Back-to-School Tips for Staying Healthy

HEALTHY TIPS FOR BACK-TO-SCHOOL

It’s back to school time for kids and teenagers, which is an extra busy time for parents and their children and may be an extra stressful time due to the ongoing COVID-19 pandemic. Are you wondering what you can do to make back-to-school time healthier for your young ones and family? We’ve put together a few tips and tricks to support parents and their kids during this time, and ways in which naturopathic medicine can help!


Make healthy lunches

Although another to-do list item, healthy lunches can go a long way in helping your child thrive during their school year. A lunch packed full of vital nutrients supports their immune systems, cognitive/learning capacities, weight and activity levels. Some tips are:

  • Choose water over juice, pop and other sugary drinks

  • Always include vegetables

  • Fruit can be a good source of snacks/dessert

  • Always include a source of protein - like nut butter/nuts; healthy lean meats like fish, chicken, turkey; legumes like chickpeas (hummus), beans, lentils; cheese

  • Make lunches large so there is enough for snacks during the day, and whatever isn’t eaten can be brought home

  • Try to limit sugar intake - including granola bars, sugary snacks like fruit snacks, candy and chocolate, juice/pop, and pastries/baked goods


Proper sleep is key!

Sleep is important for brain health, immune support and energy levels, especially in children! Children ages 6-12 years old should get between 9-12 hours of sleep per night. 

  • Set a sleep schedule and stick to it! Schedules are helpful at maintaining consistency in sleep patterns, making it easier to fall asleep and wake up at the same time each day.

  • Avoid screen-time for at least 1 hour before bed, ideally 2 hours! Screens emit light that can disrupt the production of melatonin, a hormone that rises in the evening and promotes healthy sleep. Instead of computers, TVs and phones, emphasize activities like reading a book, taking a bath, listening to music, playing a board game, journaling, creative arts or other non-screen activities.

Engage in enough physical activity

Children ages 6-12 years old should get at least 60 minutes of physical activity each day. At school, this can include recreational time at recess as well as physical education classes, however this may not be enough. Consider:

  • Engaging in recreational activities outside of school - for example, team or individual sports

  • Minimize sedentary time around the house - engage children in helping out with household chores such as laundry, raking leaves, gardening, etc.

  • Plan family activities, such as walking/bicycling around the block each night, or playing out in the snow come winter.

  • If possible, encourage walking to and from school with a chaperone/parent instead of driving

Book a visit with your Naturopathic Doctor!

Your naturopathic doctor is an expert in holistic ways in which to promote health and prevent disease. An ND will make specific, individualized recommendations for your child, based on their current health status, main health concerns and goals. Some ways in which naturopathic doctors can help include, but are not limited to:

  • Assessing immune health and recommending therapies that support the immune system

  • Optimizing diet and physical activity levels based on your child’s age and interests

  • Making stress reduction recommendations

  • Assessing digestive health and food sensitivities

Interested in learning more about ways in which naturopathic medicine can help support your family’s health during back-to-school time? Give us a call today!

STRESS AND THE HORMONE CONNECTION

stresshormoneconnection.jpg

Stress is one of the top concerns for which patients seek medical support. Stress is a hormonal response of the body when we perceive we are under threat. The “fight or flight” response is a sympathetic nervous system response which is engaged when we encounter a stressful event, such as running into a predator. This response allows our bodies to fight or flee, protecting ourselves from danger. Once the danger has passed, our bodies shift to a relaxation state, or an activation of the parasympathetic nervous system.

Today, it is common to see chronic stress - stressful events or situations that do not pass, which results in our sympathetic nervous system being active for much longer than it is meant to be. Having chronic stress responses can lead to a variety of changes in our body, including changes in blood pressure, blood sugar, digestive issues, and hormonal imbalances.

Cortisol

Cortisol is one of the main hormones released by our adrenal glands (which sit atop the kidneys) during periods of stress. Normally, cortisol is released in a diurnal pattern - this means they rise and fall in a similar pattern throughout a 24 hour period. This is called our circadian rhythm. Typically, cortisol should be at its highest in the morning right after we wake up, and will drop throughout the day until it reaches its lowest levels in the evening around bedtime. Throughout the night, they will slowly begin to increase again until waking time the next day, and so on. In this normal pattern, cortisol functions in regulating the immune system, managing inflammation, and regulating our blood sugar and metabolism. However, during periods of increased stress, more cortisol is released into our bloodstream, which can impact our circadian rhythm and lead to health consequences - such as changes in appetite and weight, blood sugar imbalances, high blood pressure, memory impairment, and interference with other hormones such as melatonin, estrogen and testosterone.

How can I measure my cortisol levels?

Cortisol levels can be measured in the blood through regular blood work - keep in mind that because of cortisol’s diurnal rhythms, cortisol levels will change throughout the day and will be different depending on the time the blood draw is done. Also, cortisol may increase if you are nervous about getting a needle. Alternative ways to measure cortisol include through saliva and urine, which can be easily done at home multiple times throughout the day to provide a “4-point” measurement of cortisol (measured at four points throughout the day to make a graph of your diurnal rhythm).

Your naturopathic doctor has access to all of these types of testing, and can requisition a test for you to assess your cortisol levels. There are urine testing options, specifically Rocky Mountain Analytical’s Comprehensive Hormone Insights (CHI) test and Precision Analytical’s DUTCH test, both of which offer cortisol testing at multiple points throughout the day as well as an extensive assessment of hormonal health, including levels of estrogens, androgens and progesterone and their metabolites. These tests allow for an assessment of your hormone levels and an analysis of the interplay between them!

Based on the results of your test, your naturopathic doctor will recommend a holistic plan for you to support your hormones and decrease the impact stress has on your body and health. There are lots of modalities that have been found to help manage stress and reduce cortisol levels, including nutritional supplements, dietary changes, lifestyle recommendations, and even traditional medicine such as acupuncture and homeopathy.

Keep in mind that cortisol levels can be altered for medical reasons other than stress, and these conditions would be approached and treated differently!

Have questions about stress and cortisol testing? Call us today to get more information and to set up an appointment with one of our naturopathic doctors!

References:

https://www.ncbi.nlm.nih.gov/books/NBK538239/

ABCDEs FOR MELANOMA

Melanoma is a type of skin cancer and is the seventh most common cancer in Canadians. Risk factors associated with development of melanoma include ultraviolet (UV) exposure from the sun, indoor tanning, having lots of moles (also called nevi) or strange-looking moles, having fair skin, having a family history of skin cancer, some genetic conditions, and having a weakened immune system.

dreamstime_m_176159245.jpg

One way in which you can be proactive in at-home screening for melanoma is by taking a look at your moles using the ABCDE rule (see below). Changes in size, shape, colour and other characteristics of a mole are some of the first warning signs of melanoma. The ABCDE rule is helpful for remembering which signs to look out for:

Asymmetry: The shape of one half of the mole is different from the other.

Border: The edges of the mole are ragged, notched, blurred, uneven or poorly defined.

Colour: Colours, which can be brown, black, grey, pink, tan, red, white or bluish vary within the mole.

Diameter: The mole is larger than 6 mm (bigger than the size of a pencil eraser) or has grown in size.

Evolution: The mole is changing in size, colour, shape, texture, or looks different from surrounding moles.

If you have a mole that has any of these characteristics, you should see your family doctor and get it tested.

Written by Dr. Dana Kolenich ND

References:

[1]https://www.cancer.ca/~/media/cancer.ca/CW/cancer%20information/cancer%20101/Canadian%20cancer%20statistics/Canadian-Cancer-Statistics-2019-EN.pdf?la=en

[2] https://www.aafp.org/afp/2012/0115/p161.html

[3] Parmar, G., Kaczor, T., & Boudreau, E. (2020). Textbook of naturopathic oncology: A desktop guide of integrative cancer care. Medicatrix Holdings Ltd.


SUNSCREEN AND SAFE SUN GUIDELINES

It’s officially summer, and that means lots of sun exposure! A popular topic during this time is the use of sunscreen. This article will cover the benefits and risks of sun exposure, and how we can optimize the benefits while reducing our risks by implementing safe sun practices.

Why do we need to worry about sun protection?

Here’s a quick overview on how the sun affects our health.

The sun emits different kinds of electromagnetic radiation, including ultraviolet (UV) radiation (which is where we will focus our article). UV radiation can be classified as UVA, UVB or UVC. UVC radiation is blocked by the Earth’s atmosphere, so only UVA and UVB radiation reaches the planet’s surface (and us). UVB radiation is the type that plays a role in our body’s ability to make vitamin D.

Maintaining healthy levels of vitamin D is important for overall health, including supporting our immune system, maintaining healthy bones, and supporting mood balance. Since the sun is our main source of vitamin D, why do we need to be careful with sun exposure?

UV radiation is the single greatest risk factor in the development of skin cancers, which are some of the most common cancers in Canadians. UV radiation from the sun can damage the skin, resulting in sunburns, as well as skin aging, wrinkling and loss of elasticity. Therefore, balancing sun exposure to optimize benefits while reducing the risks is ideal! Below are ways to implement safe sun practices for adults, babies and children.

What you can do?

Avoiding the sun at peak times

sun protection products.jpg

The sun’s rays are the strongest at midday, between 10 AM and 4 PM, which is when the risks are highest. Avoid getting sunburns and suntans, as these are the result of skin damage from the sun. Emphasize activities in the shade rather than in direct sun, or implement the use of shade from trees or umbrellas.

Use sunscreen

Sunscreen is used to protect the skin from the potential damage of ultraviolet (UV) radiation exposure from the sun. The Canadian Dermatology Association recommends a broad-spectrum (protecting against both UVA and UVB rays) sunscreen with a sun-protection factor (SPF) of 30 or higher. Generally, the higher the SPF, the more effective it is at protecting us from the sun (however, this does not mean that it is foolproof!). Sunscreen should be used on all exposed skin areas and reapplied as per manufacturer's instructions, potentially more often if swimming or sweating. Lip products containing SPF can be used to protect the skin on our lips.

Keep in mind that the skin is one of the body’s largest organs, and may absorb ingredients from the products we use on it. Using the Environmental Working Group’s (EWG’s) Healthy Living app can help you find clean and effective cosmetics and sunscreens. For a more information on “clean” sunscreen options, check out the EWG Sunscreen Guide!

Wear sunglasses and a wide-brimmed hat

Physical barriers to the skin, such as dark clothing, sunglasses and a wide-brimmed hat offer shade options and physical ways to block the sun’s rays. Sunglasses help protect your eyes from potential sun damage, including cataracts. Clothing that has a tight weave, darker in colour, and increased fabric weight and thickness are better clothing options to help protect against the sun’s rays.

Babies need protection too!

Babies’ skin and eyes are particularly sensitive to damage from the sun. Babies should be kept out of direct sun, and should wear hats with a wide brim and be dressed in loose fitting lightweight clothing that covers their arms and legs. These methods are ideal, however you can also use a baby-safe SPF 30 sunscreen. Make sure babies avoid getting tans or sunburns!

Can sunscreen decrease my body’s ability to make vitamin D?

Research suggests that sunscreen, especially when applied correctly and consistently and with a high SPF, can decrease the production of vitamin D, but only by a small amount. This may be because sunscreen does not perfectly block UVB radiation exposure to the skin, and therefore some vitamin D can still be made. If you are worried about not getting enough vitamin D, your naturopathic doctor can test your vitamin D levels and may recommend a vitamin D supplement, which provides a source of vitamin D without the radiation exposure from extended periods of time in the sun.

Written by Dr. Dana Kolenich ND

References:

[1] Queirós, C. S., & Freitas, J. P. (2019). Sun Exposure: Beyond the Risks. Dermatology Practical & Conceptual, 9(4), 249–252. https://doi.org/10.5826/dpc.0904a01

[2] https://dermatology.ca/public-patients/sun-protection/sun-safety-every-day/

[3] Li, H., Colantonio, S., Dawson, A., Lin, X., & Beecker, J. (2019). Sunscreen Application, Safety, and Sun Protection: The Evidence. Journal of Cutaneous Medicine and Surgery, 23(4), 357–369. https://doi.org/10.1177/1203475419856611

[4] https://www.aafp.org/afp/2000/0715/p375.html

[5] https://pubmed.ncbi.nlm.nih.gov/31069788/

Healthy Ice Pops

1429317541581.jpeg

Ingredients:

  • 1 1/2 cups frozen raspberries or other berry of choice, defrosted

  • 1/4 cup fresh mint leaves

  • 1 1/2 tbsp lemon juice from one large lemon

  • honey or maple syrup to taste

  • 14 wooden popsicle sticks

Directions:

  1. In a blender, puree together the frozen berries and mint. Add lemon juice and honey/maple syrup - taste the mixture for sweetness.

  2. Spoon mixture into an ice cube tray and freeze for 30 minutes, or until partially frozen.

  3. Insert wooden sticks and return trays to the freezer for another 3 hours minimum. Once fully frozen, enjoy!

Recipe adapted from Food Network’s Italian Ice Pops

Allergy Season - Tips to help you through!

Spring has arrived, and with it comes allergy season. If you struggle with seasonal allergies, your Naturopathic Doctor has many tools to help support your health during this time!

Here’s a few tips to help you get started:

  • Neti Pots are a useful tool during allergy season to help rinse the sinuses.

  • A HEPA filter in your home, bedroom and/or office can help reduce pollen exposure in the air during peak times.

  • Probiotics of certain strains have been well-researched to help shift the immune response away from a state (called Th2) that is responsible for mounting allergies.

  • Vitamin C can help stabilize mast cells, which are responsible for releasing histamine into blood circulation, leading to symptoms of allergies. Some vitamin C formulas contain bioflavonoids (for example, quercetin) which can help to support the anti-histamine response.

  • Reducing stress and getting good quality sleep will help to reduce inflammation in allergy season.

As always, discuss whether supplements are right for you with your Naturopathic Doctor!

Holistic Migraine Management

Holistic Migraine Management - Online Workshop - Tuesday April 20, 2021 - 7pm

unnamed.jpg

Headaches can be the product of many problems. They can be related to mechanical issues in the muscles and joints of the neck and head, or they can be related to hormones, stress, diet and many other problems in the body. In this workshop we will explore many causes and treatments for all these headache influencers.

Headaches can sometimes be difficult to manage due to the complexity of all systems that can contribute. It is important when working at improving and eliminating headaches that a thorough plan is developed according to each person’s own dysfunctions and needs.

In this workshop Mackie Physiotherapy will be partnering with Saskatoon Naturopathic Medicine and Dr. Darlene Reid-Ahenakew ND to help us understand the components that are out of practice realm of physiotherapy. She will bring an in-depth understanding of physiological systems, total body health, and supplements that can be beneficial in headache treatment.

Dr. Darlene Reid-Ahenakew ND is a well-known Naturopathic Doctor in Saskatoon practising at Saskatoon Naturopathic Medicine in Stonebridge. She helps many patients with chronic headaches and migraines stop the cycle of pain by uncovering physiological root causes. Hormone imbalances, gut health, stress responses, food intolerances, and nutrient deficiencies can all promote systemic inflammation and chronic pain. During this workshop, Dr. Reid-Ahenakew ND will discuss how to identify these issues in yourself and the different treatment approaches.

What is it about?
This workshop will examine the physiological causes of headaches. Theresa Ziegler will be discussing the musculoskeletal causes; as well, we have a guest speaker, Dr. Darlene Reid-Ahenakew, a Naturopathic Doctor who has special interest in uncovering the root cause of chronic headaches. Both will be discussing the causes, prevention, and management of headaches.

Optimize Your Health During Nutrition Month!

NUTRITION MONTH

March is Nutrition Month! Nutrition is the study of how we, through our diets, get the nutrients we need to live. “Let food be thy medicine and medicine be thy food”, a quote attributed to Hippocrates, is a simple but powerful statement on the importance of our diet. Optimizing nutrition status - making our diets as healthy as possible - is one of the foundational goals in improving our health at every age.

National+Nutrition+Month.jpg

A diet providing all of the nutrients we not only need to live, but need to live healthy lives, is dependent on many factors. We can generalize what a healthy diet looks like for the majority of people, however it is important to be aware of certain factors that can impact an individual’s nutritional requirements. For example, those who are pregnant will have different nutritional requirements than others. Additionally, certain medical conditions, treatments and even some medications can impact proper absorption of nutrients. Optimal nutrition is also a public health issue - for example, low socioeconomic status is associated with poorer nutrition [1] - possibly because it can be difficult to afford or even access healthy foods.

Although the food you eat is one of the most important aspects of nutrition, it is not the only important factor. Nutrition also involves how your food is broken down into nutrients, how well these nutrients are absorbed, how well your body puts these nutrients to use, and finally how well your body eliminates what it no longer needs and protects you from potentially toxic substances. 

How can a Naturopathic Doctor (ND) help optimize your nutrition? NDs have extensive training in nutrition, and can offer a variety of services and assessments to support your individual nutritional needs:

  • Lab testing to assess for nutritional deficiencies or conditions associated with nutritional deficiencies

  • Education surrounding appropriate diets for your health status and goals

  • Expertise on all aspects of digestion, including optimizing the absorption of nutrients and supporting your body’s ability to eliminate waste products

  • Assessing your current diet and making recommendations to support an optimal diet

  • Addressing obstacles that come up (ie. financial, accessibility, resources) that make it difficult to make healthier changes

  • Providing expertise on what nutritional supplements may be helpful for you

Interested in optimizing your nutrition? Book an appointment with one of our Naturopathic Doctors today!

[1] Alkerwi A, Vernier C, Sauvageot N et al. Demographic and socioeconomic disparity in nutrition: application of a novel Correlated Component Regression approach. BMJ Open. 2015; 5(5):e006814.

Lower Blood Sugar and Cholesterol and Improve Heart Health with Berberine!

BERBERINE AND CARDIOMETABOLIC HEALTH

Berberis Vulgaris (Barberry)

Berberis Vulgaris (Barberry)

Berberine is a bright yellow-coloured alkaloid compound found in many plants, some of the more common ones including Hydrastis canadensis (goldenseal), Berberis vulgaris (barberry), Coptis chinensis (Chinese goldthread), and Berberis aquifolium (Oregon grape). Berberine has been used traditionally to combat inflammatory disorders, infectious diseases, diabetes, digestive disorders and many others, and has demonstrated benefits on blood sugar metabolism, cardiovascular effects, cholesterol and atherosclerosis.

Berberine appears to exert its cardiovascular effects through various mechanisms that play a role in protecting the blood vessels, decreasing inflammation and modulating levels of cholesterol and blood sugar. Berberine has been shown to affect the modulation of an enzyme called adenosine monophosphate-activated protein kinase (AMPK). AMPK is responsible for maintaining healthy blood vessels through a variety of different mechanisms, including the regulation of another enzyme, called endothelial nitric oxide synthase (eNOS), which is responsible for producing nitric oxide in the cell layer lining our blood vessels. Nitric oxide is important in regulating how our blood vessels dilate (which plays a role in our blood pressure), platelet and white blood cell activation and adhesion (which plays a role in the development of arterial plaques), and antioxidant functions (which is important for preventing damage from free radicals like glycated blood sugar, which is prevalent in diabetes). In simpler terms, AMPK and eNOS are important for maintaining a healthy cardiovascular system. When eNOS is not functioning properly, it can contribute to the development of high blood pressure, diabetes and high cholesterol. Berberine has been found to increase the production of nitric oxide through enhancing activity of eNOS [1, 2, 6, 7].

Current research on berberine has been focused on its metabolic and cardiovascular properties. A research study suggested that berberine was shown to decrease levels of total cholesterol, triglycerides and LDL cholesterol levels, while increasing HDL-cholesterol (which is thought to be protective, or the “good” cholesterol). A meta-analysis demonstrated that the addition of berberine to simvastatin, a cholesterol-lowering drug, resulted in a greater reduction of triglycerides and total cholesterol, and a reduction in the number of side effects, compared to the use of simvastatin on its own [5].

Berberine also benefits blood sugar levels and reduces body fat mass. A research study on diabetic patients showed that those who were given berberine had a reduction in blood sugar levels and cholesterol levels, and those with metabolic syndrome also experienced a decrease in their body mass index (BMI) and waist circumference [3]. A study on women with polycystic ovary syndrome (PCOS), a disorder characterized by insulin-insensitivity, obesity and high cholesterol, found that berberine decreased waist circumference and waist-to-hip ratio, insulin sensitivity and blood sugars and cholesterol levels comparable and/or superior to that of metformin [4].

Berberine is generally well-tolerated, and side effects of usage are usually mild in nature, such as abdominal discomfort, diarrhea, constipation, decreased appetite, and dermatological rashes. Berberine may interfere with certain medications and may not be suitable for everyone. As always, with any natural health product it is important to consult with your naturopathic doctor to see if berberine is safe for you.




References:

[1] Neag M, Mocan A, Echeverria J, et al. Berberine: Botanical Occurrence, Traditional Uses, Extraction Methods, and Relevance in Cardiovascular , Metabolic, Hepatic, and Renal Disorders. Front Pharmacol. 2018; 9:557. https://pubmed.ncbi.nlm.nih.gov/30186157/

[2] Hoffmann D. (2003). Medical Herbalism: The Science and Practice of Herbal Medicine. Healing Arts Press.

[3] Pirillo A, Catapano AL. Berberine, a plant alkaloid with lipid- and glucose-lowering properties: from in vitro evidence to clinical studies. Atherosclerosis. 2015; 243(2): 449-61. https://pubmed.ncbi.nlm.nih.gov/26520899/

[4] Wei W, Zhao H, Wang A, et al. A clinical study on the short-term effect of berberine in comparison to metformin on the metabolic characteristics of women with polycystic ovary syndrome. Eur J Endocrinol. 2012; 166(1):99-105. https://pubmed.ncbi.nlm.nih.gov/22019891/

[5] Zhang LS, Zhang JH, Feng R, et al. Efficacy and safety of berberine alone or combined with statins for the treatment of hyperlipidemia: a systematic review and meta-analysis of randomized controlled trials. Am J Chin Med. 2019; 47(4):751-767. https://pubmed.ncbi.nlm.nih.gov/31094214/

[6] Affuso F, Mercurio V, Fazio V, et al. Cardiovascular and metabolic effects of berberine. World J Cardiol. 2010; 2(4):71-7. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2999047/

[7] Bagade A, Tumbigeremutt V, Pallavi G. Cardiovascular Effects of Berberine: A Review of the Literature. Journal of Restorative Medicine. 2017; 6: 37-45.

Mistletoe and Cancer Care - It does more than spark a kiss!

Festive+Mistletoe.jpg

Mistletoe and Cancer Care - It does more than spark a kiss!

A plant commonly associated with the holidays, Viscum album, also known as mistletoe, is a natural therapy used often in integrative cancer care. Mistletoe is a semi-parasitic plant that grows on a variety of trees from which it obtains its nutrients. It contains a variety of compounds, the most commonly studied of which are lectins, that have been shown to stimulate the immune system and have anti-cancer effects. Cell studies on mistletoe extracts have demonstrated inhibition of cancer cell growth [3] and increase in immune function parameters, including natural killer cells, which are white blood cells responsible for the destruction of tumor cells [4, 5].

Mistletoe is primarily administered as a subcutaneous injection, and commonly used alongside chemotherapy, radiation therapy and/or other conventional treatments in countries such as Switzerland, Germany, and Austria to improve quality of life and manage side effects associated with treatments in patients with cancer [2]. 

Numerous studies have been conducted on the therapeutic use of mistletoe. One of the best methodologically-designed studies was conducted on mistletoe in advanced pancreatic cancer patients, which suggested that patients in the mistletoe treatment group had longer overall survival times compared to those in the control group [6]. The majority of research on mistletoe suggests it supports quality of life in cancer patients and decreases severity and frequency of treatment-related side effects [8, 9]. Mistletoe is generally well-tolerated and safe to use alongside various common chemotherapeutic agents [7].

To learn more about mistletoe therapy, contact us and/or book an appointment with Dr. Dana Kolenich ND!

[1] Pelzer F, Tröger W. Complementary treatment with mistletoe extracts during chemotherapy: safety, neutropenia, fever, and quality of life assessed in a randomized study. J Altern Complement Med. 2018; 24(9-10):954-961. https://pubmed.ncbi.nlm.nih.gov/30247950/

[2] Melzer J, Iten F, Hostanska K et al. Efficacy and safety of mistletoe preparations (Viscum album) for patients with cancer diseases. A systematic review. Forsch Komplementmed. 2009; 16(4):217-226. https://pubmed.ncbi.nlm.nih.gov/19729932/

[3] Eggenschwiler J, von Balthazar L, Stritt B, et al. Mistletoe lectin is not the only cytotoxic component in fermented preparations of Viscum album from white fir (Abies pectinata). BMC Complement Altern Med. 2007; 7:14. https://pubmed.ncbi.nlm.nih.gov/17493268/

[4] Büssing A, Rosenberger A, Stumpf C et al. Development of lymphocyte subsets in tumor patients after subcutaneous administration of mistletoe extracts. Forsch Komplementmed. 1999; 6(4):196-204. https://pubmed.ncbi.nlm.nih.gov/10529579/

[5] Beuth J, Ko HL, Gabius HJ, et al. Behaviour of lymphocyte subsets and expression of activation markers in response to immunotherapy with galactoside-specific lectin from mistletoe in breast cancer patients. Clin Investig. 1992; 70(8):658-61. https://pubmed.ncbi.nlm.nih.gov/1392440/

[6] Viscum album [L.] extract in patients with locally advanced or metastatic pancreatic cancer: a randomised clinical trial on overall survival. Eur J Cancer. 2013; 49(18):3788-97. https://pubmed.ncbi.nlm.nih.gov/23890767/

[7] Weissenstein U, Kunz M, Urech K et al. Interaction of standardized mistletoe (Viscum album) extracts with chemotherapeutic drugs regarding cytostatic and cytotoxic effects in vitro. BMC Complement Altern Med. 2014; 14:6. https://pubmed.ncbi.nlm.nih.gov/24397864/

[8] Beuth J, Schneider B, Schierholz JM. Impact of complementary treatment of breast cancer patients with standardized mistletoe extract during aftercare: a controlled multicenter comparative epidemiological cohort study. Anticancer Res. 2008; 28(1B):523-7. https://pubmed.ncbi.nlm.nih.gov/18383896/ 
[9] Tröger W, Galun D, Reif M, et al. Quality of life of patients with advanced pancreatic cancer during treatment with mistletoe: a randomized controlled trial. Dtsch Arztebl Int. 2014; 111(29-30):493-502. https://pubmed.ncbi.nlm.nih.gov/25142075/