Surviving Against All Odds: Analysis of 6 Case Studies of Patients With Cancer Who Followed the Gerson Therapy A. Molassiotis, RN, PhD, and P. Peat, RGN, DiplPallCare Discussion These 6 case studies provide some strong impressions of the potential anticancer effect of the Gerson regimen. However, a case study cannot and should not be conclusive of the effect of a treatment. It is rather an opportunity to provide an initial attempt to compile plausible arguments about a phenomenon, synthesize interpretable data, explore appropriate research questions for future research, or identify areas that need more scientific attention. Hence, what the above 6 cases provide is compelling survival data that could potentially be attributed to the Gerson regimen, although the data are inconclusive at times because of confounding variables. Most cases have used some form of conventional treatment, either concurrently or before they started the Gerson regimen. This fact alone makes interpretations problematic. Case 5 is, however, a fascinating example of someone who declined conventional treatment of a cancer that untreated would have reduced the patient’s survival to 3.2 to 6.6 months.11,12 While on the Gerson regimen, he experienced a very slowly progressing cancer and a 6-year survival. Furthermore, case 4 had only 1 cycle of chemotherapy, unlikely to have sufficiently managed her lymphoma. The above 2 cases have no confounding variables of past or concurrent treatments, and the outcome should be attributed to the Gerson regimen with some degree of confidence. Cases 1, 2, 3, and 6 have, however, confounding variables including concurrent use of complementary therapies (case 2), Chinese medicine (case 6), concurrent use of (conventional) hormone therapy (case 3), and use of radiotherapy (cases 3 and 6) and surgery (case 1). Homeopathic remedies used in cases 2 and 6 were for symptom palliation only (as explained by the patients) and are unlikely to affect the course of the tumor itself. Carbamazepine use (case 6) has no known anticancer activity, being an antiepileptic drug. Case 3 is less impressive, as concurrent use of hormone therapies makes it difficult to assign an effect to one or the other treatment, although it may be the combined effect of the 2 treatments that could account for this extraordinary survival story of a woman with a metastatic disease of poor prognosis. However, studies in the past have shown no effect of tamoxifen used alone on metastatic liver disease unless it was used in combination with 5-FU and interferon,13 which did not take place in our case. Other limitations of the current review include the insufficient data on how the patients followed the Gerson regimen over the years, which and how many adverse effects were attributable to it, and how serious those events were. Despite the above limitations in the data, patients seem to have benefited from the alternative therapy they used both in terms of survival (Table 2) and maintenance of a good quality of life (as shown in the medical records judged by the patients’ overall health and communicated by some of the patients). Besides the presence of confounding variables that make interpretations difficult, the natural progression of some of the cancers mentioned in this review may further complicate interpretations and may make the reviewed cases less compelling. For example, reviewing oncologists commented that melanoma is an unusual malignancy in that it can excite an immune response, and spontaneous remissions do occasionally occur, estimated at less than 5%,26 especially in patients with small-volume locoregional disease, as in case 1. Also, tumor shrinkage was reported in case 6; clinical experience suggests, as also commented by reviewing oncologists, that postoperative hematoma changes can be misinterpreted as disease progression if scans are done more than 72 hours postsurgery, which normally settles over 3 months. This can be misread as tumor shrinkage. While the cyst may have been a hematoma, the presence of abnormal tissue supports the diagnosis of disease regression. The key questions are whether the Gerson therapy improves survival and whether patients with cancer objectively benefit from it. The retrospective review by Hildenbrand et al7 showed that patients with malignant melanoma appeared to benefit in terms of survival. The review of patient records in Gerson clinics in Mexico in the late 1980s undertaken by British physicians found no evidence of the regimen’s survival benefit, although the authors commented that a small number of patients did show improvements.9 The psychological part of the same investigation suggested that the patients were helped psychologically through the use of the Gerson regimen by increasing their hope and empowering them.9 The medical establishment has taken a negative and dogmatic approach toward unorthodox therapies. 27 However, such preliminary indicators combined with a large number of anecdotal reports of extraordinary survival merit more scientific attention using appropriate and systematic monitoring and prospective evaluation of objective patient outcomes. The medical community has spent considerable time and energy in the past 50 or more years arguing against the Gerson regimen through letters to the editor, commentaries, discussion and opinion papers, review of (almost always) incomplete patient followup data, and legislation and directives against the use of the Gerson therapy, and neither side (for their own reasons) has put any effort into getting evaluable and interpretable data that would stand scientific scrutiny. Funding for 1 large and well-controlled prospective study would have been sufficient to give some key initial answers. Could the Gerson regimen have physical effects in patients with cancer? A number of researchers have shown that this is possible based on laboratory experiments, including the finding that a high-potassium/ low-sodium environment (as that induced by the Gerson regimen) can partially return damaged cell proteins to their normal undamaged configuration.28 Other medical hypotheses have also been discussed in the literature.29,30 Could the effects of the Gerson regimen be the result of the patients’ psychological responses to the cancer? This is also possible, as complementary and alternative medicine therapies in general empower patients, increase hope and optimism, and can help patients cope better with their very stressful cancer journey.31 Some studies argue, including Spiegel’s landmark study,32 which was further confirmed by some later studies,33,34 that a better psychological status is associated with better survival rates. However, the literature on psychological interventions and survival in cancer has shown mixed results, and the evidence specifically from support group interventions is not convincing.35 Careful dietary manipulation may at least improve quality of life in cancer patients and potentially also increase survival.36 Indeed, a considerable research activity in the breast cancer field suggests that this may be linked to some lifestyle factors by reason of its high incidence in Western society.37 Although multiple factors appear to increase the risk of breast cancer, diet is one of the most important lifestyle factors associated with it.38-41 Dietary interventions that have been assessed for their potential effect on breast cancer recurrence emphasize fat reduction and increased vegetable intake42,43 (key dimensions of the Gerson regimen). Indeed, an analysis of computerized data on lifestyle changes that preceded many spontaneous regressions of cancer (n = 200) indicated that 55.6% of the sample had used some form of detoxification (ie, coffee or castor oil enemas or fasting), 87.5% had made major dietary changes, more usually a strictly vegetarian diet, and 55% had taken a mineral supplement, most commonly potassium and iodine.44 Most of the above are in one way or another parts of the Gerson regimen. Another regimen with some nutritional similarities with the Gerson therapy, the Gonzalez diet, has shown positive outcomes in advanced pancreatic cancer.45 Hence, dietary manipulation could play a major role in preventing cancer recurrence. Some patients will continue to choose complementary or alternative medicine, regardless of whether health care professionals agree with these choices. It would be best if their decision making is well informed by providing accurate information on such alternatives. A common concern of health care practitioners is that patients turning to alternative medicine will delay potentially effective conventional treatments, decreasing their chances of survival. However, research has shown that most patients turn to such options when the orthodox medicine is unable to offer anything more.46 It would be worth exploring such a dietary regimen in the future and moving away from our conceptual struggle with modern high-tech medicine. We have a responsibility and a professional duty to help patients make the best treatment decisions for themselves, and the only way to do so with regard to the Gerson regimen is to carry out a prospective evaluation of its efficacy in a rigorous manner. A randomized trial, the gold standard of evidence-based medicine, may not be the most appropriate or even ethical design, as it is doubtful if patients would be willing to be randomized to the Gerson regimen. Indeed, the National Institutes of Health has funded a clinical trial of a similarly intense dietary regimen, the Gonzalez regimen mentioned earlier, and although it started as a randomized trial, eventually the design had to be drastically modified, as patients were unwilling to accept random assignment to treatment groups.14 A preference trial or a prospective case-control trial may provide more appropriate approaches. Studies should look not only at survival benefits but also at psychological and quality of- life variables as well as symptom experience. Safety data would also need to be collected. As the Gerson regimen is a very intense regimen and requires a significant amount of time, energy, and resources to be carried out, it may be more appropriate to consider the different elements of the regimen (preserving the principles of the therapy) and assess what is their contribution to improving the physical health of cancer patients and whether it decreases recurrence of the disease. It may also be more appropriate to attempt to integrate this regimen in selected specialist conventional treatment centers, in which patients would have appropriate follow-up by medical practitioners, medical supervision, and a higher regard for patient safety than that experienced by some patients on a number of occasions. Monitoring of patients is essential as they may be at risk of dehydration and loss of micronutrients from the daily enemas and develop calorie, protein, vitamin, and mineral deficiencies. Hence, appropriate monitoring of albumin, transferin, vitamin B12, blood urea nitrogen, and folic acid levels should take place regularly in an integrated environment. The study by Lechner and Kronberger8 also clearly suggests that the Gerson therapy could be equally effective when given concurrently with surgery or other orthodox treatment modalities (although this study was not a randomized trial and all patients had received conventional treatment). This may be a more preferable therapeutic approach, and its benefits were also evident in case study 3 described earlier. Although the effectiveness of the Gerson regimen has not been rigorously proved, equally it has not been disproved either. Hence, while the situation is far from clear, patients will continue to turn to it (and other similarly intense and unproven alternative therapies) in the years to come, in a desperate attempt to keep alive when everything else has failed. A definitive trial on the efficacy of the Gerson regimen is long overdue. Information from such a trial would be of great value as it would assist patients to make informed decisions, protect their safety, and add to the patients’ choices in improving their survival chances and quality of life in their fight against cancer. Integr Cancer Ther 2007; 6; 80, March 2007 Remember we are NOT Doctors and have NO medical training. This site is like an Encylopedia - there are many pages, many links on many topics. Support our work with any size DONATION - see left side of any page - for how to donate. You can help raise awareness of CAM.