[shalvoy.1]

Happy Spring! This month we are continuing our discussion on treatments that are considered alternative.
The title of this club isn’t completely accurate. The articles we are discussing are about how melatonin can be used in cancer treatment. This is not simply how it is used to resolve fatigue symptoms but about how it affects signaling pathways to potentially improve outcomes.
Our two articles this month are:

Use of Melatonin in Cancer Treatment: Where Are We?

Wang L, Wang C, Choi WS. Use of Melatonin in Cancer Treatment: Where Are We? International Journal of Molecular Sciences. 2022; 23(7):3779. https://doi.org/10.3390/ijms23073779

Interactions of melatonin with various signaling pathways: implications for cancer therapy

Mihanfar, A., Yousefi, B., Azizzadeh, B. et al. Interactions of melatonin with various signaling pathways: implications for cancer therapy. Cancer Cell Int 22, 420 (2022). https://doi.org/10.1186/s12935-022-02825-2

Mindy Blackwell has offered to be our lead this month. Thanks Mindy!
I look forward to discussing this topic with you all.

• This topic was modified 1 year, 11 months ago by shalvoy.1.
• This topic was modified 1 year, 11 months ago by shalvoy.1.

[blackwell.72]

Mindy Blackwell- gyn/onc
Article #1
Use of Melatonin in Cancer Treatment: Where Are We?

Wang L, Wang C, Choi WS. Use of Melatonin in Cancer Treatment: Where Are We? International Journal of Molecular Sciences. 2022; 23(7):3779. https://doi.org/10.3390/ijms23073779
Article #2
Interactions of melatonin with various signaling pathways: implications for cancer therapy

Mihanfar, A., Yousefi, B., Azizzadeh, B. et al. Interactions of melatonin with various signaling pathways: implications for cancer therapy. Cancer Cell Int 22, 420 (2022). https://doi.org/10.1186/s12935-022-02825-2

You only have to answer 3 of 4 questions.
A little intro as to why I chose these articles:
Since the club that we discussed High Dose IV Vitamin C, I have dug very deep into the metabolic approach to cancer. I took a 12 week Functional Medicine For Nurses course and I have learned that there is so much more than chemo to treat cancer and most of it is actually curative whereas in my own opinion, chemo does not truly cure. Not just cancer but every disease/symptoms has a root cause that can be treated or reversed.
There are clinics and physicians all over the country that manage cancer patients on a metabolic level. Many do chemo and these other treatment and some just focus on the metabolic treatments only. I had the pleasure, accidentally of speaking with the director of the Riordan Clinic in Kansas about this and was referred to an entire symposium from 2019 which each physician’s lecture is recorded and I have been listening and learning more than I ever imagined could possibly be out there.
We focus a lot on genetics in the allopathic health system but genetics are less than 8% risk and lifestyle/environment is more than 92% risk for disease. Our genetics have not changed in thousands of years but our health and environment have.
I hope you enjoy this journal club – I have tons more information and resources if anyone else is interested in pursuing this more. It is a lot of information, especially if it is the first you have seen this so I tried not to dive as deep w/ the intro.
Thank you for the High Dose Vitamin C club- it is making a huge difference for my family’s battle.

1. What was the knowledge gained from the article?

I am getting a better understanding of the function of the mitochondria and how it is the root system to our health. We hear a lot about diet and lifestyle but not to this depth or detail and not in relation to the mitochondrial function and this article was a completely different explanation of diet and lifestyle effects.
The diet supplementations explanation of magnesium- optimizes mitochondrial function and the creation of ATP, regulates blood sugar, and the activation of muscles and nerves. The magnesium ions are critical to the mitochondria function and have an enormous potential to influence cancer and optimizing the mitochondrial metabolism nay be at the core of effective cancer treatment.
Melatonin – is a protectant of the bio-energetic function of mitochondria.
Article #1- says that melatonin with chemotherapy reduces resistance to chemo and systemic toxicity so we know that the efficacy decreases if treatments are missed or dose reduced so adding melatonin should help prevent missing treatments. I did not realize how big a role that melatonin plays in our overall health and what a strong antioxidant it is. I never thought much about melatonin, basically I completely overlooked it without realizing how important it is.
Article #2 mentioned the Warburg effect so I looked it up:
In 1924, Otto Warburg initially described that cancer cells, as opposed to normal cells, exhibit a unique property to ferment glucose into lactate even in the presence of sufficient oxygen. This glycolytic pathway has been thought to be a key energy source and is now called the “Warburg effect.” Nakagawa, T., Lanaspa, M.A., Millan, I.S. et al. Fructose contributes to the Warburg effect for cancer growth. Cancer Metab 8, 16 (2020). https://doi.org/10.1186/s40170-020-00222-9

2. Will the research/information in this article change or influence your practice? If so how?
Absolutely, It is changing in many ways but probably the most profound in my nursing role will be the discussions with patient on diet/nutrition and lifestyle. I will be much more in depth in my discussions.
I will be looking more closely at supplements patients are taking and better able to discuss how/why they are taking them. If they are taking melatonin I will be able to specifically discuss the benefits with them.
3. What other questions does the article raise about current practice?

I ask daily, if there are all these other things out there besides chemotherapy, why are we not offering it to our patients? Ok, you want to argue that they are not cures etc,. but what about offering some of these that concurrently with chemo can greatly decrease or eliminate side effects and treatment delays.
Why are we allowing select studies? Why don’t we demand that these other options that happen to be natural and friendlier to the body be studied?
Article #1 explains it that although it has high efficacy and low toxicity companies don’t want to develop this hormone as it is a natural and non patentable molecule. It is shameful that just because anything natural cannot be owned or patented and is not profitable that we overlook and promote other things that are profitable but not best. So, our current practice has a lot more it could be offering which is very upsetting but I do know that there are places that offer melatonin and other treatments by themselves or to be taken with chemo in a functional medicine setting, I just wish more people were aware of it and would try instead of give up when the chemo does not work or makes them too sick.

4. Do you agree/disagree with the conclusions of the author, why?
I do agree that there are significant benefits but if they are going to promote supplements there should have been some mention as to the quality of the supplements and the source. That makes a difference in the body’s response to them. We should not be ingesting anything synthetic, or manmade and if the supplements are not from a natural source without added ingredients they are not going to be as effective or beneficial.
Article #1 I think would have had better conclusions if they would have used higher doses.

I have more resources for anyone wanting to explore further.

[shawver.25]

My name is Jeff and I’m one of the nurses in JCRU.

1. What was the knowledge gained from the article? These articles were very informative talking about how melatonin could have anti-cancer properties/ effects at the cellular level. We all know melatonin to be a medication to help with sleep and circadian rhythm but we probably didn’t know that it has these interactions within the various signaling pathways in the body (at least 10 different pathways are mentioned in the second article- that is definitely eye opening and makes me want to delve into it further). I, like you, didn’t think much about melatonin except as a sleep aid and overlook it when thinking about overall body health. The 2nd article states “Indirectly, it acts as a free radical scavenger and can be used as a chemopreventive agent for cancer”; this really opens my eyes to what melatonin can do and how it potentially works.

2. Will the research/information in this article change or influence your practice? If so how? I would love to say these articles would change my practice but I am not able to prescribe medications for patients. Melatonin is available over the counter and if nothing else I can encourage patients diagnosed with cancer to take it (even if they don’t have issues sleeping). One of the articles mentioned not only potentially positives but negatives of melatonin and emphasized how taking melatonin increased quality of life. If there is anything we can do to increase quality of life for our patients I am all for that!

3. What other questions does the article raise about current practice?
What other medications that we give everyday could potentially be beneficial with cancer treatment?
Will further studies be done to figure out the best route of administration for melatonin in cancer treatments?
Why is there such a huge difference in range (0.3mg- 1600 mg) in the therapeutic doses? Again this goes with it being hard to conduct further studies on melatonin due to it being a naturally occurring substance and no money to get behind its use.

4. Do you agree/disagree with the conclusions of the author, why?
I do agree with these articles in that we should be looking at alternatives to chemotherapy alone. It is incredibly difficult in that big pharma wouldn’t make money off these studies and therefore won’t even look into conducting further research on something that is naturally occurring and could make our oncology patients lives better (or even cure their cancer- which would in turn make their lives better)!

[shawver.25]

Mindy- thank you for hosting this journal club! I hosted the High dose vitamin C journal club and doing the research to find the articles was very interesting to me and gave insight to the cellular level and how different substances can impact the body. It is very eye opening to look at these “alternative medicines” and see what potential options are out there. I say “alternative medicines” only because they aren’t broadcast as common pence whereas chemotherapy is the gold standard. Where did you find the 12 week Functional Medicine for Nurses course? Where did you find the 2019 symposium and is it available to everyone to read?

[goodman.100]

What was the knowledge gained from the article?

I had no idea melatonin did anything other than affect circadian rhythm- I have only known it as a sleep supplement. Mihanfar et al (2022) list 10 possibly pathways where melatonin can be useful in cancer treatment. Wang et al (2022) point out that melatonin also helped relieve chemotherapy side-effects in clinical trials, and can even enhance tumor response to radiation.

Will the research/information in this article change or influence your practice? If so how?

Similar to the articles on IV vitamin C therapy, I don’t know that there is much I can do with practice change regarding melatonin therapy, since more research is needed. It does make me wonder what other endogenous substances could be used in cancer therapy.

What other questions does the article raise about current practice?

What dose, route, and frequency of melatonin would be necessary to see positive outcomes in cancer treatment? Would patients receiving melatonin be sleepy all the time or have disrupted sleep cycle? What dose timing would be required- would melatonin be taken regularly or be given with chemo? These are important questions to answer- Wang et al pointed out that too much melatonin can actually promote tumor growth. The authors list melatonin doses ranging from 0.3 mg–1600 mg daily for 4 weeks to 3.5 years. That’s quite a range. Obviously, this needs more research.

Do you agree/disagree with the conclusions of the author, why?

As the authors in both articles concluded that more research is needed, I agree with them. Like IV vitamin C therapy though, I wonder where additional research will come from since this is not a patentable drug, but a naturally occurring substance.

Mihanfar, A., Yousefi, B., Azizzadeh, B. et al. Interactions of melatonin with various signaling pathways: implications for cancer therapy. Cancer Cell Int 22, 420 (2022). https://doi.org/10.1186/s12935-022-02825-2

Wang, L., Wang, C., & Choi, W.S. Use of Melatonin in Cancer Treatment: Where Are We? International Journal of Molecular Sciences. 2022; 23(7): 3779. https://doi.org/10.3390/ijms23073779

[goodman.100]

Mindy-

Thanks for hosting this journal club and sharing you knowledge with us! It is amazing that once you open the door of CAM (Complimentary and Alternative Medicine) you realize how much we are missing in our research and treatment. I have always found mitochondria very interesting since they have their own DNA that is separate from hours, and there are diseases we can have that are diseases of the mitochondria. I definitely agree there is more research needed in this area and I wish we could provide more to patients utilizing CAM. I have mentioned before that I have had positive experience with acupuncture so I sometimes recommend it to patients.

[blackwell.72]

Jeff-
Someone sent me the Iink of the function medicine for nurses course and told me I needed to do the class because of all my naturals interest.

https://inursecoach.com/course/functional-medicine-for-nurses/

It was not cheap but I felt for me it was well worth the money.
I had a conference call with the director of the Riordan clinic for my mom and he told me to watch the Dr Winters video.
When I found the video it had the whole playlist of the entire symposium’s lectures. The melatonin lecture is in there too.

The Riordan clinic under their oncology tab had a lot of resources. I used that as my foundation to get a plan together with a local functional medicine doc for my mom. Links are below.

https://riordanclinic.org/what-we-do/integrative-oncology/

Dr Nasha Winters Mitochondria and cancer

Melatonin

Vit c and infection

[blackwell.72]

Jeff and Greg-
Same as in my current practice, I am not at liberty to suggest or even give a dose range to a patient BUT – I can drop little seeds with the physicians. I have to tread lightly or I will be “crazy” and completely ignored. I have had the best response when I start out with – my nurses’ journal club just studied or is studying xxx! I know that one fellow must have looked into the high dose C because she asked how my mom was doing and I told her we are doing an IV C regimen w/ a functional medicine clinic along with the chemo and her response was, “That is great, we should be giving all our patients vitamin C.”
Some physcians are no where near ready to hear any of this so for them, I don’t say anything but you can bet I try to plant some seeds w/ their NP or anyone else that works closely with them.
When a patient asks for something “crazy” I run with it. I look into it “because the patient made me curious and I was surprised that it is a thing!”
I have had patients ask for Ivermectin and a z-pack (huge benefits for ovarian cancer). The 2nd patient that asked the nurse was going on how crazy she was and our physician said, “there are studies to support that but we don’t do that here, if that is what she wants she needs to find someone that does that.” IVM has shown great benefits to all cancers but yo won’t find any studies done in US.

I am hopeful that we are trailblazers and are instrumental in getting these other treatments considered by our physicians. It really should be patient before profit but as long as pharma is in control it will continue to be profit before patient.

Thank you again Jeff for being brave enough to do the first journal club outside of the box – you may have save my mom’s life!
I just bought a t-shirt that says: Big farms over big pharma!

[blackwell.72]

Greg –
This is a great video that talks about dosing etc,. The question session at the end is great because other physicians are asking questions about things we have all been told about melatonin and he explains.

Optimizing Oxidation in the Care of Chronically Ill Patients

[goodman.100]

Mindy- Thanks for sharing the video! I will sit down and watch the entire thing when I have the time. It definitely is frustrating that we aren’t working more with this sort of thing.

You mentioned in your original post that we should be aware of supplements source and quality. Through OSU we have access to a database called ConsumerLab that tests and provides information on all sorts of supplements and even foods such as olive oils. They provide information about the current available research and evidence supporting various functions of each supplement, list pros and cons, and rate commercially available supplements based on if they contain what they advertise, if they have heavy metal contamination, and what is the cost per serving. I use it frequently. To find it, go to OneSource. Under the “My Workplace” section click on “Health Sciences Library.” Click on “Journals, Databases, and More” in the middle, then “Databases” on the left. Now you are at the database list, which is quite long. It is alphabetical, so scroll down to ConsumerLab.

[shawver.25]

Mindy- thanks for the additional videos! I will haveta check them out when the timing allows. I also feel like healthcare is supposed to be in the forefront of advancements yet so many physicians are reluctant to try anything new. Granted I know sometimes the doctor wants to do these alternative medicines but the institution they work at handcuffs them in the practice. Still asinine that insurance and big pharma dictate the care we can give to our patients and the functional medicines available can be just as beneficial (if not moreso). I

That is incredible the higher doses of vitamin C are helping your mom!! If you don’t mind sharing- is she doing any other alternative medicine therapies in addition to chemotherapy?

Greg- that is a quite valuable resource for checking supplements/ foods! My wife is a dietitian and has made multiple comments about supplements and how certain ones are better than others (as with anything). I don’t normally need supplements but to check other foods and things would be a useful tidbit of information.

[lu-hsu.24]

What was the knowledge gained from the article?
I was unaware of all the beneficial properties of melatonin. I must admit when I would see it on a patient’s medication list, I just assumed it was being used as a sleep aid. However, after reading about melatonin I can see it could also be used as part of their therapy. Melatonin could potentially be used as an anti-cancer agent by promoting apoptosis with less side effects and increasing their quality of life.
It was also interesting to know that the cerebrospinal fluid and blood showed the highest level of melatonin at 0200 – 0400 in the morning.

What other questions does the article raise about current practice?
How do we know the amount of melatonin that is required to have these beneficial effects of being an anticancer agent? How do we know the benefits and if it is truly therapeutic when used with other therapies if there is no standard?

Do you agree/disagree with the conclusions of the author, why?
I agree that melatonin has the potential and possibility to be beneficial to our cancer patients as an alternative type of therapy. However, I also think there needs to be more research to conclusively have it included with current therapies since there still is no standardized dosing or administration of it.

[lu-hsu.24]

Mindy
I also agree that if they were doing a proper study on the benefits of supplements, they should have shared the quality, source, and therapeutic dosage.
Jeff
I am in complete agreement with you that if there is anything we can do to support our cancer patients and increase their quality of life, I too would encourage it. I also agree that the true therapeutic benefits of Melatonin still need further study before it will become part of our patient’s treatment plan.
Greg
I think we are all coming to the same conclusion that there definitely needs to be further research. What is the dose and route that can give our patients the therapeutic benefits, and how do we get the standard treatment? I also would be concerned of our patient’s sleep habits, and will they sleep all the time?

[blackwell.72]

Thank you for participating in this Journal club- good discussions!

[burk.109]

1. Knowledge gained for articles.
a. I found it very enlightening that melatonin was being studied/used for the use of anti-cancer effects. I have always only thought of Melatonin as a natural sleep aid and never considered that it could be used for other positive purposes. Working to regulate the immune system and provide a response to the tumor seems like it could be a game changer in cancer. As well as the fact that it increases the quality of life in some these patients is even more exciting.
2. What other questions were raised?
a. I now wonder what other substances/medications/vitamins can be used as a impactful and positive response in cancer as well as other disease lines. For me, it seems that something that is “naturally” occurring and not a pharmaceutical would be a more intriguing alternative if it showed promising results.
3. How will this change your practice?
a. These articles were very informative, and I plan to present these to others staff as well as questioning the OSU physicians/pharmacists are considering these studies when mapping out patient care.

Megan Burk, RN

[Author]

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