Reprinted from ALTERNATIVE THERAPIES, Vol. 10, No. 3, May/June 2004

MITCHELL GAYNOR, MD

Environmental Oncology: An Emerging Science In Cancer Prevention And Treatment

Interview by Jennifer Repo • Photography by Reykha Capoor

Mitchell Gaynor, MD, is founder and president ofGaynor Integrative Oncology (www.gaynoroncology.com) and clinical assistant, professor of Medicine at Weill Medical College, affiliated with Cornell University and New York Hospital. After receiving his medical degree from the University of Texas, Southwestern Medical School in Dallas, Texas, Dr Gaynor completed his residency at Weill-Cornell Medical Center where he also served as chief medical resident. He then completed his fellowship in clinical hematology-oncology at the New York Hospital-Cornell Medical Center as well as post-doctoral research at Rockefeller University, New York City. He is board certified in medical oncology, hematology, and internal medicine. He is a member of the American Society of Clinical Oncology, the American College of Physicians, and the New York Academy of Sciences.

Dr Gaynor is medical director and director of Medical Oncology at the Weill-Cornell Medical Center for Complementary and Integrative Medicine. He is a consultant at The Strang Cancer Prevention Center, where he was formerly director of Medical Oncology. He has served on the Executive Review Panel at the Department of Defense-Alternative Medicine for Breast Cancer Sector and the Smithsonian Institute's Symposium on New Frontiers in Breast Cancer and the Environment.

He is the best-selling author of 3 books, The Healing Power of Sound: Recovery from Life-Threatening Illness Using Sound, Voice, and Music (Shambhala Publications, 2002), Dr Gaynor's Cancer Prevention Program: Lower Your Cancer Risk Now! (Kensington, 2000), and Healing Essence: The Proven Path to Wellness (Kensington, 2001). He is currently writing his fourth book, Nurture Nature/Nurture Health: A Doctor's Guide to Environment and Health, to be published January 2005.

Alternative Therapies: How did you become interested in incorporating nutrition into oncology?

Mitchell Gaynor: In 1987,1 was at Rockefeller University working in the lab of Dr Joseph Nevins, looking at the immune system and at cancer-gene interactions. I began reading initially dozens and later hundreds of articles explaining nutrient-gene interactions critical in the development as well as prevention of cancer. I was absolutely flabbergasted that in all of my medical training, my internship, residency, during my hematology and oncology fellowship, also at Cornell, that nobody had ever endorsed what I was now learning—that hundreds of scientific papers demonstrated how various nutrients could affect genes that contribute to promoting or preventing cancer. Nutrients, I learned, could turn genes on and off, regulating cancer cells, and could profoundly affect the very parts of the immune system that are responsible for preventing a recurrence of cancer. Throughout my career, I have focused on combining the very best that medical science has to offer as far as new chemothera-peutic advances, monoclonal antibody therapies, and advances in stem cell transplantation. I have incorporated these with mind-body practices and nutritional modalities, both of which affect the immune system, the endocrine system, and the body's detoxification system.

AT: How has integrative medicine in cancer treatment and prevention evolved over the past few years?

Gaynor: What we've seen develop is the whole field of integrative oncology, which incorporates nutritional factors, environmental toxicants, and life stressors. This field includes the interaction of a number of different techniques such as music therapy, qigong, acupuncture, yoga, and nutrition. These are important for 2 reasons: (1) to increase the effectiveness of various chemotherapeutic and radiation treatments, and (2) to decrease the toxicity of cancer therapies, which as all of us know, can be quite profound.

What I've also noticed, however, is that despite the fact that there is more information now about integrative and complementary care, people are more confused than ever about what to do with complementary modalities, especially if they have an illness like cancer. Patients say to me on a regular basis, "Dr Gaynor, they said fiber was protective against cancer and now they say that it is no good. One day soy is a great thing for prevention of breast cancer, the next day I read that we shouldn't have any soy products if you have a family history of breast cancer." People are confused about antioxidants, too. I have patients coming in all the time saying that their doctor or medical oncologist told them not to take antioxidants, so they avoid all fruits and vegetables.

AT: Do research and data support the view that natural compounds are significant in cancer prevention and treatment?

Gaynor: We know that there are number of compounds which inhibit cancer cell proliferation directly. These include substances like bee propolis, which comes from the bee hive. It contains a very potent inhibitor of an enzyme, called cyclooxygenase 2 (COX-2), that is upregulated in a lot of cancers. There is turmeric, which is what gives curry its yellow color. There is EGCG [epigallocatechin-3-gallate], which is the antioxidant found in green tea. It is a polyphenolic that has a variety of different effects. There is genistein, which is found in soy and which has a host of activities that inhibit cancer cell proliferation. It can inhibit tyrosine kinase, and it induces apoptosis. Resveratrol, which is found in the skin of red grapes, has a variety of effects, and selenium increases glutathione peroxidase, which helps detoxify carcinogens.

Then there are compounds that act by indirect means to inhibit cancer. Others are nutrients like vitamin C and antho-cyanidins, which can inhibit a variety of different enzymes. Then there is the nutritional interaction within the immune system, which amazingly, has been largely ignored in cancer treatment. There are a number of natural products that can stimulate the very parts of the immune system which we know are important for both preventing and fighting cancer. These include maitake and shiitake mushrooms, ginseng, glutamine, and melatonin.

As far as herbs go, in 1995, Dr T.K. Yun, from South Korea, did a study on 1,987 people. This was what is called a case-control study: a person without cancer is studied for each patient with cancer, and a comparison of various factors is made. The results for ginseng were very similar to those of the earlier study. Patients who had been taking ginseng for 1 year had a 36% lower cancer incidence than did nonconsumers of the herb; patients who had been taking it for 5 years or more had 69% less. Ginseng showed the most protective effect against cancer of the ovaries, larynx, esophagus, pancreas, and stomach. There seemed to be no significant effect of ginseng consumption on breast, bladder, thyroid, and cervical cancers.

AT: Isn't it true that the current paradigm for conventional medicine in general and for oncology in particular focuses on just treating the symptoms?

Gaynor: Yes, and what is wrong with this is that in the early 1970s, Richard Nixon declared a war on cancer. Since that time, tens of billions of dollars have been spent on cancer research, and much good has come out of it. Many new drugs have been developed, new monoclonal antibodies, better techniques in transplantation, but the fact of the matter is that overall, cancer mortality has not improved since that time. Even more alarming, there has been an increase of many types of cancer since that time. I think that rather than only a war on cancer, we also need a war on carcinogenesis.

AT: Why?

Gaynor: For example, if somebody wakes up with a cough and goes to the doctor and gets a chest x-ray, and the doctor says, "You have a mass in your lung, and it looks like cancer." That lung cancer didn't start that morning. That cancer started, very often, decades earlier. This, in practical terms, is the process of carcinogenesis. Carcinogenesis can start when there is a pre-car-cinogen, a cancer-causing chemical in the environment that becomes activated in the body.

A carcinogen that hasn't been detoxified or excreted can lead to problems with DNA mutations, DNA synthesis, and DNA repair. The classic example of this is knocking out the tumor suppressor gene p53. What's significant about this is that phytochemicals—chemicals from plant substances—can influence and lower our chances of a cell becoming cancerous by affecting each of these stages of carcinogenesis

For 50 years, the tobacco industry successfully argued that cigarette smoking did not cause lung cancer, saying that there was no proof. There was ample epidemiological evidence and basic science data that smoking caused lung cancer; every doctor knew smoking caused lung cancer. In the courts, the cigarette industry maintained that the burden of proof had to be so strong that you had to literally show what molecule was causing the cancer in a given individual. It was a ridiculously defined burden of proof.

It wasn't until the mid-1990s, when researchers at Johns Hopkins University showed how benzopyrene, a chemical in cigarette smoke, knocked out the tumor suppressor gene p53 and caused lung cancer to develop. This was the smoking gun that resulted in the multibillion dollar tobacco settlement. Now, we have about 80,000 chemicals in our environment that need to be thoroughly tested. So we need a war on carcinogenesis, which would include battles against obesity, smoking, and environmental degradation.

AT: You've been highly involved in researching how the environment contributes to many of our health crises. Would you say that awareness of environmental toxins is becoming more significant in integrative oncology?

Gaynor: Absolutely. We are living in a country today where 1 in 3 Americans at some point in his or her life is going to hear the words "you have cancer." I think that is an atrocious statistic. I don't think that it is any coincidence that Japanese women living in Japan have one seventh the incidence of fatal breast cancer as that of American women. I don't think that it is any coincidence that Asian men living in Asian countries have one thirtieth the incidence of fatal prostate cancer as that of American men. Clearly, they are putting things in their bodies that we are not.

Now, one of the reasons I think natural products are so important is because we are so at risk, and our systems are so at risk, from a plethora of carcinogens that we are being exposed to. Since 1976, the Environmental Protection Agency has been measuring toxins from fatty tissue from both autopsies and patients undergoing elective surgery. Twenty toxic compounds, including dioxin, styrene, xylene, and DDE (a metabolite of DDT and PCB) were found in more than 75% of all samples.

This is quite alarming given that many of these are known, or suspected to be, carcinogens in humans. What is even more alarming is that when we test these chemicals for carcinogenici-ty, they are tested one at a time; they are never tested the way that they are found in nature and in our bodies, which is in clusters. There have been recent studies, one in particular that looked at breast cell proliferation with combinations of certain organic toxins and found that they do act synergistically. Now, the concept of synergy has been known in oncology for many years. When you look at a smoker and look at somebody who has been exposed to asbestos and observe the relative risks of lung cancer, the paradigm is frightening.

We know that a smoker has an 11 times greater risk of developing lung cancer than a nonsmoker. We know that somebody who has been exposed to asbestos has a 5 times greater risk of developing lung cancer than one who has never been exposed. If you have a smoker who has also been exposed to asbestos, the risk isn't 16 times greater; it is 55 times greater. Very few of the persistent organic pollutants that we are all exposed to have been studied for health risks in combination. Since we're living in a country where 1 in 3 Americans hears the words, "you have cancer," we need to take a much harder look at indicators of harm that many industrial pollutants clearly represent.

I also think it is very important to look at children and what we are doing to children. How are children being exposed to persistent organic pollutants? Well, in 6 months of breastfeeding, 20% of a mother's fat-stored dioxin is transferred to the infant. That 20% very often represents more than the maximum lifetime allowable dose of dioxin for humans. Ten percent of American women carry enough mercury in their blood to cause damage to the fetus should they become pregnant, yet the Environmental Protection Agency and the current administration in Washington is rolling back provisions of the Clean Air Act to regulate mercury.

In 1976, the EPA reported that PCBs, which have a whole host of effects on the immune system, on cancer, and on brain development, were found in 99% of tested samples of human breast milk. Twenty-five percent of these samples contained PCB levels exceeding the legal limit for milk of 2.5 ppm. If that milk were cow's milk, it would be illegal to sell it in the United States. Many breast milk contaminants are endocrine disruptors, which means that they act as weak estrogens in the body. Many of the most commonly used pesticides and herbicides, as well as a variety of industrial pollutants, dioxin, and benzene are also found in breast milk. Again, these don't occur singularly, they occur in combinations, and we know that combinations of certain organic carcinogens act syner-gistically to induce breast cell proliferation. So do we have to simply accept the statistic that 1 in 8 women develop breast cancer? I think we really need to take a hard look at the environment toxicants in our air, water, and food.

Regarding how dioxin affects human health, the EPA estimates that more than 500 people per year develop cancer just from eating fish from the Great Lakes that are contaminated with dioxin, PCBs [polychlorinated biphenyls], and pesticides. A National Cancer Institute study compared blood samples from people with lymphoma versus age-matched control. They found that those with the highest of levels of persistent organic pollutants had a 5-fold increased risk of lymphoma compared with those with lower levels. My practice really does mirror the national statistics in that there is a dramatic rise in lymphoma in the United States in the last 30 years.

Some people are still going to argue, and say, "Well, we are living longer, we have unhealthier lifestyles, more people are overweight. It is about our lifestyle and not about environmental pollution." And to that, 1 say, look at children. In my new book, Nurture/Nature Nurture/Health, I have chapter after chapter about the health effects of the environment on childhood illness. With children, you can't say it is their lifestyle. They don't smoke, they don't drink alcohol, and they are certainly not working in chemical factories. Yet, (EER) Exposure, Epidemiology, and Risk data show that childhood lymphoma has increased 30% since 1973. Childhood acute lymphoblastic leukemia has increased 20% over the last 30 years. Childhood brain tumors have increased 21% since the 1970s. But there are a lot of positive things we can do and positive steps that we can take.

AT: And those are?

Gaynor: For instance, there are natural products that can decrease the activation of carcinogens as well as upregulate the enzymes that we know detoxify them. An enzyme called COX-2, which I referred to earlier, can actually make a number of carcinogens more active in the human body. One example is that COX-2 can convert the carcinogen benzopyrene to benzopy-rene diol epoxide, which is an even more potent carcinogen. However, there are a number of natural products that can inhibit COX-2. These are called natural COX-2 inhibitors. Most people have heard of COX-2 inhibitors. Celebrex and Vioxx are pharmacologic COX-2 inhibitors used in treating arthritis. But there are a number of natural COX-2 inhibitors found in our diet. One example is resveratrol, which as I mentioned earlier, is found in the skin of red grapes. Another is curcumin, which is found in turmeric. Catechins in green tea are potent COX-2 inhibitors. COX-2 is upregulated in most solid tumors. There are studies now that have been published out of Cornell, using the COX-2 inhibitor Celebrex in patients with lung cancer. But it probably wouldn't surprise you that populations consuming some natural COX-2 inhibitors regularly have lower rates of certain cancers in several epidemiological studies. COX-2 has also been found to regulate angiogenesis, or the formation of new blood vessels for tumors.

AT: What exactly is the role of detoxification in cancer prevention?

Gaynor: Detoxification is very important. We all have enzymes in our bodies that break down carcinogens. Antioxidants and nutrients found in garlic and green tea can increase levels of detoxifying enzymes. These enzymes are detected in almost all tissues. They are inducible by a variety of nutrients, as well as Omega-3 fatty acids. There is interindividual variability in our levels of these enzymes due to genetic factors and not everybody is equal. A study by Kathy Helzhauer at Johns Hopkins School of Health compared detoxifying enzymes' ability in women with and without breast cancer. The study found that women with an abnormal detoxifying enzyme gene had up to a 4-fold increased risk of breast cancer. This is important since one of the genetic variants of this gene is found to occur in 45% to 50% of the population. These variants have also been associated with an increased risk of smoking-relat-ed lung cancer. The need for detoxifying enzyme activity remaining optimal is clear.

Growing scientific data support the link between breast cancer and toxic chemicals found in the water, air, and earth. Certain organochlorine chemicals, such as DDT, DDE, HCB, and dieldrin act like estrogen in a woman's body, where they can bioaccumulate for decades. The harmful effects of DDT, though banned, is something to take note of. A study in Liege, Belgium showed that women with breast cancer, compared with those without breast cancer, are 5 times as likely to have DDT residues in their blood and 9 times as likely to have residues of HCB, an organochlorine still in use. Other studies show the transference of these toxins through breast milk resulting in diseases, and sometimes death, for nursing infants. Air pollution, cigarette smoke, pesticides, herbicides, prescription hormones, and many cosmetics and common household products are frequent sources of carcinogenic chemicals.

AT: Recently, there has been a lot of media attention to possible environmental links to autism and other neurologic disorders. What is your perspective?

Gaynor: More than 1 in every 200 children in the United States suffers from behavioral disorders, including ADHD. A report by Physicians for Social Responsibility and the Learning Disabilities Association of America links the cause to a "range of toxic exposures." Chlorpyrifos, a pesticide most frequently used in schools and in hundreds of other common products for lawns, pet products, carpets, etc., can affect the nervous system in humans.

Parkinson's disease, a slowly progressive neurologic disease, affects up to 1.5 million Americans. Its cause has been linked to exposure to environmental toxins. The pesticide rotenone caused disease-type brain lesions in mice. A variety of toxins, including herbicides and pesticides in fruit, have been linked to the onset of this disease.

In August 2002, the National Institute of Environmental Health Sciences (NIEHA) launched a $20 million initiative to study the link between toxins and Parkinson's disease. Lou Gehrig's disease or (ALS) Amyotrophic Lateral Sclerosis is estimated to be twice as high for Gulf War veterans as their nondeployed counterparts.

The link between human illness and environmental toxins is irrefutable. Sadly, the experience in which we wasted 50 years debating whether smoking causes cancer is being played out again with most environmental toxins.

AT: Can you briefly share some of the ways we can fortify our bodies through nutrition and other positive lifestyle choices?

Gaynor: Eat 6-8 servings of fruit and vegetables daily. This provides you with 42 to 56 servings weekly. From that, provide yourself weekly with at least 4 servings of cruciferous vegetables; at least 4 servings of green leafy vegetables; at least 4 servings of garlic, onions, shallots, or leeks; at least 3 servings of beans; at least 6 servings of peas and soybean foods; at least 4 servings of apples; at least 3 servings of tomatoes; at least 4 servings of melons; at least 4 servings of citrus fruits; and at least 4 servings of carotenoid-containing vegetables such as garlic, onions, shallots, leeks, peas, soybeans, melons.

Nutrition has been associated with up to 30% to 70% of all cancer as well as heart disease. When we examine the cost of such diseases, breast cancer, $1 billion; lung cancer: up to $3 billion per year; and cardiovascular disease, $30 billion, we see another extraordinary benefit of prevention. By incorporating into the diet phytochemicals, I believe we could markedly reduce the incidence of both heart disease and cancer.