Interestingly, Austin also tracked eighteen late-stage cancer patients at Hospital Del Mar in Tijuana, a clinic run by Drs. Francisco Contreras and Ernesto Contreras, which combines metabolic therapy with detoxification, laetrile, enzyme supplements, megadoses of vitamins, and special vaccines. All eighteen patients died within three years of their stay at the Contreras clinic, according to Austin. "On the basis of these results, I recommend that all cancer patients avoid the laetrile clinics, despite the fact that I've run across occasional anecdotes suggesting efficacy. Even if a rare patient is helped, zero out of eighteen is a terrible indicator," says Austin.

More positive evaluations of the Gerson therapy, and scientific research supporting the validity of key components in the Gerson protocol, will be discussed later in this chapter.

The Gerson clinic lacks the staff to monitor patients' conditions once they return home. Gerson Institute members tend to explain the therapy's failures by saying those patients either did not follow the regimen strictly enough or went off the therapy. This is often true, but sometimes patients discontinue the therapy because they are no longer seeing results: tumors continue to grow or the patient becomes too weak to adhere to the program.

What is beyond dispute is that the therapy is not easy to follow. It's a rigorously demanding approach and should not be undertaken without the intention to persevere. Sticking to the regimen may sometimes seem like a full-time job. In his book, Max Gerson cautions, "It is advisable not to start the treatment, if for any reason strict adherence to it is not possible." Each element in the therapy is important, and all are interrelated in their workings. The diet is restrictive. Milk, most cheeses, and butter are forbidden, as are tobacco, salt, coffee, tea, cocoa, chocolate, alcohol, sharp spices, refined sugar and flour, candies, ice cream, cakes, nuts, mushrooms, soybeans, pickles, cucumbers, and all berries with the exception of red currants. Also taboo are canned, frozen, processed, smoked, salted, dehydrated, powdered, or bottled foods.

Juices must be freshly squeezed every hour so that the oxidizing enzymes will not be destroyed by light or air. Even the type of juice extractor and grinder are specially selected. Standard home juicers are not recommended because the electric charge produced by their centrifugal actions destroys enzymes and their preparation process mixes oxygen into the juices, hastening their decomposition. Gerson patients are encouraged to buy a more expensive, stainless-steel grinder and press.

After treatment at the Gerson hospital, patients are advised to continue the regimen at home for one and a half years or more, until the liver, pancreas, and oxidation, immune, and other systems have been restored sufficiently to prevent a recurrence of cancer. The support of family and close friends-both emotionally and on a practical level-is believed to play a vital role in the therapy's success.

For those who do persevere, the benefits can be dramatic. "It's a lot of work," says Charlotte Gerson, "but those people who want to be well, and remain well, with their bodies rebuilt, with their organs rebuilt, and normal and functioning, they go through it, and they do the job, and they regain health in all areas, whether we are talking about cancer, multiple sclerosis, rheumatoid arthritis, glaucoma, kidney disease, or even diabetes."

The therapy is multifaceted. Dr. Gerson placed great emphasis on the liver, which he believed to be the body's most important organ in defeating malignancy. He maintained that nearly all cancers were allowed to develop because of poor liver function. Support for this view comes from Dr. Jesse Greenstein, former chief of the National Cancer Institute's biochemistry laboratory. In his 1954 book, Biochemistry of Cancer, Greenstein wrote, "There seems to be little doubt that hepatic insufficiency is a concomitant phenomenon with cancer." According to Dr. Raymond Brown, former investigator at Sloan-Kettering Institute for Cancer Research, Gerson's "thesis that a damaged liver is a primary precursor of degenerative disease is consistent with current concepts that liver status reflects the functional capacity of the reticuloendothelial system.", The reticuloendothelial system defends against infection and disposes of the products of cell breakdown. It is composed of macrophages, liver cells, and cells of the lungs, bone marrow, spleen, and lymph nodes.

The liver, the body's largest organ, weighs seven to ten pounds and performs a multitude of tasks. Among its vital functions are metabolizing essential fats (and thus preventing their accumulation in the bloodstream), synthesizing necessary blood proteins, breaking down and eliminating toxic substances, and secreting bile, which is stored in the gallbladder and the enlarged bile duct. Bile, which empties into the small intestine, acts as a carrier for all liver wastes. One reason animal proteins are drastically reduced on the Gerson diet is that they have been found to interfere with liver-boosting medications and to impede the detoxification process. Keeping animal protein at a minimum frees the protein-dissolving enzymes to "digest" cancer tissue rather than food, according to Max Gerson.

Gerson also found that both animal and vegetable fats have the effect of promoting tumor growth. Whenever he eliminated fats from his cancer patients' diets, the results improved substantially. Recent research supports his finding. Studies show that the higher the level of cholesterol and fats in the blood of cancer patients, the less chance the patients have of surviving. Cancer patients receiving Gerson therapy therefore avoid both animal and vegetable fats. An exception is linseed oil, which helps the body transport vitamin A. Linseed oil has been shown to have antitumor action, and it is rich in an essential fatty acid that reduces blood viscosity. Low blood viscosity correlates with a decreased tendency to spreading (metastases) of cancer.

Eliminating animal protein is only one aspect of Gerson's liver therapy. Patients are also given injections composed of liver extract, administered daily for four to six months, sometimes longer. These liver injections provide vitamins, minerals, and enzymes believed to help restore the liver to its proper functioning. Intramuscular injections of liver extract are combined with vitamin B~12 injections, which Dr. Gerson held to be important for proper protein synthesis. Full restoration of the liver may take from six to eighteen months, during which time patients should have their blood monitored by a physician so that the supplements and diet can be adjusted.

Nobel Prize-winning biochemist Dr. Albert Szent-Gyorgyi believed that the liver may hold the secret of cancer prevention and cure. In 1972, he reported that extracts of mouse liver "strongly inhibited" the growth of inoculated cancer in mice. He and his associate, Dr. Laszlo Egyud, isolated from liver extract a potent anticancer substance, which they dubbed retine. This liver derivative proved so effective in the laboratory, Dr. Szent-Gyorgyi was moved to predict, "We are on the verge of finding the key to curing cancer.... Retine stops the growth of cancer cells without poisoning other cells."4

Another major feature of the Gerson therapy is restoring the balance of potassium and sodium in the body. Dr. Gerson maintained that cancer alters the body's normal sodium-to-potassium balance, already disturbed by the modern oversalted diet. Liver, brain, and muscle cells normally have much higher levels of potassium than of sodium, but in cancer patients, observed Gerson, the ratio is reversed. The Gerson therapy aims to remove as much sodium from the cancer patient's body as possible, replacing it with potassium. The diet stresses foods rich in potassium and low in sodium, with no salt added.

In addition, patients receive a potassium solution, added to juices ten times daily. Edema, or fluid retention, caused by an excess of sodium, reportedly disappears with great frequency when patients ingest high amounts of potassium in juices. Restoring potassium levels to normal in the major organs of severely ill patients can take a year or two.

Gerson's emphasis on restoring the potassium balance in cancer patients finds considerable support in modern research. Several studies outline rationales to explain Gerson's theory that elevating the potassium level while restricting sodium in the diet acts against tumor formation.5 Freeman Cope, M.D., wrote in Physiological Chemistry and Physics in 1978, "The high potassium, low sodium diet of the Gerson therapy has been observed experimentally to cure many cases of advanced cancer in man, but the reason was not clear. Recent studies from the laboratory of Ling indicate that high potassium, low sodium environments can partially return damaged cell proteins to their normal undamaged configuration. Therefore, the damage in other tissues, induced by toxins and breakdown products from the cancer, is probably partly repaired by the Gerson therapy through this mechanism."

Supplying oxygen to the cells is another central feature of the Gerson therapy. Dr. Gerson believed that cancer cells thrive by fermenting sugar in an oxygen-depleted cellular environment. This still-controversial theory, put forward by the great biochemist Otto Warburg in 1930, has some support in modern research. To enhance the patient's oxidation function, Dr. Gerson gave patients oxidizing enzymes through vegetable, fruit, and raw-calves'-liver juices. The Gerson clinic discontinued the use of raw-liverjuice in 1989, but the present diet is still a rich source of oxidation enzymes. These enzymes are also produced naturally by a healthy, restored liver. Through the Gerson treatment, "oxidation is usually more than doubled," says the patient brochure, which adds that "most 'incurable' diseases are oxygen deficiency diseases also (heart attack, strokes, cancer, etc.)."

Tumor breakdown begins, according to Max Gerson, when the detoxification process is active, the repaired liver is producing oxidative enzymes, and the potassium-to-sodium balance has been restored. Once the body starts breaking down and eliminating the tumor, detoxification is critical so that the liver is not overloaded with toxins. Here is where the coffee enema becomes especially important. Some recent scientific research gives credence to the coffee enema as a detoxification measure. In 1981, for example, Dr. Lee Wattenberg and colleagues demonstrated that substances found in coffee promote the activity of a key enzyme system that detoxifies a vast array of electrophiles from the bloodstream. According to Gar Hildenbrand of the Gerson Institute, this "must be regarded as an important mechanism for carcinogen detoxification." This enzyme group is responsible for neutralizing free radicals.

Dr. Peter Lechner, who is investigating the Gerson program in Graz, Austria, has reported that "coffee enemas have a definite effect on the colon which can be observed with an endoscope." Two chemicals in coffee, theophylline and theobromine, dilate blood vessels and counteract inflammation of the gut. Palmitates, a group of substances also found in coffee, enhance the enzyme system responsible for the removal of toxic free radicals from the serum. (Note: While coffee enemas are part of the Gerson program, drinking coffee is forbidden.)

For a full review of the scientific research supporting the use of coffee enemas, see Ralph Moss's two-part article "Coffee: The Royal Flush," in The Cancer Chronicles, Autumn 1990 and December 1990.

The Gerson diet features three organic vegetarian meals daily. Along with a potassium supplement, six of the thirteen daily juices contain three drops of half-strength Lugol solution, an iodine-potassium compound, plus a small amount of thyroid extract. Dr. Gerson theorized that these substances are absorbed by the cancer mass along with the oxidizing enzymes. The combination makes it impossible for the cancer cells to ferment, and they die, he held. Iodine appeared to him to be a decisive factor in the normal differentiation of cells. He believed that iodine also counteracted the cancer-stimulating effect of certain hormones. Several studies validating Gerson's hunches have shown that thyroid extract boosts natural resistance to infection by increasing antibody formation and augmenting the power of reticuloendothelial cells.