Phytotherapy: When to prescribe, what effects to expect?
Prof. N. Savickienė
The Role of Phytotherapy in Oncology
Prof. Nijolė Savickienė from the Department of Pharmacognosy at the Lithuanian University of Health Sciences (LSMU) recommends using herbal preparations to prevent oncological diseases, as well as to reduce the undesirable effects of chemical, radiation, or other treatments. Additionally, the biologically active substances and compounds in herbal preparations can help prevent secondary diseases or complications resulting from cancer treatment.
Cancer is among the most severe and dangerous diseases. Cancer patients frequently use herbal preparations and various herbal remedies alongside conventional treatment. Which plants are effective for treating tumors?
What Promotes Tumor Formation?
"To understand which plants can be beneficial for cancer patients, we should first know how a tumor grows and what processes occur in the body," the professor notes. According to the speaker, there are many reasons for the development of tumors, but it is important to remember that malignant tumors are the result of chronic inflammation. The development of the inflammatory process, the formation of proliferating cells, and growth are closely related to cellular and humoral immune mechanisms. Thus, disrupted immune processes can promote the development and growth of tumors. Common infections (e.g., Zoster, Herpes, etc.), with their affected unstable tissue, can become a place where altered cells form. Therefore, oncological pathology can develop due to chronic viral or bacterial infections. The damage caused by prolonged stress, which can also disrupt the body's immune homeostasis, is well known to all. All of these factors promote changes within the cell itself and its microenvironment.
According to Prof. N. Savickienė, when discussing cancer, she notes that changes in the body closely link to oxidation and reduction processes. An imbalance in these processes can promote malignant transformations. Additionally, she highlights that disturbances in the internal environment's pH and disruptions in cell mitosis and apoptosis processes can also promote cancer processes.
"Scientific literature studying tumor processes shows that a common observation in the formation of a malignant tumor is the slowing of the apoptosis mechanism within cancer cells. Thus, impaired initiation of apoptosis or its absence can cause many diseases, including cancer, autoimmune diseases, etc. A cancerous cell exhibits deregulation of apoptosis - with possible suppression of pro-apoptotic pathways and/or activation of anti-apoptotic signaling pathways," the speaker explains.
In searching for plants suitable for cancer patients, researchers look for biologically active compounds that can specifically initiate and activate apoptosis mechanisms in altered tissue.
Biologically Active Compounds in Oncology
The professor notes that biologically active compounds suitable for cancer patients are those that can initiate apoptosis in altered cells but at the same time can promote mitosis in normal cells. Beneficial compounds negatively affect the development of metastases and tumor tissue angiogenesis, suppress tumor cell proliferation, DNA replication, regulate the immune system and immune response, thus preventing secondary diseases, i.e., they can help prevent situations where the treatment of oncological diseases triggers the development of a new malignant tumor.
The main compounds, according to Prof. N. Savickienė, that doctors should focus on and that exhibit cytotoxic (anticancer) effects are:
- Alkaloids (vinblastine, colchicine, etc.);
- glycoproteins (e.g., lectins);
- flavonoids (hypericin, genistein, luteolin, quercetin, diosmin, hesperidin, etc.);
- carotenoids (lutein, zeaxanthin, lycopene);
- lignans;
- polysaccharides (glucans, etc.);
- terpenoids.
Lectins are a new perspective in oncology. Their advantage, according to the professor, is that they can selectively act only on altered foreign tissue and cells.
Carotenoids are known for their antioxidant effects, which are particularly beneficial for patients after undergoing therapies such as chemotherapy and radiation therapy. In addition, biologically active compounds such as flavonoids and carotenoids have anti-inflammatory effects. Health professionals recommend administering these compounds after treatment to improve the quality of life for cancer patients.What plants contain the mentioned anticancer compounds?Greater celandine - plants with cytotoxic effects
Prof. N. Savickienė notes that the priority feature of plants intended for cancer patients is cytotoxic compounds, such as alkaloids and glycoproteins, which have the unique ability to act on altered tissue, a tumor. Therefore, a highly beneficial plant for cancer patients is Greater Celandine (Chelidonium majus L.). These plants contain more than 20 different alkaloids, including benzylisoquinoline alkaloids (benzophenanthridines: chelerythrine, chelidonine, sanguinarine, isochelidonine; protoberberines: berberine, coptisine, dihydrocoptisine, stylopine; protopines) and glycoproteins.
"The plant's name - celandine - speaks for itself. It is a fiery plant, burning. Many have felt its effect in eliminating warts," the interlocutor says. Traditionally, people use Greater Celandine for digestive system disorders such as gallbladder, bile ducts, and liver diseases; dyspepsia and flatulence. People also apply the plant externally to remove warts, papillomas, corns, calluses, and treat eczema. Researchers have established the pharmacological effect of Greater Celandine extract in in vivo studies. The research results reveal that the compounds in the extract exhibit:
- antiviral activity (against Influenza family viruses);
- antimicrobial activity (the alkaloid berberine present in the plant successfully regulates intestinal secretion induced by E. coli toxins);
- anti-inflammatory effect (the alkaloid sanguinarine in the plant, when administered subcutaneously to rats at 5 mg/kg, showed the strongest anti-inflammatory effect);
- antitumor effect;
- immunomodulatory effect; anxiolytic and analgesic effects.
Advanced Research Findings and Safety Considerations
"The alkaloids chelidonine and protopine present in the plant exhibited antitumor activity, acting on sarcoma 180 and Erlich carcinoma cells. Administering 50 μg/kg of the alkaloid chelidonine to mice for 7 days resulted in a 22–25% slowdown in tumor growth. Greater Celandine inhibited stomach mucosa carcinogenesis, hepatocarcinogenesis, pancreatic tumor development, and the plant extract cytotoxically affected lymphoma cells," the professor enumerates research results. Furthermore, the aforementioned alkaloid chelidonine delayed telomerase in tumor cells. As known, the enzyme telomerase is active in almost all malignant tumors but not in healthy cells. Therefore, this enzyme is an ideal target, and drugs or plants that could "turn it off" contribute to halting the uncontrolled growth of cancer cells.
Research has also confirmed the immunomodulatory effect of Greater Celandine. "For a cancer patient, coordinating the immune response is crucial—not merely stimulating or strengthening, but coordinating it," explains the professor. In one study, researchers administered 50 mg/kg of glycoproteins extracted from Chelidonium majus L. into the peritoneum of mice one day before radiation. Five days after radiation, they observed an increase in leukocytes compared to the control group. In another experiment, researchers injected mice with 50 mg/kg of glycoproteins from Chelidonium majus L. into the peritoneum before administering a lethal dose of radiation. After 30 days, 80% of these mice survived, compared to the control group where all mice died within 15 days.
The anxiolytic and analgesic effects of Greater Celandine are due to the plant extract activating gamma-aminobutyric acid receptors, i.e., inhibiting neuronal activity, regulating impulse conductivity, calming the nervous system, improving sleep cycles, and suppressing neuropathic pain.
Safety and Usage Guidelines for Greater Celandine
"It's crucial to remember that Greater Celandine is a poisonous plant, and one should use it with caution," the professor stresses. "It is advisable to use precisely standardized preparations of Greater Celandine rather than preparing infusions or teas at home."
The role of plant antioxidants in cancer
Prof. N. Savickienė reminds that another group of active compounds beneficial for cancer patients are carotenoids. These are antioxidants, and their effects have also been evaluated in numerous studies. For example, in in vivo studies, lutein, zeaxanthin exhibited an antiproliferative effect (halting tumor cell growth). It has been found that these substances have a positive effect on colorectal, bladder, cervical, breast, and prostate tumors. In in vivo studies, lycopene also showed an antiproliferative effect on bladder, cervical, breast, and prostate tumor cells.
"Plants that contain these mentioned carotenes include marigold (Calendula officinalis L.). This is a well-known plant with its main compound being faradiol, i.e., a triterpene saponin that has exceptional anti-cancer, anti-inflammatory, and anti-edema effects. Additionally, plants also contain carotenoids (lutein, zeaxanthin, lycopene, α-carotene, β-carotene), which, like flavonoids (isorhamnetin, quercetin), are responsible for their antioxidant, epithelial regenerative effects. Sesquiterpene compounds and components of essential oil (α-cadinol) exhibit antiseptic activity, and plants also contain polysaccharides, coumarins, among others." - a pharmacist names biologically active substances.
Research has also been conducted on medicinal marigolds in vivo, observing positive effects of Calendula officinalis L. extract, meaning that plants can:
- promote epithelialization and regeneration of damaged tissues;
- reduce the activity of liver enzymes (transaminases);
- exhibit anti-inflammatory, anti-edema effects (the inflammation-suppressing effect of triterpene alcohol
- faradiol is similar to indomethacin);
- inhibit contact dermatitis induced by sodium lauryl sulfate; promote the process of phagocytosis;
- inhibit the growth of many bacteria (Bacillus subtilis, Escherichia coli, Staphylococcus aureus, Pseudomonas aeruginosa, Candida albicans, Trichophyton mentagrophytes var.interdigitale, Trichophyton rubrum, Trichophytum concentricum, Epidermophyton floccosum);
- due to the triterpenes present in the plants, inhibit the proliferation of colorectal cancer, leukemia, and melanoma cells, as well as Erlich carcinoma cells.
The effectiveness of externally used marigold ointment has been studied: a successful third-phase clinical trial was conducted with 254 patients after breast tumor removal. The patients underwent post-operative therapy. In cases of dermatitis, 126 patients used the medicinal marigold preparation externally, while 128 patients used trolamine. It was found that the medicinal marigold preparation more effectively suppressed acute dermatitis and radiation-induced pain than trolamine.
Another group of compounds responsible for antioxidant processes is flavonoids. "Interestingly, depending on the goals and objectives, it is necessary to differentiate the concentration of flavonoids. If we want to ensure antioxidant protection, a low concentration of flavonoids is sufficient. To initiate the apoptosis mechanism in altered tissue, large doses are needed - about 1,000 mg several times a day," emphasizes the professor.
Flavonoids (hypericin, genistein, luteolin, quercetin, diosmin, hesperidin) and stilbene, resveratrol, have the following effects:
- antioxidant;
- antiallergic (suppresses histamine secretion);
- antiproliferative, apoptosis-inducing;
- anti-inflammatory;
- antiviral.
Features of using narrow-leaved plantain
Patients with oncological diseases can use herbal raw materials that accumulate polysaccharides and compounds that act as both prebiotics in eliminating dysbiosis and as immunomodulators, as well as manufactured products. Polysaccharides have anti-cancer effects, promote faster wound healing, which is relevant after surgeries, injuries, and when treating ulcers. Polysaccharides have radioprotective effects, therefore they are recommended to be taken during and after radiation therapy.
Extensive research is being conducted on polysaccharides - beta-glucans. Sources of beta-glucans include fungi (blue, green, brown), and aloe vera. It has been found that beta-glucans modulate immune defense by:
- activating the complement system;
- enhancing the function of T lymphocytes, macrophages, natural killer cells;
- stimulating the synthesis of interleukin-1 and interleukin-2.
Prof. N. Savickienė also emphasizes the importance of dietary fibers. Fiber materials (cellulose) are carbohydrates, polysaccharides: cellulose, hemicellulose, lignin, pectin compounds. Why should they be consumed? These are high molecular weight compounds capable of participating in ion exchange reactions, even in reactions binding carcinogens.
Some plants that are rich in polysaccharides are well-known narrow-leaved plantains (Plantago lanceolata L.). "Since childhood, we remember applying a plantain leaf on a wound. This is empirical, folk medicine. However, the effect of the plant, the chemical composition of plantain extracts, and their application possibilities have been studied by science. It has been found that they act as prebiotics, as a fertilizer for good bacteria, which is important during radiation and chemotherapy."(main methods of cancer treatment) cause a negative response in mucosal microflora. "Therefore, thanks to polysaccharide materials, for example, extract of mallow, we have the possibility to stabilize colonies of Bifidobacterium lactis, create conditions for a nutritional substrate with polysaccharide mucins. Polysaccharides activate intestinal receptors, accelerate content movement, activate peristalsis, therefore suitable for use in case of constipation," says the professor.
Are purple coneflowers suitable for cancer patients?
According to Prof. N. Savickienė, this is a common question that is often heard. "Yes, cancer patients can take preparations of coneflowers, but not for more than 4-6 weeks," says the interlocutor, adding that both individual plant components and their effects have been studied. Purple coneflowers (Echinacea purpurea (L.) Moench.) accumulate alkylamides (mostly isobutylamide), phenolic acids (caffeic, chicoric), polysaccharides, flavonoids, lectins, essential oil, and macro- and microelements. It has been found that preparations of purple coneflowers activate indicators of cellular and humoral immunity:
- polysaccharides stimulate macrophages and natural killer cells;
- chicoric acid stimulates phagocytosis in vitro and in vivo, inhibits hyaluronidase, can protect type III collagen from degradation;
- flavonoids have antibacterial, anti-inflammatory, and antioxidant activity.
According to the professor, the limited consumption time is due to the fact that these plants are immune system stimulants. Therefore, this aspect (whether they initiate the expression of cancer cells) was specifically examined. There is no evidence that they promote the growth of cancer cells. Coneflower preparations are recommended after all types of therapy.
Is the millennia-old ginseng suitable for cancer patients?
According to the professor, there has long been a belief that cancer patients should not use ginseng (Panax ginseng). This plant, like the purple coneflower, acts as a stimulant. For many years, people thought, mistakenly believing in a myth, that it stimulated all processes, both benign and malignant. However, research has now established that ginseng does not stimulate malignant processes. Studies investigating various compounds in ginseng have demonstrated that the plant:
- stimulates macrophage phagocytic activity (Shin et al., 2004, in vivo studies);
- ginsenosides Rg3, Rg5, Rk1, Rs5, Rs4 have cytotoxic effects on liver tumor cells (hepatomas) (Park et al., 2002, in vitro studies);
- ginsenoside Rg3 inhibits prostate tumor cells (Liu et al., 2000, in vitro studies);
- ginsenosides inhibit the development of metastases in ovarian tumors (Nakata et al., 1998, in vivo studies);
- ginsenosides inhibit the development of metastases in melanomas and lung tumors (Hasegawa et al., 2002, in vivo studies);
- a separate component - saponins - stimulate the apoptosis of cancer cells (Hwang et al., 2002, in vitro studies);
People also use Ginseng preparations for a limited time of 4-5 weeks, several times a year. According to the professor, patients often buy and consume another plant with similar effects, called Siberian ginseng, Eleutherococcus senticosus. Like ginseng, it acts as an adaptogen. Studies assessing its effects have shown that this plant can benefit cancer patients, but only after completing all types of therapy. The plant regulates T and B lymphocytes, promotes interleukin activity, has the ability to stabilize tissue, and its glycoprotein fraction reduces liver intoxication.
The Efficacy of Eleutherococcus Senticosus in Supporting Cancer Treatment
Researchers evaluated the impact of Eleutherococcus senticosus on liver tissue after consuming strong toxic substances. In vivo studies indicated that after intoxication with carbon tetrachloride, administering extracts of Eleutherococcus roots and rhizomes intensified the activity of liver cell antioxidant enzymes and exhibited hepatoprotective, anti-inflammatory effects. Taking the extract of black Eleutherococcus roots and rhizomes for 8 weeks inhibited fat accumulation in liver cells. Clinical trials have shown that taking liquid extract of black Eleutherococcus roots and rhizomes for 4-6 weeks (10 ml 3 times a day) significantly increased total lymphocytes (p<0.0001), T lymphocytes (p<0.00001), killer cells (p<0.1), and B lymphocytes (p<0.05) compared to placebo.
Systemic enzymes - improving quality of life
The professor notes that taking systemic enzymes is beneficial for cancer patients. In cases of inflammation and malignant tumors, he recommends using cysteine proteases, such as bromelain and papain, as additional therapy.
- to reduce the side effects of chemotherapy and improve patients' quality of life;
- to reduce the inflammation and edema initiated by radiation therapy;
- after surgical intervention, to reduce edema and accelerate wound healing;
reducing leukocyte adhesion, infiltration, stimulating their phagocytosis, reducing the viscosity of exudate. The goal of enzyme therapy is not to destroy the tumor, but to improve the quality of life of patients. These enzymes can be administered both during the main therapy, for example, chemotherapy, and after treatment.
Which plants are compatible with synthetic drugs?
According to Prof. N. Savickienė, this is also a very important question. Taking into account various sources of monographs, it is possible to select plants that, when used together, can achieve even better treatment results or further improve the quality of life.
So, positive interactions can occur between these plant compounds:
- soy (Glycine max (L.) Merr.) fruit extract and tamoxifen (favorable treatment course);
- doxorubicin and Ginkgo biloba L. leaf extract (reduces doxorubicin-induced cardiotoxic effects);
- cisplatin and Ginkgo biloba L. leaf extract (reduces cisplatin-induced nephrotoxic effects);
- cisplatin and silymarin (positive treatment response, reduces cisplatin-induced nephrotoxic effects);
- vinblastine and common licorice extract (positive treatment response).
When should patients with oncological diseases use herbal preparations, and which ones are appropriate?
The professor notes that it is important not only which biologically active compounds a cancer patient takes, but also when. It is important to know that:
- glycoproteins, for example, lectins - cytotoxic compounds used after chemotherapy and radiation therapy;
- enzymes - cysteine proteases - can be used during chemotherapy and radiation therapy;
- flavonoids (hypericin, genistein, luteolin, quercetin, diosmin, hesperidin, etc.), resveratrol and carotenoids (lutein, zeaxanthin, lycopene), as well as antioxidants, are used after chemotherapy and radiation therapy;
- polysaccharides (glucans, etc.) can be used during chemotherapy and radiation therapy.
Prepared by Natalija Voronaja
Source "Internistas"
