This article is part of the 2019 Oncology Special Issue of Natural Medicine Journal. Read the full issue here.
In this interview, leading botanical researcher Ajay Goel, PhD, AGAF, describes 3 herbs that he has studied which show great promise in cancer care: curcumin, boswellia, and French grape seed extract. Goel discusses the research associated with these botanicals, as well as any contraindications or safety issues.
Approximate listening time: 33 minutes
About the Expert
Ajay Goel, PhD, AGAF, is a professor and chair of the Department of Translational Genomics and Oncology at the Beckman Research Institute City of Hope Comprehensive Cancer Center in Duarte, CA, as well as director of biotech innovations at the City of Hope Medical Center. He has been recognized as an American Gastrointestinal Association Fellow (AGAF) for his research on colorectal cancer. Goel has spent more than 20 years researching cancer. He has been the lead author or contributor to more than 300 scientific articles published in peer-reviewed international journals and has also authored several book chapters. Goel is currently researching the prevention of gastrointestinal cancers using integrative and alternative approaches, including botanical products. Three of the primary botanicals he is investigating are curcumin (from turmeric), boswellia, and French grape seed.
About the Sponsor
EuroMedica® specializes in bringing proven natural medicines to the United States and in developing unique formulas containing clinically tested, safe, and effective ingredients. EuroMedica’s founder and president, Terry Lemerond, has more than 45 years' experience in the nutritional supplement industry, beginning with the founding of his first companies, Enzymatic Therapy and PhytoPharmica, and culminating in his current company, EuroMedica.
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Karolyn Gazella: Hello. I'm Karolyn Gazella, the publisher of the Natural Medicine Journal. Today we'll be talking about three key botanicals for cancer care, but first I'd like to thank the sponsor of this topic who is EuroMedica. My guest today is Dr Ajay Goel, who is a professor and chair of the molecular diagnostic department with the Beckman Research Institute at the City of Hope Comprehensive Cancer Center. Dr Goel, thank you so much for joining me.
Dr Ajay Goel: Good morning. Thanks for having me on the show. It's a pleasure.
Gazella: So before we dig into our topic, I'm always curious as to what motivates researchers. And in your case, why were you drawn to the study of botanicals?
Goel: Thanks for asking this very relevant question. So I think my answer would be twofold. One, I've always been a firm believer, and there's a lot of data gathered over the last decades or even centuries, that natural medicines are a lot more potent, lot more valuable, a lot more effective then we have given them credit for. If you look at some of the oldest systems of medicines like Chinese traditional system medicine or Indian system of Ayurvedic medicine, they've been there for centuries. They've been there for a long time and we knew that some of the botanicals which were used in these traditional medicinal approaches, they work beautifully. What we didn't have was, we didn't have all the science behind it, but we can negate the fact that these botanicals did not work. So that's one.
Second, I work in oncology and I work very closely with my oncology colleagues and what bothered me all this time is that first, we don't have good modern drugs for treating patients with cancer. So that's one, but whatever drugs we have, the problem is they don't work on most patients. But even in the patients, very small number of patients where they work, they have huge toxicity profile. They have adverse effects associated with them, which makes them almost, I've seen patients who would say that I would rather give up my care rather than accepting any of these modern drugs. So I think that's a twofold answer. One, the natural medicines are lot more powerful. And second, they don't have all the baggage, they don't have all the side effects and toxicity, which most of the modern drugs give us. So I think those were the two motivational reasons for me to continue to research the field of botanical medicine.
Gazella: Yeah, that makes a lot of sense to me. Now today we're going to be focusing on three botanicals in particular. I'd like to start with curcumin, and I have to say, we here at the Natural Medicine Journal really enjoy talking about curcumin because the science is so fascinating and interesting. And there's just a lot of it frankly. So specific to cancer, what are the key mechanisms of action when it comes to curcumin?
Goel: So again, very wonderful question, and just like you said, curcumin is probably, and I check this on a daily basis or a weekly basis, the body of scientific evidence behind curcumin and especially in the context of cancer grows on a daily basis. You know? So to the best of my knowledge, this is the only botanical for which we have the most amount of scientific evidence. And by that I mean, scientifically peer reviewed publications showing the efficacy of curcumin in virtually every kind of cancer, and all kinds of other diseases as well. Now, what is the mechanism of action? How does it work in patients who have cancer? Actually, we can talk about it all day long because there's not one singular mechanism which stands out. But if have to pick one or two, I think it boils down to curcumin's ability to fight inflammation.
So I think it's probably one of the most potent anti-inflammatory agent. And as we recognize all the molecular underpinnings are the basis of most disease, including cancer. We recognize that although once a patient has cancer, we know that many of the genes are not behaving the way they're supposed to. But what is the process which starts this misbehavior of genes? It's always inflammation.
And when we talk about inflammation, we're not talking about acute inflammation, something which we all can easily recognize if you fall or get hurt, we have a bruise or a localized pain somewhere. Now what we're talking about is chronic inflammation, which is completely asymptomatic, there are no symptoms for that. But that is very intimately linked with our foods and diets and lifestyles, and as you would know our lifestyles have changed a lot in the last few years and few couple of decades. And that is the reason why we have such a huge epidemic of cancer because chronic inflammation stays there, and if it continues to persist, it leads to many diseases including cancer. And so if I have to pick one mechanism, it'll be anti-inflammatory activities of curcumin.
Gazella: And you said that there might be another second mechanism that you're drawn to as well.
Goel: Yeah, so the second mechanism would be it's antioxidant potential. What that essentially means is, its ability to capture and get rid of all the free articles floating around in ourselves. Because if we let these free radicals, which are very reactive, hang around in the cells, they begin to oxidize lipids and fats and proteins, basically rupturing all the cells. So if you can capture and scavenge, or just absorb all of these free radicals, get rid of this and increase this amount of antioxidative stress that is the second properties. It's a very, very potent antioxidant along with its anti-inflammatory potential.
Gazella: Great. Now I know that you have done some work with curcumin and cancer. Can you describe some of your research? I realized that there's a lot of research in this area, so maybe choose some of the more recent published trials on curcumin.
Goel: Yes, absolutely. So curcumin is one of my most favorite botanicals. As you can tell I've worked on it for a long time, and we have published quite a bit on curcumin. So if I have to highlight some of the trials which we are very proud of would be fairly simple in a way. So one of the things we recognize, how do cancer cells grow? So cancer cells love to grow because that's in their benefit, that's to their advantage. And one of the ways cancer cells continue to grow without dying is they basically shuttle away all the nutrition from the surrounding healthy cells around them. So they are very slick. They are clever. So for their own survival they need nutrition. And the way they get this nutrition is by fooling the healthy cells around them by telling them this is to their advantage. Please allow me to continue to derive all the nutrition from you, away from you.
And what we showed in one of the beautiful studies, which has been cited a lot, is that cancers don't grow in a silo, they grow in communication. We call it tumor microenvironment, which basically means tumor cells are growing, your healthy cells are growing, your stromal cells are growing. And if some strategies, some drug, some botanical, can basically block that sense of communication between cancer cells and healthy cells, what would happen? Healthy cells would not give the nutrition to the cancer cells. And when that happens, the cancer cells will die. And that's exactly what we showed in a very elegant study a few years back. There had been cancer cells are treated with curcumin, within a matter of hours or days, these cells begin to wither away. And what we showed was this is exactly curcumin does.
It basically stops a communication of cancer cells with the healthy cells. And once that happens and the healthy cells stop giving the nutrition to the cancer cells and eventually the cancer cells die away. So that's one mechanism which is very, very important. Second, which is very relevant to a lot of the patients who get cancer actually, they typically would meet their physician saying, I already have a cancer and you're prescribing me the chemotherapy or radiation therapy. Can I take curcumin along with, maybe it'll enhance the benefits of my treatment? And most of the times if the physicians are not aware of the beneficial effects of curcumin, they will tend to suggest, no, please don't interfere with my care and don't take anything, any supplement, especially along with my care.
And that is not true because we showed, and there are many other studies done on this aspect too where we very clearly showed that patients who have, especially colon cancer or even pancreatic cancer, because those are the areas of my research, that in these cells, in these patients, if these patients are given curcumin along with their standard of care chemotherapy, actually the efficacy of the chemotherapy multiplies many, many fold. And the quality of life of these patients while they're already on chemotherapy when they take curcumin along with improves significantly. Which is a good thing because now the patient don't have to experience all the toxicity from the chemotherapy, but continue to improve the quality of life.
On the same lines, we published another study where we showed actually the combination of chemotherapy along with curcumin, actually, if you use it, you can reduce the dose of chemotherapy by tenfold, or 10 times, and still have the same level of benefit which you would have with chemotherapy alone. So this is amazing because what that means is you could reduce not only the dose of the chemotherapy by 10 times, you're reducing that expense by 10 times. And you also, more importantly, reducing the toxicity by tenfold, but still having the same level of benefit. So these are some of those studies which are very, very important. And more recently, which we'll probably cover in the conversation later, we have begun to see that when we combine curcumin with other drugs or other botanicals there's a lot of synergy between these. Which is, again, something which we are very excited about.
Gazella: Yeah, I mean this is some amazing research, and we could probably talk about curcumin all day long, just focusing on the research. But I would like to talk about the form of curcumin, because there is a lot of debate, some controversy surrounding the form of curcumin that can be used or should be used for efficacy. Now this is due in part because of absorption issues. I'm curious as to what form you prefer to use in your research, and why do you prefer that form over the several other forms of curcumin that are presently on the market?
Goel: Thank you for asking this question, I think this is very, very relevant to anybody who would consider taking curcumin because the form of curcumin I've used in my research for the last 10 plus years is called BCM 95 curcumin. And the reason I chose this curcumin for all my research for over the years is simply threefold. One, this is a high absorption curcumin. So what that means is, curcumin by itself, if you take a generic curcumin, one of the challenges or limitations of curcumin is that it is poorly absorbed by our human bodies. If you take some amount of it, most of it will come out of your body within a matter of hours. So if that's the case, your body is not going to be healed. Your body is not going to derive all the benefits of curcumin if much of it comes out so fast. So it is very, very important that anybody considering taking curcumin, they should take a curcumin which is high absorption curcumin.
So that is the reason I use BCM 95 curcumin because there's been studies done that it is somewhere between 10 to 12 times better absorbed compared to generic acumen. That's one. Second, not only is it absorbed in the body 10 to 12 fold better, but it stays in the body longer too, which is almost a no brainer that if you are taking something for therapeutic purposes you would want that thing to stay in the body longer, because longer it stays there it'll continue to fight inflammation like we talked. It'll continue to fight oxidative stress. So the second thing is it stays in the body longer. Third, which is equally important is that this is, I call it a clean curcumin, because it's all natural. So one of the limitations of many forms of curcumin is that people, many of the manufacturers or vendors will try to increase their yield of curcumin from turmeric.
And in the process they will use strong synthetic chemicals to get as much curcumin they can get out of turmeric. And in the process what happens is you have curcumin, but as a consumer, as a patient, or as a physician when you're giving this curcumin to your patients, you're basically ingesting small amounts of chemicals which are not good for your body. So that's the third reason I used BCM 95 because it does not use any strong chemicals. It is all natural and one of the mechanisms, the way it is better absorbed in the bodies is that the curcumin is actually mixed together with the natural essential oils which are present in the root of turmeric, and that is a way to enhance its absorption. So it's all natural, better absorbed, stays in the body longer.
Gazella: That makes a lot of sense. Now are there any contra indications or safety issues with curcumin specific to oncology?
Goel: To the best of my knowledge, no. There have been studies done, we call these dose escalation studies where people will take highest possible dose of curcumin until they see some toxicity. And these studies have been done in human trials and people have used up to 12 grams of curcumin a day for, I think, I believe it was six months, and virtually no toxicity or adverse effects at all. Some people do sometimes feel for a very short term, some sort of upset stomach, but that only lasts for a day or two. But typically in terms of toxicity or serious adverse effects or any concerns, absolutely zero.
Gazella: Okay, good. Now before we move on to our next botanical, what is the therapeutic dosage that you recommend of the BCM 95 in oncology? I imagine it varies based on the individual and their circumstances, but is there a general dosage range?
Goel: Absolutely. So again, we can't, because curcumin and other botanicals they're not drugs, so there's a fair degree of range of forgiveness if you take a little bit more, or a little bit less, because they are very safe. So we don't have to worry that much. So based on my experience, especially if you're working with a high quality curcumin extract such as BCM 95 I think for the oncology patient a general range should is somewhere around two grams to three grams a day. Which should be split equally in three or four doses over their entire days. You don't want to take your all two or three grams in one dose. So it should be split in, you know, morning, afternoon, evening, or maybe four doses if somebody can manage. So somewhere in the range of two to three grams a day. And then depending upon their disease severity stage of the cancer and so forth I've seen patients even using up to five grams, but I think that would be extreme situation. But about three grams I would say is the average dose over entire day.
Gazella: Okay, perfect. So let's talk about boswellia. Now when we think of boswellia, I personally think about joint pain and osteoarthritis. How does boswellia work when it comes to cancer care? And just describe for us the oncology mechanisms of the actions for this particular botanical.
Goel: Absolutely. Again, so boswellia, just like you said, most people when they think about boswellia they think about joint pains and osteoarthritis and so forth because that's where it's been used for longest times. And one of the traditional uses for boswellia has been in arthritis, and even in patients who have actually another condition would be asthma. People have used boswellia quite a bit there. But in terms of cancer, I mean evidence is not there that much, but we have done quite a bit of studies. And I would say in the last three to five years there's a lot more studies around cancer. And one of the ways it helps in patients who have cancer is, again, it's ability to fight inflammation. So when we talk about inflammation, we just covered earlier we were talking about again, chronic inflammation. And when we talk about chronic inflammation, inflammation in our body is not controlled by one pathway.
There are multiple pathways of controlling inflammation. We just talked about curcumin. And one of the preferred ways curcumin functions there is by inhibiting an enzyme called cyclooxygenase two or COX-2. So that's a very, very key pathway which basically triggers inflammation, and curcumin works beautifully there. But there's another pathway which is equally important when it comes to inflammation we call it five lipoxygenase pathway, or 5-LOX pathway, and if that pathway is active, that will mean there'll be increased inflammation in our body which we don't want. And what we have shown is that in cancer patients, if they take boswellia, what happens is this 5-LOX activity goes down. And when that goes down there is a reduced inflammation and these patients tend to do so much better in terms of the response to cancer. So I think one of the preferred mechanism for boswellia, especially in the context of cancer, will be anti-inflammatory activity, and that activity mediated through 5-LOX pathway.
Gazella: And now you mentioned that these are human clinical trials involving boswellia and oncology, is that the case?
Goel: Not really. Some of these things are preclinical studies, but my understanding is there a couple of trials currently being planned. But for curcumin there are many human trials. And of course [crosstalk 00:18:40]. But for boswellia, most of the evidence so far has been preclinical evidence, which means before human trials.
Gazella: Got it. Okay. So now I understand when it comes to boswellia that boswellic acids are important. So what should practitioners look for when deciding on which a boswellia product to use, or what form of this botanical would be the most effective?
Goel: Again, thanks for asking such an important question. So just like we covered curcumin, and again, I think that's a normal notion that when we take any botanicals we have to be sure that we're taking the best product out there for which we have the best science. So when it comes to boswellia, I think one must consider taking... So when we look at boswellic acids, which are extracted from boswellia serrata tree, it's actually a combination of multiple boswellic acids present in there. And some of them are actually anti-inflammatory, while other actually ingredients or the actives in total boswellic extract could be pro-inflammatory, which is something you don't want. So if you have something pro-inflammatory is going to increase more inflammation, which is not desired. So one of the most important active anti-inflammatory boswellic acid is called AKBA, or one keto alpha boswellic acid.
So as a consumer who is desiring to take boswellic acid for cancer or for other indications to fight inflammation, you have to look for a boswellia extract which is highly enriched for AKBA. So you need to look for a product which is pure and has highest amount of AKBA content, because that is the one which has most anti-inflammatory activities. If you take a total extract with other boswellic acid in there, there may be some component of pro-inflammatory boswellic acid. So one has to pay attention to the extract which is rich and AKBA.
Gazella: Can you spell that for me Dr Goel?
Goel: Yes. So the acronym is A-K-B-A. So it stands for one alpha keto boswellic acid.
Gazella: Perfect. Yeah. A lot of our healthcare professionals who are listening will want to know that, so thank you for that. Now are there any safety concerns with boswellia?
Goel: Again, to the best of my knowledge, no. But again, compared to curcumin, we don't have too many safety studies. But based on my experience, based on our studies we have done, I think one of the things when we talk about safety we have to keep in mind the amount of, or the dose of, any product we are using, whether it's curcumin or boswellia or anything else for that matter, anything in life. So I think if you're going to cover this, so boswellia, again, in the context of cancer patients, I think those are for about two to three gram also has shown a lot of anti-inflammatory and anti-cancer activity. So I think to the best of my knowledge, if somebody is using these range or even twice as much, I don't think there's any concern for toxicity of any sort.
Gazella: Okay, that's good to know. So now I want to talk about the third and final botanical, which is French grape seed extract. And again, we don't often think about cancer when it comes to this particular botanical. So how does the preliminary research show us that French grape seed extract works when it comes to oncology?
Goel: Yeah, so I'm very excited, and when we begin to work quite a bit on a French grape seed extract, just like you said, when people think about grape seed extract, or grapes in general, I think most people think about resveratrol and so forth. Which is used in many different contexts and especially anti-aging products and so forth. But if you know, resveratrol typically comes from the skin of grapes and from the flesh of the grapes. But grape seed extract, just like the name says, comes from the seeds of the grapes. And it's unfortunate that being in US, we tend to go to stores and many times we ended up finding grapes which are very proudly sold as seedless grapes. So I think it's not necessarily a good thing. But when we look at grapes with seeds, they have these very, very active molecules.
We call them OPCs, oligomeric polys anthocyanidins. So OPCs, and they are present in grape seed extract, which are again very, very important anti-inflammatories, antioxidants. And we are particularly excited about this particular VX1 French grape seed extract, because if you take a genetic grape seed extract, it'll have lot of tannins and a very small amount of OPCs. So if you ground up all the grape seed extract it'll have probably majority of it will be large molecular weight tannins. So as a consumer, if you take the generic grape seed extract, what happens is you're thinking you're taking 300 or 500 milligram of grape seed extract. But most of it, more than 90% of it will never enter our cells.
That's what we want because if it goes into the cells it produces anti-inflammatory or antioxidant activity. But most of the generic grape seed extracts are so enriched in high molecular tannins, which are unable to enter our cells. But this particular grape seed extract, French grape seed extract is unique because it gets rid of all these large molecular tannins, and it is enriched for these very, very small OPCs which can easily enter the cells, cause this anti-inflammatory activity, antioxidant activity, and give health to patients who have cancer. So we have done several studies in the last two, three years, and we are seeing phenomenal results as an anti-cancer agent.
Gazella: Well that's great. And here again, we have another example where the form is important. And it's my understanding that with this particular extract you should look for it to be standardized to contain that appropriate concentration of polyphenols. So to get the most therapeutic effect, what specific form of this extract do you recommend? What should practitioners look for on the label?
Goel: So I think what they should be looking for a grape seed extract which is highly enriched or standardize for highest amount of OPCs, which is again oligomeric proanthocyanidins. So you have to look for a extract which is enriched for these because these are the small polyphenols which can enter our cells and show the activity what we're looking for. Because if you're just using a generic extract, which is not standardized for OPCs, you will not get the benefits what you seek.
Gazella: Right, exactly. And it won't match what's happening in the research literature.
Gazella: Again, any safety issues with this one?
Goel: Nope, not at all. But these are very, very safe compounds for the most part. And we have done quite a few studies where we use very large doses of these compounds and we have not seen any sort of adverse effect or toxicities.
Gazella: Okay, perfect. Now in the beginning of our interview you mentioned the synergies, specifically with curcumin, that when you combine curcumin with other botanicals. So regarding these three herbs that we just discussed, do you see any synergy between the three? Would there be any advantages to using these three in particular together?
Goel: Absolutely. Although we have not done studies on all three together, but we have done studies where we've combined curcumin with boswellia. Again, the curcumin extract being BCM 95 curcumin, and boswellia being extract which is named as BosPure, which is highly enriched for AKBA. So we have done studies where we have combined curcumin and boswellia together and we have seen amazing synergistic activity. And the reason I say it is amazing is because we have compared the efficacy of this combination of curcumin with boswellia, and we have compared it to the efficacy to standard of care chemotherapies. And it was amazing to see that just the combination of these two compounds was much more potent than chemotherapy alone. That's beautiful because now you don't need to worry about taking a chemotherapy because if you can take these two natural, safe, inexpensive compounds and have the same level of benefit for chemotherapy or even better, then this is a win/win.
More recently we have done a study where we have combined curcumin with this French grape seed extract, same kind of activity. That the combination was so potent, a lot more efficacious compared to standard of chemotherapy. And another thing in this particular study we noticed where we combine curcumin with French grape seed extract, that this combination was very, very important in killing cancer stem cells. Which is very important because patients who have cancer, we can get rid of the cancer cells, but most times we leave behind something we know, cancer stem cells, which are basically super powered version of the cancer cells, which those who don't respond to any kind of treatment.
And if you leave them behind, these patients will experience, you know, cancer coming back in six months or one year because these cells are left behind. But what in this study where we have used combination of curcumin and French grape seed extract we have shown actually this combination is not only very, very promising in killing cancer cells, but it gets sort of most of the cancer stem cells, which is wonderful news for the cancer patients. What that means is if they use this combination, there's a very less or likelihood that their cancer will ever come back. So we are very excited. We are planning on studies, we will try to combine all three compounds together. But so far we have looked at individual combination of these two.
Gazella: Yeah, that is exciting, especially about the stem cell. Now I'm assuming that so far these have been all in vitro studies.
Goel: Actually no. So this reasons study that we did, we call it a ex vivo study, which what that means is we actually using human cancer sample from a patient itself. So in this combination study, we actually took the colon cancer tissue from the patient who had colon cancer, and we have developed a unique way to grow this tumor outside of the human body. But the good news is we are looking at actual cancer sample from an actual patient who have colon cancer. So these are not real human trials, but they are not neither in vitro studies. So we call them ex vivo studies where we can continue to see the effect of these compounds, these botanicals and drugs, on the actual human tumor.
Gazella: That's great. Yeah. And you know, it makes sense, and the curcumin and boswellia in particular makes sense because you were talking about the two different inflammatory pathways that they impact. One, you know COX-2, and then the one is the 5-LOX pathway. So that would make sense that combining the two you're going to have even a heightened anti-inflammatory effect.
Goel: Absolutely. And similarly when we combine curcumin with this French grape seed extract, because this French grape seed extract works on absolutely very different anti-inflammatory pathways too. And I think although we are still working on the mechanistic aspects of this, but what we are seeing is that when you combine curcumin with this French grape seed extract, I think in a matter of few days we can see the effect, which is very, very, very pronounced and very important in killing cancer cells.
Gazella: Well that's great. Well, you know Dr Goel, you have been a true leader when it comes to researching botanicals in oncology care. So I'm curious about, you know, what your thoughts are on what the future holds when it comes to the utilization of botanicals and cancer care? What can we expect to see in this area of integrative oncology?
Goel: I think that's a very important question. And I think, I've been working in those fields for 20 plus years, and I can already tell you I've seen a change already. And I think we will continue to see this change. And by change I mean as that patients have become a lot more smarter because they have access to all the scientific studies and literature, which is online and so forth. So they become more curious. They ask the right questions, they desire to use some of these integrative approaches in their cancer care and so forth. And I can tell you that every single day, you know, I hear from a lot more patients who are beginning to adopt some of these integrative approaches on their own, sometimes with the consent of their physician, sometimes on their own. But since you asked me what are the future, I think the future is that we are going to see continued awareness and continued educational effort of recognizing the benefits.
And at the same time, that's where we started, the benefits of these botanicals as well as the safety of these compounds in helping patients who have cancer and other diseases. And I have no doubt about it, we are already seeing a huge growth and awareness about the potential of these natural medicines. And I can only imagine that it'll continue to grow. And I think at some point the mainstream modern medicine will begin to use these things. Maybe not stand alone, but possibly as adjunct or in combination with the standard modern drugs they're using. So the future is bright.
Gazella: I would agree, and I hope that certainly does happen. It's exciting to watch, honestly. Well, this has been very informational. Once again, I would like to thank our sponsor who is EuroMedica. And Dr Goel, I'd like to thank you for joining me today. Let's stay connected so we can stay on top of the research, the exciting research that you're doing.
Goel: Absolutely. Thank you so much for having me on the show, and I really enjoyed it.
Gazella: Great. Have a great day.
Goel: You too. Bye-bye.