Managing Early Stages of CLL with Ayurveda
Updated: Jun 7, 2019
This post was inspired by, and is based on a real life case study of one of my patients who was diagnosed with Chronic Lymphocytic Leukaemia.
WHAT IS CANCER?
Cancer is not one specific disease but a group of related diseases. Cancerous cells can be formed in almost any part of the body and these cells can spread to almost any other part of the body. Usually human cells grow and divide to form new cells, as needed by the body. As cells grow old or become damaged, they die and are replaced by new cells. However, when cancer develops this process ceases to function correctly. As cells become more abnormal, old or damaged cells survive when they should have died and new cells are formed when they are not needed. These extra cells can multiply endlessly and may form growths called tumours. Many cancers form solid tumours, which are lumps of tissue. Cancers of the blood, such as leukaemia, generally do not form solid tumours.
WHAT IS LEUKAEMIA?
Leukaemia is a type of cancer that starts in the blood-forming cells of the bone marrow. Just as with other types of cancer, cells that turn into leukaemia cells do not mature normally. They often divide to make new leukaemia cells faster than normal and they do not die when they should. There are four common types of leukaemia, which are grouped based on how quickly the disease progresses (acute or chronic) and on the type of blood cell the cancer starts in (lymphocytic or myeloid). Since this case study is focused solely on Chronic Lymphocytic Leukaemia (CLL), the other forms will not be discussed.
The categorisation of leukaemia as acute or chronic depends on the maturity level of the abnormal cells. The acute form progresses rapidly which results in an accumulation of immature, useless cells in the bone marrow and blood while the chronic form progresses more slowly and allows more mature, cells to be made. In western allopathic medicine chronic leukaemia is harder to cure than acute leukaemia.
Defining leukaemia as myeloid or lymphocytic depends on which bone marrow cells the cancer begins in. Lymphocytic leukemias (also known as lymphoid or lymphoblastic leukaemia) start in the cells that become lymphocytes. Lymphomas are also cancers that start in those cells. The main difference between lymphocytic leukemias and lymphomas is that in leukaemia, the cancer cell is primarily in the bone marrow and blood, while in lymphoma it tends to be in lymph nodes and other tissues.
WHAT IS CHRONIC LYMPHOCYTIC CANCER (CLL)?
Leukaemia is a disease that contains large amounts of malignant leukocytes (white blood cells) in the blood. CLL shows a strong increase in one type of (malignant) mature white blood cells: the so-called B-lymphocytes. These abnormal cells accumulate not only in the blood but also in the bone marrow, the lymph nodes, spleen and liver. The most common form of CLL starts in B-lymphocytes cells. B-lymphocytes are a subset of white blood cells and they play a crucial role in immunity and fighting infections. Additionally, B cells regulate many other functions essential for immune homeostasis and they are required for the initiation of T-cell immune responses.
CLL begins from malignant B-lymphocytes in the bone marrow and the cancerous cells slowly increase over time. Eventually the excessive leukaemia cells spread to the bloodstream resulting in a large amount of white blood cells. The low level of normal blood cells in the bloodstream can make it harder for the body to get oxygen to its tissues, control bleeding or fight infections. In time, the cells can spread to other parts of the body, including the lymph nodes, liver, spleen and other organs where they can affect the normal functioning of those organs. Some patients exhibit slow clinical development and do not require any special therapy, while others have an aggressive progression and short survival despite intensive treatment.
PREVALENCE OF CLL
In western countries, worldwide, Chronic Lymphocytic Leukaemia (CLL) is the most common form of leukaemia in adults accounting for approximately 25 to 30 percent of all leukemias in the United States. The incidence rates among men and women in the United States are approximately 6.75 and 3.65 cases per 100,000 population per year, respectively and in Europe, the rates are 5.87 and 4.01 cases per 100,000 population per year, respectively. Every year in the Netherlands, 600 to 700 new patients are diagnosed with CLL. Worldwide, there are approximately 191,000 new cases and 61,000 deaths per year attributed to CLL.
CLL can occur at any age, but especially in adults over 50 years old and more often in men than in women (see figure below for Dutch statistics). On the y-axis is the number of patients per year and on the x-axis the age of patients. The blue line represents male patients and red line female patients.
RISK FACTORS FOR CLL
In allopathic medicine, the cause of CLL is not clear. There is no correlation with exposure to radiation or chemicals, or with conditions that cause low or impaired immunity. The American Cancer Society however acknowledges that some studies have linked CLL to overexposure to Agent Orange and herbicide use in the Vietnam War. Other studies suggest that long-term exposure to some pesticides may be linked to higher risk of CLL.
Both American and Dutch Cancer Associations agree that genetic predisposition is the highest risk factor for developing CLL. It occurs in certain families, with the disease being reflected in successive generations at an ever-younger age. CLL is prevalent mainly in Caucasians, and is rarely seen in East Asians, even if they live in the Western world.
A number of recent studies have shown that chronic inflammation contributes to cancer progression and even predisposes to different types of cancer. CLL patients may exhibit a wide range of symptoms like extreme fatigue, low-grade fever, weight loss and night sweats; these are typically seen in chronic inflammatory diseases.
STAGES OF CLL
Forty percent of patients diagnosed with CLL have no symptoms. The disease can remain present for many years without any complaints. In the early stages of the disease (Stage Rai 0/I or Benit Stage A), an allopathic physician will often not offer any treatment to the patient. The allopathic doctor will regularly check how the disease develops. Patients at stages Rai I/II or Binet B/C are treated if the disease becomes active or progressive. As the disease progresses and the normal blood production in the bone marrow becomes increasingly disturbed, the following symptoms may occur:
- Enlarged, usually unpleasant lymph nodes. Often symmetrical in multiple places (e.g., throat, armpits, groin area, chest cavity and abdomen);
- Enlarged liver and/or spleen;
- Extreme fatigue;
- Rare fever and/or weight loss;
- Anaemia may occur due to a lack of red blood cells, or an increased risk of bleeding due to a lack of platelets (thrombocytopenia).
- Repeated infections occur due to: i) a lack of normal white blood cells; ii) decrease in the normal antibodies (immunoglobulins).
In Western allopathic medicine, current treatments for later stages of B-chronic lymphocytic leukaemia include chemotherapy, radiotherapy, steroids, purine analogues (fludarabine) and monoclonal antibodies (rituximab, alemtuzumab). These treatment methods offer temporary relief of symptoms, but there is no effective cure. Although people can live for many years after treatment, there are side effects. Complete remission after such treatments is possible however the chances of reoccurrence are very high.
The symptoms of inflammation, which are present at the start of CLL, tend to worsen as the disease progresses showing an increased release of pro-inflammatory cytokines in the blood. Additionally, increased serum levels of chemokines were detected in patients with CLL. Chemokines are a type of cytokines, which support the migration of mature lymphocytes in the lymph nodes and promotes the cells survival. Chemokine receptors expressed on CLL cells regulate the migration of the leukaemia cells within the bone marrow and lymphoid organs.
With the recent understanding of the role of inflammatory cytokines in CLL progression, modern scientific research is focused on developing drugs that reduce the secretion of chemokines. From an Ayurvedic perspective, this approach is focusing on symptom management rather than the root cause of the disease. While allopathic medicine focuses on using pharmaceuticals to manage symptoms, Ayurveda is a holistic medical system that emphasises optimal health promotion, preventing diseases and eliminating the cause of disease. Ayurvedic medicine concentrates on maintaining the quality and longevity of life.
Ayurveda does not claim to be able to cure CLL, but it suggests methods to better manage the disease so as to increase a patient’s vitality and lifespan, especially when applied during the early stages of CLL. As opposed to the “watch and wait” approach of allopathic doctors, an Ayurvedic physician will prescribe a particular diet, lifestyle and herbs with the aim of reducing inflammation and strengthening immunity so as to slow down the progression of the disease. This case study explores the options available in Ayurveda to CLL patients in the early stages of the disease especially when allopathic doctors choose not to provide any treatment.
A STATE OF HEALTH VERSUS CLL
WHAT IS HEALTH?
There are three types of definitions of health, which tends to be generally accepted and used. Firstly, health can be defined as the absence of disease or impairment. Secondly, health can be perceived as a state where any individual can deal with the regular demands of daily life. Thirdly, health can be defined as a state of balance and stability that exists within an individual and his or her social and physical environment.
In the 1948 constitution of the World Health Organisation (WHO), health is defined as “a state of complete physical, mental and social well-being and not merely the absence of disease or infirmity”. Those who established the WHO constitution were clearly aware of the tendency of seeing health not only as a state dependent on the presence or absence of diseases.
In Ayurveda health is defined as when a person’s mind, body, and soul are in perfect balance. To maintain a healthy body, a persons digestion and absorption (Agni), quality of tissues (Dhatus), constitution (Dosha), and waste elimination (Malas) must all be in balance i.e. not excessive or deficient. Additionally, the mind, which is fed through the five sense organs, should be content, sharp and at peace. Lastly the soul or spirit must be satisfied, and happy.
The third definition stated above makes health dependent on whether a person has established a state of balance within oneself and their environment. This is most similar to the Ayurvedic and WHO definition. It means that those with a disease or impairment will be considered as being healthy to a level defined by their ability to establish a state of balance so that they can make the most of their life notwithstanding the presence of the disease.
EARLY STAGES OF CLL & HEALTH STATUS
It is generally accepted that being diagnosed with cancer is a state where the body is no longer considered healthy. Yet some people that have been diagnosed with CLL can live a relatively normal life for up to 20 or more years after the diagnosis. This raises some obvious questions with regards to the first definition of health and its consequences for patients diagnosed with early stages of CLL.
About 40% of the patients diagnosed with CLL do not have any symptoms or feel ill, are they still considered to be healthy? From a western allopathic perspective they are labelled as having a disease, yet from an Ayurvedic perspective and according to the second and third definitions above they could be healthy.
Patients that have early stages of CLL and accept the third definition of health may have an advantage as they may be aware of the need to work concurrently on two tasks: one, to alleviate the disease and the second to establish a state of balance, as best they can, within body and mind, and in relation to their environment.
When a CLL patient places a high value on health (not only on the presence or absence of disease), they would be likely to undertake whatever is necessary to enhance their health. This is what I have observed with the patient that has inspired me to write this post. His diagnosis has led to a major transformation in his diet and lifestyle, which in the absence of the disease would not have taken place.
Apart from changing his diet to include more fresh fruits and vegetables, he has minimised his alcohol intake to 2-3 glasses of red wine a week and has taken on a regular practice of asana (yoga postures), pranayama (breathing techniques), and meditation. He feels healthier that ever before and considers his diagnosis an eye-opener and a lifesaver rather than a disease. The diagnosis has also resulted in a closer relationship with his 6 year old daughter and his family.
Contrary to how the general population views cancer as a disease with a death sentence, this patient has decided to use the opportunity to turn his life around for the better. Hopefully many more patients diagnosed with early stages of CLL can have such a positive attitude since a positive state of mind is beneficial for improving overall wellbeing and the healing process.
AYURVEDA & CANCER
As explained above when the body is healthy and functioning normally, Agni, the Doshas, tissues and waste products correspond to certain standards regarding their quantity, quality and function. However, this situation is not constant, and due to changes in diet, lifestyle and in some cases genetic predisposition therefore the Dosha’s may become unbalanced, resulting in disease. In Ayurveda, every disease including cancer has its starting point due to an imbalance of the Dosha’s. Additional contributing factors can be the formation and accumulation of undigested nutrients (Ama), obstruction of the body channels (Srotas), and a disturbed assimilation in the tissues (Dhatus).
In Charaka and Sushruta Samhitas, the two famous Ayurvedic classical texts, cancer is described as an inflammatory or non-inflammatory swelling, characterised as either Granthi (minor neoplasm) or Arbuda (major neoplasm). In the case of a benign neoplasm (Vata, Pitta or Kapha) one, two or all three bodily control systems are malfunctioning. However this is not considered harmful because the body is still trying to coordinate among these systems. When a malignancy occurs, this becomes very harmful because all the three Dosha’s lose mutual coordination resulting in tissue damage and a disease that becomes difficult or impossible to cure.
The three dosha’s are viewed as the body’s functional control systems, Vata (nervous system), Pitta (venous system), Kapha (arterial system) that coordinate with each other to maintain equilibrium. This is comparable to the western concept of homeostasis. Irregular interactions between Prakriti (a person’s unique constitution) and environmental factors disturb the natural balance of the Doshas and impair immunity; this can lead to abnormal cell growth and cancer. Furthermore, the interface between imbalanced Doshas and weak Dhatus (body tissues) is expressed as cancers of a specific organ.
Sushruta also described the concept of Kriyakala in Varnaprashnadhyaya, an ancient Vedic Sanskrit text, which seeks to explain the incidence of Varnas in terms of Doshic disturbances. Varna may be explained as an inflammatory process that may lead to ulceration and chronic inflammation, and therefore promoting all stages of carcinogenesis.
Another concept in Ayurveda is Medhakara. It refers to the cellular intelligence required for proper communication between two cells. An abnormal functioning in the cellular Agni can cause Medhahara (lack of intelligence) where cells loose the ability to properly communicate with each other. This results in confusion within the cells leading to malignancy and cancer. Cancer patients have an extremely dysfunctional cellular intelligence.
AYURVEDIC PERSPECTIVE ON CLL
In Ayurveda, the term Rakta Arbuda is commonly used to refer to cancers of the blood i.e. Leukaemia and it is considered to be a malignancy, which is challenging or impossible to cure. According to Vagbhat, the aggravated Dosha will constrict and compress the blood within the veins resulting in early maturity of the blood cells which leads to obstruction of blood and this produces a lump of mamsa (muscle) covered with muscular sprouts. This lump will grow very quickly and will result in blood cancer causing patients to suffer from Anaemia and other blood complications.
The complications in the blood can be compared to the accumulation of toxins (Ama) in the blood and these toxins (e.g. carcinogens) can be the cause of a malignancy. Other complications of Rakta Arbuda mentioned in Ayurveda include the tendency to bleed uncontrollably, splenomegaly and hepatomegaly. These are similar to the clinical features leukaemia in western medicine.
POTENTIAL CAUSES OF CLL AS PER AYURVEDA
Sushruta has mentioned mithya aahar-vihar (i.e. improper diet and lifestyle) as the cause of Rakta Arbuda. Additional a person’s genetic make up could also be a cause. According to Sharma & Porte, 2016, the some risk factors include:
- Daily use of packaged and processed foods containing preservatives, flavouring agents such as nitrates, formaldehyde, and benzene.
- Exposure to heavy metals and waste radioactive materials from atomic energy plants
- Over exposure to pesticides like DDT, chloroform, ethylene oxide, amitrole, some chlorophenoxy herbicides, DDT, dimethyl hydrazine, hexachloro benzene, hexamethyl phosphoramide, chlordecone, lead acetate, lindane, mirex, nitrofen, and toxaphene.
MANAGING CLL IN AYURVEDA
According to Ayurveda, all cancer therapies treat the affected tissues indirectly by restoring balance in the Doshas, rejuvenating Dhatus and rebuilding immunity in cancer patients. The combination of treatment recommended in all blood cancers including CLL is mainly focused on treating “Pitta Imbalance” and providing immune boosting effect. An Ayurvedic physician will advise a patient to take some Ayurvedic herbs, which will help promote healthy cell formation and regulate metabolism (Agni) so as to stop the progression of the cancer. Additionally, an appropriate diet and lifestyle will be prescribed, which generally includes fresh wholesome food, yoga and meditation.
ANTI-INFLAMMATORY AND IMMUNE ENHANCING DIET
The diet of a CLL patient should help to heal and fight the cancer in a natural way. An alkaline, vegetarian diet, rich in fresh fruits and vegetables is generally recommended to fight inflammation and strengthen immunity. The following foods should be consumed in larger quantities:
- Red beetroot: A recent scientific study has shown that Beetroot-carrot juice when used alone or in combination with conventional CLL treatment (chlorambucil) has improved patient’s appetite, general sense of well-being and reduced fatigue. Additionally it resulted in a substantial reduction in leukocytes and lymphocytes count in peripheral blood as well as improvement in the relevant biochemical parameters. In the study, beetroot (Beta Vulgaris L., 200 g.) blended with carrot (Daucus Carota, 250 g) at a dose of 330 ml of fresh raw beetroot and carrot juice was given orally two hours before breakfast. The juice was given to the patient daily, once per day, 6 times a week for the duration of 1 month and 15 days (Shakib, Gabrial, & Gabrial, 2015). 30-100 ml of fresh Beetroot juice daily is recommended to boost immunity and improve blood count.
- Pomegranate: (Punica granatum) is a sacred fruit in some world religions. Many cultures and systems of medicine use it for various health problems. Early laboratory research seems to show that pomegranate extracts may have anti-cancer properties against prostate, bowel and liver cancer. One small study found that men who drank pomegranate juice every day had their cancer grow slower than normal. Other studies of men who drank pomegranate juice or had extract did not show any benefit (Cancerresearchuk.org, 2017).
- Dairy products from animal sources including Ghee (5 to 10 grams a day).
- Black Pepper: Multiple studies have identified black pepper as a strong antioxidant (Karthikeyan and Rani, 2003) & (Govindarajan, Vijaykumar, Pushpangadan, 2005).
According to Dr. Chauchan, an expert Ayurveda consultant for various Ayurvedic institutes in Europe, India and Asia, cooling foods are recommended in all types of blood cancers since the pitta dosha is out of balance. He recommended the following diet:
- Warm food, fresh food such as vegetable soup made from fresh green leafy vegetables is recommended. Zuchini, Bottle Gourds, Long Gourds, Round Gourds, Turnips, Carrots, Radishes. They are good for all types of diseases caused by Pitta imbalance.
- Coconut water should be consumed regularly, preferably every day in the morning on an empty stomach.
- An alkaline diet rich in fresh vegetables and fruits is highly recommended. This includes fruits, which are not acidic in nature e.g. apples, pears, papaya, melons are excellent anti-cancer fruits. Apples are excellent for all cancers. Fresh organic apples should be consumed almost every day.
Grapes, mangoes are also ok. Citrus fruits like oranges, lemons are not recommended as they all cause imbalance in Pitta Dosha.
- Nuts and dates should also be consumed, but in moderation.
- Turmeric and other spices in moderate quantity can be consumed. Too much spices in general tend to create imbalance in Pitta.
- Green leafy vegetables should be made into soup every evening.
- Potatoes are fine but fried are not recommended.
- Mushrooms increase fire element (Pitta) in the body. So they should be consumed after few days gap only
- Non-Vegetarian soup and small chicken chunks are allowed if the patient is very weak, otherwise it will increase Pitta, which is the root cause of the disease.
- Wheat and mix of various wholegrain breads is recommended.
- Wheat grass juice is recommended.
- No extra calcium intake is recommended if patient is consuming Mukta Pishti since the pearl corals are already a rich natural source of calcium.
According to Dr. Chauchan the following foods should be avoided:
- Heavy foods that can increase Ama (toxins) should be avoided e.g. heavy, greasy, sticky foods like Yogurt, Banana, Arbi, Okra (Lady’s finger), cheese, sweets, milk products, packaged food, noodles, pasta (packaged), food full of preservatives, and canned food.
- Chillies since they increase heat in the body and aggravate Pitta Dosha.
- Soft drinks are bad because they provide CO2 (carbon di-oxide) and deprive living cells of oxygen.
- High protein diet should be avoided.
- All non-vegetarian food should be avoided.
- All types of alcohol should not be consumed.
- Constipation should be avoided at all costs. Consuming soups of green leafy vegetables, as well as consuming fruits like papaya, melons, apples, pears and coconut water will help to get rid of constipation and improve appetite.
- Cruciferous or brassica vegetables that belong to the family Brassicaceae (formerly Cruciferae) have been proven in animal and human studies to contain anticancer agents (Senthilkumar, Chen, Cai, & Fu, 2014). This family of vegetables includes broccoli, cabbage, cauliflower collard greens, kale, kohlrabi, mustard, horseradish, radish, turnips, Chinese cabbage.
- Oil the body daily before taking a shower.
- Never overeat or eat when there is no appetite. Doing so will increase toxins in the body.
- It is recommended to fast for at least one day in a week to ignite Agni (digestive fire) and improve appetite. Fasting on coconut water or soups is recommended.
- Pranayama (breathing exercises): In 1931, Dr. Otto Warburg received the Nobel Prize for discovering that cancer cells do not need oxygen unlike all other cells in the human body. Cancer cells are fully or partially anaerobic, which means that they get their energy without using oxygen.
Therefore, it is believed that cancer cells cannot survive in the presence of high levels of oxygen. Breathing deeply in fresh air and pranayama exercises can be used to increased oxygenation of the body and to improve lymphatic circulation.
- Yoga Asana
Dr. Anil Mehta recommends that the following herbal preparations should be consumed. He advised that the treatment would take up to a year.
Livlong is an effective formula that has a powerful cleansing effect on liver and gallbladder. It helps to remove the substances that are toxic to the body and has a positive effect on the metabolism. When the liver is overloaded with toxic substances (wrong food, alcohol, and drugs), it unable to detoxify therefore the rest of the body becomes overloaded and Ama (toxins) can build up in unwanted places. Livlong is good for the functioning of the bile ducts, supports the bile production, the transport of bile and the bowel function.
Livlong contains the following ingredients: Phyllanthus amarus (Bhumyaamalaki), Triphala (combination of Terminalia chebula, Terminalia belerica, & Emblica officinale), Adhatoda vasica (Vasaka), Eclipta alba (Bhringaraja), Swertia chirata (Kirata), Boerhaavia diffusa (Punarnava), Berperis aristata (Daruharidra), Andopraphis paniculata (Kalamegh) and Gum Acacia.
The MP complex formula is useful for all conditions caused by Pitta dosha imbalance. It is also a brain tonic that has a beneficial effect on the hormonal system. MP complex nourishes and rejuvenates the Asthi Dhatu (bone and cartilage tissues). Due to high organic bioavailability of calcium in this preparation, it stimulates calcium uptake, and has a beneficial effect on the digestive fire (Agni). It also supports the action of vital organs, reduces the acidic, hot and sharp properties of an excess of pitta dosha and increases Kapha dosha.