1. Nina Bulajic, M.D., Ph.D. VII Evropski kongres integrativne medicine, Beograd, oktobar 2014.

2. Macrobiotics Lifestyle based on ancient Chinese philosophy Staples: principles of the Universe based on YIN, YANG & Five Energy Transformation theory Lifestyle: whole foods, maintenance of chi flow in the body, personal development Originates from Japan (G.Osawa, M.Kushi), developed in XX century in Western countries, especially USA

3. Macrobiotics in integrative medicine Weiger WA, Smith M, Boon H, Richardson MA, KaptchukTJ, Eisenberg DM. Advising Patients Who Seek Complementary and Alternative Medical Therapies for Cancer. Ann Intern Med, 2002, 137:889-903. Lerman HR. The Macrobiotic Diet in Chronic Disease. Nutr Clin Pract 2010,25:621-626. : Carefully planned macrobiotic diet, as part of a healthy lifestyle, can be effective in the prevention of obesity, cardiovascular diseases, diabetes and cancer. It may also be a method of treatment in all these conditions.

4. The aim : Evaluation of macrobiotics in the treatment and secondary prevention of cancer. Cilj: Evaluacija makrobiotike u lečenju i sekundarnoj prevenciji kancera

5. Retrospective interventional study Retrospektivna interventna studija Inclusion criteria: 42 patients diagnosed with various malignancies who attended the macrobiotic consultations from 2006 – 2014 evaluated by conventional medicine with complete medical records conducted advice on macrobiotic lifestyle at least 6 months The macrobiotic diet was corrected in accordance with the latest scientific knowledge, when it was necessary, especially during chemotherapy protocols Kriterijumi za uključenje u studiju: 42 pacijenta sa raznim malignitetima koji su došli na makrobiotičke konsultacije u periodu 2006-2014. i sa potpunom medicinskom dokumentacijom Sprovodili makrobiotički stil života najmanje 6 meseci Makrobiotička dijeta je korigovana u skladu sa najnovijim naučnim saznanjima kada je bilo potrebno, naročito za vreme hemioterapije

6. Age distribution (starosna distribucija) Age at the receptionNo. of patients 25 - 302 30-405 40-506 50-6025 60-704

7. Gender distribution (rodna distribucija) Total (ukupno): 42 patients Female (ženski pol): 28 (66,6%) Male (muškarci): 14 (33,4%)

8. Localisation of malignancy (lokalizacija maligniteta) Primary localisationNo. of patients Breast (dojka)9 Female genital organs (ženski genitalni organi) 6 Urinary bladder (mokraćna bešika)1 Stomack and oesophagus (stomak i jednjak) 5 Colon (debelo crevo)5 Liver (jetra)2 Larynx (grkljan)2 Lungs (pluća)5 Haematological malignancies (hematološki maligniteti) 7

9. Invasiveness of malignancies (invazivnost maligne bolesti) InvasivenessNo.of patients In organ and regional lymph nodes (u organu i regionalnim limfnim žlezdama) 17 Spreading in local tissues and distant lymph nodes (širenje u lokalna tkiva i udaljene limfne žlezde) 11 Metastases in distant organs (metastaze u udaljenim organima) 8 Localised lymphomas (lokalizovani limfomi) 2 Diffuse lymphomas (difuzni limfomi)2 Myeloma multiplex (multipli mijelom)1 Policytemia (policitemija)1

10. Oncological protocols (onkološki protokoli) * Hepatocellular liver cancer; breast cancer - kancer jetre, kancer dojke ** Colon adenokarcinoma metastatic in lungs and liver; microcellular lung carcinoma metastatic in liver – kancer debelog creva sa metastazama na plućima i jetri, kancer pluća sa metastazama na jetri ***NHL (Non Hodžkin limfom) – after the first session of chemotherapy MB applied and no recidive for 3 years, Myeloma multiplex – bone marrow transplantation planned, MB applied, after 7 years no need for conventional medical treatment ProtocolCompletition Totally completed (potpuno sproveden) 30 (71,4%) Partly recejted (CT and /or radiotherapy) –delimično odbijen 6 Totally rejected (potpuno odbijen)2 * Lack of indications (bez indikacija)2** Unnecessary after adoption of macrobiotics (nepotreban nakon primene makrobiotike) 2***

11. MB intervention related to course of the disease Vreme intervencije makrobiotikom In the course of the disease (u toku bolesti) 32 After surgery without CT/ radiotherapy (posle operacije, bez dalje hemo ili radioterapije) 5 In remission of the disease (u remisiji) 1 Prevention after completed oncological protocol (prevencija nakon kompletno sprovedenog onkološkog protokola) 4

12. Favorable outcome of MB intervention – Uspešni ishod Course of the diseaseMalignancy invasivennesMedical protocolNo.of patients Slowed progression (relatively favorable out come) RELATIVNO USPEŠNI ISHOD -In organs -In primary organ and distant metastases -In organ -In primary organ and distant metastases -Complete -No CT 55125512 Total13 P rogression stopped ZAUSTAVLJENA PROGRESIJA -NHL in remission -Myeloma multiplex -Breast cancer metastatic in bones and lungs 0 Hormonal treatment and chemical castration 111111 Total3 No relapse up to 5 years No relapse 5 do 10 y 6868

13. Favorable outcome (Uspešni ishod) 30 out of 42 patients (71,4%) – kod 30 od 42 pacijenta (71,4%) In 17 patients the progression of the disease completely halted or were introduced into remission (56,6% favorable outcome), and in 13 cases the disease progression slowed after adoption of macrobiotics (according to oncological assessments in relation to the average of patients who do not carry out this lifestyle) – 43, 4% favorable outcome. Kod 17 pacijenata progresija bolesti se potpuno zaustavila ili su uvedeni u remisiju (56,6% uspešnih ishoda), a u 13 slučajeva progresija bolesti se usporila (prema onkološkoj proceni u odnosu na prosečne pacijente koji nisu usvojili ovaj način života) – 43,4% uspešnog ishoda

14. Patients without relapse up to 5 years (No. 6) Pacijenti bez pojave bolesti do 5 godina PatientMalignancyMed. therapyStart of MBNo relapse up to V.V. NHL Non Hodžkin limfom Complete At the end of protocol 1,5 y S.D.NHLComplete At the beginning of protocol 5 y D.Z.NHL Complete until remission In remission3 y S.V. Urinary bladder Mokraćna bešika Complete U the course of protocol 2 y M.D. Gastric Želudac CompleteAfter protocol3,5 y A.S.Ovarial Jajnik Only surgeryAfter surgery2 y

15. Patients without relapse more than 5 years (No. 8) Pacijenti bez pojave bolesti više od 5 godina PatientMalignancyMed. therapyStart of MBNo relapse up to M.Đ. Cervix – Grlić materice CompleteAfter protocol8 y J.B. Colon- Debelo crevo SurgeryAfter surgery8 y N.A.Larynx- GrkljanCompleteAfter protocol5,5 y B.V.Lungs - Pluća Complete (surgery) After protocol10 y, 6 on MB S.K.Breast - DojkaComplete At the beginning of protocol 8 y M.LJ:Uterus - MatericaComplete At the end of protocol 8 y G.C.PolicytemiaCompleteDuring protocol7 y J.K.Myeloma multiplex UnnecessaryBefore medical treatment, 1 y after diagnosis 7 y

16. Unfavorable outcome after MB intervention12 out of 42 (28,6%) Nepovoljni ishod nakon primene makrobiotike – 12 od 42 pacijenta (28,6%) Course of disease Invasiveness of malignancy Medical protocolNo of patients No effect Bez efekta -In organ -In prim organ and distant metastases -In organ -Complete -No CT 2 (lungs, ovarial 3 (lungs, colon, HL) 2 (breast) Total7 Progression in other organs Progresija u druge organe 1.Breast cancer 2.Stomack cancer 3.Larynx cancer After CT metastases in liver After CT metastases in lungs 111111 Total3 Relapses Ponovna pojava bolesti 1.Breast cancer 2.Colon cancer -CT rejected after surgery, MB applied, local recidive - After surgery, CT i MB, remission, after new ovarial cancer, CT repeated 1111

17. The course of the disease related to degree of oncological protocol rejection Tok bolesti u odnosu na odbijanje onkološkog protokola PatientMalignancy Med. intervention Outcome J.B.Colon cancerSurgery No relapse up to 8 y A.S.Breast cancerSurgery No relapse up to 2 y Z.I.Breast cancer CT, ceasses for negative side effects MB with no effect, lethal outcome M.K.Breast cancerSurgery No relapse up to 2 y, later unknown LJ.N.Breast cancer Surgery, CT rejected MB with no effect, lethal o. J.Š.Breast cancerSurgery, CT rejected Loc. relapse, afterwards completed protocole

18. The course of the disease related to degree of oncological protocol rejection Tok bolesti u odnosu na stepen odbijanja onkološkog protokola 8 patients had not implemented the proposed oncology protocol. In 2 cases of complete and 2 cases of partial rejection the outcome was lethal, in one case of partial rejection there was a relapse, and in 3 cases of partial rejection of the protocol relapse did not appear over 2 years. 8 pacijenata nisu prihvatili preporučeni onkološki protokol. U 2 slučaja potpunog i 2 slučaja delimičnog odbijanja ishod je bio fatalan, u jednom slučaju delimičnog odbijanja bolest se ponovo javila, a u 3 slučaja delimičnog odbijanja protokola bolest se nije javila više od 2 godine

19. Conclusion Zaključak Macrobiotics is a valuable method of traditional medicine in the secondary prevention of malignancies, and also can be effectively used as a complementary method in the treatment of cancer. Makrobiotika je vredna metoda tradicionalne medicine u sekundarnoj prevenciji malignih bolesti, a tako đ e i efikasna komplementarna metoda u lečenju kancera.