By Judy Foreman, Globe Staff, 08/09/99
Four years years ago, Betty Frizzell, a retired schoolteacher from Cookeville, Tenn., was diagnosed with pancreatic cancer, one of the deadliest malignancies there is. Normally, people with advanced tumors, like Frizzell’s, live only about five months after they are diagnosed.
Frizzell, now 64, is thriving on a diet of fruits and vegetables plus a regimen of dietary supplements including pancreatic enzymes and – believe it or not – coffee enemas. She does get a bit tired of carrot juice, she says, and the coffee enemas – two in the morning, two at night – are ”very time consuming.” But she’s convinced it’s worth it: ”I’m sure I wouldn’t be alive today if I had not chosen this route.”
”Pancreatic cancer strikes almost as many people as leukemia, yet so far, less progress has been made,” says Dr. Robert Mayer, director of the center for gastrointestinal cancer at the Dana-Farber Cancer Institute in Boston. In fact, pancreatic cancer is so tough to detect that by the time it is discovered, survival is often counted in weeks: 36 to 40 weeks if the cancer hasn’t spread to nearby organs, 16 to 20 weeks if it has. This year, 28,600 Americans will be diagnosed with the disease and 28,600 will die of it, according to the American Cancer Society. That’s why the mere hint of good news, even from a tiny study of a wacky-sounding therapy involving mega-doses of dietary supplements and coffee enemas, is making the mainstream medical establishment sit up and take notice.
In the July issue of the journal Nutrition and Cancer, a pair of New York private practitioners, Drs. Nicholas Gonzalez and Linda Lee Isaacs, reported their findings on a preliminary study of 11 patients, including Frizzell, with inoperable pancreatic cancer. In all 11, pancreatic cancer was confirmed by a biopsy. The patients, who followed a dietary regimen at home developed by Gonzalez and Isaacs, lived a median of 17 months after diagnosis, nearly triple the usual survival rate. The regimen included mega-doses of vitamins and minerals plus pancreatic digestive enzymes such as trypsin and chymotrypsin. Patients ate no red meat or poultry, had fish several times a week, plus eggs and whole grains. And twice a day, they gave themselves coffee enemas (admittedly bizarre, especially given the fact that a decade ago coffee was thought to possibly cause pancreatic cancer; it has since been shown not to.)
Gonzales suspects that caffeine taken rectally may relax muscles of the liver and gallbladder ducts, causing ”toxins,” including byproducts from the body’s attempts to destroy cancer cells, to spill into the intestines. Drinking coffee doesn’t have the same effect, he says. (For what it’s worth, he adds, decaf doesn’t, either; what appears to work is one tablespoon of ground coffee, brewed or percolated, per pint of water.)
Odd as the regimen sounds, it ”certainly warrants further investigation,” says Dr. Jeffrey White, who heads the office of cancer complementary and alternative medicine at the National Cancer Institute. In fact, his office recently decided to give $1.4 million over five years to researchers at Columbia University College of Physicians and Surgeons to test the regimen. Even the director of the new study, Dr. John Chabot, vice chair of the department of surgery at Columbia, doesn’t have the faintest idea why the Gonzalez-Isaacs regimen might work.
”Frankly, when I first read” about it, ”I said, `That can’t possibly work.’ Then I read the pilot data…[and] said, `There really might be something there. I had to come to grips with it myself. I have no idea how or why it might work, but the data are compelling enough that I can’t ignore it.” In fact, he adds, ”it doesn’t matter what the underlying theory is about why it works because I think that’s something for us to investigate once we demonstrate that it works.” If it does.
The pilot findings could be due to ”selection bias,” notes Dr. Karen Antman, who heads Columbia’s cancer center.
The people who were able to find Gonzalez and Isaacs and to follow the strict regimen may, for instance, have been more highly motivated or healthier than other patients. And she can’t imagine why coffee enemas would help: ”I don’t get it.” But the mere fact that some patients are alive after three years when they ”should have had a median survival of four to six months” means doctors should test the regimen, not just argue with advocates of alternative therapies, she says. Barrie Cassileth, chief of integrative medicine at Memorial Sloan-Kettering Cancer Center in New York, agrees.
Variations on the Gonzalez-Isaacs regimen have been around for decades and have been ”something everyone has scoffed at, including me,” she says. What’s new is that Gonzalez ”is going about the situation very systematically, trying to collect research data. That is impressive…I support him 100 percent and I will continue to let patients know about this study” at Columbia, she says. She wishes the coffee enema part could be dropped because ”that’s what makes people laugh at it.” But the researchers say that, to be valid, the new study has to replicate the whole regimen because nobody knows which parts, if any, may help. Gonzalez concedes that he, too, was initially taken aback by the idea of coffee enemas. ”When I first heard about coffee enemas, I thought that was the single weirdest thing I ever heard of,” he says.
Until 20 years ago or so, the coffee enema was actually listed in the Merck Manual as a general treatment to help people feel better, though not for any particular disease. Since then, it has gained some notoriety, mostly as a new-age remedy for depression and other ailments; coffee enemas have been widely publicized on the Internet and by Hollywood stars such as Janet Jackson.
Michael Lerner, president of Commonweal, a health and environmental research institute in Bolinas, California, has researched what scientific literature there is on coffee enemas and, while not an advocate, notes that they were part of a cancer treatment developed decades ago by Dr. Max B. Gerson, a German physician. But solid data on efficacy is scarce, Lerner says. Cassileth of Sloan-Kettering agrees, noting that repeated enemas could weaken colon function, triggering constipation. Coffee enemas could also remove potassium from the body and trigger potentially fatal electrolyte imbalances, as well as dehydration, she says, though Gonzalez says this is unlikely.
As for the pancreatic enzymes, Gonzales thinks they may have a direct anti-cancer effect, though this is unproved.
The design of the new study is simple. Columbia researchers are seeking a relatively small group of people – 72 to 90 patients – with pancreatic cancer at Stages II, III or IV, that is, cancer that is confirmed by biopsy to have spread beyond the pancreas. Half the patients will then be randomly assigned to get the dietary regimen through Gonzalez and Isaacs and half to a chemotherapy drug, gemcitabine, which improves quality of life but prolongs it only slightly. About 30 patients have been interviewed, but all want the dietary regimen, not gemcitabine. There’s another problem, too. Ideally, says Mayer of Dana-Farber, the researchers should not lump together three stages of cancer. If one group lives longer but has more people with less advanced cancer, it will be impossible to know whether the treatment was better or the patients were simply less sick.
Meanwhile, Betty Frizzell just keeps growing organic veggies in her garden, making her own bread and cooking Sunday dinner every week for 14 people. (Then she prepares her own meal.) Her big problem now is that the government ”is fixing to build a big interstate highway” on half of her 90-acre farm. She fears ”it will be harder to fight the federal government than pancreatic cancer.”