The liver flush revisited

Pic shows “stones” produced by a “liver flush”

We posted something about the “liver flush” about three years back, but a recent thread in a local community forum where someone got so excited he posts “I removed my own gallstones!” prompts me to bring up the subject again. It goes to show you that the viral emails just won’t die. I’m sure the same email supposedly by a “Dr Lai Chiu-Nan” with details how you can “remove gallstones naturally” is still going round and round.
People are fooled after drinking the vegetable oil and juice concoction and then get excited when they pass out little green balls which they take for “gallstones” but in actual fact they aren’t.

From Quackwatch on The Truth about Gallbladder and Liver “Flushes”

In the usual “flush”, half a cup or more of a vegetable oil is consumed together with citrus juice and Epsom salts (magnesium sulphate), usually after a brief fast. Many green, brown, yellow or black blobs of various sizes may later appear in the bowel movements. Some bear a slight resemblance to gallstones, but they are not stones. They are merely bile-stained “soaps” produced by partial saponification (soap formation) of the oil.

The above Quackwatch article is indeed a good read should you be interested to know more. While at the end of the day the “liver flushes” are ineffective, they are probably also harmless for most with some caveats to bear in mind.

The greatest risk may apply to those who postpone surgery despite being at risk of major complications i.e. those with regular symptoms or who have recovered from potentially lethal complications such as acute pancreatitis or acute cholangitis (bile duct infection).

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That Live Blood Cell Analysis scam is still Alive

Had a call from a colleague today about a patient who was frantic after being told his blood was “infected”. This was from a drop of blood analysed by some “medical equipment” and there were indications of “bacteria” present in the blood so it seems. Not surprisingly he was advised to take some special supplements to counteract this.

It sounds to me that the Live Blood Analysis scam is still very much alive. We’ve blogged about this extensively in the past and so we won’t repeat ourselves.

Here are the posts:

Live Cell Analysis: High-Tech Hokum

Medical misinformation in Malaysiakini: the Live Blood Analysis hocus pocus

Live blood analysis: a bleeding scam

Back in 2009 the then DG said there’s No evidence to back LBA’s effectivenes

His statement was in response to Monday’s Starprobe report on LBA scams (Bleeding scam).

The LBA, also called nutritional blood analysis or live cell analysis, is a test where practitioners claim they could diagnose a host of illnesses including vitamin deficiencies, infections and even cancer by observing the abnormalities in a drop of blood.

They then proceed to persuade customers to buy nutritional supplements or undergo alternative therapies.

“Live blood analysis is not a valid test as there is no scientific evidence to support the claims made,” he said.

On whether an LBA test can be considered valid when a medical doctor performs it, Dr Ismail said: “There is no scientific basis for the technique and hence even if it is carried out by a medical doctor it is still not valid. No doctor should carry out such a test.”

He said the Ministry’s health technology assessment unit had completed its assessment on LBA and found no evidence to support its effectiveness.

But dear MOH, it appears it’s still going on. Patients are still being scammed. So what say you?

External link worth reading:
Live Blood Cell Analysis: Another Gimmick to Sell You Something

Alternative cancer “treatments” disproven

A dire warning for cancer patients who choose to discard evidence based treatment for Alternatives to Medicine. These alternatives such as Laetrile (B17), Gerson therapy, Chaparral and Shark cartilage are not only “unproven” but in fact when proper studies have been conducted, they have been discredited and can be considered disproven.
Patients who use such alternative to treatments have a poorer survival time, even after controlling for type and stage of disease summed up in this review article:
Alternative Cancer Cures: “Unproven” or “Disproven”?
So for patients diagnosed with cancer, would you go for proven, unproven or worse still, disproven treatment?
The choice is yours.

Sabah Snake Grass Warning II – Mind your kidneys

Like many alternatives to medicine, there is a paucity of safety and efficacy data on Sabah Snake Grass. Anecdotal reports of it supposedly working can be misleading since any supposedly beneficial effect may be misinterpreted due to confounding factors (e.g. patient concomitantly receiving treatment) or even natural recovery (yes, even some cancers can spontaneously remit!). Moreover, for each apparent success there may be hundreds of failures which are not publicised. The true efficacy of any treatment can only be known if there is a a proper clinical trial conducted.

What about the side effects? Since our initial post Sabah Snake Grass Warning, there has been some feedback on other possible side effects besides the drop in blood counts that I mentioned in the original post. Bodyaches and more importantly kidney impairment seems to be a common theme. Physicians, oncologists and care givers need to be wary and watch out for these.

From a surgeon:

A few of my patients who had taken it for breast cancer reported severe myalgia.

From a nephrologist:

Had some chaps with CKD (Chronic Kidney Disease) take this and lose GFR (Glomerular Filtration Rate, a measure of kidney function) faster than expected. Cessation (of SSG) didn’t reverse damage but rate of decline normalised

From a haematologist:

I had a patient who took SSG in sachet form, 5 sachets put into a big flask of water and he drank for the whole day for 3 days continuously. He came with severe joint pains and renal impairment, loss of appetite & was very lethargic. It took more than a week to get better and the kidney function is slowly improving, thank God!

From a layperson:

Hmmmm … I don’t have cancer but was guilty of taking the sabah snake grass as supposedly as a health supplement. The result of my recent health check shows a drastic jump in the protein leakage in my urine, from “negative” to ++++ in three months. The other renal profile tests shows the kidneys are functioning normally.
The only thing I can think of is the sabah snake grass I took in between my medical check ups. So, I have immediately stopped ingesting the sabah snake grass and will have another renal profile check with my doctor in September.

Once more, please be very cautious. We implore that normal people should not be taking Sabah Snake Grass for supposedly health reasons. It is potentially harmful to your health!
Doctors should check if their patients are taking SSG and specifically look out for renal adverse effects.

Sabah Snake Grass Warning


News and information about Sabah Snake Grass (Clinacanthus nutans, 优顿草) is spreading in the Internet and claims that it can “cure cancer” abound. There are even normal healthy people ingesting this plant in the belief that it can “prevent cancer” and that is what really alarms me.
One should not be surprised that this plant can have anti-cancer properties. For ages, plant alkaloids have been a source of compounds used in modern chemotherapy e.g. the vinca alkaloids like Vincristine were originally derived from the Madagascar periwinkle, and taxanes like Taxol were derived from the bark of the Pacific Yew tree.

Ingesting these plant alkaloids is essentially taking chemotherapy in a raw form.

The plant will exert a chemotherapy-like effect on the individual though the response is variable as the “dosage” will be very crude (measured in the number of leaves one ingests without regard to the actual quantum of the active ingredient).
The notion that just because it is “natural” does not mean it does not have side effects. Indeed one would expect side effects as mentioned in this blog – if you take enough of the stuff, more toxic side effects will be experienced as expected with any cytotoxic agents.
I have personally seen patients where the blood counts dropped after ingesting Sabah Snake grass so yes, it appears to have a suppressive effect on the bone marrow like many other chemotherapeutic agents. There was a patient who had Acute Myeloid Leukaemia and underwent chemotherapy followed by a bone marrow transplant. She has remained in remission for over 15 years – effectively cured – but something possessed her to take Sabah Snake Grass recently. Perhaps she was influenced to think taking it would “prevent” cancer or improve her health.

This is misguided as it is akin to the idea that normal people should undergo chemotherapy to prevent cancer.

In this particular patient after taking 3 leaves a day for a year, her blood counts which were previously normal, started dropping, particularly her white cell count. Her MCV (Mean Cell Volume) also started rising, and one of the causes of a rising MCV is a drug affecting the maturation of the red blood cells. We do not know if in the long term there will be permanent damage to the bone marrow since some chemotherapeutic agents can cause a condition known as Myelodysplastic syndrome. She has wisely decided to immediately stop taking Sabah Snake Grass.

Lastly, please note that cancer is NOT one disease. Different cancers are different diseases and respond very differently to chemotherapy. Some are sensitive to chemotherapy e.g. lymphoma, NPC, breast and ovarian cancer, but some others are not. I am not surprised at all there will be anecdotal reports of apparent response of some patients with cancer after ingesting Sabah Snake Grass. After all, it is raw chemotherapy and if the cancer is sensitive it may respond. Response is not the same as cure as true cure means complete disappearance of cancer for at least 5 years. The word “cure” is sadly misused by many.
The worse thing cancer patients can do is to hide the fact from their doctors that they are taking Sabah Snake Grass. If they happen to be also undergoing conventional chemotherapy at the same time, the additional chemotherapeutic effects of Sabah Snake Grass may enhance toxicity to the organs.

Please, please do not fall for the “Natural = Safe” misconception.
Poison ivy is “natural”.
Poppy plants are “natural”.
Sabah Snake Grass is “natural” but it is chemotherapy. It probably warrants further research and identification of active compounds for use in modern chemotherapy, but if cancer patients take it, it is at their own peril or risk for there is lack of proper safety and efficacy studies.
Normal people certainly should not take it. Please help spread the word.

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Omega 3 fish oils increases risk of prostate cancer

If you are male and consume Omega 3 Fish Oils, beware: Omega 3 Fish Oils Linked To Increased Prostate Cancer Risk

Eating a lot of oily fish or consuming omega supplements may not be good for a man’s health. New research reveals that males with high blood concentrations of omega-3 fatty acids are at a higher risk of developing prostate cancer.

The finding comes from a large prospective study published in the Journal of the National Cancer Institute.

A 71 percent increased risk of high-grade prostate cancer and a 43 percent increase for all prostate cancers were associated with high concentrations of EPA, DHA, and DPA.

These results are consistent with a 2011 study carried out by the same research team which found that high concentrations of DHA more than doubled the risk of high-grade prostate cancer.

The researchers were shocked to find that higher blood levels of omega-3 fatty acids, usually promoted as good for the heart, were associated with a higher risk of aggressive prostate cancer.
The consistency of these findings could mean that “these fatty acids are involved in prostate tumorigenesis and recommendations to increase long-chain omega-3 fatty acid intake, in particular through supplementation, should consider its potential risks.”

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Soy Fails to Stop Prostate Cancer Recurrence

Medscape reports

Taking daily soy protein supplements does not prevent prostate cancer from recurring after radical prostatectomy, according to a study published in the July 10 issue of JAMA.

This finding comes from an interim analysis that prompted an early halt to a long-running randomized controlled trial.

“It was useless to continue,” lead investigator Maarten C. Bosland, DVSc, PhD, from the University of Illinois at Chicago, told Medscape Medical News. “You might argue that it’s not even ethical to continue a study when you know there is no treatment effect.”

When the trial was initiated in 1997, it was widely thought that soy would protect against prostate cancer because of highly suggestive epidemiologic data, Dr. Bosland explained.

“There was a great differential between prostate cancer risk in countries like Japan, where people eat a lot of soy, and that in the United States, where people eat very little soy,” he said.

Dr. Bosland and colleagues designed and initiated the trial because, of the few trials that have investigated the effect of soy on prostate-specific antigen (PSA) levels, none actually looked at the ability of soy to protect against prostate cancer itself.

The negative interim results come after a disappointing Canadian study found that vitamin E, selenium, and soy supplements do not prevent prostate cancer (J Urol. 2009;182[Suppl]:V736).

Traditional Chinese Medicine for Stroke – no significant effect

A Chinese herbal combination, NeuroAid, was studied in a multicenter, double-blind, placebo-controlled trial involving 1100 patients. There was no statistical difference in the outcomes between the treatment arm and the placebo arm.

Ref: Chinese Medicine Neuroaid Efficacy on Stroke Recovery A Double-Blind, Placebo-Controlled, Randomized Study

Further reading in Medscape:

NeuroAid (MLC601), a traditional Chinese medicine that combines extracts of 9 herbal and 5 animal components in capsule form, has been shown to restore neurologic and cellular function in animal models of ischemic stroke, Chen reported. Clinical studies in the long-term treatment of stroke patients (2 weeks to 6 months after stroke) showed NeuroAid to be associated with improved recovery in terms of functional outcome and neurologic disability, but these studies were not placebo controlled, he added.

The CHIMES study investigated the use of NeuroAid in acute, moderately severe stroke. Conducted in Southeast Asia (90% of patients were from Singapore/Philippines, with the others from Malaysia and Thailand), the study involved a total of 1100 patients with a National Institute of Health Stroke Scale (NIHSS) score 6 to 14 who were randomly assigned to either active treatment NeuroAid or placebo. The medication was started within 72 hours of stroke onset and was continued for 3 months.

The primary outcome — shift in the modified Rankin scale (mRS) — showed a nonsignificant trend toward benefit in the active-treatment group (odds ratio [OR], 1.09; 95% confidence interval [CI], 0.86 – 1.32).

An mRS score of 0 to 1 at 3 months, a secondary endpoint, showed an OR of 1.11 (95% CI, 0.86 – 1.42) in favor of NeuroAid. The researchers point out that both of these ORs are higher than those in recently completed stroke neuroprotection trials.

No statistical difference was seen for any of the other secondary outcomes, which included NIHSS improvement, difference in NIHSS total and motor scores, Barthel index, and Mini–Mental State Examination scores.

Subgroup analyses showed no statistical heterogeneity for the primary outcome; however, a trend toward benefit in the subgroup receiving treatment beyond 48 hours after stroke onset was noted.

Adverse effects were similar for the 2 groups.

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Does taking papaya leaves “cure” dengue?

Helen Wong asked this question in Facebook

Hi, does this mean papaya leaves juice may be an alternative cure for dengue fever ? My doctor insisted it’s rubbish but I recovered slowly after 2x ‘force it down my throat due to the pungent smell & bitter taste

Thank you for asking. The quoted study Carica papaya Leaves Juice Significantly Accelerates the Rate of Increase in Platelet Count among Patients with Dengue Fever and Dengue Haemorrhagic Fever was conducted in Malaysia.
What basically this study showed is in a small group of 228 patients with mild dengue, there was a slight increase in the average platelet count at the 48 hour mark

The increase while “statistically significant” shows an average platelet count of about 80 x 10^9/l for those who took papaya leaves vs 70 x 10^9/l for those who did not i.e. a difference in average platelet count of only 10 x 10^9/l which is of doubtful clinical significance (normal platelet count ranges from 150-400 x 10^9/l)
What happens after the 48 hour mark is not known as the study does not mention this. The difference could be negligible for all we know.

Whatever you ingest, the platelet count will recover by itself usually starting by the 7-8th day of illness. Dengue fever in the vast majority is a self-limiting illness.
The misconception in the public lies in the over-rated importance of the platelet count. What is far more important than the platelet count is the fluid and hydration status. Dengue patients require adequate hydration, and patients sick enough to need admission will require intravenous fluids as the problem with dengue is shock and organ failure. Current national dengue guidelines de-emphasize transfusion of platelets and in fact there is little or no role for prophylactic transfusion of platelets.

In summary, no, papaya leaves will not “cure” dengue. We do not think the platelet count is significantly affected from a clinical perspective and this detracts from the more important point in the management of dengue which is adequate fluids and hydration.

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The Coenzyme Q10 Hype


I’ve seen it selling in drug stores pitching benefits to all and sundry. While there have been small scale studies showing possible benefits in people with heart disease I’ve had my doubts. Yet the hard sell goes on promoting CoQ10 to the general public as a wonder supplement.

Medline Plus has a reasonable take on CoQ10 and lists the benefits of CoQ10.
I would think you are wasting your money if you take something for other than what it is Likely to benefit you (practically nothing in for normal individuals!). If benefits are only Possible (read: maybe) or under the Not effective category you would be better off saving your money.
There was a small trial in heart failure patients which showed an apparent benefit. But even then as per this critical article in SBM on Coenzyme Q10 for heart failure: The hype and the science, there is some doubt.

Bottom line: if you have ischaemic heart disease it may benefit you to take CoQ10, but the evidence is from only small scale studies. If you are a normal individual, save your money.

More links:
Boots reaches new level of dishonesty with CoQ10 promotion

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