Mark Moyad, MD // University of Michigan Medical Center
The Cheapest, Best, Safest Available “Drug” for Cancer-Related Fatigue (CRF) that no one knows about until now, despite being proven to work at the Mayo Clinic, MD Anderson Cancer Center & 40+ other medical centers many years ago!!??? What the heck is Moyad talking about?! (Shameless plug #235-See “The Supplement Handbook” by Moyad on Amazon after reading this article).
I often get the following question: Hey Dr. Moyad you look like a perfectly sculpted international male middle-age model, so why continue working in medicine and even with PCRI when you could make more money just having magazines and world renowned fashion designers take pictures of you and lionize you 24 hours a day? Okay, actually that is not the question people ask me, but in my dreams, I am often asked that exact question by my wife, friends, parents, dog, kids, neighbors, and celebrities.
The question I really get often is “Why is there no single, cost-effective, safe, and effective treatment to reduce fatigue from cancer treatment?” This condition is known as CRF officially, or Cancer-Related Fatigue. And, the amazing answer is that for many years there has been something that could help, and it is really cheap and safe, but no one knows about it because it is a DIETARY SUPPLEMENT!!! What the HE—DOUBLE TOOTHPICK!! That is right! This is probably going to be more surprising for you than finding out that Big Foot and Elvis are still alive (they are still alive by the way, and live together in the Upper Peninsula of Michigan in a small cottage on Lake Superior-I read it in one of those magazines by the check-out counter at the grocery store yesterday—and we all know how accurate those magazines are—the article on Big Foot and Elvis was right next to the bigger article on page 1 of the man that locked himself in his new empty refrigerator on accident and could not escape for 2 months but survived by eating his own left foot).
Mark A. Moyad, MD, is the Jenkins/Pokempner Director of Complementary & Alternative Medicine at the University of Michigan Medical Center and he has written many popular books on the subject of diet, supplements, and overall health. His most recent book is: The Supplement Handbook: A Trusted Expert’s Guide to What Works & What’s Worthless for More Than 100 Conditions. He will be moderating the 2016 Prostate Cancer Conference in September. Don’t miss it! Learn more on page 10.
Prevalence of CRF
So, how bad is CRF really Doc Model Moyad? In clinical studies and in real life, it can occur in as many as 60-90% of patients! And it is also one of the most common or primary side effects of one of the best prostate cancer drugs ever invented known as “Xtandi,” and it is a common side effect of most of the other incredible prostate cancer drugs from hormone therapy to Zytiga, and of course chemotherapy. Basically, it is this fatigue side effect that all the prostate cancer drugs have in common but not a single effective CRF option exists in cancer? WRONG! WRONG! WRONG! (3 times should be enough for emphasis and annoyance).
So, let me now provide a recent quotation from famous Mayo Clinic doctors in the most prestigious cancer medical journal in the world: “Nevertheless, for patients who want to try a pharmacologic product and physicians who are early adopters of new promising agents, the pure ground root American ginseng product, as used in the above studies, might be an option to consider” . This was an editorial or comment from some of the top experts in the field of conventional treatments for CRF from the #1 oncology medical journal in the world, which is arguably one of the strongest potential endorsements of a dietary supplement to prevent or treat a common cancer treatment side effect not explained by other factors.
Clinical Trials for Ginseng
Why such verve for American ginseng (also known as “Panax quinquefolius”…thank you to my Latin teacher from 7th grade and sorry for always being late to class!)? The excitement was based on two strong-in-methodology clinical trials, somewhat similar to phase 3 drug trials [2,3]. A total of 364 participants were enrolled from 40 MEDICAL CENTERS (not four but 40, folks!) in the most recent trial and patients were dealing with breast, colon, or prostate and even other types of cancer . After approximately two months a significant difference (aka twice the effect at reducing fatigue compared to placebo) was observed with ginseng. Side effects were similar to placebo! Participants received 2000 mg of Wisconsin ginseng (a type of high-quality American ginseng) or placebo in that trial.
This same research group from the Mayo Clinic (I love the Mayo-it is my favorite condiment to use in my weekly sub sandwich) also observed anti-fatigue effects at 1000 mg per day in a previous clinical trial of 290 cancer patients . And, the pure ground root ginseng in these clinical trials was donated by the Ginseng Board of Wisconsin (Wausau, WI, go to www.ginsengboard.com to get more information or go to www.ginsengherbco-op.com to purchase the exact cheap product used in the clinical trials…oh and I have no commercial interest in this company at all). It is also of interest that in these large clinical trials patients appeared to receive greater anti-fatigue benefits when ginseng was used earlier in the course of conventional cancer treatment (as opposed to later or after treatment).
Another small, single-arm clinical trial of 800 mg per day of another type of ginseng known as “Panax/Asian Ginseng” (from Indena S.p.A. Milan, Italy) at MD Anderson Cancer Center found a significant reduction in CRF within one month in cancer patients. This study needs confirmation in a larger randomized trial . This supplement also appeared to significantly improve quality of life and also appeared to improve sleep, appetite, pain, and other issues related to CRF in 30 days. WOW spelled backward!
Thus, the cumulative evidence from the Mayo Clinic directed and MD Anderson Cancer Center studies are more than sufficient evidence to offer ginseng as a primary anti-fatigue option, especially since patients have few options in this area, and some of the more expensive pharmaceutical based products (stimulants, anti-depressants…) have been disappointing when further studied and some cost more than a Porsche filled with money (okay I embellished that slightly but they cost “mucho dinero”—thank you Spanish teacher from high school and sorry for making dumb jokes in class like what is the weather forecast for Mexico City…”Chili today and Hot Tamale” or what happened to the Spanish fisherman that said “yes” too much…well he got “Si-sick” or what happened when the Spanish boy dropped the mayonnaise jar in the pool…he shouted “Sinko de Mayo”!.....Ouch…. I know….I should stick to my night job…you are lucky I did not tell my French jokes like what happened when 3 cats fell through the ice in Lake Michigan…well the Spanish Sheriff said told the media that “un deux trois quatre cinq”…if you do not get it then google it cause it is hilarious).
How Ginseng Affects Fatigue
Ginseng appears to reduce the inflammatory process associated with cancer or chronic fatigue due to inflammation in general [1-5]. Ginseng may reduce cortisol and thus reduces stress overall to improve energy levels. Whether or not the primary anti-fatigue effects are being derived from the standardized ginsenoside and/or polysaccharides content or another specific active compound in the supplement is a matter of debate and more research. Again, the fact that there were no side effects beyond placebo and American ginseng has been found to have no real current strong drug interactions or interfere overtly with major drug metabolism is noteworthy. Ginseng from water extraction or from pure ground root has been associated with the best results and safety, and ginseng extraction methods due to alcohol or methanol based procedures could be less effective, and some researchers believe toxic with long-term use . Additionally, ginseng (American or Panax ginseng) has a long history of having an ability to improve energy levels in healthy individuals, but again because it worked for more extreme fatigue from cancer treatment, it can help with many types of fatigue from my experience. Ginseng can be ingested with or without food, but with a meal could reduce gastrointestinal side effects like acid reflux caused by pill consumption in general. Cut the capsules in half to make them easier to swallow if the pill is too large (use a pill cutter please). AND THE BEST PLACE TO BUY IT IS FROM THE GINSENG BOARD OF WISCONSIN (Wausau, WI, go to www.ginsengboard.com to get more information or go to www.ginsengherbco-op.com to purchase the exact cheap product used in the clinical trials) because we want to reward the research (like we would with a drug) and use the same cheap and effective product used in the Phase 3 Mayo Clinic trial of cancer patients. And, you will not have to deal with the potential quality control issues with ginseng that you can get by just buying some random ginseng product from the health food store down the street or your local drug store that could be filled with contaminants and does not contain the standardized drug-like ingredients used in the Mayo clinical trials.
Finally, let's solve the final mystery (not of Jimmy Hoffa or the Loch Ness monster…oh and both of them are also alive by the way and living near Malibu Beach, CA and yes I read that from another high-quality magazine near the check-out counter at Walmart right next to the article of the man that claimed he has been in a UFO many times as they buzzed through Iowa cornfields to make those weird, mysterious shapes and the government told him not to say anything), no, the mystery of why no one really knows why the best, safest, cheapest drug/supplement in the world for CRF gets no attention or love? It is because a dietary supplement is not allowed to claim to prevent, treat, mitigate, or cure a medical disease or condition despite the fact that most of the best-selling effective supplements in the U.S. are just prescription drugs in other countries and that doctors generally recommend supplements for medical conditions . Still, a recent survey of U.S. oncologists demonstrated that most admit that they do not talk about herbal supplements with patients because they do not believe they know enough about them . So, who loses here? Health care professionals lose (unless they attend a Moyad course on dietary supplements or read this article) and so do patients because they do not get the information from some of the wonderful doctors they trust the most! THIS IS SAD, BUT IT IS THE REALITY of some of the silly and dumb rules that govern dietary supplements. NO ONE REALLY WINS!!! However, this article is one of the many reasons why I believe a little education can change this silly game quickly so that patients and health care professionals win! SO, LETS START WINNING. SHARE THIS ARTICLE WITH EVERYONE INCLUDING YOUR PATIENTS, DOCTORS, CATS…!!! YEAH!!! WINNING IS FUN!!! See you at the PCRI September 2016 Meeting! Winning!!!
So, I need to go now because this article is way too long, and I am experiencing what is now known as “FTFPCS” or “Finger Tip Fatigue from a Personal Computer Syndrome” which an attorney on TV just told me that a pharma company is responsible for, and as long as I call the number on the screen I could make millions! Oh boy! WINNING AGAIN!!!
1. Ruddy KJ, Barton D, Loprinzi CL. Laying to rest psychostimulants for cancer-related fatigue? J Clin Oncol 2014;32:1865-1867.
2. Barton DL, Liu H, Dakhil SR, Linquist B, Sloan JA, Nichols CR, et al. Wisconsin ginseng (Panax quinquefolius) to improve cancer-related fatigue: a randomized, double-blind trial, N07C2. J Natl Cancer Inst 2013;105:1230-1238..
3. Barton DL, Soori GS, Bauer BA, Sloan JA, Johnson PA, Figueras C, et al. Pilot study of Panax quinquefolius (American ginseng) to improve cancer-related fatigue: a randomized, double-blind, dose-finding evaluation: NCCTG trial N03CA, Support Care Cancer 2010;18:179-187.
4. Yennurajalingam S, Reddy A, Tannir NM, Chisholm GB, Lee RT, Lopez G, et al. High-dose Asian ginseng (Panax ginseng) for cancer-related fatigue: a preliminary report. Integrative Cancer Therapies 2015; 14:419-427.
5. Moyad MA. Lee J. The Supplement Handbook. Rodale Publishing, NY, 2015.
6. Lee RT, Barbo A, Lopez G, Melhem-Bertrandt A, Lin H, Olopade O, et al. Natiional survey of US oncologists’ knowledge, attitudes, and practice patterns regarding herb and supplement use by patients with cancer. J Clin Oncol 2014;32:4095-4101.