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Cancer 1 of 3 : next >>

[The cancer process | Symptoms of cancer | Causes of cancer | Cancer treatment]
[Cancer prevention | Diet and cancer prevention | Foods to avoid | Foods to include]
[Vitamins, minerals & cancer | Antioxidant supplements | Other nutrients | References]

Cancer is a group of over 100 diseases in which abnormal cells grow and spread in an uncontrolled way. Cancer is one of the leading causes of death in developed countries, with lung cancer responsible for more deaths than any other type of cancer. Many factors play a role in the development of cancer, and these may vary between the different types of disease. They include nutritional, environmental, genetic, social, emotional, psychological and spiritual factors. It is only in the last 20 years that diet has been accepted as playing a vital part in the prevention of cancer.

The Cancer Process
Normally, cells divide to produce more cells only when the body needs them. If cells divide when new ones are not needed, they form a mass of excess tissue, called a tumor. Tumors can be benign (not cancer) or malignant (cancerous). The cancer cells in malignant tumors can invade and destroy nearby tissues and organs. Cancer cells can also break away from a malignant tumor and travel through the body to form new tumors in other places. The spread of cancer is called metastasis.

Cancer develops in two stages, an initiation stage and a promotion stage. During the initiation stage, the genetic code of a healthy cell is altered by a substance known as a carcinogen. This is followed by the promotion stage in which the cancer cell is encouraged to multiply. The initiation stage happens frequently and quickly while the promotion stage is lengthier. In some cases it may take as long as 30 years for cancer to become apparent.

Symptoms of Cancer
As cancer occurs in many forms, the symptoms of one type of cancer may be quite different from those of another cancer type. However, there are certain warning signs that often occur with cancer. These include:

  • Change in bowel or bladder habits
  • A sore that does not heal
  • Unusual bleeding or discharge
  • Thickening or lump in the breast or any other part of the body
  • Indigestion or difficulty swallowing
  • Obvious change in a wart or mole on the skin
  • Nagging cough or hoarseness.
These symptoms are not always warning signs of cancer as they can also be caused by less serious conditions. A person who has any of these symptoms should see a doctor who can determine what the problem is. There are several tests which can help to determine if cancer is the cause of a particular medical problem. These include a biopsy, in which a sample of tissue is removed and checked under a microscope for cancer cells.

Causes of Cancer
Many factors contribute to the development of cancer. Some of the most common cancer causes include smoking, chemical pollutants, excess sun exposure, radiation, some pharmaceutical drugs, alcohol, viruses and psychological influences. Nutritional factors for cancer include food chemicals, obesity, diets high in saturated and polyunsaturated fats and protein, and nutrient deficiencies.

Cancer Treatment
Cancer is treated with surgery, radiation, chemotherapy, hormones, or biological therapy. Treatment may involve just one method or a combination of methods. The choice of cancer therapy depends on many factors including the type and location of the cancer, whether the cancer has spread, a patient's age and general health.

Cancer Prevention
While it is impossible to avoid all cancer-causing substances, it is possible to lower the risk of developing the cancer by avoiding risks where feasible, and increasing consumption of nutrients that act to prevent development of cancer. It is important to avoid exposure to the risk factors mentioned above. Other lifestyle factors, including effective relaxation and stress management techniques can play a large part in reducing the risk of developing cancer. Regular checkups and self-examinations can also be useful in preventing death from cancer as they may reveal the disease at an early stage, when treatment is likely to be effective.

Diet and Cancer Prevention
Between 20 and 60 per cent of deaths from cancer may be diet-related, making diet second only to tobacco as the most influential factor in the development of cancer. Cancers particularly influenced by diet include those in the colon, prostate, ovary, uterus, breast, skin, vulva, kidneys, cervix, stomach, esophagus, mouth and liver. The body has many mechanisms to thwart the progress of cancer, such as detoxification of carcinogens, preventing and correcting damage to DNA, immune stimulation, and sealing off an abnormal cell growth. All these mechanisms rely on good nutrition.

A good diet can prevent cancer and a bad one can increase the risk, but it is not always clear exactly what is good and what is bad. It is known that nutrients play a role in contributing to or preventing cancer, but the exact relationship between dietary ingredients and cancer is elusive. There are many different types of cancers and some of these can take years to develop, thus making it difficult to pinpoint cause and effect. Food contains many chemicals, known and unknown, and the effects of many of these have not yet been investigated.

The dietary guidelines from the American Cancer Society are:

  • Choose most of the foods you eat from plant sources.
  • Limit your intake of high fat foods, particularly from animal sources.
  • Be physically active: achieve and maintain a healthy weight.
  • Limit consumption of alcoholic beverages, if you drink at all.

Foods to Avoid
Food contains many substances which can cause cell mutations or promote cancer. High intakes of saturated fat, sugar, alcohol, artificial sweeteners and food additives may cause cancer. Alcohol may promote the growth of abnormal cells, and food additives known as nitrites which are found in processed meats can be converted in the body to carcinogenic nitrosamines. Frying, smoking, barbecuing and broiling fatty meat and fish may produce cancer-causing chemicals, and these foods should be avoided as much as possible.

Foods to Include
[Fiber | Fat]

There are many substances in food which prevent the development or progression of cancer. No specific diet is guaranteed to prevent cancer but a diet which is low in fat and high in fruits and vegetables will help reduce the risks. Fruits and vegetables are rich in vitamins, minerals, fiber and other cancer-preventing compounds. A person whose diet is high in fruits and vegetables also tends to eat less fatty and high calorie foods. Studies from many different countries consistently show that diets high in fruits and vegetables reduce the risk of cancer.

Most experts recommend eating at least two fruits and three vegetables, especially dark orange and green ones, every day. Eating a variety of foods is also very important as no single food provides all the nutrients a person needs, and different nutrients protect against different types of cancer. Cruciferous vegetables such as broccoli, cabbage and cauliflower may have particularly beneficial effects as they contain high levels of vitamins and minerals and other phytochemicals.

Fruits and vegetables are also high in fiber. A high fiber diet may reduce the risk of several cancers, including colon and rectal cancer, by binding to potentially toxic bile acids, moving food more quickly through the intestines and exerting beneficial effects on gut bacteria. Fiber has also been shown to protect against other cancers such as those of the breast and prostate.

Maintaining a healthy weight is very important as obesity increases the risk of developing cancer, and many studies have shown that low fat diets protect against cancer. High fat diets are associated with an increased risk of many types of cancers. This is particularly true for diets high in saturated fats such as those from animal sources. High levels of certain polyunsaturated fats also appear to increase the risk of some cancers while monounsaturated fats do not.

Vitamins, Minerals and Cancer
[Dietary antioxidants | Vitamin A | Carotenes | Vitamin C | Vitamin E | Selenium]

Dietary Antioxidants
There is a lot of evidence to suggest that insufficient amounts of antioxidants can increase the risk of cancer. In groups of people who have low levels of these nutrients, the cancer rates are higher. Vitamin C is the body's most powerful water soluble antioxidant while vitamin E and carotenes are lipid soluble. Antioxidants neutralize metabolic products, including free radicals; prevent carcinogens from attacking DNA and cell membranes; inhibit chromosome aberrations; restrain replication of transformed cells; suppress actions of cancer promoters; and induce regression of pre-cancerous lesions. Antioxidants can also boost immunity and counter the immune-suppressive effects of oxidized cholesterol and other substances, and may also slow or halt the growth of tumors by enhancing communication between cells, and stimulating the activity of the immune system.

Vitamin A
[Breast cancer]

Many studies suggest that high blood levels of vitamin A can help prevent certain forms of cancer, particularly cancers of epithelial tissues, such as the lung, mouth, stomach, colon, cervix and uterus. Vitamin A plays an important role in the growth and differentiation of cells, strengthening the immune system and suppressing cell transformation into cancerous cells. Vitamin A deficiency- related changes resemble cancer in these cells.

Breast Cancer
Breast tissue may be particularly sensitive to the tumor-suppressive action of vitamin A. In a study published in 1997, researchers at Harvard School of Public Health compared the concentrations of various forms of vitamin A in the breast fat tissue from 46 cancer patients and 63 women with benign breast lumps. They found an increased risk of disease in those with low levels of vitamin A.1

Results of a 1997 study suggest that the development of lung cancer may be due to a decreased ability of cells to respond to vitamin A-related compounds known as retinoids. When researchers at the University of Texas looked at the lung tissue from 79 patients with lung cancer and 17 without lung cancer they found that all the healthy cells carried receptors that bound retinoids. However, only 42 to 76 per cent of the cancerous cells had this ability. Of the six different types of retinoid receptors, three were found at lower levels in cancer cells.2 This study raises the possibility that increasing dietary intake of vitamin A or taking supplements can be used to reduce the risk of lung cancer.

[Lung cancer | Breast cancer | Prostate cancer | Colon cancer | Cervical cancer]

Many population studies have suggested that diets high in carotenes can protect against several types of cancer including those of the cervix, ovaries, uterus, mouth, gastrointestinal tract, lung, prostate and breast. Other types of studies have shown that cancer victims often have lower carotenoid levels than healthy individuals.

In a study published in 1991, researchers investigated the links between beta carotene and cancer in New Zealand families. The study involved 389 people diagnosed with cancer and 391 hospital patients without cancer. They also assessed the family members of the study participants to compensate for the fact that changes in beta carotene levels may have occurred after the cancer developed. Low levels of beta carotene were found in people with a number of cancers, including those of the lung, stomach, esophagus, small intestine, cervix, and uterus. Low levels of beta carotene were also found in the relatives of these cancer patients. The strongest findings were those for lung cancer. In this study, patients with cancers of the breast, colon, prostate, and skin did not have lower levels of beta carotene and neither did their families. The results of this study suggest that the cancer sites associated with low levels of beta carotene are, in general, sites for which smoking is a strong risk factor.3

Lung Cancer
Several population studies have investigated the links between lower levels of carotenes and lung cancer. In a study published in 1998, researchers at Johns Hopkins University measured nutrient levels in blood samples from 258 patients with lung cancer and compared these with those in samples from 515 people free of cancer. Blood concentrations of cryptoxanthin, beta carotene, lutein and zeaxanthin were significantly lower among the cancer patients. Small differences were noticed for alpha carotene and lycopene.4

In a 1994 study, researchers compared the diets of 413 non-smokers suffering from lung cancer with those of 413 people without cancer. The results showed that high dietary intake of fruit and vegetables and beta carotene was linked to a decreased risk of lung cancer in both men and women.5

Breast Cancer
In a study published in 1998, researchers in Missouri examined blood levels of various nutrients in women who developed breast cancer after donating blood to a bank over a ten-year period. They then compared these levels to women who were free of cancer. They found lower levels of the carotenes beta cryptoxanthin, lycopene, lutein and zeaxanthin in patients who developed breast cancer.6 In a study published in 1996, Italian researchers investigated the relationship between selected nutrients and breast cancer risk in 2,569 women with the disease and 2,588 women with no history of cancer. The results showed significantly less risk in women with high beta carotene intakes.7

In a 1994 study published in the British Journal of Cancer, West Australian researchers investigated the effect of increased intake of beta carotene on survival in breast cancer patients. Over a six-year period, only one death occurred in the group with the highest consumption of beta carotene, while there were eight and 12 deaths in the intermediate and lowest groups of consumption respectively.8

In a study published in the Journal of the National Cancer Institute in 1996, researchers examined the links between dietary intake of carotenes (including nonfood supplements), and premenopausal breast cancer risk. The study involved 297 premenopausal women 40 years of age or older who were diagnosed with breast cancer from November 1986 to April 1991. These were compared with 311 women without cancer. The results showed a reduction in risk associated with high intake of several nutrients including beta carotene, lutein and zeaxanthin.9

Prostate Cancer
High beta carotene intakes may improve survival in those with prostate cancer, according to results from the Chicago Western Electric Study published in 1996. The study involved 1,899 middle-aged men who were followed for a total of 30 years. During that time, 132 men developed prostate cancer and survival was found to be less likely in those with low beta carotene intakes.10

Lycopene-rich tomatoes seem to be linked with a lower risk of prostate cancer. In a study published in 1995, researchers at Harvard Medical School assessed the links between diet during a one-year period, and prostate cancer in almost 48,000 men in the Health Professionals Follow-up Study. They found that men who ate more foods such as tomatoes, pizza and tomato sauce which are high in lycopene were less likely to be at risk of prostate cancer.11

Colon Cancer
In a 1997 study done in Italy, researchers assessed carotenoid levels in four healthy patients, seven patients with pre-cancerous lesions and seven patients with colon cancer. They found significantly lower carotenoid levels in the cancer patients.12

Cervical Cancer
Population studies suggest that low carotenoid levels, including beta carotene may increase the risk of cervical cancer. In a 1993 study, researchers examined the relationship between cervical cancer and carotenoid levels in 15,161 women who donated blood in 1974. Over the next 16 years, 50 women developed cancer. The blood samples of these women were compared with those from 50 women free of cancer and the results showed that the levels of total carotenes, alpha carotene, beta carotene, cryptoxanthin, and lycopene were significantly lower among cancer cases than they were among controls.13 Laboratory studies show that beta carotene can slow the growth of cervical cancer cells.14 Increasing intake of beta carotene may help to overcome this tissue-specific deficiency.15

Vitamin C
[Prostate cancer | Lung cancer | Stomach cancer | Colon cancer | Breast cancer]

People with high vitamin C intakes seem to have a reduced risk of almost all forms of cancer. The protective effect seems to be strongest for cancers of the esophagus, larynx, mouth and pancreas. Vitamin C also seems to provide some protection against cancers of the cervix, liver, stomach, rectum, breast and lungs.16 However, in many of these studies it is not possible to tell whether the protective effect is due to vitamin C, vitamin E, or carotene, to a combined effect of these nutrients, or even due to additional substances found in food. Results from the Western Electric Study published in 1995 suggest a link between low vitamin C levels and death from cancer. The researchers obtained information on diet and other factors from 1,556 employed, middle-aged men. During the follow-up period, 231 men died from cancer. The results showed that those with the highest vitamin C and beta carotene intakes were 40 per cent less likely to die of cancer than those with the lowest intakes.17

Prostate Cancer
Vitamin C seems to improve survival in those with prostate cancer. Researchers involved in the Western Electric Study examined the links between dietary beta carotene and vitamin C and the risk of prostate cancer in 1,899 middle-aged men over a 30-year period. During this time, prostate cancer developed in 132 men. The results showed that associations between vitamin C intake and risk of prostate cancer differed depending on whether the cancer was diagnosed during the first 19 years of follow-up or the next 11 years of follow-up. Overall, higher intakes of vitamin C and beta carotene were linked to improved survival.18

Lung Cancer
Vitamin C may also help to protect against lung cancer. Researchers involved in a 1997 study obtained dietary information from 561 men from the Dutch town of Zutphen, in 1960, 1965, and 1970. During the period from 1971 to 1990, 54 new cases of lung cancer were identified and analysis of the diets of the men showed an increased risk of lung cancer in those with lower fruit and vegetable and vitamin C intakes.19

Stomach Cancer
Results from a study published in 1995 suggest that low vitamin C intake is linked to an increased risk of stomach cancer. In the 1960s, researchers collected detailed dietary information and in 1987, they assessed average food intakes. They then examined the links between this information and death from stomach cancer. The results showed that the average intake of vitamin C was strongly related to the risk of stomach cancer. However, vitamin C intake was not related to the risk of lung and colorectal cancer in this study.20 Other studies have shown similar results.21

Colon Cancer
In a study published in 1992, researchers investigated the links between fruits and vegetables and vitamin C intake in 11 580 residents of a retirement community who entered the study free from cancer. During the period from 1981 to 1989 a total of 1335 cases of cancer were diagnosed. The results showed a decreased risk of colon cancer in women with higher vitamin C intakes. Supplemental use of vitamins A and C also showed a protective effect on colon cancer risk in women.22

In a 1994 study, Italian researchers investigated the relationship between estimated intake of certain nutrients, including vitamin C, and the risk of disease in 828 patients with colon cancer, 498 with rectal cancer and 2024 people without cancer. Those in the highest intake group for vitamin C had a 60 per cent lower risk of cancer than those in the low intake group.23

Breast Cancer
The results of a 1994 study suggest that women with high vitamin C intakes have a lower chance of dying of breast cancer than those with the low intakes.24 The study involved 678 women who were diagnosed with the disease from January 1982 through June 1992. However, results from the Nurses Health Study did not show a protective effect against the disease.25

Vitamin E
[Cancers of the gastrointestinal tract | Breast cancer | Cervical cancer | Lung cancer]

Several population studies show that low levels of vitamin E are linked to the development of certain cancers, including those of the mouth, liver, lung, colon, rectum, cervix and breast.

Cancers of the Gastrointestinal Tract
Results from the Iowa Women's Health Study show that high intakes of antioxidants including vitamin E are linked to lower risks of colon, oral, pharyngeal, esophageal and gastric cancers.26 As part of the study, the results of which were published in 1993, researchers analyzed the links between vitamin E and colon cancer in 35,215 women aged 55 to 69 years without a history of cancer. During the follow-up period, there were 212 cases of colon cancer. The results showed that low vitamin E intake increased the risk of colon cancer, with those in the high intake group having 30 per cent of the risk of those in the low intake group. The protective factor was stronger in the younger women.27

Breast Cancer
Some studies suggest that low vitamin E levels increase the risk of breast cancer. In a study published in 1992, researchers investigated the relationship between blood levels of various nutrients including vitamin E, and the risks of breast cancer and proliferative benign breast disease (BBD) in postmenopausal women. Women who had a high intake of vitamin E from food sources only, had around 60 per cent less risk of breast cancer compared to those in the low intake group.28 However, not all studies have shown protective effects.29

Cervical Cancer
In a 1990 study, Utah University researchers investigating the relationship between cervical cancer and dietary intake of antioxidant vitamins and selenium in 266 women with cervical cancer and 408 women without the disorder found that women with high vitamin E intakes had a 40 per cent lower risk of cervical cancer.30 Blood levels of vitamin E have also been found to be low in women with cervical cancer.31

Lung Cancer
High vitamin E intakes may decrease the risk of lung cancer. In 1974 and 1975, researchers at Johns Hopkins School of Hygiene and Public Health, Baltimore, collected blood samples from 25,802 volunteers. They assessed vitamin E levels in samples from 436 cancer cases and 765 matched control subjects. The results showed that high vitamin E levels protected against lung cancer.32

[Colorectal cancer | Lung cancer]

Epidemiological studies suggest that the risk of cancer is reduced in areas where the soil is high in selenium. Blood samples taken from large groups of people also show that they are more likely to develop cancer if they have low blood levels of selenium and the antioxidant selenium-containing enzyme, glutathione peroxidase. Low serum, dietary and soil selenium levels are particularly associated with lung, gastrointestinal tract and prostate cancers. Selenium may be most effective when combined with vitamin E.

Colorectal Cancer
In a 1997 study of the relationship between selenium and colon cancer, researchers at the University of North Carolina determined selenium levels in patients referred for colonoscopy. The results showed that those with the lowest selenium levels had almost four times the risk of colon cancer when compared to those with the highest levels.33

In a German study published in 1998, researchers investigated the selenium and glutathione peroxidase levels in 106 colorectal cancer patients and compared these to those in people without cancer. When average selenium levels in the cancer patients were compared with those in the control group, no significant differences were found. However, a significant reduction of serum glutathione peroxidase activity was seen in cancer patients. Those patients with low selenium levels had lower survival times and rates than the patients with higher selenium levels. The lowest selenium level was found for patients with advanced tumor disease. It is unclear from the results of this study whether low selenium levels are a cause or effect of cancer.34

Lung Cancer
In a study published in 1993, Dutch researchers examined the links between long-term selenium status and lung cancer among 120,852 Dutch men and women aged 55-69 years. The results showed that the lung cancer risk in those with the highest intake of selenium was half that of those in the lowest intake group. The protective effect of selenium was concentrated in subjects with a relatively low dietary intake of beta carotene or vitamin C.35

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