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magazine presents MUSHROOMS ANCIENT healing WISDOM PROTECT and PROMOTE HEALTH Maitake, Shiitake, Lion’s Mane & More $4.95 CHECK OUT THESE GREAT BOOKS PUBLISHED BY ACTIVE INTEREST MEDIA RETAIL $15.95/EA ASK YOUR LOCAL NATURAL HEALTH STORE OR LOOK ONLINE AT AMAZON magazine presents MUSHROOMS by LISE ALSCHULER, ND, and KAROLYN A. GAZELLA Copyright © 2009 by Lise Alschuler, ND, Karolyn A. Gazella, and Active Interest Media, Inc. All rights reserved. No part of this booklet may be reproduced, stored in an electronic retrieval system, or transcribed in any form or by any means, electronic or mechanical, including photocopying and recording, without the prior written permission of the publisher, except for the inclusion of quotations in a review. Published by: Active Interest Media, Inc. 300 N. Continental Blvd., Suite 650 El Segundo, CA 90245 This booklet is part of the Better Nutrition Healthy Living Guide series. For more information, visit www.betternutrition.com. Better Nutrition magazine is available at fine natural health stores throughout the United States. Design by Aline Design: Bellingham, Wash. The information in this booklet is for educational purposes only and is not recommended as a means of diagnosing or treating an illness. All health matters should be supervised by a qualified healthcare professional. The publisher and the author(s) are not responsible for individuals who choose to self-diagnose and/or self-treat. MUSHROOMS CONTENTS Introduction: The Fruitful Fungi...........................................4 Chapter One: Magic or Medicine?....................................... 6 Chapter Two: Health Applications.....................................12 Chapter Three: Scientific Validation.................................21 Chapter Four: Choosing Mushroom Supplements..... 28 Selected References....................................................................31 Introduction The Fruitful Fungi F or centuries we have known that some foods can heal and some can harm. Perhaps no food demonstrates both sides of that truism as well as mushrooms. Poisonous mushrooms can cause severe illness and even death, but others can improve health and treat disease. Of the 14,000 different types of mushrooms, a handful have incredible healing powers. Known as medical mushrooms, these select fungi have the therapeutic potential to ease many serious illnesses including cancer, AIDS, Alzheimer’s, and diabetes. But what exactly is a mushroom? Fungus Among us The mushroom is actually the fruiting body of a fungus. Unlike a plant, a fungus does not contain chlorophyll. Chlorophyll, plants’ green or purple pigment, uses the energy from the sun as fuel for growth. A fungus survives and thrives by living off nutrients absorbed from organic materials such as trees or dead plants. Mold and yeast are also a part of the fungus family. Fungi do not belong to the plant or animal kingdom; they claim a kingdom of their own. According to plant pathologist Barbara Ambruzs with 4 M U S H R O O M S Iowa State University, growing mushrooms is more like caring for a dog versus a plant “since mushrooms need attention about two to three times a day.” A better comparison might be rabbits: Mushrooms are very proficient multipliers. Whereas plants reproduce with seeds, mushrooms rely on their spores. The fruit of the mushroom—the part that is visible above ground—produces hundreds of thousands of microscopic spores. Under ideal circumstances, mushrooms can grow very rapidly, transforming from the size of a pinhead to a golf ball literally over night. Some mushrooms will be noticeably larger in just a few hours. A few types of mushrooms can even spread over hundreds of miles. Because they appear so suddenly, the ancient Romans believed mushrooms were magical. In ancient Egypt, only the pharaohs were allowed access to mushrooms because they were believed to contain the key to immortality. Mushrooms are one of nature’s oldest food sources. They can enhance other ingredients or even serve as a main course. Beyond their flavor, mushrooms are a nutritional powerhouse packed with important protein, fiber, minerals, and vitamins. Mushrooms are fat-free, cholesterol-free, low in calories, and very low in sodium. They also contain polysaccharides— health-promoting complex carbohydrates. Many ancient civilizations used mushrooms for more than just food— they believed they had significant healing powers. Today, the scientific community is finding they were right. These popular healing mushrooms have wonderfully descriptive names like Turkey Tail, Lion’s Mane, Dancing Mushroom, Sun Mushroom, Silver Ear and the American favorite, White Button. The next chapter provides complete descriptions of the nine most important healing mushrooms presently being evaluated by the research community. All of these mushrooms are also available as dietary supplements at your local natural health store. A steep tradition of historical use combined with scientific validation is driving intense interest in this food and supplement category. M U S H R O O M S 5 Chapter One Magic or Medicine? E astern nations such as Japan and China have perfected the medicinal mushroom craft. For centuries, mushrooms have been thought to be a valuable tool in promoting health and vitality. The traditional use of mushrooms as natural medicines is unprecedented. Modern science continues to confirm the ancient wisdom about the mighty mushroom, converting the magical myth into medical reality. Types of Mushrooms Of the thousands of varieties of mushrooms presently growing throughout the world, several types possess specific medicinal properties. Here is a brief description of the nine most widely studied types of mushrooms, listed in alphabetical order. We will cover specific health applications in more detail in chapter three. Agaricus bisporus (White Button). Members of this family of mushroom have a familiar button cap with radiating gills on the underside. In fact, the word agaricus means gilled mushroom. The white button, portabella, and crimini are all Agaricus bisporus mushrooms. About 90 percent of United States mushroom production is with this type of mushroom, making it the most commonly grown mushroom in America. Onehalf of the Agaricus mushroom crop is produced in Pennsylvania. The Agaricus mushroom has become a great low-calorie alternative to meat and also contains many important vitamins. Preliminary animal studies have shown that White Button mushrooms can enhance immune activity. Agaricus bisporus (White Button) 6 M U S H R O O M S Agaricus blazei (Sun Mushroom). This edible mushroom is native to the rain forests of Brazil. Sun mushrooms grow within very specific climacteric conditions with certain humidity levels and air quality. Researchers have found the higher content of polysaccharides (mainly Beta1,3 Glucan carrying Beta 1,6 branched chains) in Agaricus blazei than any other medicinal mushrooms. The medicinal properties of this mushroom have been studied for more than 30 years, and now upwards of 90 percent of all Brazilian Agaricus blazei is exported to Japan for use in the prevention and treatment of cancers. Cordyceps sinensis (Cater pillar Mushroom). Found primarily in higher elevations of Asia, particularly Tibet, the Cordyceps mushroom grows parasitically upon the larvae of a moth. The relationship between the mushroom and the larvae is unclear, but we do know that the Cordyceps fungus mummifies the caterpillar and sprouts the mushroom fruit off of the back of the catCordyceps sinensis erpillar’s head, poking through the soil (Caterpillar Mushroom) like blades of grass. The caterpillar portion of the fungus is termed Cordyceps sinensis and the mushroom portion is termed Hirsutella sinensis. More than 1,500 years ago, Chinese herdsmen observed that their livestock became more energetic after eating the caterpillar mushrooms. According to traditional use, Cordyceps can cure infertility and increase sex drive. They are reported to be much more potent than Panax Ginseng. Presently, research on Cordyceps focuses on increasing stamina, lowering cholesterol, and enhancing immune function. The mushroom, Hirsutella sinensis, is the most medicinally active portion of the fungus; it’s from this part that most commercial products are derived. Confusingly, these products are referred to as Cordyceps. Coriolus versicolor, also known as Trametes versicolor (Turkey Tail). This mushroom is found anywhere there are dead logs and stumps, making it one of the most common mushrooms in woods throughout North America. Somewhat resembling a turkey’s tail, this mushroom has a history as a natural remedy in Traditional Chinese Medicine and may M U S H R O O M S 7 Coriolus versicolor (Turkey Tail) be the most studied medicinal mushrooms of all. Turkey Tail has two key health-promoting components: polysaccharide K (PSK) and polysaccharide-peptide (PSP). Polysaccharides are special sugar molecules, and some of them ��������������������������������������������������������� have therapeutic benefit. In the 1970�������������������� ������������������������ s, the Japanese government approved PSK to treat several types of cancers, and it remains a best-selling cancer drug in that country. According to the American Cancer Society, “researchers have found that PSK has several anti-cancer properties, including slowing the spread of cancer cells in the body.” Hericium erinaceus (Lion’s Mane). This edible mushroom has cascading white tendrils and is appropriately referred to as the Lion’s Mane mushroom. While this mushroom has only recently gained popularity in North America, it has been used in Traditional Chinese Medicine for hundreds of years. The young mushrooms are tasty and have the texture of seafood when cooked. Some compounds in Lion’s Mane have been shown to stimulate the immune system and control blood sugar levels. Lion’s Mane mushroom has been shown to combat dementia. Japanese researchers demonstrated that fractions of Lion’s Mane can inhibit the formation of toxic peptides in brain cells (amyloban) and ������������������������������ also stimulate the production of Nerve Growth Factor (NGF) in the Hericium erinaceus (Lion’s Mane) brain (hericenone). Maitake (Dancing Mushroom). In Japanese, the word maitake literally means “dancing mushroom.” Ancient lore has it that when the Japanese found Maitake mushrooms in the mountains, they began dancing for joy. The way the fruit bodies of the mushroom overlap make it look like a cluster of dancing butterflies. In Japan, Maitake is known as the “King of the Mushrooms” for both its taste and health-promoting benefits. Maitake can grow very large—typically the size of a basketball—and it grows naturally in Japan’s northeastern mountains. It also grows in some parts of North America and Europe. Historically, Maitake mushrooms have a variety of specific uses and also help promote overall wellness and vitality. Scientific research has confirmed Maitake’s ability to lower high blood pressure and lower blood sugar levels in people with diabetes. Its proven immune-enhancement capabilities 8 M U S H R O O M S have made it a focal point in treatment for cancer and HIV. A beta glucan/protein compound found in Maitake known as D-fraction has been widely researched, and its immune enhancing potential has been confirmed in clinical trials. The SX-fraction of the Maitake has been shown in clinical studies to control blood ������������������ glucose����� . According to Harry Preuss, MD, with Georgetown University Medical Center, “Because maitake mushroom is a safe, edible product, it has a lot of promise in the oncology and metabolic fields.” Maitake (Dancing Mushroom) Reishi. The Reishi mushroom has the longest historical use of all the mushrooms. It has been used medicinally in China for more than 4,000 years. The Reishi mushroom grows like a parasite on logs, tress, and plants. It is soft and flat and has a cork-like consistency. Its fruit is red in color and kidney-shaped. Traditionally, Eastern cultures have used Reishi mushrooms for a variety of conditions including heart disease, inflammation, ulcers, and more. Modern research has confirmed some of the traditional health benefits of Reishi mushrooms. According to Memorial Sloan Kettering Hospital, positive immune-stimulating results have been shown using Reishi in patients with advanced cancers. Reishi in the wild M U S H R O O M S 9 Shiitake Shiitake. This mushroom is a major staple of Japanese and Chinese diets. It is a dark brown, umbrella-shaped mushroom. Although it is native to east Asia, it has been commercially grown in the United States for the past 20 years. Shiitake mushrooms are packed with important essential amino acids, vitamins, and minerals. In addition, they contain the polysaccharide (sugar molecule) lentinan. Lentinan is another anti-cancer drug approved by the Japanese government in 1980s. Shiitake has shown benefit in many other areas, including reducing high cholesterol, lowering blood pressure and healing infections. Tremella fuciformis (Silver Ear or White Jelly Leaf). This mush room is popular in Chinese cuisine. It is also used to make a cough syrup for treating chronic bronchitis and a number of other cough-related conditions such������������������������������������������������������������������������� as asthma��������������������������������������������������������������� and����������������������������������������������������������� dry cough in T�������������������������������������������� ��������������������������������������������� raditional Chinese M������������������������ ������������������������� edicine. Tremella������� ’s composition is more than 70 percent dietary fibers such as acidic polysaccharides and is a rich source of vitamin D. Modern research indicates its usefulness in fighting tumors, lowering blood glucose, combating high cholesterol, and protecting against radiation. A polysaccharide called GXM in tremella has been shown to have greater water-retaining ability than hyaluronic acid, making it a popular ingredient in cosmetic and skin care products. Packed With Power It’s no wonder mushrooms have become a culinary favorite of health conscious consumers throughout the world: They’re packed with therapeutic power in the form of active constituents and important vitamins, minerals, and amino acids (for specifics, see the table on page 11). Some people, though, just don’t like the taste of these fabulous fungi. If you’re one of them, don’t fret: You can glean mushrooms’ health benefits by using a highquality mushroom supplement. As we learn more about power-packed mushrooms, we are uncovering a variety of health benefits that match the myriad mushroom qualities we find in nature. The health implications are impressive, thanks to the aggressive scientific validation that has occurred during the past few decades. 10 M U S H R O O M S What’s in a mushroom? TYPE NUTRITIONAL CONSTITUENTS ACTIVE COMPOUND(S) Agaricus bisporus B vitamins, vitamin D, zinc, selenium, potassium, copper Cordyceps protein, fatty acids adenosine cordycepin (3’-de-oxyadenosine) polysaccharides Coriolus calcium Polysaccharide K (PSK) Polysaccharide peptide (PSP) Hericium erinaceus protein, zinc Amyloban Hericenones Maitake vitamin D, B vitamins, protein, ergosterols D-fraction SX-fraction Reishi selenium, iron Shiitake 8 essential amino acids vitamins A, B, C, D, iron, potassium Lentinan Tremella vitamin D, calcium, dietary fiber GXM-fraction Cautionary Advice Nonpoisonous mushrooms are extremely safe when consumed in moderate amounts or taken as directed as a dietary supplement. When eating edible mushrooms, keep these tips in mind: •Buy organic whenever possible to avoid pesticides and toxic chemicals. •Be sure the mushrooms are firm and not slimy or old. •Eating large quantities of mushrooms can induce temporary bloating and/or diarrhea, especially if you have not eaten mushrooms in the past. •Individuals with gout or kidney stones should avoid eating large quantities of mushrooms (more than 15 grams per day). •People taking anticoagulant or immunosuppressive medications should consult their physicians before taking medicinal mushroom supplements. M U S H R O O M S 11 Chapter Two Health Applications M ushrooms have numerous and diverse health applications, including treating and preventing cancer, fighting infections (including serious chronic infections such as HIV and herpes), treating diabetes, lowering cholesterol and blood pressure, and preventing dementia and Alzheimer’s. Following is an overview of how specific mushroom extracts can help with these serious illnesses. Cancer Prevention And Treatment Medicinal mushrooms and their extracts are well indicated in the integrative treatment of cancer. Agaricus, Maitake D-fraction, lentinan from Shiitake, PSK from Coriolus, and Reishi extract have all been found to exert profound immune-directed anti-cancer actions. Most of the studies on these mushroom extracts have looked at the use of mushrooms in conjunction with conventional therapy (surgery, chemotherapy, and/ or radiation). What emerges from this research is a compelling picture of benefit. The use of these medicinal mushroom extracts stimulates tumor-destroying immune cells. Our immune system is our primary defense against cancer. Unfortunately, through a combination of elaborate immune evasion strategies on the part of cancerous tumors, along with immune suppression by tumor-killing therapies such as chemotherapy and radiation, most people with cancer are left without their most important weapon in hand: a strong immune system. Medicinal mushroom extracts stimulate some of the most critical points of our immune system—macrophages and dendritic cells. Their release of potent communication molecules, certain interleukins and cytokines, activate the combat soldiers of our immune system—natural killer cells and T-cells. The result is targeted immune destruction of tumor tissue. In addition to this immune activation, ������������������������������ certain medicinal ���������������������� mushroom extracts constituents,������������������������������������������������������ such as ��������������������������������������������� M�������������������������������������������� aitake D-fraction��������������������������� , trigger apoptosis (cellular suicide) selectively in cancer cells. The combination of these actions is significant. Most people with cancer who take medicinal mushroom extracts have slowed progression of their cancer and, most importantly, survive longer. The overall quality of life for these survivors is better due to the mushroom extracts. They experience less fatigue and fewer com12 M U S H R O O M S Apoptosis is referred to as cellular suicide. Some questions about using mushroom extracts in the context of cancer remain unanswered, though. Which extract is best? Do certain mushrooms work differently than others in different cancer types? Combine these uncertainties with a general lack of understanding about how long one should use these extracts, and we are left with significant gaps in our knowledge about how people with cancer can gain the most benefit from medicinal mushroom extracts. In light of these unanswered questions, the best we can do is take mushroom extracts strategically. A strategic usage of mushroom extracts for someone with cancer relies upon paying attention to how one feels and responds to the treatment. There is certainly overlap in how these mushroom extracts work, and each mushroom has different active constituents. If an individual achieves benefit from one of the mushroom extracts, he has every reason to continue using that extract. If the benefit seems limited or is short-lived, it is entirely appropriate to switch to another mushroom extract. Alternatively, if it is hard to determine the actual benefit on a day-to-day basis, one may want to rotate the use of the mushroom extracts in order to obtain benefit from them all. Finally, combination M U S H R O O M S 13 Medical Illustration Copyright @ 2008 Nucleus Medical Art. All Rights Reserved. www.nucleusinc.com plications from chemotherapy and radiation, and they have fewer infections. The anti-cancer benefit of medicinal mushroom extracts has been demonstrated in people with breast, lung, colon, esophageal, brain and neck, liver, stomach, colon, cervical, prostate and bladder cancers, as well as leukemia, and myeloma. products of these mushroom extracts may be helpful, although it is important to make sure that the amount of each mushroom in the product is high enough to be effective. Specific dosage information for each type of mushroom extract can be found in chapter four. Medicinal mushroom extracts appear to be exceptionally well-tolerated by people with cancer, though some people do experience mild nausea when taking them. There are rare allergic reactions to mushrooms, and allergies to other fungi may increase the likelihood of an allergic reaction to medicinal mushrooms. Given the low toxicity of mushroom extracts, the general enhancement of the effects of conventional treatment, significant survival benefits, scientific validation, and the clinical experience of many healthcare professionals, the use of medicinal mushroom extracts in the treatment of cancer is strongly indicated. Fighting Infections In a world teeming with microorganisms, our survival is dependent upon having strong immune defenses. Medicinal mushrooms are one way to bolster our immune defenses and reduce infectious disease. Medicinal mushrooms—Agaricus, Maitake, and Reishi in particular—have been shown to reduce the risk of infection with viruses and bacteria. These mushrooms have the ability to stop a viral infection in its tracks if taken at the time of exposure. However, it can be a bit challenging to determine exactly when we are exposed to a virus. It makes sense then to consider taking medicinal mushrooms preventively. For someone who is susceptible to experiencing colds and flu during the winter months, a daily dose of medicinal mushrooms may allow for an illness-free winter. Even adding mushrooms to our diet will help us to prevent infection. The modest salad vegetable, the white button mushroom, has been shown to increase the function of dendritic immune cells, the “eyes” of our immune system. Thus, making sure that our salads and vegetable dishes contain white button mushrooms will increase our immune surveillance and decrease our susceptibility to colds and flu. The white button mushroom can increase the function of immune cells. 14 M U S H R O O M S Medicinal mushrooms can increase the number and activity of circulating immune cells in people receiving chemotherapy. People with certain chronic infections can also benefit by taking medicinal mushroom extracts. Serious infectious diseases such as hepatitis B, polio, herpes, streptococcus-caused ear infections and pneumonia, and human immunodeficiency virus (HIV) are indications for medicinal mushrooms. In these infections, mushroom extracts such as gandoerma polysaccharide from Reishi, Maitake D-fraction, and lentinan from Shiitake have all been shown to improve immune defenses, reduce infection, and lessen the symptoms of the diseases. This application for medicinal mushrooms is quite important given the alarming rise of antibiotic-resistant infection and hard-to-treat viral illnesses. While larger clinical trials are still needed to determine just how effective and reliable these mushroom extracts are for treating infectious diseases, the data so far is encouraging. With appropriate physician guidance, there is certainly little risk in adding mushroom extracts to an integrative treatment plan for chronic hepatitis, HIV infection, herpes, ear infections, or pneumonia. Medicinal mushrooms are also a powerful way to support the immune system during times of immunosuppression. For instance, chemotherapy or radiation can suppress the immune system. Medicinal mushrooms have been shown to increase the number and activity of circulating immune cells in people receiving those treatments. Medicinal mushrooms help prevent infection in these immunocompromised people. Additionally, if the mushroom extracts are successful in preserving white blood cell counts, then delays in the chemotherapy or radiation treatment can be avoided. Avoiding treatment delays allows the patient to receive the maximum benefit. It is important to note that medicinal mushroom extracts increase not only the number of immune cells, but also the activity of immune cells. Thus, even if a person is unable to produce sufficient M U S H R O O M S 15 white blood cells, a mushroom extract will help the white blood cells that they do have in circulation to be as active as possible. Highly active white blood cells will promote more robust defenses against infection. Diabetes Treatment Diabetes has become a prevalent condition throughout the world. Medications, while effective, do not cure diabetes. Diabetes is a disease that requires a comprehensive, integrative approach. Medicinal mushrooms may be an important component of this integrated treatment approach because some mushroom ������������������������������������������������������������������ extracts such ������������������������������������������������ as Maitake SX-fraction can �������������������� lower both insulin and glucose. In order to understand why this is so significant, let’s take a quick look at diabetes and its precursor condition, insulin resistance. Glucose is essential for the production of energy in all tissues of the body, including the heart, muscles and immune system. If we eat a lot of sugar and simple carbohydrates, we’ll experience an increase in blood glucose levels. High-carbohydrate meals and lots of simple sugars flood the blood stream with sugar. In response, our pancreas releases insulin. Insulin facilitates cellular uptake of glucose. Over time, repeated exposure to sugar causes blood sugar and insulin levels to stay elevated, and unfortunately, other organs become resistant to the effects of insulin. Insulin resistance is actually referred to as a “pre-diabetes” condition also known as metabolic syndrome or syndrome X. Insulin resistance is the stage of compensation by the pancreas for increased blood sugar before the pancreas exhausts itself. It is associated with cardiovascular disease, liver disease, obesity, and cancer. This is why it is so important to lower both sugar and insulin levels. Repeated exposure to sugar causes blood sugar and insulin levels to stay elevated. 16 M U S H R O O M S Mushrooms decrease insulin resistance and lower blood sugar levels. Insulin resistance can be reversed with diet and exercise. Diets that are composed primarily of whole foods such as fruits, vegetables, and grains— and not simple sugars or refined carbohydrates (namely flour and high fructose corn syrup) help to reverse insulin resistance. Exercise has been scientifically demonstrated to prevent and improve insulin resistance. The addition of supplements such as B vitamins, chromium, essential fatty acids, and magnesium can also lower insulin resistance. Herbs such as Gymnema sylvestre and green tea may be helpful. Another powerful addition to an insulin resistance reversal program is medicinal mushrooms. Mushrooms decrease insulin resistance and lower blood sugar levels. Agaricus blazei extract and Maitake SX-fraction have each been shown in clinical trials to lower both insulin and blood sugar and to reduce insulin resistance. Harry Preuss, MD, and his colleagues at Georgetown University have conducted key research utilizing Maitake SX-fraction. According to Preuss, Maitake mushroom and the SX glycoprotein extracted from it can help individuals overcome many of the underlying causes associated with metabolic syndrome. An extract from Reishi mushroom has also been shown in a clinical trial to reduce blood sugar levels in diabetics. Cordyceps mushroom extract has been shown in multiple animal studies to lower blood sugar. Mushroom extracts are essentially nontoxic and, in addition to lowering blood sugar, improve immune function and help prevent infections—a concern for diabetics. Other Applications High Blood Pressure, High Cholesterol, Dementia, And Quality of Life High blood pressure and high cholesterol often occur together, and they can be a deadly combination. Diet and lifestyle changes can address mild elevations. Natural supplements that lower blood pressure and M U S H R O O M S 17 cholesterol will also help delay or avoid the need for medications. If blood pressure or cholesterol are already moderately or severely elevated, drugs can be life-saving. However, in some individuals, their benefit can be temporary. For these individuals, it may be necessary to integrate natural supplements to achieve better long-term control. Mushroom extracts are one type of natural supplement that lowers both blood pressure and cholesterol (total cholesterol and LDL cholesterol) in some individuals. Cordyceps mushroom extract lowers total cholesterol by an average of 20 percent in more than half of the people that take it. In addition, Cordyceps prevents the oxidation of LDL cholesterol. LDL cholesterol is a more damaging type of cholesterol, and it becomes most dangerous when it is oxidized. Preventing its oxidation is one way to minimize the risk of heart disease caused by high cholesterol. Reishi mushroom extracts also lower cholesterol by inhibiting an enzyme, HMG-CoA, required for the production of cholesterol by the body. In addition, they lower blood pressure and inhibit platelets from sticking to each other and forming clots. Several other types of mushroom extracts have also been show to lower cholesterol and blood pressure in animal studies and small human studies. Many people with chronic high blood pressure have underlying kidney disease. The kidney disease can both cause the high blood pressure and result from long-standing high blood pressure. Interestingly, mushroom extracts, such as Cordyceps extract, support kidney function and can even improve function in people with chronic renal failure. Mushroom extracts are well tolerated and can be a useful addition to a cardiovascular health plan. Dementia—particularly Alzheimer’s type—is a frightening and incapacitating ailment. Treatment for Alzheimer’s disease has limited success. Given the exceptionally high costs that this disease creates for its victims and their loved ones, new therapies are welcome. One such therapy is Lion’s Mane mushroom. This mushroom has been demonstrated in small human trials to reduce the symptoms of Alzheimer’s. In one study, Alzheimer’s patients showed significant improvement in their physical and perceptive capabilities after taking Lion’s Mane mushroom in their daily soup for six months. Lion’s Mane has two separate and distinct substances with clinically demonstrated effectiveness in battling damages in the brain caused by Alzheimer’s. One substance, hericenone, stimulates the production of nerve growth factor (NGF) in the brain. Massive neuronal cell death is the ultimate outcome of Alzheimer’s disease, and the production of NGF that is able to cross the blood-brain barrier will lead to the growth of new neurons to replace those that die. Another substance, amyloban, 18 M U S H R O O M S People have been eating mushrooms for more than 3000 years to achieve wellness and enhance quality of life. may ���������������������������������������������������������������������� inhibit��������������������������������������������������������������� the toxicity of the plaques caused by the accumulations of a�� ��� myloid beta peptide. The destruction of neurons caused by the formation of amyloid beta peptide in the brain is a major cause of Alzheimer’s disease. These actions may help preserve memory and might be useful in preventing dementia. Lion’s Mane mushroom extracts with standardized levels of amyloban and hericenones have shown no toxicity and may help slow the progression of Alzheimer’s disease and even reverse some of its symptoms. In an animal study at China Pharmaceutical University, this standardized extract showed equal or even greater anti-Alzheimer’s effectiveness than the leading prescription medicine, Aricept (a Pfizer product). M U S H R O O M S 19 Quality of life and overall wellness are goals we all share. People have been eating mushrooms for more than 3,000 years to achieve this goal. Over these many centuries, people have determined that mushrooms reduce fatigue, increase stamina, prolong life, increase vitality, reduce illness, and improve emotional well being. Modern research has confirmed these effects. Mushroom extracts even help people with significant challenges to their quality of life, such as people with cancer undergoing chemotherapy treatment. Cordyceps mushroom extract has been shown to alleviate fatigue and to improve physical endurance in adults of all ages. Patients with cancer receiving chemotherapy who take Maitake D-fraction mushroom extract report increased quality of life. Most of us appreciate more energy, more stamina, and enhanced mental health. Add to that increased immune function, better blood sugar control, lowered cholesterol and blood pressure, improved memory, and better cognitive function, and mushroom extracts become hard to resist! Cordyceps Reishi Shiitake (lentinan) Tremella √ √ √ √ √ √ √ Infection √ √ √ √ √ √ Diabetes √ √ √ √ High Cholesterol & High Blood Pressure √ √ √ √ Hepatitis √ √ √ √ √ Kidney Disease √ √ √ √ √ √ √ √ √ √ √ Inflammation Weight Loss 20 √ √ Dementia Quality of Life Issues Maitake Coriolus (PSK) Cancer Hericium Agaricus Health Applications For Medicinal Mushroom Extracts M U S H R O O M S √ √ √ √ √ Chapter Three Scientific Validation The long traditional use of medicinal mushrooms has compelled significant scientific investigation into their medicinal properties. In fact, taken as a group, medicinal mushrooms are among the most extensively researched natural substances in the world. A much bigger book would be required to summarize all of this research in detail, but let’s take a look at some of the highlights. Immune Stimulation Several mushroom extracts have been shown to increase the activity of our immune cells. White button mushrooms have been shown to increase the function of dendritic immune cells. Dendritic cells are the sentries of the immune system, responsible for identifying invading microbes or spotting virally infected or cancerous cells and then presenting them as targets for attack from other cells of our immune system. In this way, white button mushrooms increase our immune surveillance and immune defensive actions. Agaricus blazei (sun mushroom) has been found to activate macrophages (roaming dendritic cells), natural killer cells, and T lymphocytes. These cells comprise our cellular immunity, which is our main, and best, defense against cancer and viral infection. An extract of Cordyceps mushroom was given to rats exposed to harmful radiation. The Cordyceps extract stimulated cell division and increased the number of normal white blood cells in the rats’ spleens and lymph nodes. These cellular changes resulted in enhanced and accelerated immune recovery following low-dose radiation injury. An extract from Maitake mushroom, D-fraction, also activates macrophages. Specifically, Maitake D-fraction stimulates macrophages to re- Cordyceps extract stimulated cell division and increased the number of white blood cells. M U S H R O O M S 21 lease a powerful messenger chemical called interleukin-12 (IL-12). IL-12 activates one of our most dominant weapons against cancerous tumors, our natural killer cells. Studies indicate that when Maitake D-fraction is taken alongside chemotherapy, immune activities are increased as much as three times. Cancer Prevention And Treatment Some mushroom extracts have potent anti-cancer properties. Grifola frondosa (Maitake), Agaricus blazei (Sun Mushroom), Coriolus versicolor (Turkey Tail), Ganoderma lucidum (Reishi) and Cordyceps sinsensis (Caterpillar Mushroom) increase cancer cell death, or apoptosis, specifically in leukemia, myeloma, and cancers of the liver, bladder, and prostate. Studies show that mushroom extracts cause apoptosis of cancer cells without damaging or destroying healthy normal cells. Mushrooms also cause cancer cell death by causing certain immune cells to release powerful molecules called interleukins. Interleukins are potent immune-stimulating messenger molecules that activate immune cells to destroy tumors. Shiitake mushroom lettuce wraps. For more information visit www.mushroomcouncil.com. Photo provided by The Mushroom Council. 22 M U S H R O O M S A specific mushroom extract, Maitake D-fraction exclusively distributed by Maitake Products, Inc., has been shown to slow down the growth and metastatic spread of lung, liver and breast cancers. This anti-cancer effect is thought to be the result of increased natural killer cell activity. The anti-cancer effects from Maitake D-fraction appear to be enhanced when combined with vitamin C. Another mushroom extract, PSK from the Coriolus mushroom, is currently used in conjunction with conventional treatment to cause increased cancer cell death and to provide immune support. PSK extract, when given along with conventional chemotherapy or after radiation therapy, has been shown to increase survival for people with leukemia and cancers of the esophagus, stomach, colon, liver, lung, head, and neck. A mushroom extract from Reishi mushrooms is also effective against cancer. Three human trials (one randomized controlled trial and two case study reports) have been done in advanced cancer patients using Ganoderma lucidum polysaccharide extract, an active compound of Reishi mushrooms. All the patients treated with this specific extract experienced improved quality of life and increased immune function. The Shiitake mushroom extract lentinan, administered intravenously to patients with stomach cancer, causes immune-directed tumor disruption. In patients with breast cancer, lentinan injection following surgery stimulates immune-mediated reduction of residual tumor. Lentinan administration to patients with other cancers, including cancers of the prostate and stomach, increases natural killer cell activity and improves survival. Shiitake mushrooms have a pleasant and mild taste and have been a part of the diet in many Asian cultures for centuries. Beyond intravenous administration, regular dietary consumption of shiitake mushrooms or shiitake supplements can help provide gentle and effective immune support. Another way in which mushrooms fight cancer is through their effect on blood supply to tumors. Mushrooms contain ergosterols, which are natural anti-angiogenic substances. Angiogenesis refers to the growth of blood vessels that support tumor growth and angiogenesis is considered essential to tumor survival. Anti-angiogenic substances inhibit the growth of blood vessels to tumors, making them smaller and more susceptible to chemotherapy. The levels of ergosterol in mushrooms are as follows: • Agaricus 737 IU per 100g • Maitake 460 IU per 100g • Shiitake 110 IU per 100g • Reishi 66 IU per 100g M U S H R O O M S 23 Antimicrobial Mushroom extracts are potent antibacterial and antiviral agents. Streptococcus pneumoniae is a bacteria that can cause serious, and in some cases lethal, diseases such as pneumonia, meningitis and septicemia, as well as less serious illnesses like ear infections and sinusitis. Clinical studies show that oral administration of Agaricus blazei mushroom extract given before or during introduction of Streptococcus pneumonia protected mice against developing infection. The protective effect of the Agaricus extract was not due to antibiotic properties, but rather due to stimulating the defensive reactions of the immune system. Mushroom extracts have antiviral actions and are particularly effective if taken at the initial stage of exposure to the virus. This has been demonstrated for Agaricus blazei mushrooms in inhibiting the initial stage of viral replication of polio virus. Reishi mushroom has been shown to inhibit HIV, herpes simplex virus type 1 & 2, and Epstein-Barr virus. In patients with HIV, lentinan (from Shiitake mushrooms) administered intravenously improves immune function. The lentinan increases CD4 cell count and neutrophil activity, both of which are low in patients infected with HIV and imperative to proper immune function. A randomized, placebo-controlled trial with 90 chronic hepatitis B patients studied the effects of Reishi mushroom extract. Treatment with Reishi extract reduced viral expression in 25 percent of the subjects and improved liver function compared to the people who did not take the extract. Lowering Blood Sugar Mushroom extracts are effective at lowering blood sugar levels, primarily by decreasing insulin resistance. Insulin carries glucose, or sugar, into cells. In insulin resistance, cellular sensitivity to insulin is decreased. In a state of insulin resistance, glucose cannot enter the cell, and blood sugar levels are elevated. Studies have shown that mushrooms decrease insulin resistance and lower blood sugar levels. One such study was a randomized, double-blind, placebo-controlled trial with 72 adult type-2 diabetics. In addition to their standard anti-diabetic medications, the subjects were randomized to receive a supplement of 1,500 mg Agaricus blazei extract or placebo daily for 12 weeks. At the end of the study, subjects who received the mushroom supplement had less insulin resistance than the individuals who took the placebo. Despite the promising changes in insulin resistance, this study was too short to show any changes in blood sugar levels. An extract from Maitake mushroom known as Maitake SX-fraction also has blood sugar–lowering effects. This extract lowers both glucose and 24 M U S H R O O M S i nsulin levels in a manner that may be more effective than a standard blood sugar lowering medication, glipizide. The Maitake SX-fraction appears to exert its blood sugar–lowering actions by reducing insulin resistance. This mechanism suggests that maitake SX-fraction may help patients with type 2 diabetes achieve better control of their blood sugar. A randomized, placebo-controlled trial was conducted in 71 patients with type 2 diabetes mellitus. Reishi mushroom extract decreased blood sugar levels by 10 percent at 12 weeks compared with baseline values. This Reishi mushroom extract appears to have long-acting blood sugar– lowering effects. Mushroom extracts lower both elevated blood pressure and high cholesterol levels. Lowering Cholesterol And Blood Pressure Mushroom extracts lower both elevated blood pressure and high cholesterol levels. Active compounds from Reishi mushroom extract have been shown to inhibit cholesterol synthesis by inhibiting HMG-CoA. This is the same way many cholesterol- lowering drugs work, especially statins, the most commonly prescribed cholesterol-lowering medications. Cordyceps mushroom extract has been shown to lower total cholesterol and triglyceride levels in normal and diabetic mice. This has been confirmed in several human trials including a randomized, double-blind, placebo-controlled multicenter trial using Cordyceps in 273 patients with high cholesterol. In this study, subjects consumed Cordyceps for at least four weeks and for up to eight weeks. Total cholesterol levels decreased by an average of 20 percent and triglycerides levels dropped by 9.2 percent in 56.7 percent of the subjects. In vitro (test tube) studies have also shown that Cordyceps mushroom extracts may possess potent antioxidant activities, particularly against LDL (“bad”) cholesterol. This is important because it is the oxidation of LDL cholesterol that causes damage to arteries, which, in turn, creates plaques in blood vessels. Thus, prevention of LDL cholesterol oxidation through the antioxidant activity of Cordyceps is an important part of preventing cardiovascular disease. Ganoderma mushroom extracts have been M U S H R O O M S 25 found to lower blood pressure through a variety of mechanisms. They also inhibit platelet aggregation (the clumping together of platelets in the blood), thus decreasing the risk of clot formation. Dementia Prevention Lion’s Mane mushroom (Hericium erinaceum) has been studied for its ability to improve symptoms of Alzheimer’s disease. As previously mentioned, hericenones have been found to stimulate nerve growth factor, which counteracts some of the neurodegeneration (nerve death) found in Alzheimer’s disease. Additionally, Amyloban, another constituent in Lion’s Mane mushroom, reduces the toxicity of the beta-amyloid plaques found in the brains of people with Alzheimer’s disease. The combination of these actions can reduce the symptoms of Alzheimer’s. In one study, Alzheimer’s patients showed significant improvement in their physical and cognitive capabilities after taking Lion’s Mane mushroom extract for six months. A product called Amyloban 3399 contains the two bioactive ingredients from Lion’s Mane mushroom used in the studies. Amyloban 3399 is patented in Japan; patent is pending in the United States. Liver Health Several clinical studies indicate that Cordyceps sinensis mushroom extract may stimulate T-cell immunity and decrease fibrosis of the liver in hepatitis B patients. Although these trials are small, the results are encouraging. Polysaccharides isolated from Reishi mushrooms decrease liver enzymes, which are elevated when the liver is inflamed. The mushrooms’ ability to lower these enzymes indicates that the underlying liver inflammation from the hepatitis virus is decreased. The reduction in liver enzymes is, in part, due to Reishi mushrooms’ ability to reduce harmful free-radical production in the liver. By reducing free radicals, Reishi exerts an antioxidant and anti-inflammatory effect in the liver. Kidney Effects Cordyceps mushroom extract was studied in 51 patients suffering from chronic renal failure. The patients experienced significant improvement in renal function and cellular immunity. Hormonal Effects Agaricus mushrooms have also been shown to possess anti-estrogenic actions by inhibiting aromatase, an enzyme that converts the adrenal hormone adrenostenedione (stored in fat cells) into estrogen. After meno26 M U S H R O O M S Taking medicinal mushrooms can improve overall quality of life. pause, the majority of estrogen in a woman’s body is derived from adrenostenedione. Inhibited aromatase causes a post-menopausal woman to produce less estrogen—a good thing, since estrogen is a growth factor for many breast and ovarian cancer tumors. This makes Agaricus mushrooms especially helpful in women with estrogen receptor (ER)–positive breast or ovarian cancers. It is unknown whether Agaricus would aggravate estrogen deficiency and menopausal symptoms associated with decreased estrogen (such as hot flashes, irritability, anxiety, vaginal dryness) in a post-menopausal woman without breast cancer. This has not been reported in any human trial, but it warrants further research. Enhancing Quality of Life One of the most significant and universal benefits of medicinal mushroom extracts is their ability to improve the overall quality of life of the people who are eating or taking them. This improvement of daily living has even been demonstrated in people who start out with poor quality of life due to disease or conventional cancer treatment. One example of this is Agaricus blazei. This mushroom was studied in 100 women with cervical, ovarian, and endometrial cancer receiving chemotherapy. In those women who also received the Agaricus extract, natural killer cell activity was significantly higher and chemotherapy-associated side effects such as decreased appetite, hair loss, emotional instability, and general weakness were all improved. Cordyceps extract, has been shown to improve the energy metabolism in the liver of mice and to alleviate fatigue and improve physical endurance in humans. M U S H R O O M S 27 Chapter Four Choosing Mushroom Supplements Not all mushroom supplements are created equally. While most medicinal mushrooms provide health benefits when eaten, this is not always easy to do. Many of the medicinal mushrooms that are discussed here are exceptionally hard to find as whole mushrooms. Some mushrooms are an acquired taste—and for some people it will never be acquired. The good news, and the bad news, is that mushroom extracts are widely available. Finding high-quality, reliable mushroom products among the many products being sold can be challenging. There are, however, some guidelines to follow in selecting the best of the best. Qualities of Superior Mushroom Products Source: Where mushrooms are grown is of key importance. Mushrooms absorb much from the material on which they grown. Mushrooms grown in soil contaminated with heavy metals, pesticides or other toxic compounds will contain those same contaminants. Organically grown mushrooms are the only ones that should be taken medicinally. The majority of mushroom products now on the market are cultivated in controlled laboratory conditions. A cultivated mushroom product must be manufactured under Good Manufacturing Practices (GMP) and this should be clearly stated. These mushroom products also need to be tested for heavy metals, pesticides, herbicides, and other contaminants. Extraction: A number of scientific studies conducted in the past on mushroom extracts have utilized hot water extracts of mushrooms. Hot water extraction of the mushroom biomass is used to pull out certain polysaccharides. The hot water extract is then purified and dried into a powder for medicinal use. Hot water extraction effectively frees certain types of polysaccharides, which are the active compounds found in the cell walls of mushrooms. In most types of medicinal mushrooms, polysaccharides typically comprise only 0.4–2 percent of the total mass of the mushroom by dry weight. Brazilian Agaricus blazei contains up to 7 percent polysaccharides. Mushroom products derived from hot water extraction have concentrated the polysaccharide content significantly, often in a 20:1 concentration. Active 28 M U S H R O O M S ingredients or fractions of mushrooms are not always obtained by way of hot water extraction. SX-fraction (Maitake) and Amyloban (Lion’s Mane) are obtained by alcohol extraction. Another compound from the Maitake mushroom that is useful for weight loss is extracted by room-temperature water. Cultivated mushrooms may contain relatively stable amounts of active polysaccharides, such as beta-1,3 or beta-1,6 glucans, but the effectiveness of the product still depends on the cultivation method and the environmental conditions. Therefore, it is important to take a mushroom supplement product made based on a standardized extract, such as Maitake D-fraction, SX-fraction or Amyloban from Lion’s Mane that guarantees sufficient amounts of active ingredients. It should also be noted that pure polysaccharides may not have proper bioavailability to be readily absorbed by the body. The immunopotentiating or antitumor activity is gained by using both the beta glucans and protein complexes. Our Recommendations Many quality mushroom products are available on the market. The following products have been clinically researched or are manufactured in the same manner as a studied product. These products are representative of good quality mushroom products: • Grifron Maitake D-Fraction capsules, tablets and liquid extract • Maitake SX-Fraction • Reishi 14:1 to 20:1 extracts • Coriolus (Turkey Tail) 20:1 extract • Cordyceps CS4 strain • Agaricus blazei Murrill (Brazilian) • Amyloban 3399 Lion’s Mane • Whole Shiitake mushrooms M U S H R O O M S 29 Dosage Dosing mushroom products depends greatly on the product being used, the size of the person, and the indications for which the mushroom extract is being taken. The following are general dosage guidelines for adults. •Agaricus blazei Murrill extract can be taken in doses of 900 mg to 4,000 mg daily in divided doses. •Cordyceps CS4 strain extract is typically taken in doses ranging from 620 mg to 9,000 mg daily •Coriolus extract is typically dosed at 3,000 mg of 20:1 extract daily in divided doses. •Hericium is dosed at 3 g of the dried mushroom daily or taken in the form of 650 mg capsule that contains PLM fraction (hericenones 0.5 percent, Amyloban 6 percent) three times daily. •Maitake D-fraction is dosed at 0.5 mg to 1 mg per kg body weight per day. •Maitake SX-fraction is taken as 350 mg tablets that contain 18 percent SX-fraction three times daily. •Reishi mushroom 14:1 extracts with dried mushroom in doses ranging from 150 mg to 300 mg three times daily. •Raw Reishi or equivalent concentrated extract can be taken in doses of 2 g to 6 g per day. •Shiitake mushroom extract can be taken at 6 mg to 16 mg daily, which is equivalent to six to eight raw mushrooms daily. •1 g to 3 g of Lentinus edodes mycelium (LEM) can be taken two to three times per day. •Shiitake 12:1 extracts 300 mg with 700 mg of dried mushroom can be taken daily in divided doses. 30 M U S H R O O M S Toxicity Mushroom extracts are generally very safe and nontoxic. People who are taking immunosuppressive (e.g., prevent the rejection of transplanted organs or treat autoimmune diseases) or anticoagulant (e.g., to prevent clot formation) drugs should not take mushroom extracts. Medicinal Mushrooms As a group, medicinal mushrooms are among the most extensively researched natural substances in the world. There is impressive scientific validation for a variety of serious illnesses. Taken as a dietary supplement or eaten as a food, they are valuable additions to your health-promoting plan. Selected References Ahn W., Kim D, Chae G, Lee J, Baes S., Sin J, Kim Y, Namkoong S, Lee I. Natural killer cell activity and quality of life were improved by consumption of a mushroom extract, Agaricus blazei Murill Kyowa, in gynecological cancer patients undergoing chemotherapy. Int J Gynecol Cancer 14: 589—594, 2004. Gao Y, et al. Effects of Ganopoly (Ganoderma lucidum Polysaccharide Extract) on the Immune Functions in Advanced-Stage Cancer Patients. Immunol Invest 32(3): 201-15, 2003. Chung-Hua H, Yang-Li L, Su-Ching L, Kung-Chang H, Pesus C. The Mushroom Agaricus blazei Murill in Combination with Metformin and Gliclazide Improves Insulin Resistance in Type 2 Diabetes: A Randomized, Double-Blinded, and Placebo-Controlled Clinical Trial. J Alt Comp Med 13(1): 97–102, 2007. Kawagishi H, Zhuang C. Compounds for dementia from Hericium erinaceum. Drugs of The Future 33(2):149-155, 2008. Kawagishi H. The anti-dimentia effect of Lion’s Mane mushroom and its clinical application. Townsend Letter for Doctors and Patients, April 2004. Klotter J. Maitake SX-fraction. Townsend Letter for Doctors and Patients, May 2007. Kodama N, et al. Maitake D-Fraction enhances antitumor effects and reduces immunosupression by mitomycin-C in tumor-bearing mice. Nutrition 21(5):624-9, May 2005. Kodama N, Komuta K, Nanba H. Effect of Maitake (Grifola frondosa) D-Fraction on the activation of NK cells in cancer patients. J Med Food 6(4):371-7, 2003. Konno S. Effect of Various Natural Products on Growth of Bladder Cancer Cells: Two promising mushroom extracts. Alternative Medicine Review 12(1):63-68, March 2007. Konno S, et al. Anticancer and hypoglycemic effects of polysaccharides in edible and medicinal maitake mushroom. International Journal of Medicinal Mushrooms 4:185-195, 2002. M U S H R O O M S 31 Konno S. Maitake SX-Fraction: Possible hypoglycemic effect on diabetes mellitus. Alternative & Complementary Therapies, Dec 2001. Lin H, et al. Maitake beta-glucan MD-fraction enhances bone marrow colony formation and reduces doxorubicin toxicity in vitro. International Immunopharmacology 4:91-99, 2004. Murray, Michael, and Joseph Pizzorno with Lara Pizzorno. Healing Foods. Atria Books 2005. Nagai K, et al. Dilinoleoyl-phosphatidylethanolamine from Hericium erinaceum protects against ER stress-dependent Neuro2a cell death via protein kinase C pathway. Journal of Nutritional Biochemistry 17:525-530, 2006. Preuss HG, et al. Enhanced insulin-hypoglycemic activity in rats consuming a specific glycoprotein extracted from maitake mushroom. Mol Cell Biochem 306:105-113, 2007. Preuss, Harry. E-mail correspondence, August 25, 2008. Ren Z, Guo Z, Meydani S, Wu D. White button mushroom enhances maturation of bone marrow-derived dendritic cells and their antigen presenting function in mice. J Nutr 138(3):544-50, 2008. Xun C, Shen N, Li B, Zhang Y, Wang F, Yang Y, Shi X, Schafermyer K, Brown S, Thompson J. Radiation mitigation effect of cultured mushroom fungus Hirsutella Sinensis (CorImmune) isolated from a Chinese/Tibetan herbal preparation -Cordyceps Sinensis. International Journal of Radiation Biology 84(2):139 – 149, 2008. http://www.mushroomcouncil.com/ http://www.mskcc.org/mskcc/html/69353.cfm http://botit.botany.wisc.edu/toms_fungi/apr2001.html http://www.maitake.com/ For more information about the authors, visit: www.drlise.net www.karolyngazella.com 32 M U S H R O O M S LOOK FOR all our BETTER NUTRITION HEALTHY LIVING GUIDES at your local independent health food store or at www.betternutrition.com betternutrition.com magazine presents MUSHROOMS O SCIENTIFICALLY VALIDATED NATURAL MEDICINES f the thousands of varieties of mushrooms available, several possess specific medicinal properties and have been studied by some of the most prestigious research organizations throughout the world. Mushrooms eaten as a food or taken as a dietary supplement can be used to prevent and treat a variety of serious conditions such as cancer, diabetes, and Alzheimer’s. In this booklet, naturopathic oncologist Lise Alschuler and health writer Karolyn A. Gazella provide comprehensive information about the most widely studied medicinal mushrooms. ABOUT THE AUTHORS OF THIS BOOKLET Lise Alschuler, ND, is a naturopathic physician with board certification in naturopathic oncology. She practices naturopathic oncology at Naturopathic Specialists, LLC, in Scottsdale, Ariz. Dr. Alschuler has authored many articles in professional and popular press publications and is the coauthor of the Definitive Guide to Cancer: An Integrative Approach to Prevention, Treatment and Healing. She currently serves as president of the American Association of Naturopathic Physicians. Karolyn A. Gazella is the coauthor of the Definitive Guide to Cancer and Return to Beautiful Skin. Karolyn has been involved in the natural health industry for more than 17 years. She is the founding publisher of the journal Integrative Medicine and has written hundreds of articles on the topic of natural health. Karolyn is a regular contributor to Better Nutrition magazine and the managing editor of the Healthy Living Guide series. NUMBER 13 betternutrition.com