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Bladder Cancer Wellness Plan

About Bladder Cancer

Nearly 70,000 individuals in the United States will be diagnosed with bladder cancer in 2011, the 5th most common cancer, and almost 15,000 will die of the disease.[1]

It occurs at a rate roughly 3 times higher in the U.S. than in Asian countries.[2]

70% of cases are non-muscle invasive lesions, which recur frequently but do not often affect mortality, and 30% are muscle invasive, which tend to be provigressive and have poor survival.[3]

Because most people with bladder cancer have recurrences and survive long-term, lifelong monitoring is required.

Urothelial carcinoma of the bladder is thought to be significantly influenced by environmental factors, particularly cigarette smoking, which accounts for roughly 50% of all cases.[4]

Causes/Contributing Factors

80% of bladder cancer diagnoses occur in those over 60, with a 3x higher occurrence in men than women, and although it is more prevalent in Caucasians, delayed diagnosis leads to worse prognosis in African American individuals.[6]

Smoking is the largest contributor to bladder cancer occurrence, responsible for 1/2 of all cases, with an increase in risk which persists as long as 20 years after quitting.[7]

Other environmental and occupational toxins have also demonstrated risk, including toxins found commonly in industrial and agricultural settings.

It may also be caused by the infectious agent, Schistosoma haematobium, though this is mainly limited to Africa and the Middle East.

Dietary factors include a higher processed meat intake, while vitamin B12 appears to have a protective effect.[8]

A recent study found that higher intakes of a-linolenic acid content, derived from plant foods, was associated with a 74% lower risk of developing bladder cancer.[9]

Relevant Diagnostic Testing

Cystoscopy (procedure to see inside bladder and urethra)

Biopsy (sampling of cells collected for further testing)

Imaging (allow the doctor to examine the structures of the urinary tract)

Urine cytology (examination of urine cells under a microscope)

Vitamin D level – Low vitamin D levels have been associated with increased risk for bladder cancer and survival, and the ratio of 25(OH)vitamin D/D binding protein (DBP) may be the most predictive.[10]{11}

STAY ACTIVE
Be physically active, every day. Even light intensity exercise has benefit.[12]
Dietary Action Plan

Emphasize:

  1. Brightly colored, fresh vegetables, leafy greens and fresh fruits (choose organic if possible)
  2. Cruciferous vegetables, such as broccoli, cauliflower, cabbage, etc., especially raw broccoli
  3. Foods high in alpha linolenic acid, such as flaxseeds, pumpkin seeds, walnuts, brussel sprouts and soybeans, among others
  4. Whole foods (foods that are as close to their natural form as possible)
  5. Low sugar/low glycemic diet (Glycemic index (GI) and glycemic load (GL) are measures of the effect on blood glucose level after a food containing carbohydrates is consumed)
  6. Omega-3 fatty acids, found in cold water fish such as sardines, wild-caught salmon, cod, mackerel, tuna
  7. High fiber, from whole grains, beans, vegetables and fruits
  8. Healthy fats, from avocados, nuts, seeds, olive oil, coconut oil, cold water fish
  9. For animal protein, choose lean poultry and fish over red meat, and aim to view meat as a condiment rather than a staple. Try to choose grass fed and organic meats and eggs whenever possible. Eat no fish larger than a salmon to minimize environmental contaminants, including mercury.

Avoid:

  1. Processed and grilled meats. Also, try to limit intake of red meat
  2. Fast foods, fried foods, baked goods and packaged, processed foods
  3. Sugar, sweeteners  and artificial sweeteners
  4. Vegetable oils, shortening, margarine and anything with hydrogenated or partially hydrogenated oils
Bladder Cancer Supplement Protocol

Curcumin Phytosome

  • Derived from the spice turmeric, curcumin has multiple mechanisms of anti-cancer action. Additionally, it may enhance the effects of Bacillus Calmette-Guerin (BCG), the most commonly used agent for bladder cancer.[20][21] Doses range depending on type of curcumin, Meriva® and Longvida® have been shown to be much more efficiently absorbed forms.[22][23]
  • Suggested dose: 1-2g of Meriva® or Longvida® curcumin per day.

Diindolylmethane (DIM)

  • Diindolylmethane (DIM), extracted from cruciferous vegetables, such as broccoli, cauliflower, cabbage, etc., has been shown to induce apoptosis (programmed cell death) and reduce the invasiveness of bladder cancer cells, and may improve chemotherapeutic effectiveness against more resistant cells.[26]
  • Suggested dose: 250mg per day.

Milk Thistle

  • Silymarin and silibinin from milk thistle have anti-proliferative and anti-metastatic properties, and have increased apoptosis (programmed cell death) in bladder cancer cells.[24][25]
  • Suggested dose: at least 500mg silymarin per day.
Vitamin D
  • Low vitamin D levels have been associated with a greater occurrence and risk of dying from bladder cancer.
  • Suggested dose is that sufficient to raise vitamin D blood levels to >40 ng/mL, which may require 5000 IU per day or more.[13]
Additional Beneficial Supplements

Green Tea Extract

  • Catechins, antioxidants found in green tea, particularly EGCG, have been shown to inhibit bladder cancer cell invasion and spreading (metastasis).[14][15]
  • Suggested dose: 1g EGCG and mixed catechins per day.

Vitamin E & mixed tocopherols

  • A small trial of vitamin E for patients with low grade bladder cancer significantly reduced cancer recurrence in both smokers and non-smokers.[16] A previous study found that long-term vitamin E supplementation was associated with a 40% reduction in bladder cancer mortality, and some evidence suggests it may enhance the effectiveness of some chemotherapy.[17][18]
  • Suggested dose: 400 IU of mixed tocopherols and tocotrienols per day.

N-Acetyl Cysteine

  • This antioxidant has been shown to inhibit several processes in bladder cancer cells, including adhesion, invasion, and migration.[19]
  • Suggested dose: 600mg, 2-3 times per day.

Quercetin

  • The antioxidants in quercetin have been shown to inhibit the growth of cancer cells, and protect bladder cancer cells from carcinogenic toxins.[27][28]
  • Suggested dose: 200-400mg three times per day.

Melatonin

  • A hormone, supplemental melatonin intake has improved survival in a number of cancers, and may enhance conventional therapy effectiveness.[29]
  • Suggested dose: at least 3mg at night, preferably time-released.

Vitamin K2

  • Vitamin K-2 (MK-7) has the longest half-life, meaning it is the most stable, of all forms of vitamin K. Shown to improve bone and cardiovascular health, higher intakes of this form have also been associated with reduced cancer occurrence & fatality, and may improve effectiveness of other therapies.[30][31][32]
  • Suggested dose, 100 mcg vitamin K-2 (MK-7).
Footnotes

[1] American Cancer Society Cancer Facts and Figures 2011. American Cancer Society, Atlanta (2011).

[2] Parkin, DM, Bray, F, Ferlay, J, et al. (2005) Global cancer statistics, 2002. CA Cancer J Clin 55, 74–108.

[3] Altekruse, S. F. et al. (Eds). SEER Cancer Statistics Review, 1975–2007 (National Cancer Institute, Bethesda, 2010).

[4] Freedman ND, Silverman DT, Hollenbeck AR, et al. Association between smoking and risk of bladder cancer among men and women. JAMA. 2011 Aug 17;306(7):737-45.

[5] Ros MM, Bueno-de-Mesquita HB, et al. Fruit and vegetable consumption and risk of aggressive and non-aggressive urothelial cell carcinomas in the European Prospective Investigation into Cancer and Nutrition. Eur J Cancer. 2012 Nov;48(17):3267-77.

[6] Sharma S, Ksheersagar P, Sharma P. Diagnosis and treatment of bladder cancer. Am Fam Physician. 2009 Oct 1;80(7):717-23.

[7] S.A. Strope, J.E. Montie. The causal role of cigarette smoking in bladder cancer initiation and progression, and the role of urologists in smoking cessation. J Urol, 180 (2008), pp. 31–37.

[8] Wu JW, Cross AJ, Baris D, et al. Dietary intake of meat, fruits, vegetables, and selective micronutrients and risk of bladder cancer in the New England region of the United States. Br J Cancer. 2012 May 22;106(11):1891-8.

[9] Brinkman MT, Karagas MR, et al. Intake of a-linolenic acid and other fatty acids in relation to the risk of bladder cancer: results from the New Hampshire case-control study. Br J Nutr. 2011 Oct;106(7):1070-7.

[10] Mondul AM, Weinstein SJ, Virtamo J et al. Influence of vitamin D binding protein on the association between circulating vitamin D and risk of bladder cancer. Br J Cancer. 2012 Oct 23;107(9):1589-94.

[11] Peiris AN, Bailey BA, Manning T. Relationship of vitamin D monitoring and status to bladder cancer survival in veterans. South Med J. 2013 Feb;106(2):126-30.

[12] C B, M M, R D, et al. Cross-Sectional & Longitudinal Associations between Light-Intensity Physical Activity & Physical Function Among Cancer Survivors. Cancer Epidemiol Biomarkers Prev. 2013 Mar;22(3):475-6.

[13] Garland CF, French CB, Baggerly LL, et al. Vitamin D supplement doses and serum 25-hydroxyvitamin D in the range associated with cancer prevention. Anticancer Res. 2011 Feb;31(2):607-11.

[14] Qin J, Wang Y, Bai Y, et al. Epigallocatechin-3-gallate inhibits bladder cancer cell invasion via suppression of NF-κB mediated matrix metalloproteinase-9 expression. Mol Med Rep. 2012 Nov;6(5):1040-4.

[15] Rieger-Christ KM, Hanley R, et al. The green tea compound, (-)-epigallocatechin-3-gallate downregulates N-cadherin and suppresses migration of bladder carcinoma cells. J Cell Biochem. 2007 Oct 1;102(2):377-88.

[16] Mazdak H, Zia H. Vitamin e reduces superficial bladder cancer recurrence: a randomized controlled trial. Int J Prev Med. 2012 Feb;3(2):110-5.

[17] Jacobs EJ, Henion AK, Briggs PJ, et al. Vitamin C and vitamin E supplement use and bladder cancer mortality in a large cohort of US men and women. Am J Epidemiol. 2002 Dec 1;156(11):1002-10.

[18] Kanai K, Kikuchi E, et al. Vitamin E succinate induced apoptosis and enhanced chemosensitivity to paclitaxel in human bladder cancer cells in vitro and in vivo. Cancer Sci. 2010 Jan;101(1):216-23.

[19] Supabphol A, Muangman V, Chavasiri W, et al. N-acetylcysteine inhibits proliferation, adhesion, migration and invasion of human bladder cancer cells. J Med Assoc Thai. 2009 Sep;92(9):1171

[20] Tian B, Wang Z, et al. Effects of curcumin on bladder cancer cells and development of urothelial tumors in a rat bladder carcinogenesis model. Cancer Lett. 2008 Jun 18;264(2):299-308.

[21] Kamat AM, Tharakan ST, et al. Curcumin potentiates the antitumor effects of Bacillus Calmette-Guerin against bladder cancer through the downregulation of NF-kappaB and upregulation of TRAIL receptors. Cancer Res. 2009 Dec 1;69(23):8958-66.

[22] Marczylo TH, Verschoyle RD, Cooke DN, et al. Comparison of systemic availability of curcumin with that of curcumin formulated with phosphatidylcholine. Cancer Chemother Pharmacol. 2007 Jul;60(2):171-7

[23] DiSilvestro RA1, Joseph E, Zhao S, Bomser J. Diverse effects of a low dose supplement of lipidated curcumin in healthy middle aged people. Nutr J. 2012 Sep 26;11:79. doi: 10.1186/1475-2891-11-79.

[24] Vinh PQ, Sugie S, Tanaka T, et al. Chemopreventive effects of a flavonoid antioxidant silymarin on N-butyl-N-(4-hydroxybutyl)nitrosamine-induced urinary bladder carcinogenesis in male ICR mice. Jpn J Cancer Res. 2002 Jan;93(1):42-9.

[25] Tyagi AK, Agarwal C, et al. Silibinin down-regulates survivin protein and mRNA expression and causes caspases activation and apoptosis in human bladder transitional-cell papilloma RT4 cells. Biochem Biophys Res Commun. 2003 Dec 26;312(4):1178-84.

[26] Sun Y, Cheng MK, et al. Inhibition of STAT signalling in bladder cancer by diindolylmethane: relevance to cell adhesion, migration and proliferation. Curr Cancer Drug Targets. 2013 Jan;13(1):57-68.

[27] Sekeroğlu V, Aydin B, Sekeroğlu ZA. Viscum album L. extract and quercetin reduce cyclophosphamide-induced cardiotoxicity, urotoxicity and genotoxicity in mice. Asian Pac J Cancer Prev. 2011;12(11):2925-31

[28] Kim Y, Kim WJ, Cha EJ. Quercetin-induced Growth Inhibition in Human Bladder Cancer Cells Is Associated with an Increase in Ca-activated K Channels. Korean J Physiol Pharmacol. 2011 Oct;15(5):279-83.

[29] Cutando A, López-Valverde A, et al. Role of melatonin in cancer treatment. Anticancer Res. 2012 Jul;32(7):2747-53.

[30] Nimptsch K, Rohrmann S, Kaaks R, et al. Dietary vitamin K intake in relation to cancer incidence and mortality: results from the Heidelberg cohort of the European Prospective Investigation into Cancer and Nutrition (EPIC-Heidelberg). Am J Clin Nutr. 2010 May;91(5):1348-58.

[31] Nimptsch K, Rohrmann S, Linseisen J. Dietary intake of vitamin K and risk of prostate cancer in the Heidelberg cohort of the European Prospective Investigation into Cancer and Nutrition (EPIC-Heidelberg). Am J Clin Nutr. 2008 Apr;87(4):985-92.

[[32] Zhang H, Ozaki I, Hamajima H, et al. Vitamin K2 augments 5-fluorouracil-induced growth inhibition of human hepatocellular carcinoma cells by inhibiting NF-κB activation. Oncol Rep. 2011 Jan;25(1):159-66.

Customized Protocols and free wellness consultations

Bladder Cancer Protocol

Multiple nutritional supplements have been associated with reduced cancer incidence and/or cancer progression. This list contains those with the greatest evidence-based benefit.