Gerson Therapy

Surviving Against All Odds: Analysis of 6 Case Studies of Patients With Cancer Who Followed the Gerson Therapy

A. Molassiotis, RN, PhD, and P. Peat, RGN, DiplPallCare

ative medical attitudes, unavailability of funding, lim-ited availability of appropriate patient data, and lack offollow-up in treated patients. The American CancerSociety and the US National Cancer Institute (NCI)do not recommend the use of Gerson therapy, warn-ing that patients should not turn away from main-stream therapy.

Besides the (potentially biased) publication of suc-cessful treatments in the book by Gerson5 and a sum-mary of the experience of the therapy published in the1970s,6 there is only 1 report in the international med-ical literature that has attempted to show some positiveresults in a more coherent and scientifically appropri-ate manner.7 The latter report was a retrospectivereview of 153 patients with malignant melanoma, com-paring their 5-year survival rates with those of pub-

A considerable number of patients with cancer have usedor are using the Gerson therapy, an alleged anticancermetabolic diet. However, there is almost no scientific sup-port for this regimen. Hence, the present case review studyof 6 patients with metastatic cancer who used the Gersontherapy aims at critically evaluating each case to derivesome valid interpretations of its potential effect. All 6 caseshad a cancer diagnosis with poor prognosis. Despite thepresence of some confounding variables, it seems that theGerson regimen has supported patients to some extentboth physically and psychologically. More scientific atten-tion needs to be directed to this area so that patients canpractice safe and appropriate therapies that are based onevidence rather than anecdotes.

Keywords: Gerson diet; alternative therapy; alternative medi-cine; complementary medicine; cancer

The Gerson therapy is a nutritional approach thatallegedly has anticancer effects. It was developed byMax Gerson in the 1920s as a metabolic therapy thatclaims to cure a number of chronic and degenerativediseases by detoxifying the body and boosting theimmune system.1,2 This dietary regimen is basedbroadly on detoxifying the body with coffee enemas,a diet based on organic fruits and vegetables, a largeamount of freshly made juices, and supplementationwith several enzymes or natural medication (ie,niacin, acidol pepsin, Lugol’s solution [iodine], pan-creatin, potassium, co-enzyme Q10, and/or thyroidextract), as seen in Table 1.3,4

Since Gerson published his book in 1958 (now in itsthird edition) detailing the “cure” of patients withadvanced cancer,5 the medical community has beenhighly skeptical and sharply hostile toward this nutri-tional therapy. There is consistently strong criticism ofit in the medical literature, and attempts to assess theeffect of this regimen have failed to identify any bene-fit, with some of the reasons behind this including neg-

lished reports of patients receiving conventionaltreatments. The authors showed that the survivalrates of patients using the Gerson therapy were sig-nificantly higher than rates published in the litera-ture for stage II melanoma (100% vs 79%), stage IIIa (82% vs 39%), stage IIIa and IIIb (70% vs 41%),and stage IV(a) (39% vs 6%).7 This is the only peer-reviewed publication showing positive results usingthe Gerson regimen in the medical literature. Anothercase series report summarizing the 6-year experienceof using a drastically modified type of the Gersontherapy in an Austrian medical center was publishedin 1990, which provided strong clinical impressionsof the effectiveness of this regimen.8 The authors pre-sented findings from 18 matched pairs of cancerpatients (gastrointestinal and breast cancer were the2 most common diagnoses) who underwent surgerywith adjuvant modified Gerson therapy or surgery

DOI: 10.1177/1534735406298258

80

AM is at the University of Manchester, Manchester, UnitedKingdom. RP is at Cancer Options, London, United Kingdom.

Correspondence: Prof. A. Molassiotis, RN, PhD, University ofManchester, School of Nursing, Midwifery & Social Work,Coupland III, Coupland Street, Manchester M13 9PL, UK. E-mail:alex.molassiotis@manchester.ac.uk.

INTEGRATIVE CANCER THERAPIES 6(1); 2007 pp. 80-88

Gerson Therapy

INTEGRATIVE CANCER THERAPIES 6(1); 2007 81

and continuation of usual lifestyle. While the clinicaldetails of the cases are briefly presented, the authorsreported with regard to the Gerson therapy groupimpressive survival improvements (28.6 vs 16.2months), prevention or at least delay in the onset ofcancer cachexia, fewer postoperative complications,less marked side effects from the chemoradiotherapy(it is not clearly reported how many patients receivedeither chemotherapy, radiotherapy, or both), use oflower doses of analgesics, slower progression of exist-ing liver metastasis, and a lower occurrence of malig-nant effusions.8 On the other hand, reports based on areview of records demonstrating a lack of evidence ofany beneficial effect have also been published2,9; mostlydue to lack of biopsy confirmation of the cancer diag-nosis and are limited in terms of follow-up processes.

However, despite the strong medical opposition tothis therapy, many patients have used and are using itfor managing their often advanced cancer. This caneither be a public health issue if proven to be an inap-propriate intervention or an added choice for patientsif proven to be helpful. Thus, more concrete answersin scientifically rigorous and appropriate methods arenecessary. The aim of the current study was to criticallyreview data from patients with cancer who used theGerson therapy and provide some scientifically inter-pretable information about its potential effect in anattempt to reignite the debate and contribute to a bal-anced discussion on the appropriateness of such anutritional approach to cancer treatment.

MethodsThis study was a record review based on the Best CaseSeries approach as described by the NCI (http://www

.cancer.gov/cam/bestcase_intro.html, and personalcommunication). The case studies were selected forthe completeness of their data in terms of docu-mented pathological diagnosis of cancer, documenteduse of the alternative therapy, documented tumorregression appropriate for the disease type and loca-tion, and absence of confounding and/or concurrentanticancer therapies. Cases meeting all the above cri-teria are persuasive cases (of which at least 2 areneeded), but cases that do not meet all of the abovecriteria (ie, with some confounding factors) can stillbe reviewed as supportive cases. A case study designcan be capable of providing valuable insight into analternative therapy and can generate useful prelimi-nary conclusions and research questions.10

The current study is based on a review of 6 cases,with some patients being involved in the study as co-researchers. All case studies were derived from theUK-based Gerson Support Group, which has as itsmembers a considerable number of cancer patientswho have used the Gerson regimen successfully. Thisis a small national patient group that is supportingpatients who are considering the use of or are usingthe Gerson regimen through information, advice,education, and material support. We have used themedical records of patients for conducting thisreview but have also clarified points during shortinterviews with patients. The research question andthe subsequent review have been prompted by thepatients themselves, who wanted to explore theeffects of this intervention in a more rigorous wayand contribute to the development of the researchagenda around alternative therapies. All patients(and the main caregiver of the deceased person)have received information about the case study byletter, and they all signed a consent form giving per-mission to the researchers to obtain a copy of theirmedical records and use that information for thecase study. Confidentiality and anonymity were main-tained. The review process was approved by theEthics Committee of the University of Manchester,United Kingdom. The complete records of eachpatient were reviewed by the 2 researchers indepen-dently, following the case report format of the NCIBest Case Series program. Scans and slides had beenpreviously reviewed by pathologists and/or radiolo-gists—in most cases by more than 1 specialist—andhence the current review is based on their reports. Inaddition, all summaries of the evidence were submit-ted and reviewed by clinical oncologists (n = 4) whomade comments on the clinical progress of the casesrelevant to their specialty and suggested possible clin-ical explanations for the recovery observed in someof the cases. Their comments are incorporated in thediscussion of this study.

Table 1. Overview of the Gerson Regimen

Included in Gerson Regimena Not Allowed

Coffee and/or castor oil enemas Aluminum utensilsVegetable juice, 13 glasses/d or Salt

more (ie, carrot juice); juices Oilmust be pressed

Only organic fruits and vegetables CoffeeTablespoons of linseed oil Berries or nutsAcidophilus-pepsin capsules; Drinking water

drops of Lugol’s solution; Animal proteinniacin; pancreatic enzymes

Thyroid tablets Bottled, canned, refined, Rectal/oral hydrogen peroxide preserved, or frozen foodRectal ozone therapiesMegadoses of vitamin C

for severe pain

a.Treatment is individualized, and different enzymes may be usedin varied quantity based on the patient’s needs.

Molassiotis, Peat

82 INTEGRATIVE CANCER THERAPIES 6(1); 2007

Results

Case 1Case 1 was an 82-year-old female (born in 1924) diag-nosed with malignant melanoma in November 1979following a 2-year history of a pigmented skin lesion.She underwent a local excision on December 6, 1979.Histological examination revealed invasive malignantmelanoma, Clark level IV, with a maximum tumorthickness of 2 mm. A wide excision took place. Nearly1 year later, in December 1980, an enlarged rightinguinal node was palpated on examination, measur-ing 2 × 1.5 cm in diameter. Reportedly, abdominal andpelvic computed tomography scans (CTs), completeblood counts, and liver function tests were normal. In1981, this patient started the Gerson regimen. A CTscan dated April 13, 1984, reported a “well definedsolitary mass in the right groin.” A pathology report ofa biopsy sample confirmed secondary malignantmelanoma with lymph node involvement. No surgeryor any other treatment was carried out, as the patientfollowed the Gerson regimen exclusively. A physician’sletter in May 1989 stated that the patient was well andwithout symptoms, there was no lymphadenopathy onexamination, and abdominal and chest CTs were clear.This patient is alive and well at present (2006) basedon personal assessment by the principal author.

Case 2This was a 54-year-old patient (born in 1951) diag-nosed with invasive adenocarcinoma of the breast inSeptember 1996 at the age of 44, following presenta-tion with multiple breast lumps. An ultrasound scandated September 10, 1996, identified a very irregularecho-poor mass extending into the left lower quadrantof the breast. Well defined in places, it appeared to beinfiltrating into surrounding breast tissue. Furtherinvestigations of a mammogram and fine needle aspi-rate showed it to be malignant. A left mastectomy wasperformed on September 19, 1996. Histology showeda moderately to poorly differentiated invasive adeno-carcinoma of ductal type (World Health Organizationgrade 3) with a nodule 2.5 cm in diameter. Deep to thenipple, one of the main ducts showed features of duc-tal carcinoma in situ, and the overall grading was T2G3 N1 M0. Fourteen of the 15 lymph nodes examinedcontained metastatic carcinoma, which were estrogenreceptor (ER) and progesterone receptor negative. Nodisease was evident on chest x-ray and bone scan. TheNottingham Prognostic Index at the time was 6.5,putting her in the worst prognostic group and givingher a 20% chance of 5-year survival.

FEC chemotherapy was given in October 1996 for 9infusions, until February 18, 1997, when this was dis-continued because of severe neutropenic sepsis. She

started oral chlorambucil together with methotrexateand 5-FU (CMF) on March 11, 1997, and also Iscadordrops. At the same time, it was noted on x-ray thatthere was a 1-cm nodule projecting through the heartimmediately above the left hemidiaphragm that wassuspicious for pulmonary metastasis. On a further x-ray dated April 8, 1997, another nodule was noted inthe right sixth interspace, which was also reported assuspicious for pulmonary metastasis. Chlorambucilwas discontinued on April 28, 1997, as the clinicalopinion of the oncologist was that this was an indica-tion of metastatic disease and that the chemotherapyhad not been successful (lung metastasis was sus-pected but not confirmed).

Concurrent homeopathic therapy (ie, Iscadordrops) was increased at this time but discontinuedwhen the Gerson therapy was commenced shortlyafterward, in May 1997. In August 1997, after thepatient had undergone intensive treatment withthe Gerson regimen, her chest x-ray was noted to beclear, with no evidence of pulmonary metastasis. SinceApril 1997, no other conventional or alternative treat-ment of the cancer has been used. However, for vari-ous unrelated ailments, homeopathic remedies havebeen used.

The patient is followed up regularly by oncologyservices, and scans in 2000 and 2002 showed no signsof recurrence. Some problems that were resolved withtime included mild lymphoedema of the left arm (lym-phatic drainage was used), yellow-orange skin tingedue to high β-carotene intake (due to the large amountsof carrot juice consumed as per the Gerson regimen),and alkaline phosphatase imbalances. These were alltransient events that resolved with adjustments in thediet as per the Gerson regimen. The patient is aliveand well in 2006 based on personal assessment by thefirst author and current physician notes, and she con-tinues the Gerson regimen.

Case 3This case is a 59-year-old woman (born in 1947) diag-nosed with lobular carcinoma of the right breast inJanuary 1992 at the age of 45, being node negativeand ER positive. The treatment plan was wide localexcision followed by radiotherapy, the latter com-mencing on January 8, 1993. In May 1995, a surveil-lance mammogram showed microcalcification in herleft breast. Needle biopsy showed ductal carcinomain situ. It was felt to be extensive, and the treatmentplan was left mastectomy. Evidence of invasive lobu-lar cancer was found (size/extent not reported). Theaxilla was not operated on at that stage, no radio-therapy was given, and there was no further adjuvantchemotherapy or hormonal therapy. In December1997, she presented with pain in the right axilla and

Gerson Therapy

INTEGRATIVE CANCER THERAPIES 6(1); 2007 83

breast changes for the past 2 to 3 months; imagingand cytology confirmed recurrent tumor within theright breast together with a palpable node within theright axilla. The patient was being planned for a rightmastectomy and level 2 axillary dissection when stag-ing by CT scan showed evidence of asymptomaticliver metastases (up to 10), although the lungs andbones were clear. She was commenced on tamoxifen.She started the Gerson regimen in January 1998.Tamoxifen was discontinued in July 1999 at thepatient’s own request. In December 1999, she pre-sented with a number of fine nodules and a hard nod-ule in her right axilla, which led to the clinicalconclusion of “clearly showing evidence of local recur-rence of breast cancer.” Tamoxifen was reintroduced.In January 2000, liver ultrasound showed no evidenceof liver metastasis, and the same was shown in anotherliver ultrasound in September 2000. In August 2000, itwas noted that the skin nodules, which had disap-peared, had not recurred. Tests showed that the patientwas postmenopausal, and her hormone treatment waschanged to letrozole. To date, concurrent examina-tions have shown no recurrence of her disease.

Case 4Case 4 is a 33-year-old woman (born in 1973) diag-nosed with anaplastic non-Hodgkin lymphoma follow-ing core needle biopsy of an axillary mass diagnosed inAugust 1999 at the age of 25. The biopsy of the massshowed heavy infiltration by an anaplastic large celllymphoma of null type, with cells being ALK-1 posi-tive, graded at stage IIIa. Concurrent bone marrowbiopsy appeared normal and uninvolved by tumor.International performance index was graded at 2. ACT scan was initially reported as showing para-aorticdisease in the abdomen but no evidence of splenicinvolvement. The findings of the CT were consideredequivocal, but a scintimammograph did showincreased uptake in the para-aortic region. The treat-ment plan was to proceed with CHOP chemotherapy,and she had only 1 cycle of chemotherapy in earlyOctober 1999 before deciding to discontinue treat-ment of her own accord. At the end of October, shecommenced the Gerson regimen. She was taking noconcurrent medication or other treatments at the timeor since. A CT scan of the chest and abdomen onAugust 9, 2001, blood tests, clinical examination by ahematologist, and all subsequent examinations to datehave shown her to be free of disease. She is currentlyalive and well based on physician notes (2006).

Case 5This case is a 68-year-old man (at the time of death;born in 1935) diagnosed with (inoperable) cholan-giocarcinoma. Diagnosis was established by visual

analysis of endoscopic retrograde cholangiopancre-atography and supported by CT scanning. The histol-ogy report of pancreatic tissue suggests atrophy andinflammation, with no malignant cells in the biopsyspecimen. He was diagnosed in May 1997 at the age of62 years following investigations for obstructive jaun-dice. The tumor was felt to be resectable, and the planwas to proceed with surgery. Upon laparotomy onJune 9, 1997, the tumor was found to be unresectablebecause of extensive involvement of the portal vein,and biliary bypass was performed. Chemotherapy wasoffered as a treatment option, but the patientdeclined and started on the Gerson regimen inAugust 1997. A magnetic resonance imaging (MRI)scan on July 31, 1998, reported a 4-cm stricture in thecommon bile duct, with an irregular soft tissue massvisible at the liver hilum. The hepatic artery was seento be surrounded by tumor in the superior portion ofthe pancreatic head. An MRI scan on October 5,1999, suggested that the tumor was progressing but ata very slow pace. The patient was suffering no symp-toms at the time. A review on November 14, 2000,reported a 7 × 7 cm irregular mass in the portal vein,CA 19-9 of 70, no ascites, and no metastatic liver dis-ease, remaining asymptomatic. A review on November8, 2001, reported a CA 19-9 of 204, and physical exam-ination revealed an unremarkable abdomen. A reviewon February 5, 2002, reported evidence of activity inthe tumor; magnetic resonance cholangiopancre-atography showed a large tumor mass extending upthe hilum, around the duodenum, and infiltratingthe retroperitoneum. An MRI scan report on February13, 2003, showed a tumor at the head of the pancreas,now 8 cm, invading the left lobe of the liver. A smallamount of ascites was present. The patient’s diseasethen progressed steadily until his death from cholan-giocarcinoma in April 2003.

Case 6A 44-year-old woman (born in 1962) was diagnosedwith fibrillary astrocytoma following stereotacticbiopsy in August 1993 after 3 seizures in a swimmingpool. The plan was for no immediate active treat-ment, and the patient commenced carbamazepine400 mg. Three months later (November 1993), therewere further seizures, and the patient commencedChinese herbal medicines. In May 1995, MRI scanrevealed evidence of increase in the tumor size, andthe decision was made to resect the tumor. Pathologyfrom the resection showed it to be an anaplasticastrocytoma. The treatment plan was to proceed withradiotherapy (27 fractions), which was given overJune and July 1995. In September 1996, she com-plained of frontal headaches, and after an MRI scan,it seemed that the tumor had recurred in the left

Molassiotis, Peat

84 INTEGRATIVE CANCER THERAPIES 6(1); 2007

temporal lobe, showing a very large cyst behind thearea of craniotomy together with some abnormal tis-sue, but no active treatment was planned. Two con-sultant neurosurgeons agreed with this diagnosisbased on the radiological progression without clini-cal progression of the disease. At this time, thepatient discontinued the herbs she was taking andcommenced Gerson therapy. She continued to haveoccasional seizures. A review in June 1997 showedthat the cyst had decreased quite considerably in size,with no evidence of any active tumor in the sur-rounding area of the brain. A review in November1998 showed no increase in size. In 1999, the Gersonregimen was scaled down (maintenance phase of theGerson regimen), and the homeopathic remedy pul-satilla was added. A review in November 2000 showedno increase in size from the previous year. She hassince had annual reviews with no increase in tumorsize, although symptoms of headaches and seizurescontinued throughout. The patient has continuedon carbamazepine. The patient remains well and sta-ble at present.

DiscussionThese 6 case studies provide some strong impressionsof the potential anticancer effect of the Gerson regi-men. However, a case study cannot and should not beconclusive of the effect of a treatment. It is rather anopportunity to provide an initial attempt to compileplausible arguments about a phenomenon, synthe-size interpretable data, explore appropriate researchquestions for future research, or identify areas thatneed more scientific attention. Hence, what theabove 6 cases provide is compelling survival data thatcould potentially be attributed to the Gerson regi-men, although the data are inconclusive at timesbecause of confounding variables.

Most cases have used some form of conventionaltreatment, either concurrently or before they startedthe Gerson regimen. This fact alone makes interpre-tations problematic. Case 5 is, however, a fascinatingexample of someone who declined conventionaltreatment of a cancer that untreated would havereduced the patient’s survival to 3.2 to 6.6 months.11,12

While on the Gerson regimen, he experienced a veryslowly progressing cancer and a 6-year survival.Furthermore, case 4 had only 1 cycle of chemother-apy, unlikely to have sufficiently managed her lym-phoma. The above 2 cases have no confoundingvariables of past or concurrent treatments, and theoutcome should be attributed to the Gerson regimenwith some degree of confidence.

Cases 1, 2, 3, and 6 have, however, confoundingvariables including concurrent use of complemen-tary therapies (case 2), Chinese medicine (case 6),

concurrent use of (conventional) hormone therapy(case 3), and use of radiotherapy (cases 3 and 6) andsurgery (case 1). Homeopathic remedies used incases 2 and 6 were for symptom palliation only (asexplained by the patients) and are unlikely to affectthe course of the tumor itself. Carbamazepine use(case 6) has no known anticancer activity, being anantiepileptic drug. Case 3 is less impressive, as con-current use of hormone therapies makes it difficultto assign an effect to one or the other treatment,although it may be the combined effect of the 2 treat-ments that could account for this extraordinary sur-vival story of a woman with a metastatic disease ofpoor prognosis. However, studies in the past haveshown no effect of tamoxifen used alone on metasta-tic liver disease unless it was used in combinationwith 5-FU and interferon,13 which did not take placein our case. Other limitations of the current reviewinclude the insufficient data on how the patients fol-lowed the Gerson regimen over the years, which andhow many adverse effects were attributable to it, andhow serious those events were. Despite the above lim-itations in the data, patients seem to have benefitedfrom the alternative therapy they used both in termsof survival (Table 2) and maintenance of a good qual-ity of life (as shown in the medical records judged bythe patients’ overall health and communicated bysome of the patients).

Besides the presence of confounding variables thatmake interpretations difficult, the natural progressionof some of the cancers mentioned in this review mayfurther complicate interpretations and may make thereviewed cases less compelling. For example, review-ing oncologists commented that melanoma is anunusual malignancy in that it can excite an immuneresponse, and spontaneous remissions do occasionallyoccur, estimated at less than 5%,26 especially inpatients with small-volume locoregional disease, as incase 1. Also, tumor shrinkage was reported in case 6;clinical experience suggests, as also commented byreviewing oncologists, that postoperative hematomachanges can be misinterpreted as disease progressionif scans are done more than 72 hours postsurgery,which normally settles over 3 months. This can be mis-read as tumor shrinkage. While the cyst may have beena hematoma, the presence of abnormal tissue supportsthe diagnosis of disease regression.

The key questions are whether the Gerson therapyimproves survival and whether patients with cancerobjectively benefit from it. The retrospective review byHildenbrand et al7 showed that patients with malig-nant melanoma appeared to benefit in terms of sur-vival. The review of patient records in Gerson clinics inMexico in the late 1980s undertaken by British physi-cians found no evidence of the regimen’s survival

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Molassiotis, Peat

86 INTEGRATIVE CANCER THERAPIES 6(1); 2007

benefit, although the authors commented that a smallnumber of patients did show improvements.9 The psy-chological part of the same investigation suggestedthat the patients were helped psychologically throughthe use of the Gerson regimen by increasing theirhope and empowering them.9

The medical establishment has taken a negativeand dogmatic approach toward unorthodox thera-pies.27 However, such preliminary indicators com-bined with a large number of anecdotal reports ofextraordinary survival merit more scientific attentionusing appropriate and systematic monitoring andprospective evaluation of objective patient outcomes.The medical community has spent considerable timeand energy in the past 50 or more years arguingagainst the Gerson regimen through letters to theeditor, commentaries, discussion and opinion papers,review of (almost always) incomplete patient follow-up data, and legislation and directives against the useof the Gerson therapy, and neither side (for theirown reasons) has put any effort into getting evalu-able and interpretable data that would stand scien-tific scrutiny. Funding for 1 large and well-controlledprospective study would have been sufficient to givesome key initial answers.

Could the Gerson regimen have physical effects inpatients with cancer? A number of researchers haveshown that this is possible based on laboratory exper-iments, including the finding that a high-potassium/low-sodium environment (as that induced by theGerson regimen) can partially return damaged cellproteins to their normal undamaged configuration.28

Other medical hypotheses have also been discussedin the literature.29,30

Could the effects of the Gerson regimen be theresult of the patients’ psychological responses to thecancer? This is also possible, as complementary andalternative medicine therapies in general empowerpatients, increase hope and optimism, and can helppatients cope better with their very stressful cancerjourney.31 Some studies argue, including Spiegel’slandmark study,32 which was further confirmed bysome later studies,33,34 that a better psychologicalstatus is associated with better survival rates. However,the literature on psychological interventions and sur-vival in cancer has shown mixed results, and the evi-dence specifically from support group interventionsis not convincing.35

Careful dietary manipulation may at least improvequality of life in cancer patients and potentially alsoincrease survival.36 Indeed, a considerable researchactivity in the breast cancer field suggests that this maybe linked to some lifestyle factors by reason of its highincidence in Western society.37 Although multiple fac-tors appear to increase the risk of breast cancer, diet is

one of the most important lifestyle factors associatedwith it.38-41 Dietary interventions that have beenassessed for their potential effect on breast cancerrecurrence emphasize fat reduction and increasedvegetable intake42,43 (key dimensions of the Gersonregimen). Indeed, an analysis of computerized dataon lifestyle changes that preceded many spontaneousregressions of cancer (n = 200) indicated that 55.6%of the sample had used some form of detoxification(ie, coffee or castor oil enemas or fasting), 87.5% hadmade major dietary changes, more usually a strictlyvegetarian diet, and 55% had taken a mineral supple-ment, most commonly potassium and iodine.44 Most ofthe above are in one way or another parts of theGerson regimen. Another regimen with some nutri-tional similarities with the Gerson therapy, theGonzalez diet, has shown positive outcomes in advancedpancreatic cancer.45 Hence, dietary manipulationcould play a major role in preventing cancer recur-rence.

Some patients will continue to choose complemen-tary or alternative medicine, regardless of whetherhealth care professionals agree with these choices. Itwould be best if their decision making is well informedby providing accurate information on such alterna-tives. A common concern of health care practitionersis that patients turning to alternative medicine willdelay potentially effective conventional treatments,decreasing their chances of survival. However, researchhas shown that most patients turn to such optionswhen the orthodox medicine is unable to offer any-thing more.46

It would be worth exploring such a dietary regimenin the future and moving away from our conceptualstruggle with modern high-tech medicine. We have aresponsibility and a professional duty to help patientsmake the best treatment decisions for themselves, andthe only way to do so with regard to the Gerson regi-men is to carry out a prospective evaluation of its effi-cacy in a rigorous manner. A randomized trial, thegold standard of evidence-based medicine, may not bethe most appropriate or even ethical design, as it isdoubtful if patients would be willing to be randomizedto the Gerson regimen. Indeed, the National Institutesof Health has funded a clinical trial of a similarlyintense dietary regimen, the Gonzalez regimen men-tioned earlier, and although it started as a randomizedtrial, eventually the design had to be drastically modi-fied, as patients were unwilling to accept randomassignment to treatment groups.14 A preference trialor a prospective case-control trial may provide moreappropriate approaches. Studies should look not onlyat survival benefits but also at psychological and quality-of-life variables as well as symptom experience. Safetydata would also need to be collected.

Gerson Therapy

As the Gerson regimen is a very intense regimenand requires a significant amount of time, energy, andresources to be carried out, it may be more appropri-ate to consider the different elements of the regimen(preserving the principles of the therapy) and assesswhat is their contribution to improving the physicalhealth of cancer patients and whether it decreasesrecurrence of the disease. It may also be more appro-priate to attempt to integrate this regimen in selectedspecialist conventional treatment centers, in whichpatients would have appropriate follow-up by medicalpractitioners, medical supervision, and a higher regardfor patient safety than that experienced by somepatients on a number of occasions. Monitoring ofpatients is essential as they may be at risk of dehydra-tion and loss of micronutrients from the daily enemasand develop calorie, protein, vitamin, and mineraldeficiencies. Hence, appropriate monitoring of albu-min, transferin, vitamin B12, blood urea nitrogen, andfolic acid levels should take place regularly in an inte-grated environment. The study by Lechner andKronberger8 also clearly suggests that the Gerson ther-apy could be equally effective when given concurrentlywith surgery or other orthodox treatment modalities(although this study was not a randomized trial and allpatients had received conventional treatment). Thismay be a more preferable therapeutic approach, andits benefits were also evident in case study 3 describedearlier.

Although the effectiveness of the Gerson regimenhas not been rigorously proved, equally it has notbeen disproved either. Hence, while the situation isfar from clear, patients will continue to turn to it(and other similarly intense and unproven alterna-tive therapies) in the years to come, in a desperateattempt to keep alive when everything else has failed.A definitive trial on the efficacy of the Gerson regi-men is long overdue. Information from such a trialwould be of great value as it would assist patients tomake informed decisions, protect their safety, andadd to the patients’ choices in improving their sur-vival chances and quality of life in their fight againstcancer.

AcknowledgmentsWe would like to thank the patients who shared theirexperiences with us and the UK-based GersonSupport Group for facilitating communication betweenthe patients and the researchers and for actively par-ticipating in the study.

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