burst on the outside of the cells and then the other thing that is very unique about it is—so it becomes an oxidant—there are other oxidative drugs, for instance, certain chemos are oxidative but they will they oxidize both a normal cell in a cancer a cell.
When vitamin C creates peroxide outside the cell, normal cells have catalase and other enzymes that can reduce the peroxide. Abnormal cells often are catalase deficient but not all of them. Some of them actually have catalase but many cancer cells are catalase deficient so the peroxide just gets transported into the cell and becomes damaging. So it's partly a cytotoxic or at least a primer for a cytotoxic event by being oxidated at those high doses.
Just to make a footnote here, because I think is terribly important, I know I didn't use to think this way about it but this is what the science says. The upside with vitamin C, that we see and this is I think, why we think we see quality of life improvements and other things with vitamin C IVs, is that, the normal cells, although they can reduce the peroxide down to water, they also benefit from the vitamin C because they actually will take the vitamin C up and use it as an antioxidant. You get this double effect and that becomes confusing for a lot of people, "How can vitamin C be both an antioxidant and then become a pro-oxidant" and then "How come when you give it in high dose, the normal cells aren't hurt by it." Those are the real conundrums people get at. We still see this and we are teaching about it too.
Gazella: Yeah, it is fascinating. What dose are we talking, when we are talking about a "high dose" that turns it into a pro-oxidant verses an antioxidant?
Anderson: It's sort of a multiple choice answer but not really. There is some research that shows you get a little bit of oxidation around 5 to 10 grams but its very short-lived, meaning, that's not going to do anything oxidative. It's going to go in and have its little burst and be gone. What we normally see is, when you get to about 25 grams or so, you've got enough sustained vitamin C in the patient so that they get oxidation and this translates to a particular amount of tissue level of vitamin C that's been researched, so we kinda work backwards from that tissue level.
Most adults require somewhere around 50 grams of vitamin C plus or minus, to really get a sustained effect, but it really starts at 25 and that's why we tend to work people up in lower numbers and then check their blood and see how their ascorbate levels are.
Gazella: Are there contraindications or safety issues when it comes to the "high dose" IV vitamin C?
Anderson: Yeah, there definitely are. I think that like any therapy that one would use, especially in intravenous therapy where it's going right into the person plasma, you always want to know what to be screening people for and what to watch out for on the front end. And given that its an extremely safe therapy but the areas that we screen for and we watch for, the one most people know about its G6PD deficiency, which is an inherent enzyme deficiency and if you oxidize people with the G6PD deficiency, they can hemolytic crisis or other problems, which is very bad. We always screen people with a test for that, there is a simple lab test for that. The other area that we screen people in 100% of cases for is kidney function, because you are giving them an IV therapy, eventually at least most of it is going to get cleared through the kidneys. We want to make sure that the kidneys are up for the IV volume but also the vitamin C and what goes with it. As far as our 2 biggest safety criteria, we start with those and if those look good, then there's other things we may consider such as is the patient very frail, do they have any severe anemia or other things of that nature but the things that ...
And I'm basing this on a study that was published a number of year ago, probably eight years ago, looking at 50,000 doses of a high-dose vitamin C and they had 5 high-grade adverse events throughout those 50,000 doses and they fell neatly into 2 categories and sadly the only reason these happened is that the doctors doing it didn't do screening and those 2 categories were kidney function and G6PD deficiencies. If you check those first then you do your normal workup, it's very, very safe. But you do need to check those first.
Gazella: Okay. Good. That's good to know. When it comes to high dose IV vitamin C therapy, are there specific cancers that respond well and certain cancers that don't respond as well?
Anderson: You know, I wish I had a simple answer to that and that was something that in the research we were working on through the Bastyr Cancer Research Center, the NIH and some of our traditional oncology partners in Washington like Fred Hutchinson, we were hoping that at the end of it we could look back and say, "Okay, these types of tumors do really great and these don't do well." What we really saw and we're still collecting and sifting data and all that so we don't have it all down but because I was in charge of that part I can tell you what we saw. And what we saw was that overall, if you did high-dose vitamin C with appropriately chosen patients—and keep in mind the people we would do IVs on all would have Stage 4, so advanced cancer—but if you did it on advanced cancer patients, somewhere around 50% would have some kind of positive result, meaning either quality of life improved or their cancer slowed down or they had no progression. Something in the positive category.
The other 50% didn't really have a positive response. But when we look through the types of tumors that were in those, the 50%, there isn't a pattern that you see emerge. I think that what that really speaks to more than vitamin C versus tumor is the effect of vitamin C and the host that you're doing the vitamin C with. And, you know, what kind of immune function do they have left, what kind of reserve do they have, vitality, et cetera. I will say, and this is partly because we saw more of these cancers because they're more common, when we would do vitamin C with other synergistic things, breast cancer we definitely saw benefit in advanced cancer, prostate cancer, in some people colon cancer, some people not but colon and ovarian cancer were 2 other areas. And in fact there's been a few publications in recent years looking at those just with vitamin C and collaborative care and they're seeing positive too.
We saw those there but the rest of it, between the did it work or didn't it, I believe depended on the individual. Because we'd see some people with the same tumor type and it didn't work for one but it worked for another. I think that the important part there is the management tip or management idea. What we found was if we got to a particular number of IV vitamin Cs and we weren't seeing a positive result, it was time to stop and move to a different therapy. And I know in the past people have had a sense of that but they didn't know where that line was. What we found when we looked backwards at our data was, if they made it to 8 weeks at twice a week, so about 16 IVs and we weren't seeing something changing for the positive, we would stop and move on because after that we didn't get any, there was a diminishing return after that. Like anything in medicine, there's a clinical and then a clinical art side to it and knowing when to stop and say, "We need something else," is super important too.
Gazella: Yeah, that's really a great point and valuable information. I'd like to switch gears and talk about other IV therapies that you mentioned. I'd like to have you choose one of those therapies that you actually employ pretty frequently and then describe the mechanism of action and let us know about that particular therapy.
Anderson: Oh, sorry. I think I lost you there for a moment.
Gazella: Oh, that's okay. I'd like you to take a IV therapy that you've mentioned previously, one that you employ in your practice pretty frequently, and describe its mechanism of action.
Anderson: Sure. I think, there's a number so it's kind of like picking which is your favorite child but I think it's a good segue from vitamin C. The medication that's used in many parts of the world, which was originally from the parent of the wormwood plant, artemesia. there's a medication that was made from that for malaria called Artesunate. And it's, like I said it's used worldwide for malaria so it's a very well-studied medication. It's basically a constituent of the wormwood plant that's been purified. It has decades and tens of thousands of doses of safety data and all that so we started to look into it at a collaboration with a German oncology group and the reason we started to look into it is we had a couple of very high-grade breast cancer patients that were not doing very well and they were in the progressive stage and in collaboration with these German doctors they said, "If you do the Artesunate as a primer for your vitamin C they have a lot of synergy."
We thought, well there's nothing to lose here and so we actually, one of the patients actually traveled to Germany, saw these doctors and came back and they informed us how they did it all. The short version of the story is is that the Artesunate has 2 mechanisms. One is, it does also have this oxidative burst so that's the synergy with the vitamin C. It creates an oxidant activity. And then the vitamin C follows up, sort of gives the vitamin C more legs if you will. And then on the other side the Artesunate also has, because it is a constituent of a plant it has some of the immune-modulating activities that a lot of plants do and it's actually being studied for example in calming immunity in autoimmune patients like lupus and RA patients and things.
And so what we see is when we have plant or plant constituents that not only have one mechanism like an oxidant or something like that but then they also, they leave behind this calming of immune triggering through cytokines, et cetera. What we tend to see then is if the cytokine calming happens in an advanced cancer usually the seeding of tumor cells, possibly the activity of the cancer stem cells and metastases, et cetera are slowed down. And we see this with certain other agents. It's been studied with quercetin and curcumin and other things of that nature. As part of the research, one of the things we're able to do because of this collaboration with the German physicians was track a group of breast cancer patients so there were 40 Stage IV breast cancer patients, all of whom were doing an integrative oncology plan, which is individualized per person but it includes diet and includes exercise and mind, body, and nutritional supplements. All the things.
That playing field was level. Thirty of them decided to do just that and 10 decided to add on IV Artesunate vitamin C combo. Everything's the same except the IVs and we tracked them for 5 years and we have 3 years of the data summarized and the survival and in Stage IV breast cancer, the survival drops every year, so the survival was pretty decent in the integrated oncology group without IV but was exceeded by a factor of between, we started at a higher survival rate, I'm trying to say it in the right order. We started at a higher survival rate the first year of I think about 14-15%. Next year was 11% and the next year was 9%. This is above and beyond and everything else we were doing.
Since then, we've used that definitely a lot with the prostate cancer patients and breast cancer patients because we saw the same patterns. And it's been really wonderful because in the natural world, just like in the drug world, if you have synergy and you can use it in a safe manner you get further. Especially with advanced cancer. I think that was one of our first really happy discoveries and it's been a very good addition I believe.
Gazella: Now does the Artesunate, does that have any contraindications in addition to what you've described with the vitamin C? How safe is the Artesunate?
Anderson: Yeah, you know, something that was interesting to me when we were first starting to work with it because of course we were all familiar with it as an anti-malaria agent and we don't really do a lot of malaria in the U.S., so we had to look at that. And aside from the cautions and concerns around the G6PD and the anemias and things of that nature that we would screen for with vitamin C anyway, number one it's actually quite friendly with the kidneys so we don't have to worry so much about kidneys as with vitamin C. And with the exception of severe anemia and G6PD problems, et cetera, it's actually very very safe.
It's also done at a very moderate dose and it's not a lot of volume so it's really easy on the body. And we've actually had some people who can't tolerate vitamin C but do tolerate Artesunate. They can use that. It's quite safe. There are, because it's used for malaria around the entire world, there's 1 study just in children, giving it to children, that includes 5,000 children. And there's an adult, there's adult studies with 2 to 5,000 so it's quite safe if used appropriately.
Gazella: Great. And I do enjoy the fact that you bring up the research. Has the research been improving in this area, in IV therapy treatments? Has it been expanding over the years?
Anderson: Yeah, one of the nice, really nice things I think of the last especially 10 years is we're seeing, and it's certainly not at the level that you see with many commercial trade drugs et cetera because there's not a lot of funding for natural therapies but we're seeing more and more coming out of, for instance, Kansas University Medical Center and a few other places around the country and a few international ones where they're actually getting more specific and saying, "So, with this tumor type, what's going to happen with vitamin C?" In some cases there have even been human intervention trials, which was really not something we had a lot of in the past. We're seeing more all the time.
There was just a, there've been a few publications in the last 2 years. One was with ovarian cancer and another was with another group of cancers. And then there was a PhD fellow in the pharmacology department at University of South Florida just won a national award for research fellows and it turned out that their research was actually on the use of ascorbate as an anticancer agent. You're seeing it get into research areas and this is definitely not an alternative or even an integrative research center. I know some people there and it's very very straight ahead. But they were just looking mechanistically and saying, "We need more data here," and they did it.
It's exciting that people are doing this more. It's exciting that there's more data coming back and if you broaden out, especially to Europe and certain Asian countries, that's where you often see some of the more, the deeper integrated treatments like with Artesunate or curcumin or mistletoe or some of these other things and you see some pretty compelling good data. Yeah.
Gazella: Interesting. In general, when it comes to IV therapies, what would you like to see happen in the future?
Anderson: You know, I think a few things. I think one thing is if this increase in research that we've had can continue to go on, that's really important because it informs us in a way that traditional clinical practice can't. And they're both important so we need clinicians doing things and making observations and we also need research that says, "This is where the mechanism works here or not here and these are the tumor types that maybe it works better in." I think, I'm excited that people are still looking into these things and looking at them mechanistically on the research side because that helps us clinicians be more targeted and also look at does it work better if we put 2 things together such as the Artesunate/vitamin C instance.
I think that the future you know is bright in the respect that people are interested in looking at it. People are interested in some of the positives that natural therapies can do such as decreasing side effects from standard therapy, improving the effect of standard therapy in some cases and then sometimes in patients where there aren't other, they've exhausted all standard therapies, sometimes a lot of the IV natural therapies are at least improving their quality if not length of life. I think getting more research, getting more clinicians doing it. If you go back as short as 20 years ago there was so few of us, certainly in North America but probably in the whole world, doing these things. It's exciting to see more people doing it and more people in the traditional research centers looking in. I hope that trend continues cause that will only be positive for the clinicians.
Gazella: Yes. And the patients. Well, this-
Anderson: Exactly.
Gazella: Yeah. This has been very informative. Once again, I would like to thank the sponsor of this podcast who is Allergy Research Group and thank your Dr. Anderson for joining me today.
Anderson: Thank you so much. It was great.
Gazella: Have a great day.
Anderson: All right.
