But, Birdsall says, natural therapies such as those reportedly taken by Jobs center on altering the bodily environment, not the tumor itself. "Once a cancer is established, in the vast majority of cases, simply changing the environment will not be sufficient to eradicate that established tumor," he says. "Cancer requires surgery, radiation or chemotherapy to [be eradicated]."
Could Jobs have put himself in greater danger by delaying surgery in favor of alternative medicine? Because pNET grows so slowly, it's unlikely that much damage was done either, says Yao, who often monitors pNET patients before recommending therapeutic intervention. "Nine months is not a long time in this disease," he adds. "One can reasonably argue that you can observe things very carefully."
Still, at least one treatment embraced by some in the alternative care community, namely juice fasts, can be counterproductive for cancer patients, says Donald Abrams of the Osher Center for Integrative Medicine at the University of California, San Francisco (U.C.S.F.). Drinking squeezed juice delivers an intense burst of sugar to cells that would otherwise be moderated by the fiber within a fruit. "Cancer cells love sugar," he says. And from the perspective of a cancer cell, fresh-squeezed juice is no different from sugary cola. Either drink delivers a sugar shot that increases insulin and insulinlike growth factor, "both of [which] promote inflammation and both lead to cancer cell division," says Abrams, who is also professor of clinical medicine at U.C.S.F., and chief of hematotology/oncology at San Francisco General Hospital. He now provides consultations for cancer patients undergoing traditional treatment who want to incorporate complementary (or alternative) approaches into their care.
Evidence isn’t available showing whether the juice fasting Jobs reportedly tried accelerated the spread of cancer cells in his pancreas, and possibly other organs, but Abrams notes that he rarely recommends juicing to the cancer patients he counsels. In addition to producing potentially dangerous levels of insulin, the process can also harm the body overall. "The basis for these extreme dietary manipulations is to starve the tumor of the nutrients it needs," says Abrams, "but healthy cells of the body also get depleted of nutrients."
Rather, Abrams typically recommends an organic diet that is mainly plant-based but includes deep coldwater fish (for their omega-3 content); mushroom blends for immune enhancement; vitamin D and other supplements, depending on the patient; and vitamin C for wound recovery, along with physical activity and acupuncture, to address treatment side effects. He also emphasizes the importance of decreasing stress because it produces cortisol, a steroid hormone that suppresses the immune system.
Many news outlets have reported that Jobs had insulinoma, meaning it was the insulin-producing endocrine cells that had turned cancerous. If this is true, eliminating sugar, as a macrobiotic diet would have done, "could be very dangerous," Yao says, because his body may already have been depleted of insulin from the cancer rendering nonfunctional the cells that would have been producing this vital hormone.
Yet as it turns out, the idea of starving cancer cells turns out to be a key mechanism behind some of the latest medical treatments for pNET. The growth of pNET malignant cells is closely tied to a cellular pathway known as mTOR (mammalian target of rapamycin). As Yao explains, one of the functions of the mTOR pathway is to sense if a cell is not receiving its necessary nutrients. When that happens, mTOR can trigger the production of proteins, including several that promote cell proliferation and the growth of blood vessels. In normal cells, the mTOR pathway can be turned on and off, but in some cancers mTOR becomes impossible to switch off, and the cells are left to grow without any regulation. A class of drugs known as mTOR inhibitors blocks that pathway. One way they are thought to work is to "trick the cancer cell into thinking it's starving," says Yao. As a result, the cell begins a process known as autophagy, in which it begins digesting parts of itself to try to survive—but it doesn't.