I know what you’re thinking. Why is she now writing to me about my Christmas décor? Don’t I have a fake Mistletoe plant shoved in with my Christmas decorations somewhere? I’m sure you do. You’ve likely thought about stealing a kiss underneath it – why, I don’t know - but using it to treat cancer probably never crossed your mind.
This month we’ve been talking all things ‘unconventional’ about everyone’s least favorite topic: Cancer. Vaccines are probably right up there with respect to cringeworthiness, but we’ll save that nightmare of a convo for another time.
Unless you’ve been living under a rock, most people are familiar with standard cancer care: cut, poison, radiate. In the three previous posts, I explained why I believe that approach so often fails - the focus on fear, the failure to eradicate cancer stem cells, the lack of spiritual support, and the massive collateral damage to healthy cells. We have a ton of tools available to us outside of that framework. Some you’ve no doubt heard of, others probably not so much. Mistletoe likely falls in the latter category, so I would like to dedicate a bit more time to that topic. Let’s get into it.
To briefly recap on the current state of affairs, cancer doesn’t seem to be going away anytime in the foreseeable future—quite the contrary. Malignancy rates have been on a steady increase for decades with a frightening exponential spike upwards in the past few years. Despite novel therapeutics cancer death rates are the same today as they were in the 1950s. Drug development has no doubt shifted towards immunotherapy and away from more traditional chemotherapy as its cornerstone treatment – which is where botanical medicine started thousands of years ago. Funny how things come full circle.
Viscum album, or European Mistletoe, was the OG of immunotherapy. The Druids and Celtic naturopaths were the first in recorded history to use Mistletoe in medicine to treat cancer, arthritis, ‘ailments of the heart’, epilepsy, and fertility as far back as 50 BC. How’s that for historical use? In modern times, the use of mistletoe in oncology was pioneered in the early 20th century by Dr. Ita Wegman, a Dutch physician, who developed the first injectable mistletoe extract for cancer patients.
The Down Low on Mistletoe
I’m no botanist, but I know enough to tell you that all Mistletoe isn’t created equal. Think ‘roses’. There’s the climbing variety, the shrubby ones, the kind you need to toile endlessly over, and the type you couldn’t kill if you wanted to. Unless you’re me, of course. Then no plant is safe. Anyway… Mistletoe varieties are similarly different from one another. Mistletoe is a hemi-parasitic or semi-parasitic plant (depending on who you ask) that grows on various host trees, including apple, oak, maple, elm, pine, and birch. Parasitic plants are like your kids and your money. For whatever reason they don’t have any so they need yours to survive.
OK – that’s not a fair analogy. Mistletoe needs a host tree, but it does not kill its host, rather it preserves it. Cancer, a true parasite, and Mistletoe appear to be complete opposites in this regard. Native to Europe and Western Asia, European mistletoe (referred to as Viscum album) has a long history of medicinal use dating back to ancient civilizations. Early folks long recognized the plant's medicinal properties and healing powers.
From here on out, I’ll be referring exclusively to European Mistletoe (Viscum album) – not the American Mistletoe which is the kind you hang over your door at Christmas . Aside from one having white berries and the other having red, the key difference lies in the basic constitution of the two types of mistletoe, particularly in their content of bioactive compounds. Things with names like lectins and viscotoxins, which are the key proteins that shake up the immune system and make European Mistletoe/Viscum album an exciting tool in the war on cancer.
Viscum Album
Sugar Spice & Everything Nice
Lectins, viscotoxins, and yadda yadda yadda. OK. So, plants contain important stuff. It’s why your mother made you eat spinach as a child. They have proteins, polyphenols, flavonoids –lots of big words behind their flowers, stems, and leaves. Mistletoe is no different. Some of these compounds are capable of modulating the immune system. Different plants contain different things, but all plants have these in one form or another.
Analogy: Nightshades
Nightshade vegetables are notorious for their high content of a protein called lectins, which is great at irritating the human immune system. Tomatoes, bell peppers, potatoes, eggplant. They look so beautiful in my summer garden photos, but lurking behind their skins are powerful proteins that really piss off our immune system. These proteins are called lectins. Lectins are plants' defense mechanisms. They are the equivalent of your immune system’s killer cells. Look, plants need to defend themselves too. They weren’t just put here on the planet to be pretty or be food for animals. They never would have survived this long.
When animals eat foods that are high in lectin content, they get sick. Imagine it’s early in summer. The nightshade plants are just starting to set fruit. A bear walks by. He’s hungry. The tomatoes are green but come on. They’re tomatoes. If Festival Foods can ripen them in the back with red spray paint, how under-ripe can they be? So, our bear eats a bushel full of green tomatoes. Half an hour later he’s regretting this decision. After sixty minutes and a bath in the river, he’s telling his friends – ‘Hey, I seriously just crapped my brains out over there near that brambleberry bush. I’m telling you, go easy on the green tomatoes.’ And the rest of his bear buddies knowingly respect the tomatoes.
But then August rolls around. The tomatoes are feeling seductive. They lower their lectin content while they turn up the volume on sugar. Omg. The tomatoes smell so good. The bears forget about the early summer warnings and try the fruit again. And...nothing. No embarrassing accidents. No joint pain. Ok, maybe a little bit of the porridge being too hot situation, but they are miles away from that tomato plant before anyone has a code brown incident. The remaining high lectin containing tomato seeds run from top of the bears’ digestive track into the soil and the cycle of life continues.
Mistletoe – A Different Kind of Immune System Kick
Like the Nightshades, Mistletoe also contains immune-modulating compounds. They're different from those found in tomatoes, but the human body very much recognizes them as ‘well, well, what do we have here?’ These constituents heighten immune system activity, increase the quantity of specific immune cells, and directly inhibit the growth of cancerous tumors. What’s crazy is that these compounds vary based on which kind of tree our Mistletoe happened to be growing on and what time of year the plant was harvested. Pretty cool stuff. There are many different active compounds in Mistletoe extract, but the two that do the bulk of the heavy lifting when it comes to giving your immune system superpowers are called lectins and viscotoxins. Collectively, they work as natural immunotherapy by bolstering your innate immune system function and directing an all-out assault on cancer cells.
The three primary Mistletoe lectins were creatively named, Lectins I, II, and III. I might have chosen something more exciting like Darkhorse, Dragon Slayer, and Don Junior, but no one asked me. At incredibly low doses, these lectins upregulate apoptosis of cancer cells and confer direct cancer-killing properties. The Mistletoe viscotoxins are regarded as plant defensins. These compounds help protect the plant against bad guys like bacteria and fungi. In similar fashion, viscotoxins help protect the human immune system against invaders like cancerous tumors. What’s interesting about Mistletoe extract is how selective it is for cancer cells. This isn’t carpet bomb approach; it is smart and tactful. Healthy cells are safe, cancer cells are not. The power of Mistletoe lies in the complementary nature of all its compounds. There is no one mechanism of action here. The whole plant works together synergistically to produce its apoptotic and immunomodulatory effects.
That term ‘immunomodulatory’ is important here. Unlike many of our conventional immunotherapies, Mistletoe extracts don’t overly stimulate or suppress immune system function. They pull it back to center, positioning it to be perfectly on target to battle cancer. Additionally, Mistletoe therapy just helps people feel better. It can improve quality of life by reducing side effects of conventional treatments, such as fatigue, nausea, and loss of appetite. Mistletoe can enhance overall well-being and energy levels, provide pain relief and reduce the need for painkillers, and extend survival rates in some cancer patients.
Extracts Commonly Used in Cancer Therapy
Several European companies make Mistletoe extract and they all do it a little bit differently. I don’t know that we need to get into the weeds on this, but some companies use aqueous extracts, some ferment their extracts. Some companies only source from a few different host trees, others run the whole gamut. Some extracts are really high in lectin/viscotoxin content, others have much less. Regardless of their similarities and differences, the three biggest and most established companies are Iscador, Helixor, and AbnobaViscum. Helixor Mistletoe extract is the most easily accessible brand here in the US and as such the one I am most familiar with.
Mistletoe extract is named by its brand and then by its host tree. Here’s some Latin 101 for all you scholars out there.
Abietis (A) = Fir
Fraxini (F) = Ash
Mali (M) = Apple
Pini (P) = Pine
Quercus (Q) = Oak
There are a lot more host trees being commandeered by Mistletoe plants out there, but that gives you an idea anyway. So, if your Helixor brand Mistletoe extract came from a fir tree, it would be called “Helixor A.”
Who gets which extract from what tree made by which company is a complicated art form. When initially studying this, I went searching for my long-lost Magic Eight Ball from residency, but then learned that pairing patient to potion was a bit trickier than just testing for wind direction. Many factors play a role in selecting the best host tree and formulation for each individual person including gender, general constitution, body type, lectin content, and type of cancer being targeted. Short story: leave the extract selection process to a physician trained in such things.
Mistletoe Administration
When used in the setting of cancer, Mistletoe extract is given by way of a needle. It’s most commonly given via subcutaneous injection, but in some cases, it is used intravenously or even injected directly into the tumor itself. I know you all hate needles but I believe you hate cancer more. You definitely hate cancer more than a teeny tiny needle. Don’t you? Time for your brave face. I have every confidence you can do this. Unless you’re my husband and then you will refuse and make me do it for you. But everyone else I have full confidence in.
I love you, babe.
Injections are typically given every other day or 3 days per week. The dose is started low and gradually increased until the ‘target dose’ is determined. This is the dose that causes a mild but observable injection site reaction. The reaction doesn’t happen right away. It typically happens 12-24 hours after the injection and looks like a slightly raised pink circle in the area of injection about the size of a quarter. I tell patients we’re looking for something about 1-2 inches across at the largest diameter. That reaction means we’ve struck gold. The immune system is turned on, charged up, and in ‘kill cancer mode’. Money.
Sometimes that dose is really small. Sometimes the dose is really big. It doesn’t matter. Everyone is different. We just need to get to that dose and continue with every other or every third day injections. There are reasons to try to push that dose or change the schedule, but in general, this is the program. The first injection is typically taught in the office, the rest are done in the comfort of a patient’s own home.
The overwhelming majority of people will have an injection site reaction. But some don’t. In a small subset of patients, it’s a slight increase in body temperature that signals the target dose. Not a fever per se, but an increase in body temperature of about one degree Fahrenheit between morning and afternoon above what is typical for that person. Basic labs like CBC, CMP, ESR, hsCRP, and LDH are often done on a monthly basis to keep an eye on things. These are inexpensive measures to make sure your immune system is in the driver’s seat and not the cancer.
To recap, Mistletoe therapy is typically administered subcutaneously (under the skin) or intravenously. The subcutaneous injection is the most common method and involves:
Injection Site: Usually on the abdomen.
Frequency: Typically three times per week.
Initial Administration: The first injection is often done under medical supervision to demonstrate proper technique and monitor for allergic reactions, which are rare.
Injection Site Reactions: Common reactions include localized inflammation, swelling, redness, tenderness, and itching. These reactions are indicative of the body’s immune response.
The therapy can be cycled with periods of administration followed by breaks, tailored to the patient's condition and response to treatment. Continuous monitoring and adjustment are essential to maximize therapeutic benefits and minimize side effects.
The Art & Science of Warmth
This Mistletoe situation is largely supported by the ‘Physicians’ Association for Anthroposophic Medicine’ which is the European equivalent of ‘Functional Medicine’ physicians here in the United States – at least in terms of philosophy. Loosely. Treating the patient as a whole, supporting mind, body, and spirit, and discovering and managing root causes. The Anthroposophic docs might be considered a bit more woo-woo even than us functional folks. They are much more connected to source and energy and use these concepts in their practices with skill. I’m going to do a PubMed search to determine which host tree to select for a patient. They’re going to use the Force. Got me?
Mistletoe is considered a ‘warming therapy’ – and not just because of its ability to raise body temperature, although it can certainly do that. A common misconception is that fever is something that needs to be treated. Physiologically, the body intentionally warms up in the setting of an infection as a means to kill invading pathogens.
Interestingly, if we look at a person’s ‘warmth’ as their body temperature, we can observe a slow but consistent decline over time. A research study titled ‘Decreasing human body temperature in the US since the Industrial Revolution’ gathered data from 1860 to 1940, 1971 to 1975, and 2007 to 2017. They reported a 0.05 degree decrease in the body temperature of both men and women every 10 years since 1860. Today’s average body temperature is 97.9 – not 98.6, which was long considered to be ‘normal’. Probably because of global warming.
Not only do our temperatures seem to change from one generation to the next, they fluctuate from sunrise to sunset as well. We’re about 1 degree warmer in the afternoon than we are when we first wake up. This observed natural variation in body temperatures is often incorporated into Mistletoe therapy – Mistletoe bringing warmth and something else to encourage cool.
Helleborus Niger
One such adjuvant is the Christmas Rose, or Helleborus Niger. Another crazy plant that flowers in winter when everything else is dead. If Mistletoe is the ying of the story, Helleborus is the yang. Both plants bloom in the winter, but that’s pretty much where their similarities end. One brings the tide, the other sees it fall. The two therapies are intertwined in a rhythmic ebb and flow like dance with one another, constantly keeping the immune system on its toes.
Helleborus is often used alongside Mistletoe therapy on alternating days or even at different times of the day. It is used most frequently in cases of lymphoma, leukemia, myeloma, sarcoma, prostate cancer, and metastatic complications. High dose intravenous vitamin C is also considered a cooling therapy and is often utilized alongside Mistletoe and Helleborus.
Mistletoe Fever Induction Therapy (MFIT)
Fever is an interesting phenomenon. If you remember the last time you had one, you likely recall how miserable you felt. Fever raises body temperature in an effort to kill toxins, but the temperature change simultaneously kicks the immune system into high gear. Although uncomfortable, fever is a major workout for your immune system. A study published in 2001 noted that patients who never experienced fevers were 2.5 times more likely to develop cancer at some point in their life compared to those who’d had fevers in the past. Several studies have observed spontaneous remission of cancer in patients following an acute febrile illness.
Medical hyperthermia is the practice of intentional fever induction for the sole purpose of stimulating the cytotoxic and modulating effects of the immune system. Mistletoe fever induction therapy involves the use of mistletoe extract to deliberately cause a fever in cancer patients. It is far more intense than the effects seen with subcutaneous injection. Mistletoe is often administered via injection without febrile effects, but if dose is adjusted upwards it certainly can cause one. MFIT is typically high lectin IV Mistletoe or high dose subcutaneous Mistletoe given to stimulate a fever to 100.4 to 104F. Historically, this fever therapy is provided a couple of weeks before chemotherapy in an effort to enhance the effects of conventional therapy.
As to not confuse the two, MFIT is similar to medical hyperthermia, but not as aggressive. Temperatures upwards of 106F (up to 114F using localized therapy) can be achieved with medical hyperthermia but are done under strict medical supervision or hospitalization with liberal use of binders and alkalizing agents to assist the body with detox and maintain optimal pH. Both therapies aim to "wake up" the immune system and make it more active against cancer cells.
Dramatic Responses to Mistletoe Therapy
There are potentially two rather dramatic responses reported with Mistletoe therapy: Tumor lysis and pseudo tumor progression. I mention these because although both indicate a positive response to therapy, both can be frightening on the front end.
Tumor lysis refers to the rapid breakdown of cancer cells. When cancer cells are destroyed quickly, their contents are released into the bloodstream. This can cause a surge of cellular debris and metabolic byproducts that the body must process. While this indicates that the therapy is working, we don’t want too much too fast. If signs of tumor lysis occur, Mistletoe therapy is paused until symptoms subside and restarted at a lower dose.
Pseudo-tumor progression is a temporary increase in the size of a tumor observed on imaging scans, despite the therapy being effective. It’s not actual tumor growth but rather a response to treatment. As the immune system attacks the tumor, inflammation and fluid buildup can make the tumor appear larger temporarily. Over time, the inflammation subsides, and the true reduction in tumor size becomes apparent. For this reason, imaging is typically avoided in the first 6 to 8 weeks of Mistletoe therapy.
Contraindications
Latex, banana, avocado, kiwi, and chestnuts have lectin content with similar composition to that found in Mistletoe extract. True cross reactivity allergic reactions are extremely rare, skin testing is recommended before starting injections in patients with allergies to these things.
Pregnancy (first trimester). Nothing is intentionally studied in pregnancy because those studies aren’t considered ethical to do. ‘Hey pregnant lady, want to be in our safety study to test out this therapy on your unborn child?’ Yeah, no. The Mistletoe folks report safety in the latter stages of pregnancy, but a real discussion on risk benefit analysis needs to be had first.
Brain lesions can be seen as both primary and metastatic tumors. Your brain is inside your skull which is hard as a brick. Not much for wiggle room. Any therapy aimed at treating brain lesions is tricky because of the potential for tumor lysis and/or pseudo progression. Swelling inside the skull increases the risk for bad things to happen. Conventional management utilizes high doses of corticosteroids to keep inflammation under control. Because of its potential to cause tumor progression, Mistletoe is typically contraindicated in brain lesions but has been safely conducted in closely controlled settings with low lectin content extracts.
Conclusion
While Mistletoe therapy is widely accepted and used in Europe, it remains less mainstream in other parts of the world, including the United States. Ongoing research continues to investigate its efficacy and potential integration into broader oncological practice, but plants can't be patented so... Studies reporting its utility in treating hypertension, Alzheimer's disease, mood disorders, wound healing, liver and kidney dysfunction, epilepsy, and overall anti-aging properties continue to mount suggesting this plant can do far more than just cancer. Mistletoe has a centuries long history of medicinal use and is now gaining recognition if not by the conventional care system, certainly by those with eyes to read. The data speaks for itself. Extracts such as Iscador, Helixor, and Abnobaviscum are valued for their ability to support conventional cancer treatments and improve patients' quality of life, making Mistletoe therapy a significant area of interest for those of us wanting to make in roads for the millions of people suffering with cancer.
The U.S. Food and Drug Administration (FDA) has not approved Mistletoe extracts as a treatment for cancer or any other medical condition.
Resources
Biological activity of mistletoe: in vitro and in vivo studies and mechanisms of action
Efficacy and safety of mistletoe preparations (Viscum album) for patients with cancer diseases. A systematic review
Safety of higher dosages of Viscum album L. in animals and humans--systematic review of immune changes and safety parameters
Use and safety of intratumoral application of European mistletoe (Viscum album L) preparations in Oncology
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