Yellow mustard flowers in a field, macro shot.

The cancer eats with you — cancer therapy with cruciferous vegetables

The Mole­cu­lar Onco­Sur­gery working group, a coope­ra­ti­on bet­ween the Sur­gi­cal Uni­ver­si­ty of Hei­del­berg and the Ger­man Can­cer Rese­arch Cen­ter, inves­ti­ga­ted the effect of cru­ci­fe­rous plants on tumor stem cells under the direc­tion of Prof. Ingrid Herr.

Sin­ce anci­ent times, cab­ba­ge has been used as a natu­ral reme­dy against bac­te­ria, fun­gi, inflamm­a­ti­on and can­cer. Mar­cus Por­ci­us Cato Cen­so­ri­us, also cal­led Cato the Elder (234 – 149 BC), a Roman his­to­ri­an, descri­bed that raw cab­ba­ge mixed with vin­egar or boi­led with oil banis­hes and cures all dise­a­ses “from han­go­vers after exces­si­ve wine con­sump­ti­on to to serious ill­nesses like can­cer.” He wro­te, “For a can­ce­rous breast ulcer, tre­at the breast with a crus­hed cab­ba­ge leaf and it will heal.” The­se anci­ent tra­di­ti­ons are still used today in naturopathy.

During World War II, doc­tors would put sau­er­kraut or crus­hed cab­ba­ge lea­ves direct­ly on abs­ces­ses, sup­pur­a­ting wounds, or chil­b­lains becau­se medi­ci­nes were scar­ce. Cab­ba­ge pads have a pain-reli­e­ving and anti-inflamm­a­to­ry effect and are the­r­e­fo­re still used today for rheu­ma­tic com­plaints, gout, joint inflamm­a­ti­on, but also for back pain and lum­ba­go. A meal of cab­ba­ge, radis­hes, radish or sau­er­kraut juice reli­e­ves heartb­urn, gas­tri­tis, duo­de­n­al and sto­mach ulcers, lowers high blood pres­su­re, and redu­ces obe­si­ty, dia­be­tes and inflamm­a­ti­on. Gar­den cress is said to lower the blood sugar level and mus­tard sti­mu­la­tes diges­ti­on and pro­mo­tes blood cir­cu­la­ti­on in the form of a mus­tard plaster.

The therapeutic effects of mustard oils

Macro shot of harvested radishes in a black shell against a black background.

Broc­co­li, cau­li­flower and all other types of cab­ba­ge, as well as radis­hes, hor­se­ra­dish, cress, rocket and mus­tard are cru­ci­fe­rous vege­ta­bles who­se acti­ve sub­s­tances are lar­ge­ly iso­la­ted. Over 150 dif­fe­rent mus­tard oil gly­co­si­des are known, which occur in dif­fe­rent amounts in the num­e­rous cru­ci­fe­rous plants. Mus­tard oils account for the pun­gent tas­te of radish, hor­se­ra­dish and mus­tard or the some­ti­mes bit­ter tas­te of various types of cabbage. 

The typi­cal tas­te is crea­ted when the pre­cur­sor com­pon­ents of mus­tard oil, the so-cal­led glu­co­si­no­la­tes, come into cont­act with the enzy­me myro­si­na­se. The­se are stored sepa­ra­te­ly in the plant cell. Only when the plant cell is inju­red, e.g. B. by biting, che­wing, cut­ting or food pro­ces­sing, the two com­pon­ents come tog­e­ther and the mus­tard oil is for­med. Many her­bi­vor­ous ani­mals, but also viru­s­es, bac­te­ria and fun­gi, are poi­so­ned or die from a meal of cabbage. 

For humans, on the other hand, this plant fami­ly does not pose a dan­ger in nor­mal house­hold quan­ti­ties, but has a health-pro­mo­ting effect. Expe­ri­men­tal stu­dies show, for exam­p­le, the anti-infec­ti­ve pro­per­ties of hor­se­ra­dish, nas­t­ur­ti­um and water­cress, which also attack viru­s­es, fun­gi and bac­te­ria. This expe­ri­men­tal data was the basis for the pro­duc­tion of phy­to­the­ra­peu­tics from nas­t­ur­ti­um and/or hor­se­ra­dish (e.g. Ango­cin® Anti-Infekt N, Cressa­na®, nas­t­ur­ti­um tablets, hor­se­ra­dish juice). The­se are recom­men­ded for defen­se against infec­tion and tre­at­ment of acu­te inflamm­a­to­ry dise­a­ses of the bron­chi, sinu­ses and uri­na­ry tract. One can even spe­cu­la­te on a can­cer-pre­ven­ting effect of the phe­nyl­ethyl mus­tard oils from hor­se­ra­dish and water­cress, alt­hough an anti-car­ci­no­ge­nic effect has so far only been pro­ven in the mou­se model.

Epidemiological Studies and Cruciferous Vegetables

Woman in lab clothes uses a microscope while seated.

In fact, the results of num­e­rous epi­de­mio­lo­gi­cal stu­dies indi­ca­te that cru­ci­fe­rous vege­ta­bles have a high poten­ti­al for pre­ven­ti­on. In 87 stu­dies com­pa­ring die­ta­ry habits to can­cer risk in lar­ge popu­la­ti­ons, a majo­ri­ty of 67% show a redu­ced risk of many types of can­cer after fre­quent con­sump­ti­on of cru­ci­fe­rous vege­ta­bles. The cor­re­spon­ding per­cen­ta­ges for cab­ba­ge, cau­li­flower, broc­co­li, and Brussels sprouts were 70, 67, 56, and 29%. The asso­cia­ti­ons were most con­sis­tent for mali­gnan­ci­es of the lung, sto­mach, colon, and rec­tum, and least con­sis­tent for pro­sta­te, endo­me­tri­um, and ovary. 

Fur­ther­mo­re, a sys­te­ma­tic lite­ra­tu­re review by the WCRF/AICR found a ten­den­cy for fre­quent con­sump­ti­on of cab­ba­ge and a lower risk of pan­crea­tic car­ci­no­ma. In addi­ti­on, two well-con­trol­led stu­dies in pati­ents with pro­sta­te can­cer show­ed that eating cau­li­flower or broc­co­li three times a week inhi­bi­ted metasta­sis, with five servings/week being more effec­ti­ve. Inte­res­t­ingly, the­re is an indi­vi­du­al varia­ti­on in the bio­avai­la­bi­li­ty of mus­tard oils, which is attri­bu­ted to gene­ti­cal­ly deter­mi­ned dif­fe­rent acti­vi­ties of the glutat­hio­ne S‑transferase enzy­mes. In indi­vi­du­als with less enzy­me acti­vi­ty, the mus­tard oils bind less well to glutat­hio­ne and are the­r­e­fo­re excre­ted more slow­ly, resul­ting in lon­ger bio­avai­la­bi­li­ty and grea­ter the­ra­peu­tic potential.

Sulforaphane – the best described mustard oil for cancer

In terms of its the­ra­peu­tic effec­ti­ve­ness, sul­fora­pha­ne is now the best-stu­di­ed mus­tard oil and is found in par­ti­cu­lar­ly high con­cen­tra­ti­ons in broc­co­li and its sprouts. It has anti-micro­bi­al and anti-oxi­dant pro­per­ties becau­se it increa­ses glutat­hio­ne levels. 

As a result, sul­fora­pha­ne con­tri­bu­tes to deto­xi­fi­ca­ti­on and pre­vents the for­ma­ti­on of car­ci­no­gen-indu­ced DNA adducts. The­se are cau­sed, for exam­p­le, by hete­ro­cy­clic ami­nes that are pro­du­ced when gril­ling, roas­ting, deep-fry­ing and bak­ing. Many expe­ri­men­tal labo­ra­to­ry stu­dies and stu­dies in ani­mals show a pro­tec­ti­ve and the­ra­peu­tic effect of sul­fora­pha­ne in various types of tumors. Sul­fora­pha­ne indu­ces pro­grammed cell death, inhi­bits cell divi­si­on and redu­ces angiogenesis/vascularization. In addi­ti­on, sul­fora­pha­ne redu­ces the acti­vi­ty of the over­ri­ding inflamm­a­to­ry media­tor NF‑B and thus inhi­bits inflamm­a­to­ry pro­ces­ses and tumor progression. 

The latest expe­ri­men­tal stu­dies indi­ca­te that sul­fora­pha­ne even attacks can­cer stem cells that are par­ti­cu­lar­ly resistant to the­ra­py, ther­eby making various types of che­mo­the­ra­peu­tic agents more effec­ti­ve again. This has so far been shown in expe­ri­men­tal models of pan­crea­tic, breast and pro­sta­te carcinoma.

Sulforaphane in broccoli makes resistant tumor stem cells in pancreatic tumors vulnerable

Broccoli against a white background.

Around 12,650 peo­p­le in Ger­ma­ny deve­lop pan­crea­tic car­ci­no­ma each year, an extre­me­ly aggres­si­ve tumor of the pan­cre­as. The dise­a­se is often not noti­ced until late. Few pati­ents sur­vi­ve the dia­gno­sis for more than a year. Pan­crea­tic car­ci­no­ma spreads aggres­si­ve­ly, spreads to other organs and is lar­ge­ly insen­si­ti­ve to cur­rent the­ra­pies. So-cal­led can­cer stem cells, which can rege­ne­ra­te very well and are the­r­e­fo­re resistant to drugs and radia­ti­on, are pro­ba­b­ly respon­si­ble for this.

“In other tumors, typi­cal­ly less than three per­cent of the can­cer cells are tumor stem cells. Pan­crea­tic car­ci­no­ma, on the other hand, har­bors 10 per­cent or more of such aggres­si­ve cells,” says Prof. Herr. The sci­en­tists found that even new can­cer drugs that are effec­ti­ve in other tumors were unable to do any­thing against the tumor stem cells in pan­crea­tic car­ci­no­ma: the cells pro­tect them­sel­ves with a spe­cial mecha­nism, the NF-kB signal­ing pathway, which seems to be invol­ved in the pro­no­un­ced resis­tance to the­ra­py of pan­crea­tic carcinoma .

Pancreatic carcinoma is made susceptible to therapy

Acti­ve sub­s­tances that block exact­ly this signal­ing pathway and thus make the dan­ge­rous cells vul­nerable are pro­vi­ded by natu­re: vege­ta­bles from the cru­ci­fe­rous fami­ly such as broc­co­li, cau­li­flower, Brussels sprouts or kale have a high con­tent of sul­fora­pha­ne, an acti­ve ingre­di­ent against can­cer. It pro­tects body cells from dama­ge to the gene­tic mate­ri­al and initia­tes cell death when cells divi­de uncon­troll­ab­ly. Of all the­se vege­ta­bles, broc­co­li has the hig­hest sul­fora­pha­ne content.

Expe­ri­ments with cell cul­tures, mice and fresh­ly iso­la­ted tumor cells from pati­ents show­ed that sul­fora­pha­ne inhi­bi­ted blood ves­sel for­ma­ti­on in the tumor and tumor growth wit­hout caus­ing any side effects. In com­bi­na­ti­on with can­cer drugs, this effect was increased. “Last year, a lar­ge-sca­le Cana­di­an stu­dy with 1,338 pati­ents with pro­sta­te can­cer show­ed that a high con­sump­ti­on of broc­co­li and cau­li­flower could pro­tect the pati­ents from metasta­si­zing the tumor,” says Pro­fes­sor Herr.

Sulforaphane — how much broccoli do you need?

Broc­co­li has been an insi­der tip in onco­lo­gy sin­ce 1985 — and the trend is incre­asing to this day. Decisi­ve was the colon can­cer of the for­mer US Pre­si­dent Ronald Rea­gan and the broc­co­li cure pre­scri­bed by his per­so­nal phy­si­ci­ans. After all, he sur­vi­ved the dia­gno­sis 19 years. This is attri­bu­ted to the action of the isothio­cya­na­te sul­fora­pha­ne, which is for­med in broc­co­li from the inac­ti­ve pre­cur­sor sub­s­tance glucoraphanin. 

In expe­ri­men­tal stu­dies, 4.4 mg/kg/day sul­fora­pha­ne was able to inhi­bit the growth of human pan­crea­tic car­ci­no­ma xeno­grafts in mice. After nor­ma­liza­ti­on based on the body sur­face area method, this cor­re­sponds to an amount of 0.36 mg/kg/day in humans. Extra­po­la­ted to an avera­ge per­son, this would be 25 mg sulforaphane/70 kg body weight/day.

Pati­ents are now won­de­ring how much cru­ci­fe­rous vege­ta­bles should be con­su­med to achie­ve such a con­cen­tra­ti­on. The ans­wer is dif­fi­cult becau­se the con­cen­tra­ti­on of glu­ko­ra­pha­nin varies great­ly bet­ween dif­fe­rent bras­si­cas and even bet­ween the same variety. 

Preparation is key

Torso of a man in a white T-shirt and blue apron in front of a crimson background and a yellow table on which a wooden board with pink cabbage leaves held in two hands lies.

The form of pre­pa­ra­ti­on is important for main­tai­ning the sul­fora­pha­ne con­tent in broc­co­li and cab­ba­ge. Blan­ching and coo­king des­troys the myro­si­na­se in vege­ta­bles. The­r­e­fo­re, the con­ver­si­on of glu­ko­ra­pha­nin to acti­ve sul­fora­pha­ne in coo­ked broc­co­li depends on the thio­glu­co­si­da­se acti­vi­ty of the gut flo­ra. Howe­ver, this is more or less sever­ely atta­cked in many peo­p­le by Wes­tern diets (too much fat, indus­tri­al sugar, white flour pro­ducts, meat and sau­sa­ge), inflamm­a­to­ry bowel dise­a­ses, anti­bio­tics and che­mo­the­ra­py. This means sul­fora­pha­ne is not bio­available becau­se glu­ko­ra­pha­nin can­not be con­ver­ted into sul­fora­pha­ne in the body. The­r­e­fo­re, it is recom­men­ded to eat the broc­co­li raw and chew it well so that glu­ko­ra­pha­nin and myro­si­na­se are released from the plant cell, react with each other and form sulforaphane.

In order to obtain the hig­hest pos­si­ble glu­ko­ra­pha­nin con­tent when hea­ting the vege­ta­bles, the flo­rets and the pee­led stalks should be cut as small as pos­si­ble befo­re coo­king in order to redu­ce the coo­king time, which should not be lon­ger than 5 minu­tes. Coo­king in the micro­wa­ve very quick­ly des­troys the glu­ko­ra­pha­nin and sul­fora­pha­ne. When boi­ling or steam­ing, the amount of coo­king water should be redu­ced becau­se the water-solu­b­le glu­co­si­no­la­tes are washed out. Howe­ver, the ingre­di­ents remain available if the coo­king water is the basis for pre­pa­ring sau­ces or soups.

Broccoli sprouts in patient studies

Broccoli sprouts from above, in a rectangular shape.

To get infor­ma­ti­on about a the­ra­peu­ti­cal­ly effec­ti­ve dose, broc­co­li sprouts have alre­a­dy been tes­ted in pati­ent stu­dies. One of the­se stu­dies exami­ned the dai­ly con­sump­ti­on of 70 g of broc­co­li sprouts for eight weeks in 48 pati­ents with Heli­co­bac­ter pylo­ri — 70 g of sprouts con­tain sul­fora­pha­ne in an amount equi­va­lent to about two to three ser­vings of broc­co­li daily. 

Four and eight weeks later, the test group, but not the alfal­fa sprouts con­trol group, had signi­fi­cant­ly lower levels of mar­kers for Heli­co­bac­ter pylo­ri in breath and stool, and the gas­tri­tis had impro­ved. Unfort­u­na­te­ly, after the stu­dy was com­ple­ted, all mar­kers retur­ned to their ori­gi­nal levels, indi­ca­ting that the Heli­co­bac­ter pylo­ri infe­sta­ti­on was sup­pres­sed by the amount of broc­co­li sprouts used, but not cured.

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