By Nicholas Gonzalez, M.D.
If we move from the general to the specific, in our experience
all patients with pancreatic cancer fall into the sympathetic dominant
category, and therefore, in our model, require a plant-based diet.
Though for our practice we prescribe a variety of “vegetarian” diets
depending on the patient’s particular inherent level of sympathetic
activity (there is a continuum of both sympathetic and parasympathetic
dominance), most pancreatic patients end up on what we call the
“Moderate Vegetarian Diet.” This program emphasizes and allows all
plant foods, including unlimited vegetables, fruits, nuts, seeds
and whole grains. We usually recommend at least a quart of freshly
made vegetable juice a day, a good source of concentrated nutrients
and enzymes in their raw, undamaged form. This particular diet does
include animal protein in limited amounts, specifically eggs and
organic whole milk yogurt daily, as well as lean fish such as sole
twice a week but no more. We forbid entirely red meat and poultry,
which would too strongly stimulate their already hyperactive SNS.
For all our patients, including those on the Moderate Vegetarian
Metabolizer Diet, we always believe the cleaner the food the better,
and believe that organic generally is best. We do not allow refined
or junk food, such as white flour, white bread, white rice, white
sugar in all its many incarnations, and synthetic or chemicalized
food.
In terms of supplements, for those patients diagnosed with pancreatic
cancer we invariably recommend significant amounts of magnesium,
up to 1000 mgs a day, some potassium, chromium and manganese, lots
of the parasympathetisizing B’s such as thiamin, riboflavin and
folate – but little of those nutrients such as calcium, zinc and
B12 that would stimulate their already overactive SNS. We also recommend
large numbers of our pancreatic enzyme product, taken in divided
doses away from meals every few hours.
Case Reports: Six Patients with Pancreatic Cancer
Conventional medical journals often publish case reports, that
is, descriptions of individual patients whose disease might have
taken an unusual course in response to some new treatment. Such
“anecdotal” evidence, as it is technically called, differs from
a controlled clinical trial, in which different treatments are given
to large groups of patients with a particular illness. In such studies,
after a period of time, the researchers then tabulate and compare
the results observed in each group. Some scientists stubbornly insist
that only such rigorous exercises, pursued under the most stringent
rules and regulations, can “prove” to everyone’s satisfaction that
a new treatment for a disease has any value. They often argue that
case reports, these histories of individual patients, though perhaps
interesting or entertaining, have little scientific merit.
But my mentor Dr. Good, one of the finest scientists of the 20th
century and the most published author in the history of medicine,
always insisted case reports, if properly written and carefully
documented, can teach us much about the potential of a new approach.
In my own situation, when I first began to evaluate Kelley’s records,
Dr. Good said that if I could find even one patient with appropriately
diagnosed, biopsy proven metastatic pancreatic adenocarcinoma who
had lived five years under Kelley’s care he would be impressed,
since no one else in medicine anywhere to his knowledge had such
a case. Dr. Good’s knowledge was indeed extensive, since he was
at the time President of Sloan-Kettering and an expert in the disease.
A single example might not prove to everyone’s satisfaction that
the enzyme therapy had value, but it certainly should grab the attention
of any fair-minded researcher.
So case histories do have an important, if not definitive role,
particularly when considering a deadly disease such as pancreatic
cancer for which orthodox medicine can offer little. For example,
in one of the major gemcitabine (Gemzar) studies published in 1997
that led to FDA approval, of 126 patients with inoperable or metastatic
disease, only 18 percent lived one year and none lived beyond 19
months despite the use of intensive chemotherapy. With sobering
data like this, Dr. Good’s point should be well taken. Even today,
a single patient with appropriately diagnosed inoperable or metastatic
adenocarcinoma of the pancreas who lives five years, whatever the
treatment and whoever did the treating, represents a rather unusual
turn of events.
With these thoughts in mind, I present the following six cases
of patients with biopsy proven, carefully documented pancreatic
cancer. I have included five from our own private practice experience
and one taken from my original Kelley study, all of whom have enjoyed
very prolonged and unheard of survival, at times – but not always
– accompanied by significant disease regression documented by CT
scans or other radiographic studies. I include the one “Kelley case”
for its historical value, and because this patent’s survival has
been so remarkable over a period of many years. And, though the
stories of these wonderful and courageous patients surviving against
terrible odds may not prove the value of our treatment by the strictest
of academic standards, I believe they rather notably illustrate
what enzyme treatment can do even in the most dire of circumstances.
Before I turn to the cases, I did want to make yet another point,
one which Lyle always brings up whenever we talk. Lyle sees our
therapy not only as a potentially valuable treatment for serious
cancer and other degenerative diseases such as heart disease (yes,
we treat cancers other than pancreatic, and yes, we treat diseases
other than cancer) but as a tool for prevention. In this I agree
with him 100 percent . Though indeed Dr. Isaacs and I spend much
of our lives and very long days treating cancer of all types with
generally gratifying results, we certainly believe our individualized
dietary and supplement protocols can help keep us in excellent health,
and hopefully ward off killers like cancer and heart disease.
We do have patients in our practice without any major illness,
often the spouses or family members of our cancer survivors, who
begin our regimen strictly to improve their overall health and help
keep future disease at bay. I myself live by my own rules and have
followed an aggressive nutritional program since I first met Dr.
Kelley in 1981, after my second year of medical school. The rewards
have been great. I often tell patients I could not work long days,
seven days a week, caring for hundreds of very ill patients from
all over the world, continuing our research and writing efforts,
fighting the usual political battles, etc. were I not on my own
preventive therapy. Though beating cancer may be dramatic, the more
subtle day in day out, year in year out benefits of appropriate
diet and appropriate supplementation offer enormous promise for
all of us. My experience with many patients has taught me that superb
good health enjoyed over long lives is not a pipe dream, but a very
real and attainable goal.
Finally, in the following discussions, I identify patients by numbers,
to protect their identity. I learned a long time ago as proud as
we are of our successes, their privacy is important.
Patient #1: A 15-year survivor
Patient #1, like so many of my patients, has an unusual background,
with a graduate degree, study abroad, and expertise in art. Before
we first met, he had worked successfully in business for many years.
His very devoted wife had a Ph.D. and had, before retirement, worked
as a college professor.
In terms of his medical history, he had been a heavy smoker, but
otherwise seemed to be in good shape when in July of 1991, at age
70, a routine chest X-ray during a yearly physical showed a small
right lung nodule, suspicious for possible malignancy. A follow-up
CT scan of the chest confirmed a 6 mm nodule (about a quarter of
an inch) in the right upper lung, associated with a mildly enlarged
lymph node. A CT of the abdomen done the same day revealed four
lesions of the right lobe of the liver consistent with metastatic
cancer, a tumor sitting in the right adrenal gland, enlargement
of the left adrenal, and a 4.5 cm mass in the pancreas. To make
matters even worse, a bone scan showed increased uptake in the right
shoulder and right hip that the radiologist thought consistent with
metastatic disease. With these studies, Patient #1 had been given
a death sentence.
Though his doctors were convinced he suffered terrible advanced
cancer, they needed a tissue sample to confirm the diagnosis and
determine the most likely primary site. So, Patient #1 then underwent
surgery on his chest to remove the right lung nodule, which proved
to be “moderately differentiated adenocarcinoma,” a very aggressive
type of cancer that can originate in the lung or pancreas. Though
initially his doctors debated where the cancer originated, the consulting
oncologist felt this was most likely pancreatic cancer that had
metastasized to the lung, and not the other way around. In either
case, the prognosis was abysmal, since neither pancreatic nor lung
cancer respond to standard therapies such as chemotherapy, and in
either case patients face an average survival in the range of several
months.
Because of his extensive disease at the time of diagnosis, his
doctors told Patient #1 he had no more than two months to live,
and that neither chemotherapy nor radiation could help. Instead
of giving up and getting his affairs in order as the doctors suggested,
he and his wife decided to take the situation into their own hands.
They both began reading voraciously about cancer, and nutrition,
and alternatives. He began ingesting large numbers of supplements,
including vitamin C, vitamin E, even pancreatic enzymes after reading
an article discussing our work. He also switched his eating habits
to a largely plant based, raw diet, and began juicing intensively,
with his devoted wife’s help.
I first saw Patient #1 in December 1991, fifteen long years ago.
Despite his dire situation, he wanted to live, trusted me implicitly,
and proved to be a very determined and compliant patient. He seemed
to have absolute faith that he could get well on my therapy, and
the results, though gradual in coming, were gratifying. Within a
year, his general health had improved substantially, and a CT scan
of the abdomen done 18 months after his initial diagnosis showed
virtually no change in any of the lesions. Technically, the cancer
hadn’t improved, but it hadn’t advanced – and he was still alive.
After that set of scans Patient #1 told me he wanted no more testing,
period. Since he had already long outlived his doctors’ dismal predictions,
he figured he didn’t care what the scans might show and wouldn’t
change his treatment anyway. So he happily continued his therapy,
feeling grateful for each and every day, and went back to living.
He resumed giving tours and lectures at a local art museum and he
and his wife enjoyed their retirement for which they had long planned.
In 1997, after he had followed his nutritional protocol for over
five years, and with some pleading from me – since I am at heart
a scientist and wanted to know what was going on with him - he agreed
to undergo radiographic studies. A CT of the abdomen from March
1997 showed two mildly enlarged adrenal glands and a very small,
less than 1 cm (less than one half inch) mass in the dome of the
liver. However, the other large liver lesions were gone. The radiologist
in his report described the pancreas as normal – the previously
documented large tumor had simply disappeared.
Then sixteen months later, in July of 1998, nearly seven years
after his diagnosis, Patient #1 agreed at my urging once again to
“suffer through,” as he said, another series of tests. This time,
the radiologist wrote in his summary, “Reading the report from the
1993 study it sounded like the patient had obvious metastatic disease
and the largest structure being a large porta hepatis and peripancreatic
mass. No such masses are seen today. There is no adenopathy. The
adrenals are prominent and there are two very small liver lesions
that cannot be characterized because of their small size.”
Patient #1 did well until he drove his car off the side of a road
in 2004. At 84 years old, he should not have been driving, but wouldn’t
listen to me, or his wife about the issue. Unfortunately, he suffered
near fatal injuries and required lengthy rehabilitation, followed
by life in an assisted care facility. His wife, three years older,
no longer able to care for herself at 87 years old, also entered
an assisted care facility, where she and Patient #1 struggled to
return to fighting shape. They subsequently moved around a number
of times from rehab center to rehab center, and I had lost contact
with both, despite repeated messages left, and letters sent. But
I recently learned that he is still alive, now 15 years since his
terminal diagnosis.
Patient #2: A Ten-Year Survivor
In terms of his past medical history, Patient #2 had undergone
surgery for localized colon cancer in 1985, but received no radiation
or chemotherapy for the disease. He thereafter did very well until
he developed a large right neck mass about the size of a golf ball
in October 1996, while vacationing out of the country. After returning
to his home city in the midwest, he underwent a biopsy in December
1996, which revealed “adenocarcinoma” his doctors assumed had metastasized
from some abdominal organ, though they weren’t initially certain
of the point of origin. The pathology slides were then sent to Memorial
Sloan-Kettering for evaluation; there, the tissue was thought consistent
with “metastatic poorly differentiated adenocarcinoma with focal
signet ring cell features to lymph node. Possible primary sites
include lung, stomach and pancreas,” but, interestingly enough in
view of his history, not colon. Patient #2 apparently had developed
a completely new cancer.
Patient #2 then began extensive testing, including CT scans of
the chest and abdomen as well as bronchoscopy to rule out a lung
primary. All of these tests were unrevealing, but a PET scan at
Memorial in January 1997 did show activity not only in the neck,
but in the pancreas as well – indicating that organ as the origin
of the disease.
The Memorial doctors decided on a conservative approach, suggesting
that therapy not be immediately instituted. However, Patient #2
had learned of our treatment approach, and decided to proceed with
us. I first saw him in our office in January 1997; thereafter, he
proved to be a very compliant and determined patient. A follow-up
MRI of the abdomen and pelvis in October 1997 revealed no evidence
of cancer anywhere.
Today, nearly ten years after he started with us, he appears to
be in excellent health, enjoying retirement, and free of his once
life threatening cancer.
Patient #3: A Ten-Year Survivor
Patient #3 had been previously very healthy when he first developed
chronic heartburn, gradual weight loss and persistent diarrhea throughout
the summer of 1992. In August of that year, he became suddenly very
weak and short of breath; his local doctor found him to be anemic,
enough so that he had to be hospitalized for a transfusion. An endoscopy
at the time showed multiple stomach ulcers, which were thought to
be the source of the blood loss. Additional testing revealed elevated
blood levels of the hormone gastrin, which stimulates hydrochloric
acid secretion in the stomach – and which at times can be secreted
in great excess by pancreatic tumors. However, despite extensive
testing, his doctors could find no such lesion in the pancreas,
so after prescribing Prilosec to block acid production, they sent
the patient home.
On the medication he actually did fairly well, with no further
bouts of severe anemia until October 1994, when his gastrin levels
on routine blood testing were again elevated. This time around,
a CT scan did show a 6 to 7 cm mass in the retroperitoneal area
of the abdomen, the region in back of the stomach where the pancreas
sits. After a series of delays, he underwent exploratory abdominal
surgery in March of 1995 at a local hospital; unfortunately, his
surgeon discovered a very large tumor extending throughout the entire
pancreas that because of its size could not be removed. However,
a second smaller tumor at the base of the liver was excised; this
proved to be metastatic islet cell cancer presumably that had spread
from the pancreas.
After recovering from surgery, Patient #3 decided to travel for
a second opinion to the Mayo Clinic, where he was seen in May of
1995. At Mayo, the original slides were reviewed, and the diagnosis
of islet cell carcinoma confirmed. At the time, the consulting oncologist
recommended no additional therapy, explaining that it would be best
to keep chemotherapy in reserve for a later date when the cancer
had more extensively spread.
I first saw Patient #3 sometime later, in March of 1996. He, like
Patient #1 and Patient #2 proved to be a very determined, very grateful
patient, who followed his nutritional regimen to the letter.
A little over a year later, in June of 1997, his local doctors
sent him for a follow-up CT scan to check on his progress. This
time, the radiologist reported “no significant change in the appearance
of the patients pancreatic mass since previous examinations.” The
tumor was still there, but no bigger.
For several years, since he felt so well, he avoided any testing
until agreeing to another scan in September 2002. The official report
stated “Normal CT scan of the abdomen.” The large tumor in his pancreas
had simply gone away. A more recent scan was also completely clear,
and today, ten years after beginning his nutritional therapy, Patient
#3 continues on his program and continues doing well, enjoying a
full and productive life.
Patient #4: A Six-Year Survivor
In November of 2000, Patient #4 first reported a gradual 25 pound
weight loss to her physician. She was quickly referred for a CT
scan of the abdomen, which showed a 3.4 cm mass in the head of the
pancreas. A needle biopsy performed in February of 2001 confirmed
a “Poorly differentiated adenocarcinoma, ductal type,” the most
aggressive form of pancreatic cancer. The slides were also sent
to the Mayo Clinic, where the consulting physicians agreed with
the diagnosis.
Since the disease seemed localized to the pancreas, her physicians
thought the tumor might be operable. She was urged to undergo extensive
surgery, but the patient, who had already learned about our approach,
decided the risks were too great, the potential benefits too meager,
to warrant such an operation. Instead, in March of 2001, she consulted
with Dr. Isaacs in our office. A month after she began her nutrition
treatment, she underwent repeat CT scan testing, which revealed
a 3.2 cm mass in the head of the pancreas, with no evidence of metastatic
disease.
A follow-up CT scan performed in January, 2002, some ten months
after she began treatment with Dr. Isaacs, indicated a 3.0x3.0 cm
mass in the head of the pancreas, somewhat smaller than noted in
April 2001. The next CT scan in July 2003, after Patient #4 had
followed her nutritional regimen for more than two years, showed
a 3.16x2.6 cm mass in the head of the pancreas, and a CT scan not
quite a year later revealed a 3x2.8 cm mass.
Patient #4, now a five and a half year survivor, is generally in
excellent health, enjoying her life. In her case, the CT scans show
perhaps some slight shrinkage in her tumor, but no spread. Given
the aggressive nature of pancreatic adenocarcinoma, its tendency
to metastasize and kill quickly, her course has truly been remarkable.
We do find in our practice that though tumors can at times disappear,
at times in some patients they seem to stabilize, for years at a
time.
Patient #5: A Five and a Half-Year Survivor
Patient #5, with a long history of GERD (gastroesophageal reflux
disease) decided in January of 2001 to undergo laparoscopic surgery
for correction of what was presumed to be a simple hiatal hernia.
However, during the procedure, his doctor, as the records state,
discovered “multiple umbilicated, white, firm, and gritty tumors
in both the right and left lobes of the liver, apparently occupying
approximately 50 percent of the volume of the liver.” This, to say
the least, is a lot of cancer.
A biopsy of one of the liver lesions confirmed “poorly differentiated
metastatic carcinoma,” with, as the pathology report describes,
some “neuroendocrine differentiation.” After surgery, a CT of the
chest, abdomen, and pelvis revealed a large 6.5x3.7 cm mass in the
tail of the pancreas, with diffuse hepatic metastases.
The patient subsequently met with an oncologist at a major midwest
academic center, who suggested aggressive chemotherapy with cisplatin
and etoposide for 4 cycles. The oncologist admitted that even with
chemotherapy, the disease would ultimately progress and prove deadly.
Before agreeing to the treatment, in February of 2001 the patient
traveled to Memorial Sloan-Kettering in New York for a second opinion.
The doctors at Memorial reviewed the slides, confirmed a very aggressive
pancreatic carcinoma and proposed the same chemotherapy protocol
that had been previously recommended. The oncologist at Memorial
said that unfortunately, even with aggressive treatment, Patient
#5 might live at most two years. Chemotherapy, as he had been told
before, might shrink his tumors and prolong his life, but would
not be a long-term solution.
At that point, he was not yet aware of our approach, so with no
apparent options, he agreed to begin a four cycle course of chemotherapy
in February, 2001 administered by his local doctors in the midwest.
After his second cycle of chemotherapy, a CT scan in March 2001
did show response, with marked improvement in the numerous liver
metastases and shrinkage in the pancreatic tail mass.
Patient #5 completed the first 3 cycles without much difficulty,
but during the 4th cycle he became so ill the regimen had to be
discontinued in April of 2001. At that time, after learning about
our work, he decided to proceed with our treatment. I first saw
him in my office in May 2001, a month after chemotherapy had been
halted. He had no scans at that point, but a CT of the abdomen done
October 2001, five months after he began his nutritional protocol,
revealed a normal appearing pancreas with a single lesion in the
liver. By that point, Patient #5, who proved very determined and
very compliant, seemed to be improving in terms of his general health.
A CT of the abdomen in February 2002, 10 months after he had first
come to our office, indicated multiple small lesions in the liver.
I made several adjustments in his regimen, and repeat CT scans in
October 2002 confirmed that all the liver tumors were gone. Follow
up scans in March 2003 and June 2004 were also completely clear.
He has now been following his nutritional regimen for five and a
half years, is approaching six years from his original diagnosis
of very advanced and very terminal pancreatic adenocarcinoma, and
appears disease free.
Patient #6: A Twenty-Four-Year Kelley Survivor
I first learned of Patient #6 while reviewing the records of patients
with pancreatic cancer treated by Dr. Kelley. I thought I would
include her to illustrate the kind of successes uncovered in Dr.
Kelley’s files, as I pursued my five-year study of his therapy.
In early 1980, Patient #6 first experienced occasional bouts of
mid ¬abdominal pain that gradually worsened over a two-year
period. Despite the symptoms, Patient #6 did not seek medical assistance
until August 1982, when she was admitted to the local emergency
room of her midwest town with excruciating pain. When an ultrasound
showed only gallstones, her doctors assumed she might be suffering
from gallbladder disease, and proposed cholecystectomy.
Within days, she underwent exploratory surgery and removal of the
gallbladder. However, the surgeon also discovered a pancreatic mass
that had invaded into the surrounding tissues, as well as a single
1 cm tumor in the liver, which he biopsied. Due to the extent of
disease, he made no attempt to excise the pancreatic tumor.
The liver specimen proved consistent with adenocarcinoma that had
spread from a pancreatic primary. After recovering from surgery,
Patient #6 met with an oncologist, who told her that although chemotherapy
might prolong her life slightly, no treatment could cure her disease.
He suggested she get her "affairs in order." In the official
records, this physician wrote: "The patient's prognosis is
judged to be between 9 and 15 months at most."
After recovering from surgery, Patient #6 decided to seek out a
second opinion at the Mayo Clinic in Rochester, Minnesota. When
seen at Mayo in mid September, a CT scan revealed an enlarged pancreas,
and blood studies indicate abnormal liver function tests. At the
conclusion of his evaluation, the consulting oncologist wrote, in
the official discharge summary:
"I had a long discussion with her regarding treatment for
her cancer. At the present time I would favor simply observation
since we know of no known treatment that will necessarily prolong
her life. Since she is feeling well at the present time I did not
feel justified in making her symptomatic from the side effects of
chemotherapy.”
Fortunately, Patient #6 learned of Dr. Kelley’s work from a local
health food store owner, and shortly thereafter began treatment
with him in December of 1982. She responded quickly, and within
six months was back to working long days in the family business.
By the time I completed my Kelley study in 1987, Dr. Kelley had
closed down his office and disappeared. After I started my own practice,
I lost touch with Patient #6 until she referred a patient to me
in the mid 1990’s. At that time she was in excellent health twenty
years out from diagnosis, still following her prescribed diet and
still taking pancreatic enzymes. I heard recently that she is still
alive, still active, and still enjoying her life, now 24 years from
her original Mayo confirmed diagnosis of metastatic adenocarcinoma
of the liver.
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