When
I wrote Cancer Therapy in the early 1990s, I had the bright idea
of putting my mailing address in the book in the hope that some readers would
send me information on new treatments. Little did I imagine that such communication
would become a torrent of proposals. Today, hardly a day goes by without my being
made aware of some new "cure." Would that a fraction of these panned
out as well as proponents claimed!
One
of the latest in this long line is an exotic fruit drink called mangosteen,
or XanGo. Mangosteen should not be confused with mango, an
entirely different plant. It is part of a group known as the Guttiferae, a family
of mainly tropical trees and shrubs that secrete an acrid yellow resinous juice.
Mangosteen's scientific designation is Garcinia mangostana (Campin 2004). It is
reputedly named after a French explorer, Jacques Garcin (1673-1751). In Europe
and North America, the most recognizable member of this family is the popular
herb, St. John's wort.
No
one knows exactly where and when the mangosteen was first cultivated. One botanist,
Julia F. Morton, believes it originated in the Moluccas and the Sunda Islands.
Yet there are also wild mangosteen trees in the forests of Malaya. Some experts
say the trees were first domesticated in Thailand or Burma. But in the 19th century,
botanists brought seeds to Europe and America. Valiant attempts were made to cultivate
the 18-foot high trees in Africa, the Caribbean and central America. But the plant
is considered "ultra-tropical" and sensitive: nursery seedlings die
at 45º F. In fact, there are few if any mangosteens growing in the continental
US. A lone American tree in Florida was said to have yielded a single fruit...and
then died. That was the beginning and end of the American mangosteen "industry."
But
attempts continued to bring mangosteen to Europe and America as a food. "Despite
the oft-repeated Old World enthusiasm for this fruit," says Morton, "it
is not always viewed as worth the trouble to produce. In Jamaica, it is regarded
as nice but overrated; not comparable to a good field-ripe pineapple or a choice
mango."
The
mangosteen fruit is the size of a small apple, purple colored, with a hard rind.
Inside there are typically five to seven seeds surrounded by a sweet, juicy cover
(or aril). The pulp, which is said to resemble a pineapple or peach in taste,
is reputed to be a very delicious food - in Asia it is sometimes called the queen
of fruits in honor both of its flavor and its economic importance.
Uses
in Traditional Medicine
For
many years dried mangosteen fruits have been shipped from Singapore to Calcutta
and then on to China for medicinal use. As to its many uses in folk medicine,
here is what botanist Julia Morton has written:
"The
sliced and dried rind is powdered and administered to overcome dysentery. Made
into an ointment, it is applied on eczema and other skin disorders. The rind decoction
is taken to relieve diarrhea and cystitis, gonorrhea and gleet [a watery discharge,
ed.] and is applied externally as an astringent lotion. A portion of the rind
is steeped in water overnight and the infusion given as a remedy for chronic diarrhea
in adults and children.
"Filipinos
employ a decoction of the leaves and bark as a febrifuge and to treat thrush,
diarrhea, dysentery and urinary disorders. In Malaya, an infusion of the leaves,
combined with unripe banana and a little benzoin is applied to the wound of circumcision.
A root decoction is taken to regulate menstruation. A bark extract called 'amibiasine',
has been marketed for the treatment of amoebic dysentery."
Morton
also writes that "[t]he rind of partially ripe fruits yields a polyhydroxy-xanthone
derivative termed mangostin, also beta-mangostin. That of fully ripe fruits contains
the xanthones, gartanin, 8-desoxygartanin, and normangostin. A derivative of mangostin,
mangostin-e, 6-di-O-glucoside, is a central nervous system depressant and causes
a rise in blood pressure." A more complete listing of constituents is given
at ethnobotanist Dr. James Duke's informative and useful Phytochemical and Ethnobotanical
Databases (Duke 2004).
We
can conclude then that mangosteen has many uses in folk medicine, and as such,
it can join a fairly long list of plants that can be considered as promising sources
of new medicines.
XanGo
on the Go
In
this age of frenzied commercialism, entrepreneurs are always on the lookout for
ways to make it big in the natural medicines market. Under such conditions, however,
new medicines of botanical origin cannot be developed or tested in an orderly
way.
A
common feature of the way in which natural medicines such as mangosteen are promoted
is the use of network marketing. This involves the retailing of products through
the use of independent distributors. These distributors are then encouraged to
build and manage their own sales force by recruiting, motivating, supplying, and
training others to sell products. Compensation in such arrangements includes the
distributor's own sales as well as a percentage of the sales of his or her entire
"downline" (i.e., all those people signed up by an individual, who in
turn go on to become salespeople). The term network marketing is virtually synonymous
with the older but now somewhat disreputable term 'multi-level marketing' (MLM).
Network
marketing turns mere consumers into determined marketers who aggressively sell
their product, often to their own friends, relatives and neighbors. The more people
they can recruit into the growing network the more money they themselves make.
A sophisticated marketing blitz, including books and pamphlets, seemingly objective
newsletters, press releases and chattering websites, inflate the importance of
a product, creating a buzz that only dies away when the huge supply of potential
customers and salespeople is finally exhausted. Or when, as it has on occasion,
the government finally steps in. But the essential requirement for a successful
MLM operation of this sort is a kernel of promising-sounding scientific evidence,
coupled with a credible and compelling story, a compliant doctor willing to underwrite
the concept, and finally some patients (who may themselves be distributors) willing
to testify that the product led to astounding cures.
Aloe
vera, colloidal minerals, gingko biloba and ginseng were all popularized in this
way. But perhaps the most memorable example of a network marketing stampede is
noni juice, a once totally obscure Polynesian fruit that became the basis of a
huge industry. Tahitian Noni International, formerly called Morinda, last year
claimed to have passed the two billion dollar sales mark! This is the sort of
performance that makes get-rich-quick artists drool.
The
techniques of network marketing, honed through decades of trial and error, are
now being used by a Utah-based company to position mangosteen as the latest "miracle
cure" craze. The price of their XanGo mangosteen juice is currently $37 per
bottle (or four for $100). You have to ask yourself: who on earth would pay that
much for a bottle of fruit juice, no matter how delicious it might be? The reason
the marketers can succeed in selling juice at this price is obvious: when people
are suffering from medical conditions for which there does not appear to be much
hope, or for which the orthodox medical recommendations are too toxic or expensive,
they will actively seek alternatives. And then someone, oftentimes someone they
trust, such as a friend or neighbor, convinces them to give some new product a
try. Products such as mangosteen exploit humanity's understandable desire to discover
simple and painless solutions to intractable problems.
Now
that the commercial ball is rolling an increasing number of mangosteen brands
are reaching the market. But for the time being the market leader is XanGo
(www.myxango.com). A visit to their website triggers an audio webcast from a very
pleasant sounding young lady, who assures us that "by integrating the Internet,
teamwork, and personal mentoring, MyXanGo.com provides you a vehicle to improve
the areas of your life that are most important to you, and we do it for FREE."
I
listened in amazement to her polished spiel and the brazen intrusiveness of this
message. I was particularly amused when she said, "You should know that this
message is not about selling." Right. "It's not about false claims and
outlandish statements." Sure. "It's about sharing facts to help you
decide if now is the right time in your life to consider XanGo." Really.
The
rhetoric gets even more effusive. A March 2004 press release from one seller proclaims:
"Mangosteen is now on an unstoppable march to conquer the world" (Goss
2004). Put this way it sounds rather ominous…almost like a cross between Osama
bin Laden and the Attack of the Killer Tomatoes.
Xanthones
As
stated, one requirement for a successful network promotion is that there be at
least a kernel of scientific truth around which exaggerated claims can be assembled.
As with noni juice, mangosteen is not entirely without scientific documentation.
The problem, as usual, is that the claims for mangosteen are inflated till they
far outpace what has been established through careful experimentation.
Some
mangosteen promoters have mined James Duke's famous ethnobotanical database for
confirmation of their product's value. And, indeed, Dr. Duke confirms that the
plant contains several interesting components. But so do thousands of other plants
in his voluminous database. For most of the chemicals contained in this fruit
(such as beta-mangostin, catechins, cis-hex-3-enyl-acetate, gamma-mangostin, gartanin,
garcinones) the database lists NO particular biochemical activities. Only the
compound called "mangostin" seems to have some scientific backing for
its antibacterial, antiseptic and fungicidal properties (Recio 1989). Yet scores
of mangosteen websites now cite Duke's database as scientific justification for
this product. In reality, Dr. Duke has absolutely nothing to do with any mangosteen
distributor and is not particularly enthusiastic about the product.
Much
is made of the xanthone connection. According to the MyXanGo.com website: "There
are over 200 xanthones in nature. Each xanthone can have specific effects on the
body. What's remarkable about the mangosteen is that there are over 40 xanthones
identified in the pericarp, or rind, making it the single most xanthone-rich source
in the world….Only six of the xanthones have been studied in depth. While we don't
know fully why the mangosteen works on such a wide variety of physical conditions,
we know it has to do with being the world's most potent source of xanthones. Each
xanthone has its own effect, and when combined, they take on a synergistic quality
that supports the health of the entire body."
But
all of this is speculative. It is undoubtedly true that there are many xanthones
(a kind of antioxidant) in mangosteen. In fact, according to the Merck Index (11th
Ed., p. 5613) the first scientifically defined substance to be derived from mangosteen
was the xanthone mangostin. This was isolated by a German scientist named Schmid
in 1855. In 1979, mangostin was found to have significant anti-inflammatory and
anti-ulcer effects in rats (Shankaranarayan 1979). Yet although mangosteen's xanthones
have been known for almost 150 years, there are still only 19 PubMed articles
on these xanthones and none of these articles concerns the use of xanthones in
the actual clinical treatment of human disease. So I would say the jury is still
out on their effectiveness in treating anything.
The
main XanGo website also claims that the antioxidant ORAC (oxygen radical absorbance
capacity) value of mangosteen is the highest of all edible plants. "It is
so potent that literally I know of nothing else in the supplement market that
can possibly come even close to it," says J. Frederic Templeman, MD, a Georgia
family practitioner who is interviewed at the MyXanGo website. Many other XanGo-promoting
websites repeat the claim that while the previous champion, prunes, have an ORAC
value of 7,000 per ounce, mangosteen has an ORAC value of 17,000 to 24,000.
Yet
XanGo sites claim that "a new champion" has been born in the worldwide
contest for ORAC supremacy. But where in the scientific literature is the ORAC
value of XanGo published? The source of these numbers is hard to track down. For
instance, the Sunsweet prune website states that 100 grams (3.5 ounces) of prunes
have an ORAC value of 5,770. While the ORAC values for most fruits and vegetables
have been determined by standard laboratories and published in scientific journals,
this is not so for mangosteen. I have not seen independent confirmation of these
confidently promulgated claims. However, even if we assume for the sake of argument
that the figures cited are indeed accurate, it must be pointed out that merely
having an astronomically high ORAC value does not in and of itself confer any
particular advantage. Not all antioxidants that are confirmed as present in the
laboratory can be absorbed by human beings. And there is a limit to how much we
can benefit from an increased intake of antioxidants.
According
to Dr. Ronald Prior of the US Department of Agriculture Research Service
at Tufts University, Boston, Massachusetts, "a significant increase in antioxidants
of 15 to 20 percent is possible by increasing consumption of fruits and vegetables,
particularly those high in ORAC value." However, in order to have a significant
impact on plasma and tissue antioxidant capacity one can only meaningfully increase
one's daily intake by 3,000 to 5,000 ORAC units. Any greater amount is probably
redundant. That is because the antioxidant capacity of the blood is tightly regulated,
says Dr. Prior. Thus there is an upper limit to the benefit that can be derived
from antioxidants. Taking in 25,000 ORAC units at one time (as reputedly occurs
with mangosteen) would be no more beneficial than taking in a fifth of that amount:
the excess is simply excreted by the kidneys.
Marketers
of the drink have widely claimed that XanGo has exceptional health-giving properties
based on its very high ORAC score. (ORAC stands for oxygen radical absorbance
capacity - a measure of the antioxidant value of a substance.) But having a high
ORAC value does not necessarily confer any health advantage.
According
to Dr. J. Frederic Templeman, a Georgia family practitioner who has written a
small book on mangosteen, and who is widely quoted by XanGo marketers, if you
take these antioxidants "you aren't going to probably have a heart attack
as fast as someone who doesn't take them" and consuming them could therefore
constitute "literally the difference between life and death." Although
I myself have written a book on the subject of the benefit of antioxidants (Antioxidants
Against Cancer), I would say it is a tremendous stretch to claim that
antioxidants are predictably going to save anyone's life. Good health is achieved
through a combination of many factors, hereditary as well as environmental.
Effects
on Cancer
At
the XanGo website, a company spokesperson interviews Dr Templeman on the subject
of mangosteen's beneficial effect on cancer. They both agree that a single test
tube experiment is proof of the anticancer value of the juice:
Dr.
Templeman: "That's striking."
XanGo
spokesperson: "It's incredible."
At
various other websites devoted to XanGo (and there are now over 21,000 of them!)
we read in glowing terms about both the supposed quantity and quality of scientific
research on this previously obscure fruit.
Reality
Check
So
it is high time for a reality check. Has mangosteen really been thoroughly studied
in terms of its effect on cancer and a host of other diseases? Or is this simply
a wild extrapolation driven by strong commercial motives?
Dr.
Templeman refers to 44 scientific publications on this topic but there are just
29 articles on the topic of Garcinia mangostana in PubMed, the US National Library
of Medicine database of 14+ million citations. A total of four of these studies
relate to cancer. In one test tube experiment it was shown that a xanthone found
in mangosteen kills cancer cells as effectively as many chemotherapeutic drugs.
It also appears (on the basis of limited data) that compounds found abundantly
in mangosteen can inhibit the harmful Cox 1 and Cox 2 enzymes, and can also induce
programmed cell death (apoptosis) in aberrant cells (Ho 2002). Mangosteen thus
joins a fairly long list of naturally derived compounds that might potentially
have some anticancer activity.
These
29 articles do not constitute a wealth of data. For example, by contrast, PubMed
lists over 2,300 articles on the topic of vitamin C and cancer, 125 of which refer
to clinical trials. There are a similar number of studies on vitamin E and cancer.
There are 835 studies of melatonin and cancer, and a truly impressive 16,000 on
polysaccharides and cancer, including 536 clinical trials and 277 randomized controlled
trials (RCTs).
Yet,
we're to believe that four test-tube experiments constitute - to quote the aforementioned
Dr. Templeman - "mountains of evidence" on the benefits of XanGo.
According
to the promotional website of one of XanGo's many "independent distributors"
at http://bjsbytes.com/Xango/Questions.htm:
"...much
of the science behind xanthones is predominantly available to those in the medical
community until recently. Many of the clinical studies on xanthones have been
done in universities and testing facilities throughout Asia and have recently
started to catch the attention of Western researchers."
But
is this true? Reputable researchers the world over, including those in Asia, publish
in PubMed-listed journals. For example there are over 63,000 articles
on cancer in PubMed in the Japanese language. Yet despite the website's
misleading talk about "clinical studies," PubMed does
not contain a single clinical trial of mangosteen in the treatment of cancer,
or any other disease. Perhaps these promoters don't realize that a clinical study
is not something done in a laboratory, but a study that by definition is carried
out on living patients. Laboratory studies on cell lines or even animals do not
qualify for the title 'clinical study'.
Thus,
despite what you may read at any one of those 21,000 promotional websites, very
little scientific evidence exists concerning mangosteen's anticancer activity
in humans.
In
my opinion, what we have here is simply an overpriced fruit drink.
Fruit drinks are often healthful beverages. But the only reason I can see that
the promoters of mangosteen can get away with charging $37 for this product is
that they are playing on patients' hopes and fears in a cynical way. Without the
health claims, open or implied, the product could only be sold for at most $5
or $6 (which, for example, is the cost of antioxidant-rich pomegranate juice).
The
mangosteen phenomenon is a reprise of the aloe vera, gingko biloba, and especially
the noni juice story, complete with exaggerated claims for the health benefits
of an exotic fruit. It should come as no surprise that both the President and
the Chief Financial Officer of Xango once worked for Morinda (now called Tahitian
Noni International).
Compounds
found in plants have long been of great interest to cancer researchers. We must
never forget that about one-fifth of all chemotherapeutic agents (including Vincristine,
Vinblastine, Etoposide, Teniposide, and Taxol) are ultimately derived from plant
sources. Many of these took a long time to pass through the regulatory process,
since serious research into botanical medicine often goes begging for financial
and intellectual support. Starved of funds in this way, the riches of the natural
world are often neglected by mainstream science, only to be plundered by less
scrupulous organizations. The patient loses twice - by not having the fruits of
serious research and by being deceived by slick operators posing as friends and
benefactors. Some may even opt for unproven miracle juices in lieu of more certain
therapies that might save their lives.
When
it comes to cancer, we truly live in a topsy-turvy world.
Note
from Chet: Be sure to sign up for Dr. Moss's excellent newsletter at his website.
Another
Note from Chet: We get a lot of email from people who think mangosteen is
the best thing since sliced bread. Click here
to read some of their comments.
References:
Campin,
Jac. Guide to Plant Relationships (for food allergy and intolerance identification),Version
12 (14 April 2004. Retrieved April 27, 2004 from: http://www.purr.demon.co.uk/Food/RelatedPlantList.html
Duke,
James, ed. Dr. Duke's Phytochemical and Ethnobotanical Databases. United States
Department of Agriculture, Agricultural Research Service, Accessed April 27, 2004
from: http://www.ars-grin.gov/cgi-bin/duke/farmacy2.pl?1228
Hedrick,
U.P. (ed.) 1972. Sturtevant's Edible Plants of the World. NY, NY: Dover Publications,
Inc., 1972. Downloaded from: www.swsbm.com/
Ho
CK, Huang YL, Chen CC. Garcinone E, a xanthone derivative, has potent cytotoxic
effect against hepatocellular carcinoma cell lines. Planta Med. 2002 Nov;68(11):975-9.
Matsumoto
K, Akao Y, Kobayashi E, Ohguchi K, Ito T, Tanaka T, Iinuma M, Nozawa Y. Induction
of apoptosis by xanthones from mangosteen in human leukemia cell lines. J Nat
Prod. 2003 Aug;66(8):1124-7.
Moongkarndi
P, Kosem N, Kaslungka S, Luanratana O, Pongpan N, Neungton N. Antiproliferation,
antioxidation and induction of apoptosis by Garcinia mangostana (mangosteen) on
SKBR3 human breast cancer cell line. J Ethnopharmacol. 2004 Jan;90(1):161-6.
Morton,
Julia F. Mangosteen. In: Fruits of Warm Climates. Self-published. Miami, FL, 1987,
pp. 301-304. ISBN: 0-9610184-1-0
Nakatani
K, Nakahata N, Arakawa T, Yasuda H, Ohizumi Y. Inhibition of cyclooxygenase and
prostaglandin E2 synthesis by gamma-mangostin, a xanthone derivative in mangosteen,
in C6 rat glioma cells. Biochem Pharmacol. 2002 Jan 1;63(1):73-9.
ORAC
value of Sunsweet prunes: http://www.sunsweetdryers.com/Sunsweet.htm
Recio,
M. C., Rios, J. L., and Villar, A., A review of some antimicrobial compounds isolated
from medicinal plants reported in the literature 1978-1988, Phytotherapy Research.
1989:3(4)117-125.
Shankaranarayan
D, Gopalakrishnan C, Kameswaran L. Pharmacological profile of mangostin and its
derivatives. Arch Int Pharmacodyn Ther. 1979 Jun;239(2):257-69.
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