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Course Title

Nutritional Oncology

Course Description

This course presents information found in the April 2005 cover story of Health Supplement Retailer (HSR) magazine.

Overview

Nutritional oncology is the study of nutrients indicated to lower the risk of certain cancers and help improve the care of cancer patients and survivors. Scientific study and historical use of nutrients are important to customers choosing to stand up to cancer with the help of a nutritional approach. As such, retailers need the simplest methods of educating their customers on the many dietary supplements proposed as effective against cancer. This means knowing the scope of each cancer—risk factors, causes, treatments and statistics—and the supplements linked to risks of and improvements to specific cancers.

Nutritional Oncology
How nutrients affect cancer prevention and care

Cancer is still the number two killer of Americans. However, we are making progress, according to new statistics from the American Cancer Society (ACS). Death rates from colon, breast and prostate cancers have dropped, while lung cancer death rates dropped in men and held steady in women. Considering many of these rates were previously on the increase, the news has gotten better. Still, ACS expects 1.4 million Americans to develop cancer in 2005, with 40 percent of them, or 1,600 people per day, expected to die from it. These numbers are startling, but even more amazing is almost two-thirds of all cancers are preventable. In its report, Cancer Facts & Figures 2005, ACS noted one-third of all cancers are caused by smoking, and another third are caused by poor nutrition. The latter is the real focus of supplement retailers.

Cancer is an umbrella term enveloping many diseases of similar or related characteristics. The underlying mechanism of cancer is an uncontrolled growth of cells, which are determined to destroy healthy, viable cells indefinitely—until death or intervention puts a halt to their plunder. U.S. health care employs many tools not just allopathically, but also preventively. Promotion of proper dietary habits, lifestyle changes and early screenings comprise conventional prevention, while invasive surgery, radiation therapy and chemotherapy are the main allopathic treatments. The natural products industry can add substantially to these efforts.

As the monster it is, cancer can steal life from anyone. But strong, healthy immune systems fare better, on average, than weaker systems. Thus, the first target for cancer prevention and survival should be the immune system.

The blood cells, lymph and complement that soldier for the human immune system directly interact with cancer cells. Natural Killer (NK) blood cells serve their name and host by destroying dangerous cells and other invaders that can cause health problems. It is this NK cell activity and its governing system that draw the broadest attention from the dietary supplement industry.

“The greater the ability of the immune system to recognize cancer or precancerous cells, the more likely the body will be able to mount an effective immune response to kill these non-self cells,” said Ketan Desai, M.D., Ph.D., chief medical officer for Biopolymer Engineering, which produces WGP 3-6®, a beta glucan product. “It is the immune system that ultimately clears the body of disease.”

Beta glucans are soluble dietary fibers found in yeast, mushrooms and grains. These compounds have been shown to enhance the immune system by activating the white blood cells that form a front line active defense against unhealthy organisms. Focus has been on the beta-1,3-glucans and beta-1,6-glucans and their effect on cellular immunity and NK cell activity.¹

Of course, the underlying immune cell necessities are strength and numbers. Like their host bodies, cells need food for energy, strength and proliferation. At the cellular level, coenzyme Q10 (CoQ10) is a critical component in energy production within every bodily cell, especially highly active cells found in the immune system. Although it is most known for its benefits to cardiovascular health, CoQ10’s ubiquitous role in cell mitochondrial energy production, coupled with findings of deficiencies in cancer patients,² make it an ingredient worthy of consideration in the cancer prevention market. The coenzyme is also a potent antioxidant, one of the most highlighted families of nutrients in cancer science.

Free radicals, most notably oxygen, are volatile molecules that inflict damage to crucial body components by stealing electrons from healthy cells, including DNA and crucial organ cells. This damage can lead to development of cancer. As free radical scavengers, antioxidants can neutralize the activity of these rogue oxygen molecules by thwarting the theft of electrons. Antioxidants have been studied and indicated as beneficial for certain types of cancer, but their primary role in nutritional oncology is to support the immune system’s efforts to resist the development of cancer. The specific benefits of antioxidants can differ depending upon the exact substance, including vitamins, minerals and botanicals.

The epitome of an immune vitamin is vitamin C. As an antioxidant, vitamin C can help protect healthy immune cells, but it also contributes by supporting production of antibodies and interferon, a natural body protein that helps direct the immune attack against tumors.³ Vitamin C has also been shown to greatly increase NK cell activity, as well as restore normal levels of B- and T-cells, white blood cells vital to the destruction of cancer cells.⁴

In addition to shielding the immune system from oxidative stress, vitamin E specifically defends white blood cells and the thymus gland, the master immune gland that is responsible for, among other central functions, the maturation of T-cells.⁵ In both immune and cancer research, vitamin E has been studied in tandem with selenium,⁶ which is not itself an antioxidant but a necessary component of antioxidant enzymes.

Vitamin A and its precursor beta-carotene are not only important antioxidants but are also essential in the production of various white blood cells, including T-helper cells.⁷ More specifically, research has shown NK cells treated with beta-carotene experienced increased activity against tumors.⁸

Beta-carotene is not the lone antioxidant carotenoid in immune health and cancer management. As a class, carotenoids stimulate immune function and inhibit free radical formation associated with tumors.⁹ Lycopene, astaxanthin and zeaxanthin are non-provitamin-A carotenoids with potent antioxidant properties and immune system benefits. While they, as a group, protect cells and tissue from oxidation, lycopene, primarily from tomatoes, is especially adept at quelling singlet oxygen and safeguarding tissue in many prime cancer locations (i.e. liver, lungs, breasts and prostate),¹⁰ while astaxanthin has demonstrated an ability to improve anti-tumor immune response.¹¹

The list of antioxidants effective in immune system support relative to cancer management is an expanding universe of increasingly smaller substances. Foods such as soy, green tea, chocolate and wine have traditionally been touted for both taste and function, especially immunity and prevention of disease. Science has since been whittling down the active ingredients in these plant-based foods to arrive at the responsible substances.

Polyphenols are responsible for the bright pigments in fruits and vegetables such as blueberries, grapes, peppers and tea. In addition to protecting cells and tissue from oxidative stress, polyphenols have demonstrated anti-tumor and anti-inflammatory actions that lend themselves to cancer management. The biggest group of polyphenols is the family of flavonoids.

In laboratory studies, catechins from green and black tea have demonstrated an ability to scavenge oxygen free radicals before cell damage occurs,¹² reduce the incidence and size of chemically-induced tumors,¹³ and inhibit the growth of tumor cells.¹⁴ Although all tea is made from the same plant, Camellia sinensis, green tea is not processed as much as black tea and is, therefore, considered more potent.

Resveratrol, found in red wine, grapes, raspberries, peanuts and other plants, is a polyphenol produced by plants in defense against disease and injury. In addition to its strong antioxidant properties, resveratrol has many specific immune enhancing and cancer fighting actions. Evidence has indicated it can reduce activation of a special protein produced by an immune system under attack.¹⁵ This affects growth and spread of cancer cells—called metastasis. Resveratrol also reduces tumor incidence and can stall the growth of many cancer cells.¹⁶

Anthocyanins are the water soluble pigments in grapes and other berries. Similar to other flavonoids, anthocyanins and their precursors, proanthocyanins, have been found to reduce tumor incidence and tumor growth,¹⁷ but a more unique function to immune defense against cancer is their ability to affect angiogenesis, the production of blood vessels that feed tumors and promote metastasis.¹⁸ In one study, a rich profile of anthocyanins in a multiple berry extract (OptiBerry® from InterHealth USA) stemmed the flow of white blood cells to the infections or inflammation that can cause angiogenesis.¹⁹

Pycnogenol®, a French pine bark extract, contains flavonoids with powerful antioxidant capabilities. Research has shown Pycnogenol can boost secretion of tumor necrosis factor, a tumor-killing protein made by immune cells,²⁰ as well as modulate macrophage response.²¹

Scavenging free radicals is certainly a first stage defense against cancer development and progression, but there are other ways phytochemicals with less powerful antioxidant ability can help. Isoflavones, saponins, phytosterols, indoles and polysaccharides have much to offer cancer fighting immune systems.

Dietary indoles are the active constituents of cruciferous vegetables, including cabbage, broccoli and cauliflower. Chief among indoles appears to be indole-3-carbinol (I3C), an anti-tumor agent²² and precursor to diindolymethane (DIM), which is also known to suppress cancer cells.²³ Saponins, found primarily in legumes, stimulate the immune system and help regulate cell proliferation.²⁴ Polysaccharides, including arabinogalactans (AGs) and fruit pectins, are carbon-based phytochemicals found in many plants including fruits, echinacea and mushrooms. AGs have been shown to increase production of key immune blood cells and promote NK cell activity.²⁵

A number of medicinal mushrooms contain polysaccharides found to be beneficial to immune health and cancer management. Beta 1,3 and 1,6 glucans from various mushrooms, including Agaricus blazei and maitake mushrooms, have exhibited numerous beneficial effects on macrophages,²⁶ NK cells²⁷ and various T cells,²⁸ and have demonstrated an ability to influence production of antibodies and other immune system mediators.²⁹ Another maitake compound, beta-D-glucan, has been shown to suppress tumor growth by increasing certain interleukin availability, which stimulates NK cell activity.³⁰ Preclinical research has shown WGP 3-6, Biopolymer’s beta glucan product, engages innate immune response, which is not ordinarily involved in the body’s fight against cancer.³¹ This mechanism of action works synergistically with monoclonal antibodies and vaccines to significantly increase long-term cancer survival. Combining the benefits of the many medicinal mushrooms indicated as immune boosters, AHCC is a proprietary hybridization shown in research to enhance immune response by increasing certain white blood cell activity.³²

As phytochemicals are the biologically active parts of plants, pinpointing their actions and benefits is indeed a scientific goal. However, whole herbs and certain extracts containing many phytochemicals have also been studied for their effect on the immune system and cancer. Garlic possesses many immune actions, especially relative to cancer management. The National Cancer Institute (NCI) reported 28 of 37 observational studies in humans showed garlic and related allyl sulfur compounds had some cancer preventive effect. Theory is these allyl sulfur compounds render cells vulnerable to stress, a condition experienced regularly by cancer cells. Thus, these garlic compounds damage cancer cells much more than they do normal, healthy cells.

Mistletoe may be a lesser-known herb in America, but its immune and cancer supporting effects are well known worldwide. It has been widely used throughout Europe for nearly a century as an alternative or adjunct to conventional cancer treatment. Purified lectins from varieties of this herb have exhibited immune-stimulating actions such as inhibiting cancer cell growth and other cytotoxic activity.³³ As evidence of its usefulness as an adjunct therapy, mistletoe has been tested in combination with gemcitabine, a chemotherapeutic drug used to attack tumors.³⁴

There are certainly other vitamins, minerals and herbs useful in boosting the immune system. For instance, epidemiological studies have concluded deficiency of zinc, an important immune system nutrient, may be associated with increased risk of cancer.³⁵ However, it has commonly been studied in conjunction with other nutrients, making it difficult to isolate its exact benefit to cancer patients. On the other hand, studies on B vitamins,³⁶ as well as vitamin D combined with calcium,³⁷ have demonstrated effects specific to certain cancers, as opposed to general immune support in relation to overall cancer prevention. Therefore, in addition to learning the precise effects of nutrients on the immune system, its cells and actions against cancer development, retailers and their customers are equally served by knowledge of the researched benefits of various nutrients on specific cancer types.

Lung cancer remains the deadliest form of cancer in the United States. One look around the fringes of any natural products convention will provide ample evidence that even health foodies smoke. Add in the state of environmental toxicity, especially in urban and industrial areas, and retailers can expect a fair portion of their clientele to be susceptible to lung cancer. Women and black men are the two most affected groups.

Based on statistics, support for smoking cessation, respiratory safety measures and strengthened immune systems can combine to virtually erase risk of lung cancer. However, some antioxidants have been studied for their ability to even further reduce risk of developing lung cancer. Derivatives of vitamin A have successfully inhibited lung cancer cell growth while promoting cancer cell death.³⁸ Fellow antioxidant vitamin C has shown dose-dependent benefit to lung cancer risk. A 25- year study found men taking more than 83 mg/d of vitamin C experienced a 64-percent reduction in lung cancer incidence compared to men taking less than 63 mg/d of the vitamin.³⁹

Early detection of lung cancer is difficult, as there is no screening test, an important part of surviving progression of other cancers. Hence, it is important to slow growth of lung cancer to delay metastasis. While nutrients such as omega-3 fatty acids show preliminary potential to affect cancer growth,⁴⁰ antioxidants remain the most researched in this area. Various observational studies have concluded increased blood levels of vitamin E during the early development of lung cancer can limit the progression of the disease.⁴¹

Debate continues to swirl around just what are the most beneficial intake levels and to what magnitude antioxidant vitamins can help limit lung cancer risk. Beta-carotene, for example, has been shown to both increase⁴² and decrease⁴³ lung cancer risk. At this point, retailers might want to advise caution on use of the highest-dose products but could otherwise feel comprehensive in suggesting lifestyle changes and antioxidant vitamins to customers looking to avoid or counteract lung cancer.

Liver cancer is connected to lung cancer in that smoking is a big risk factor. However, it is this habit combined with alcoholism that makes liver cancer primarily a men’s disease, according to ACS. Its biggest connection to women is birth control, which was once linked to slightly higher risk of liver cancer, but newer birth control pills have not yet shown such a link. The other major risk factors, hepatitis B and C, affect both men and women but are preventable.

As is the case with lung cancer, there is no screening test, and symptoms do not normally surface until the disease is in its late stages. Liver cancer does not respond well to chemotherapy or radiation, and surgery is the only real conventional chance of long-term survival, as transplant is neither guaranteed to work nor readily available. It becomes crucial then to address preventive nutrition, and certain plants and phytochemicals have been proven to help.

While retailers may be familiar with the wide use of milk thistle in regards to liver health, there is not much research available on its effects on liver cancer. There is, however, some scientific backing for other nutrients, including lycopene. American Academy of Cancer Research has found lycopene supplementation may reduce risk of liver cancer.⁴⁴ Liver cancer was suppressed in patients who had a high-risk of liver cancer and were given Lyc-O-Mato® containing 10 mg lycopene, 10 mg of carotenoids and 50 mg of alpha-tocopherol (vitamin E).⁴⁵ Soy isoflavones genisten, daidzein and biochanin-A were shown to inhibit growth in five lines of human hepatoma cells (liver cancer).⁴⁶ Aloe vera derivative aloe-emodin inhibited cell proliferation and promoted apoptosis (cell death) in two human liver cancer cell lines.⁴⁷ Similarly, human liver cancer cells exposed to phytochemicals in strawberry extracts were inhibited in a dose-dependent manner.⁴⁸ Phytochemicals in green and black tea were also shown to affect liver cancer cells, as chemically-induced tumors decreased in size in mice fed extracts of both teas.49 Mushrooms also figure in liver cancer prevention. Maitake D-Fraction beta glucan extract given to cancer patients led to a 68-percent regression or symptom improvement.⁵⁰ On the postoperative side, patients who had a liver cancer tumor removed and who were given AHCC enjoyed a significantly longer period of nonrecurrence and an overall increased rate of survival.⁵¹

Colorectal cancer is the end result of problems in the digestive system or gastrointestinal (GI) tract. Including colon and rectal cancers, colorectal cancer is the third most common cancer in men and women, with 150,000 new cases expected in 2005—one-third of those patients will die, although early detection, improved diet and exercise are good preventive measures.

Reducing the risk of colorectal cancer or many related GI cancers (bladder, stomach, etc.) starts with a healthy digestion system. Luckily, many of the nutrients indicated for digestive health also have been studied for chemoprevention. Probiotics are friendly bacteria that occupy the GI tract, preventing bad bacteria from colonizing there. Studies have demonstrated probiotics, including Lactobacillus GG, Lactobacillus reuteri and Saccharomyces boulardii, can also reduce the prevalence of colorectal cancer.⁵² Certain prebiotics, which promote indigenous beneficial microflora production, might also lower colorectal cancer risk, by protecting against inflammatory and cancerous processes in the large intestine.⁵³

As expected, vitamins and minerals are also chemoprotective in colorectal and GI cancers. Selenium was linked to reduced incidence of bladder cancer, especially among non-smokers.⁵⁴ The mineral also reduced risk of colon cancer, especially among patients who had an adenoma removed during colonoscopy.⁵⁵ In one study, calcium alone curbed cancer cell proliferation in the distal colon;⁵⁶ combined with vitamin D in another study, calcium reduced recurrence of colorectal adenoma.⁵⁷ Further, calcium and pectin diets were both demonstrated to block carcinogenesis in the colon.⁵⁸

Vitamin C poses additional early chemoprevention by addressing infections of Heliobacter pylori, the bacteria linked to ulcers and bladder cancer.⁵⁹ Folic acid, or folate, is indicated as preventive for many GI cancers. High serum levels of folate were linked to lower incidence of colon cancer,⁶⁰ as were levels of vitamin B12.⁶¹ Folate also combined with vitamin D and calcium to modulate and inhibit colon cancer.⁶² Vitamin B6 has been found to reduce the risk of colon cancer⁶³ and suppress tumor growth and metastasis.⁶⁴ The vitamin A precursor betacarotene inhibited growth of tumor cells and increased colon cancer cell apoptosis.⁶⁵ Foods containing the carotenoid along with vitamins C and E can reduce risk of colon cancer by 30 percent to 70 percent.⁶⁶ Low concentrations of other carotenoids—including astaxanthin, alphacarotene, lycopene, zeaxanthin and beta-cryptoxanthin were discovered in numerous colon cancer cases. ⁶⁷

Beyond vitamins and minerals, a few specialty nutrients have shown chemopreventive benefits. Conjugated linoleic acid (CLA), which possesses angiogenic and anti-carcinogenic properties, has inhibited colon cancer in animal models and induced apoptosis in human colon cancer cell lines.⁶⁸ Soy and its isoflavones have shown the ability to reduce risk of colorectal cancer and colonic abnormalities.⁶⁹ One of these isoflavones, genistein, has induced apoptosis in colon cancer cells,⁷⁰ especially when joined with one of the monoclonal antibodies more recently targeted in the conventional treatment of colorectal cancer.⁷¹ Anthocyanins in chokeberry extract appear to stifle cancer cell growth in the colon, without affecting healthy colon cells.⁷² Similar phytochemicals in grape seed extract have also protected against cancer in animal models.⁷³ And, of 10 phytochemical-laden berry extracts, bilberry was found most effective at inhibiting colon carcinoma cells.⁷⁴

Cervical cancer is primarily caused by the human papilloma virus (HPV) and begins in the lining of the cervix, the lower part of the uterus. Not many nutrients have been scientifically studied in relation to cervical cancer, but phytochemicals in tea have shown some promise. EGCG and its shortened-termed relative ECG have been shown to promote apoptosis and inhibit growth in human cervical cancer cells.⁷⁵ In addition, higher intake of vegetables, especially those containing lycopene,⁷⁶ affect the scope of HPV infection, possibly lowering the risk of cervical cancer. Further, dietary intakes of vitamins B1 (thiamine), B2 (riboflavin), B12 and folic acid⁷⁷ may lower risk of cervical cancer. And, women with cervical cancer have shown lower vaginal levels of CoQ10 and vitamin E.⁷⁸

Breast cancer begins in the ducts or the lobules of the breast, and it can spread to the outlying breast tissue and other body areas. Carcinoma in situ means the cancer is confined to the area of origin— the ducts or lobules. Most women with these early stage breast cancers face high cure rates. Later stages, which cause the majority of breast cancer deaths, feature cancer spread to the remaining breast tissue and other body organs (invasive breast cancer). About one-fifth of the 211,000 new invasive breast cancer cases expected in 2005 will result in mortality. However, ACS reported death rates from breast cancers are on the decline, due mainly to early screening and improved treatments. In fact, breast cancer awareness and research have exploded; this includes nutritional approaches.

Dietary intakes of several nutrients have been shown to lower the risk and incidence of breast cancer. Populations with diets high in certain phytosterols, including beta-sistosterol and stigmasterol, have been found to enjoy the lowest breast cancer rates.⁷⁹ Similarly, vitamins B6,⁸⁰ D⁸¹ and A (as beta-carotene)⁸² have all been linked to lowered risk, as have soy,⁸³ green tea⁸⁴ and lycopene.⁸⁵

Lycopene has also proven useful in inhibiting the MCF-7 breast cancer cell line.⁸⁶ Other nutrients demonstrating the same effect include soy isoflavone genistein,⁸⁷ Reishi mushroom extract⁸⁸ and tocopherol palm oil (vitamin E),⁸⁹ all of which have shown additional benefits to breast cancer patients.

In one study, Reishi mushroom extract inhibited the expression and secretion of certain factors that lead to breast cancer cell motility (cell movement),⁹⁰ while in another study, beta glucans in maitake were linked to cancer regression or symptom improvement in 69 percent of breast cancer patients.⁹¹ Tocopherol palm oil containing alpha-, gammaand delta-tocopherols has inhibited the growth of the ZR-75-1 breast cancer cell line, further demonstrating its usefulness in estrogenic breast cancer cases.⁹² Gamma- and delta-tocopherol also appear to enhance the effectiveness of conventional breast cancer drug Tamoxifen.⁹³ Genistein was found to function similarly to Tamoxifen, inducing apoptosis and reducing cancer cell proliferation.⁹⁴ The isoflavone also caused a 40-percent reduction in tumors associated with F3II breast cancer, although a .6-percent soy extract led to a 90-percent reduction of the same type of tumors.⁹⁵ The problem with genistein is some studies have found it to actually promote certain breast cancers in women under certain circumstances,⁹⁶ and it has even been found to negate the effects of Tamoxifen. The bottom line on genistein according to experts: proceed with caution and keep attending oncologists informed of genistein and other phytoestrogen supplementation.

Other phytochemicals have displayed chemoprotective effects in the breast cancer research arena. Anthocyanins in grape seed extract have shown cytotoxic actions against breast cancer cells,⁹⁷ while French maritime pine bark extract has selectively induced apoptosis in breast cancer cell lines.⁹⁸

Prostate cancer will develop in more than 230,000 men in 2005, and 30,000 men will die from it. This gender-specific cancer is also racediscriminate, as black men are more likely than Caucasians to develop the disease and twice as likely to die from it, according to ACS. Age is another key factor, as older men are at greater risk. Diets high in animal and dairy fat, and low in fruits and vegetables are additional contributors. As is the case with breast cancer, mortality rates are declining due to early detection. With the exact cause still unknown and the rate of development greatly varied from one case to the next, prostate cancer prevention is a complicated and somewhat blind enterprise. However, prostate treatment is just as complicated and in some cases destructive, such as when it has spread to other body areas.

Good nutrition is considered a powerful preventive measure for prostate cancer. Lowered risk or incidence of prostate cancer has been linked to intakes of many nutrients, including vitamin E,⁹⁹ selenium, garlic,¹⁰⁰ lycopene,¹⁰¹ soy,¹⁰² I3C and DIM indoles,^103,104 modified citrus pectin¹⁰⁵ and saw palmetto—some of which have additional benefits to prostate cancer patients. Scientists have found selenium increases apoptosis in prostate cancer cells and decreases the DNA damage that can promote their creation.¹⁰⁶ Garlic may lower levels of prostate cancer marker PSA (prostate-specific antigen), the test for which is the primary detection method for the disease.¹⁰⁷ Soy has also lowered PSA levels in clinical trials,¹⁰⁸ and soy isoflavones genistein and daidzein have stymied prostate cancer growth and tumor development.¹⁰⁹ In fact, a soy protein diet has been shown to increase apoptosis in prostate cancer cells.¹¹⁰ Similar to soy, red clover isoflavones halted progression of prostate cancer by increasing apoptosis in low- and moderate-grade tumors.¹¹¹ Additional apoptosis was exhibited by phytochemicals in extracts of Reishi and Maitake mushrooms.^112,113 Prostate health granddaddy lycopene has lowered PSA and other prostate cancer markers by as much as 17.5 percent,¹¹⁴ and it has been credited with decreasing tumor size.¹¹⁵

The conclusive mantra of scientists in almost every study involving nutrients and cancer is greater human study is needed. To date, most nutritional research of cancer is in laboratory tubes and dishes, or in animal models. Research models aside, the quantity of research on nutritional compounds and cancer is also lagging. “There is no substitute for peer-reviewed research—it is the gold standard,” Desai said. Unfortunately, many obstacles stand in the way of nutritional supplement companies that set goals to initiate such scientific studies. The high cost of carrying out such trials is chief among challenges cited by manufacturing experts such as Desai and David Abia-Okon, whose Health Forever Products produces Jobelyn, an antioxidant product containing numerous phytochemicals. It is equally as challenging to capitalize on positive and credible research, as marketing with any hint of a cancer claim is bound to get a company in trouble with the Food and Drug administration (FDA), which requires “sufficient,” but unspecified, scientific evidence to support any claim.

Retailers face similar marketing struggles, as advising customers on the prevention or treatment of cancer via dietary supplements is illegal, if not irresponsible. A better approach may be to arm the customer with the information needed to make a personalized, educated choice. It is no secret that people looking to prevent cancer or complement conventional cancer treatments using nutritional products are numerous and aggressive shoppers. By focusing on the immune benefits and supplying information on scientific research and statistics, retailers can offer cancer-oriented customers the broad array of nutritional options available.