Eat Dirt!

Actually.

I was in the office of a naturopath yesterday and heard her recommend Terramin for rebuilding injured bone. I'm having some trouble locating a really good reference for this, but the rumor is that NASA funded a study back in the 1960s showing that Terramin (calcium montmorillonite) might help astronauts avoid bone loss in weightlessness, whereas calcium alone did not seem to help. I've located a reference to animal studies which seem to demonstrate the point.

I have no injured bones, but the absolute density of the bone in my femurs has declined from about 0.96 to about 0.89 grams per square cm in the three years from 2004 to 2007. Technically I'm in osteopenia, the stage before osteoporosis. Neither my oncologist nor my primary physician is particularly concerned about this decline, however, and neither wants to prescribe a bisphosphonate (e.g. Fosamax). Nevertheless I would like to halt the decline if possible. I have been taking 1200 mg of calcium in the form of calcium citrate fairly regularly during those years, so something different is required.

Thus I bought some Terramin. It's dirt that you can eat, from the desert of California. The claims are many: Body cleansing, trace minerals, bio-available calcium, on and on. There's plenty of hype here. I'm a skeptic, but in the spirit of doing all that I can, I'm actually eating a heaping teaspoon of dirt every day. Well, for the last two days, but I expect to continue this until the next bone density measurement, unless persuaded otherwise.

So far I have taken the dirt in juice. I put several ounces of pomegranite juice in an eight-ounce glass, mix in a heaping teaspoon of Terramin, then fill to the top with sparkling water. The dirt is a very fine powder which mixes well in water, but is nonetheless gritty in the teeth. I need to swish with water (beer is better) after taking this stuff, or eat something. It says take it on an empty stomach, but I can't imagine what difference that would make so I'll take it in whatever manner is least objectionable.

So that's the dirt from Lake Woebegone.

Merry Christmas and Happy New Year to all!

Treatable But Not Curable

NBC Nightly News broadcast a story about myeloma Wednesday, December 13, 2007. This MSNBC video shows that story, with some discussion by Dr Brian Durie of the International Myeloma Foundation, and goes on to describe myeloma and its treatment in more detail.

Fighting multiple myeloma

Low Dose Naltrexone for Headache

This post is not really about myeloma.

For thirty years or so I have had chronic headache. If I take nothing for it, I have a headache almost all of the time, often so severe that it destroys all enthusiasm for life. I have gone to neurologists, and been treated for sinus infection and on and on, with no result. Happily, though, the headache responds well to pain relievers. Over the years I mostly used acetaminophen and ibuprofen, then got excellent relief from Vioxx, which to my disappointment was soon taken off the market. Since then I have used naproxen sodium (Aleve) with good success. Taking two tablets per day, the maximum non-prescription dosage, the headaches are few and mild.

Then two months ago I threw "everything including the kitchen sink" at the myeloma. "Everything" included low-dose naltrexone (LDN). Naltrexone is an "opioid receptor antagonist," a generic prescription drug used to treat addiction. It blocks the effects of opioids. Taken in very small doses, though, naltrexone seems to tell the body that it is not producing enough endorphins, the body's own opioids. The body responds by producing more endorphins, which is thought to help normalize the immune system. My cancer markers did go down a little at the last test, so it may be working. We'll know more on January 3.



Whether or not it's helping with the cancer, there is another significant benefit. Soon after I started on LDN, which is taken at bedtime, I noticed that I wouldn't get a headache in the night even if I forgot my nighttime dose of Aleve. So I stopped taking the nighttime dose, and now only take one dose per day, in the afternoon, with no more headache pain than before, maybe even less. This is very good news, because long-term use of Aleve can put several different body organs at risk. Cutting the dosage in half should reduce that risk considerably.

The "kitchen sink" treatment also included a change in diet, with elimination of gluten. It is possible that I have an atypical gluten intolerance, and that gluten causes my headaches, in which case the improvement would be attributable to diet rather than LDN. I discount that, however, because: (1) the gluten is entirely gone but the headaches are not; and (2) the LDN produces some other very identifiable effects, including a very sound sleep. Thus my body is clearly producing extra endorphins at night, and a natural side effect would be less pain. I know this from running, which also produces endorphins; I never have a headache while running.

The LDN website makes many claims about the benefits of LDN, but oddly, doesn't mention relief from chronic pain. Some questions & implications:

• Can LDN help with other kinds of chronic pain? (For obvious reasons, it cannot be used in combination with narcotic pain relievers.)
• Can LDN be used to treat depression exacerbated by chronic pain?
• If I took LDN twice a day, could I eliminate Aleve altogether? I can easily test this possibility, but not right now because it might upset my myeloma treatment regimen.
• Do you suppose that thirty years of pain relievers contributed to my myeloma?
• What are the risks of long-term treatment with LDN? According to MedLinePlus an overdose can cause liver failure, but LDN is by definition an underdose.

I'm no more afraid of the long-term consequences of LDN than I am of Aleve. Even if, in the final analysis, it doesn't help treat the myeloma, I think I'll try to get a prescription to LDN for the headache.

Weighty Question

Over the past five or six weeks my weight has been dropping, now down to 144 and change, which is the lowest in perhaps 30 years. A very appropriate weight for me I believe. Most people would celebrate this, and I do too, sort of, but I’m logging it just in case it’s a symptom.

It does coincide with my return to running, and I have run two marathons during those weeks, but in the past my running has not caused that much weight loss.

It also coincides with the new myeloma treatment regimen which includes a new drug (LDN), increased supplements, and a substantially changed diet. Those things are most likely the cause. If so, it puts me in the happy position of needing to eat as much as I can, perhaps more than I want, because I don’t think I should lose any more. I can hear you say "poor baby!"

EXCELLENT Test Results

Yippee! Ok Don, calm down. "EXCELLENT" would be "it turns out you really don't have cancer after all." So these test results are just VERY GOOD! Can you tell I'm happy?

This was a short interval, too, only five weeks. Some important results:

• IgG is down 13%, from 3110 to 2690 mg/dL. My IgG had not declined in the previous eight sets of tests, in fact increasing linearly and predictably for more than two years;
• Spike (the SPEP test) is down slightly, from 1.90 to 1.85 mg/dL. This is not highly significant, because the SPEP does bounce around, except that this is the second DOWN bounce in a row and it has not bounced DOWN in two tests since the Big Bang.
• Calcium dropped WAY down, from 10.4 mg/dL (slightly over the normal high range) to 9.7, perfectly normal. This had been the only C.R.A.B. symptom that seemed to be closing in on me, but it has backed away.
• Creatinine is the lowest I have seen it in my four years with myeloma, down from 1.2 last time to 1.0 mg/dL. It is an important indicator of kidney function, another of the C.R.A.B. symptoms, though it wasn't out of range at 1.2.

I will post the full set of results, with graphs, on this blog by tomorrow night, but wanted to get out the news right away.

How did this happen? Heck, maybe it's just a glitch, but I like to think that the downturn was induced by some of the things I'm doing. If so, I give a lot of the credit to my friend Margaret for her work on curcumin and other supplements, plus her work on inflammation. Credit also goes to my friend Max (not his name, but he knows who he is) for putting me onto low-dose naltrexone. Further credit goes to my ever-loving sweetie Sunshine and my daughter Sweet Pea for feeding me properly, as described below.

Here is the regimen that I have been on for those five weeks (the "everything including the kitchek sink" approach):

• Curcumin 7600 mg per day in four equal doses at approximately equal intervals. Of that curcumin, 6000 mg is "normal" 95% turmeric extract, and 1600 mg is the new Life Extension Super Bio-Curcumin, which they claim is about seven times as bioavailable as normal extract. For this, thanks to Margaret and many others.
• Low-dose naltrexone (see my previous post about that here). This is a prescription drug taken each night at bedtime, consisting of 4.5 mg of naltrexone. I have my local pharmacist compound it special, because the normal dose (for another malady) is 50 mg, way too much to achieve the desired result. Thank you Max.
• Flaxseed oil, 1000 mg taken with each dose of curcumin to enhance bioavailability. Thank me.
• Resveratrol 125 mg four times daily, taken with the curcumin. Thank you Margaret.
• Quercetin 500 mg twice daily, taken with the curcumin. Thank you Margaret.
• Mostly-vegetarian diet. Lots of fruits and vegetables, lots of nuts, modest amounts of grain, a little chicken or turkey, fish about twice a week, bison rarely, no beef or pork ever. Margaret posted about C-reactive Protein here. It may be a logical target for myeloma treatment, and one way to reduce CRP is to go vegetarian. Thank you Margaret and Sunshine.
• Gluten-free diet. Gluten can cause severe inflammation in people who test gluten-intolerant, and it can cause some inflammation in many people who do not. Intolerance to gluten runs in families, and I have a son who tests gluten-intolerant, so why not go gluten-free, or nearly so? We pretty much have done that in the last five weeks and will do so in the foreseeable future. Thanks, Sunshine.
• Lots and lots of exercise, including the overheated Chicago Marathon. Thanks to Sunshine and Sweet Pea.

The doctor/oncologist, who was SO skeptical about LDN that he would only humor me with a five-week prescription, today said "see you in two months," and gave me a three-month prescription and a happy smile. He used the word "stable."

There is some bad news, though. Or maybe it's just not-too-hot news. My red-blood-count is 4.24 M/uL, the lowest it has been in my four years of myeloma, and hemoglobin (HGB) is 13.9 g/dL, also at its lowest. RBC is actually off the bottom of the low range, though HGB is still barely within. My red blood count is always a bit low, but this is still a significant change. What caused it?

• Perhaps the lack of red meat in my current diet?
• I ran 14 miles indoors (read: warm!) the day before the blood draw. Could that kill off a few red blood cells?

Anyhow my doc onc isn't too worried and recommended more bison in the diet. He did point out that all of the things I'm doing are a "treatment," and treatments have effects on the whole body. Perhaps it's time to check in with my internist too; he's awfully smart.



Yesterday's breakfast: Organic oatmeal, organic nonfat milk, kiwi, blackberries, banana, sweetened hibiscus blossoms (from Trader Joe's).


Today's salad: Organic romaine, avocado, jicama, organic strawberries, macadamia nuts, blue cheese, raspberry vinegar.


Main dish (organic beans, organic rice, organic corn, onions), more onions, cute little sweet potatoes, organic nectarine, organic catsup.

Score One for Low Dose Naltrexone

My friend Max put me onto low-dose naltrexone (LDN) some time ago. I blogged about it in June. It is a prescription drug approved for treatment of drug addiction, but used by a few doctors for cancer and other maladies, off-label and in small doses. It is thought to work by stimulating the body's endorphins back to normal levels, thereby restoring the body's immune system.


Long story short: Max called today to report his own results: IgM was over 3000 (normal is 300) and has DROPPED 18% in four and a half months on LDN. Max is not an excitable person, but he certainly did sound pleased with this result.

To be sure, an 18% reduction in IgM could be just a normal variation, or almost so, a combination of variability in the test and actual variability in his blood. Though his doctor seemed underwhelmed, Max thinks this was an actual drop, because his numbers had been steadily climbing by about that amount at every test interval. The future will reveal the truth, of course.

Max does NOT have myeloma; he has Waldenstrom's Macroglobulinemia (what a mouthful). Whereas myeloma patients normally talk about IgG or IgA, his naughty protein is IgM; it affects the body somewhat differently and is treated somewhat differently. If he had myeloma instead, who knows whether he would have experienced this benefit from LDN?

Hoping that it can, I am taking LDN too, for the past eleven days, along with curcumin, quercetin, resveratrol, mostly-vegetarian diet and the kitchen sink.

Smoldering Myeloma

Donna left a nice, informative comment on an earlier post here titled More Thoughts About Marching. This is my response, long enough for a post rather than just a comment.

We're the lucky ones, Donna, in my opinion. We found out about our myeloma by accident, long before we broke a bone, or suffered kidney damage, or whatever. We have the chance to pack a little more life into the next years than we might have done otherwise. Furthermore, we have the chance to learn about the treatment possibilities and about our own disease before having to make the serious life-changing decisions.

I'm in the position of making one of those decisions soon, because my particular oncologist is asking me to make it. Mayo and UAMC are right - studies have not shown any survival advantage in starting treatment early, so why suffer the symptoms of the treatments when there are none from the disease? Perhaps the answer is that early treatment may provide a higher quality of life even if it does not extend life; that is the proposition. At my last doctor visit I said to him that Mayo would wait until there are C.R.A.B symptoms, such as broken bones, kidney impairment, or anemia. He responded "I want to keep you from having those symptoms."

That sounds great, and I love that attitude in my oncologist! But the problem is that the treatments all have side effects, some of them permanent. I discovered this when I was treated with thalidomide; I won't bore you with the list! So it's a balancing of risks: (1) Risk of permanent injury from the myeloma, versus (2) Risk of injury from the treatments. I've been resisting hard-core treatments now for almost half a year, opting for alternative treatments instead, with uncertain results.

Here's my engineer's understanding of myeloma: Plasma cells normally produce immunoglobulins (Ig) which fight infections. The plasma cells remain in the bone marrow, and the immunoglobulins escape into the blood stream where they do their work. Malignant cells normally still produce immunoglobulins, but they are ineffective and often lack one of the "arms" that normal immunoglobulins have. They are distinguished by the type of immunoglobulin (there are several types, including IgI, IgA, & IgM). They are further distinguished by the remaining arm (or is it the missing arm?), which may be either kappa or lambda. Hence your myeloma, and mine, is IgG Lambda. In some people, the malignant cells do not produce any immunoglobulins at all, or very few; that form of myeloma is called non-secretory (nothing is secreted). And I think this is a continuum; some people may secrete only a little and others a LOT.

Sorry for the long blah blah, but I wonder if you are a non-secretor, or nearly. If so, it's not necessarily a bad thing except that it makes the myeloma harder to track. I'm surprised to see that ALL of your Ig numbers are below the normal low limits; I don't know what to think of that, except to guess that the malignant cells are suppressing the production of the normal cells which do produce immunoglobulins.

IgG by immunofixation detects both normal IgG and abnormal (monoclonal) IgG equally, as I understand it. There is another test called serum protein electrophoresis (SPEP) which can show just the abnormal IgG. I wonder what your SPEP shows. Perhaps NONE, if that is the meaning of the April notation.

I do not have Bence-Jones proteins in the urine. More commonly now, I believe, these are called "free light chains." My doctor tests for these proteins in the urine, and in the blood as well, using a test called FreeLite (nephelometry). So far I have not had more than a trace of light chains in the urine, but they are detectable and above normal in the blood. Light chains are often used to track the myeloma in people who are non-secretors, so your oncologist may be doing those tests for that reason; I assume that you are asked to submit a 24-hour urine at every test interval. I would encourage you to ask your doctor for copies of every single lab test or radiologist's report; I do that and I've never been sorry.

There are other ways for us (anyone) to communicate more directly. One of the best is the MMA List server, where myelomiacs or caregivers register as members and then receive emails sent to the list by other members. I've enjoyed this a lot lately. If you post a message to the list, people can respond through the list or directly to you. In any case, if you (or anyone) would like to email me directly, my address is minnesotadon at gmail dot com. Thanks, Donna, may your myeloma smolder forever!



Today's breakfast: Organic oatmeal, organic nonfat milk, blueberries, organic seedless grapes, banana. Estimated Weight Watcher points = 5.


Lunch today: Sunshine bread (Arrowhead Mills gluten-free baking mix, organic corn flour, organic amaranth, organic teff flour, nuts, other goodies), organic squash, onions, organic salsa, organic chunky peanut butter. Estimated Weight Watcher points = 7.

Life Extension Super Bio-Curcumin

Life Extension (LEF) recently introduced a new curcumin product called Super Bio-Curcumin, which they claim has "enhanced bioavailability and sustained retention time in the body confirmed by human clinical studies." If true, their 400 mg capsule is "equivalent to 2772 mg of a typical 95% curcumin extract," or almost seven times more potent. However, I found no information supporting their claims, so I filled out a form on their website requesting additional information on the studies that demonstrated this improvement in potency.

Meantime, believing that LEF is a legitimate organization which probably has some basis for its claims, I did order some of the new curcumin and I am already adding it to my protocol, intending to gradually replace four of the sixteen 500-mg capsules that I now take with four of the 400-mg Super Bio-Curcumin capsules. I am not doing this increase all at once because curcumin is very bioactive and can have side effects, but if I am able to get to four of the new capsules in addition to twelve regular ones, that should be the equivalent of about 17 grams of "typical" curcumin extract per day, more than double what I am taking now.

Today I received a written response to my request for information, as follows:

Don,
Thank you for contacting Life Extension. The studies are found in the October 2007 issue of Life Extension magazine. However, this issue is not yet loaded onto our website. You should be receiving your October issue any day now. If for some reason it does not arrive, please e-mail us and we will send you another copy.

Dave Tuttle
Dept. of Correspondence
Life Extension Scientific Information, Inc.


The email also included a long disclaimer, which I can summarize as "We are not your doctor, see your own doctor."

We just re-subscribed to Life Extension Magazine at this house, and have not yet received the October issue. Since we allowed our subscription to be interrupted, we may not get one at all, but I will look for this information on the LEF website. If you, dear reader, receive your copy of the magazine and care to leave a comment about Super Bio-Curcumin, please do so.



Today's breakfast, after the bike ride: Organic oatmeal, organic nonfat milk, banana, kiwi, organic grapes, organic nectarine, blueberries. Estimated Weight Watcher points = 6.


Today's dinner salad: Organic romaine, organic plum, kiwi, avocado, organic salad beans (mostly under the lettuce), raspberry vinegar. Estimated Weight Watcher points = 4.


Today's dinner: Alaskan wild catch halibut steak, organic sweet pickle relish, organic winter squash, organic salsa. Estimated Weight Watcher points = 5.

The Program

Margaret recently posted about c-reactive protein (CRP). It's made by the liver, sometimes in response to myeloma, and then it apparently also supports the growth of myeloma. It's a very naughty circle, but it makes CRP a potential target for myeloma therapy.

When I did a little research on ways to reduce CRP, vegetarian eating showed up right away as a good candidate. So, bless her heart, my Sunshine has enthusiastically agreed to do mostly-vegetarian meals for the next five weeks or so. "Mostly-vegetarian" is still a work in progress, but probably means no red meat, not more than one meal of chicken or fish per week, and very easy on the cheese. The food pictures below show a couple of examples. Note that this is not necessarily low fat, because the diet does include nuts, avocados, and other healthy vegetarian foods.

The Program for the next five weeks, each day:

• Eight grams of curcumin, half with bioperine;
• Four grams of flax seed oil;
• One gram of quercetin;
• 500 mg of resveratrol;
• 4.5 grams of naltrexone, last thing in the evening;
• Mostly-vegetarian nutrition;
• Lots and lots of exercise;
• Plenty of Sunshine.

When the LEF curcumin arrives, a new and supposedly much more bioactive form, I will use it to replace enough of the normal curcumin to get a dosage equivalent to at least 12 grams of the normal curcumin.

Bone survey was yesterday, bone density test tomorrow, results whenever.


Four times per day, left to right: One capsule of organic flaxseed oil; two capsules of Doctor's Best or NSI curcumin (rotate); two capsules of Ageless Cures curcumin (total curcumin 2 grams); one capsule of resveratrol (125 mg each, plus other stuff); one capsule of quercetin (500 mg) every other dose.


Organic romaine, avocado, organic nectarine, blue cheese, pistachios, raspberry vinegar. Estimated Weigt Watcher points = 4.


Organic corn meal, organic corn flour, can of organic corn, with a sprinkle of caraway seeds on one small piece (a successful experiment). With a drizzle of maple syrup. Estimated Weight Watcher points = 6.

More Thoughts About Marching

Margaret and Ana, Thank you both for your comments on the previous post. My heros, two kind and clever women in Italy! I do feel better.

The decline of 3% in M-spike is probably well within the margin of repeatability of that test, but at least it suggests that monoclonal proteins did not go UP. I do not know of any reason why the normal IgG should have gone up - I was not dealing with any kind of infection that I know of on blood-draw day - but of course it could be due to a transient subclinical infection of some kind. Perhaps the myeloma is not marching; we shall see in five weeks or beyond.

Meantime I will:

• Continue with the curcumin,
• Add low-dose naltrexone,
• Add resveratrol and perhaps more,
• Get the bone survey (I had a skull MRI done in April),
• Look into the new Life Extension Curcumin and perhaps use that for part of my daily dose,
• Examine the Mayo mSMART concensus protocol more carefully (I believe that this will indicate that I should not treat conventionally until CRAB symptoms appear), and
• Think long and hard about treatment philosophy when and if conventional treatment really is necessary.

That last item includes the decision whether to treat it with the minimum required to keep it under control, or clobber it (thereby also clobbering my body) in the hope of getting a remission which will allow some months or years treatment-free.

In answer to other very good questions:

• The doctor said that some calcium is bound in the IgG, so the calcium measurement in the normal Chem-20 panel would naturally rise with the IgG and might not be a separate indicator. In five weeks he will order another test for what I believe he called "free calcium," which will be more definitive.
• I did not ask about vitamin D but I do take 1000 IU daily, or is it 2000?
• I have had a thyroid test (T4 and another) which were normal. However, my primary physician thinks I neverhteless have the beginning of a goiter (!), so that is a concern and I have started taking a thyroid supplement which includes bovine tissue.
• I will ask my doctor about another cranial or spinal MRI.
• My onc just didn't order the B2M test, for some reason. Since it was also trending up I think he should have, and he said that will be included in five weeks, along with the extra calcium test.
• I've had three BMB's so far, with the most-recent showing only 6.8% plasma cells. However, all three biopsies are from the same hip; next time I will switch hips!
• I'll check into PET as well.

Thank you both for your thoughtful comments. I encourage you to keep on saving my life :-)

Marching, Marching ...

Myeloma doesn't give up easily.

I started a curcumin regimen on June 27. Today I got the results. They were not terrible, but sadly, they do not show much benefit from nine weeks of curcumin treatment. Here are some numbers:

• Free lambda light chains are down 12%, and
• “Spike” (SPEP) is down 3% to 1.90 g/dL, but
• IgG is UP 12% to 3110 mg/dL, and
• Serum calcium has edged up to 10.4 mg/dL, which is above the normal range for the first time ever.

Actual values from key tests are displayed graphically in the charts and numerically in the test result table. At bottom, it appears that the cancer is still advancing slowly and relentlessly. That’s what it does, and in my case the curcumin seems to have little effect.

Doc and I had quite a discussion today. He really wants to put me on Revlimid right away. I have lots of questions about that, such as:

• Should we hit it easy, shoot for a partial remission and stability, or
• Should we hit it hard, with more drugs, and shoot for a longer-term remission?
• Why Revlimid and not Velcade, when we know that Thalomid (thalidomide), another “IMID” drug, has already failed?
• Why not wait until there are symptoms, as Mayo would do?
• Is the above-normal calcium already a symptom?

We didn’t decide these issues; I put off the decision for another month at least. Meantime he reluctantly consented to prescribe low-dose naltrexone (LDN) for that period, five weeks actually. I will take that prescription drug, along with the curcumin and perhaps another supplement, for those five weeks and then we will see. In addition, he ordered another x-ray skeletal survey, which I will schedule ASAP.

The doctor believes that time is getting short, looking at the high IgG of 3110. But if that is a problem, it should also show up in other tests, which so far look pretty normal. Or it will show up as lesions in the bones, which we will soon determine. I’m trying to get the right balance here, of risk from the myeloma versus risk from the drugs that treat myeloma.

Meantime, I figure on living life to the fullest. Live one day at a time and make it a masterpiece!

Related links:

• My Myeloma: A discussion of my myeloma, not very technical.
• My Treatment History: Not technical.
• My Lab Test Charts: Graphic displays of several key test results over time, like the one below showing IgG from 2003 to date.
• My Lab Test Table: Best with a wide browser window. Very technical.

Curcumin in Oatmeal

Margaret recently posted some information indicating that the efficacy of curcumin may be improved by heating it. I decided to try some curcumin in my morning oatmeal, to see if that was at all edible.

I'm happy to say that it was edible. In fact, to my surprise, curcumin didn't change the taste of the oatmeal much at all. What does that say about my sense of taste? I don't know. I believe that curcumin may be an important component of the spice turmeric, but it is not the component that imparts flavor! I even used one gram each of two different brands of curcumin. This was only one fourth of my daily eight-gram curcumin dosage, however; it is possible that a full day's dose would impart more flavor (and thus be more objectionable). It did make the oatmeal very yellow, which is not very appealing.

The problem is that I don't know how much heat is necessary to improve curcumin's bioavailability, or how much is too much. Maybe nobody knows. I added the curcumin after the oatmeal was cooked, but it would get a lot more heat if added during the cooking as you would do if you were preparing an Indian dish with turmeric.



Oncologist tomorrow - I'll get my latest test results, including and especially the results of my first two months on curcumin.

Pee in a Bottle

Tomorrow I take the test! Blood test, that is, and I'll contribute my other little donation to the lab. Usually I get these tests:

• Complete blood counts (CBC), which includes counts of red cells, white cells, platelets, hemoglobin, and the like. Lots more, most of which the doctor doesn't even look at unless they go out of range.
• Chemistry, which includes calcium, sodium, potassium, and other mineral counts plus several other very important indicators such as creatinine (kidneys) and albumin (liver).
• Serum Protein Electrophoresis (SPEP) which shows how much of the protein in the blood is in the form of "monoclonal" proteins that are cast off by the malignant plasma cells of myeloma. This is a crude but important indicator of the actual tumor burden. Myeloma patients call this the "spike," because it actually does show up as a peak on a graph. Bad Spike!
• Light Chains, a particular component of the monoclonal proteins which can clog up internal organs and make things a lot worse, in fact they can make you dead. The doctor tests for light chains in the blood and also in the urine.
• Other stuff. Sometimes they do x-rays, bone density measurements, bone marrow biopsies, and other tests. None scheduled this time, but maybe if the blood tests indicate an issue.

The big jug shown above is for a 24-hour urine collection. Little more than a nuisance for a man, it's a bit more troublesome for a woman (so I hear). That urine is tested for light chains, and perhaps for other naughty proteins. The jug holds a gallon, and I never fill it, but I'm told that some people need two or even more.

I'll see the doctor in another week to review the test results. If the numbers are stable or down, then the curcumin regimen is doing some good and we will no doubt stay the course. If they are up, then I know that the doctor will recommend Revlimid, a fairly new treatment which I am reluctant to start for several reasons. I will most certainly post.

New Blog

I'm thinking about building my own computer, and have created a new blog about it here.

C.R.A.B.

I have "smoldering" myeloma (or just MGUS, depending how you look at it), which means my myeloma is not symptomatic. No broken bones, kidney failure, nothing. I even ran four marathons this year, so far.

But my numbers (IgG, M-Spike, Light Chains) keep climbing, so I walk around with my fingers crossed, hoping to continue smoldering but nervously looking for that first little flame somewhere.

Enter the CRAB criteria: Calcium, Renal (creatinine), Anemia (hemoglobin), and Bone lesions. A person is considered to have active myeloma ("end" organ damage) when any of these criteria are out of whack.

Mine seem to be well within whack, except for the first, calcium. In the last three lab tests, calcium has edged toward the high limit of normal according to that lab. So I checked the internet to see what is abnormal according to the CRAB criteria.

The first place I looked was the International Myeloma Foundation's page about CRAB. That got me more confused. So I called the hot line and Nancy Baxter called right back. Then we were both confused, so she put me on hold and called Dr. Durie! Good job, Nancy.

If I got it right, this is what he told her:

• Normal calcium readings are right around 9 or 10 mg/dL (milligrams per deciliter), not mg/L (milligrams per liter) as is suggested in Table 1 of the IMF page about CRAB. One mystery solved, something for IMF to fix on their web page.
• Perhaps the best CRAB limit for calcium is the local lab's own limit. Over that you've met one of the CRAB criteria.
• However, calcium is not usually the first criteria of the four to be met; one of the others pops up first.

The implication of all of this is that I shouldn't be too worried yet, because my calcium is still (barely) below the limit. It could easily go down again, too, because it clearly does bounce around a bit. But I will be watching.

Here is a chart of my serum calcium since diagnosis. Looks like it's creeping up in the last six months:

Life Detour

Friday night a storm blew through here and took down trees. Lots of big trees, in the yard and in our little woods. I've been working on the cleanup since.

Much more on:

• My running blog.
• Sunshine's blog.

Electrolytes OK

About a week ago I had blood drawn for lab tests. They took two different vials, an unusually low number. But today when I called, the nurse said that all the doctor had ordered was "electrolytes." When I asked what that was, she said "sodium, potassium," and such. Huh. Everything was normal, said she.

I wonder why we even did the labs. Are we really concerned about sodium? Clearly, there's something here that I don't understand.

I'm still taking curcumin, 8000 mg per day, and I think that the doctor wanted to be sure that curcumin in such high doses did not throw other things out of whack. If so, he probably did his normal chemistry panel, which includes sodium and potassium, but (more importantly?) renal and liver markers such as creatinine and albumin. If so, I want to see those numbers, normal or not! She's mailing the report.

I do wonder what the second vial of blood was for, and hope that it was for a different test, like maybe the SPEP, and that she mails that one too! Doctors offices. Sigh.

More when the reports arrive.


Two lunches and a dinner plate:
Organic whole spelt rollup, leftover roast local no-hormone no-antibiotic lamb, organic romaine, Sunshine sauce (organic yogurt, minced cucumber, organic lemon rind, minced garlic, dill), very ripe nectarine. Estimated Weight Watcher points = 6.


Chicken bratwurst, whole wheat bread, organic pickle relish, watermelon, kiwi, organic nectarine, papaya. Estimated Weight Watcher points = 7.


Wild caught Alaskan salmon, organic yogurt, spices, peas, beans, slivered almonds, dried cranberries, homemade sweet potato salad. Estimated Weight Watcher points = 9.

Tooth or Consequences

Myeloma can cause bone damage, which may be treated with bisphosphonates like Zometa and Aredia. Those strong medicines can, however, cause other bone problems, particularly a complication called osteonecrosis of the jaw (ONJ). With ONJ the jaw bone loses its blood supply and dies. It is painful and disabling, and to be avoided if possible!

ONJ is especially likely to occur if dental surgery is done while taking the bisphosphonate. I am not taking a bisphosphonate yet, but I did have a tooth which, though it wasn't painful, showed weakened roots on x-rays. This afternoon I had that tooth removed, so that I wouldn't need to have it done at some later date when I may be taking a bisphosphonate. As it turned out the tooth was abscessed, so it's a good thing I had it done now for that reason as well.

The curcumin regimen is going well - I have not missed a dose since I started in late June. Blood draw tomorrow, so I will know in a week if the curcumin is helping.

Potluck dinner in Minnesota last Sunday:
At this particular potluck dinner, good choices were possible.

Big breakfast after an early workout:

Organic oatmeal, organic fat-free milk, organic strawberries, blueberries, organic plum, kiwi, crunchy almond butter, organic rainier cherry. Estimated Weight Watchers points = 6. Good recovery breakfast - it took 16 minutes to eat it.

Salad before supper:

Salad greens (organic romaine, fennel, fresh tarragon, organic fresh basil), avocado, mango, pineapple, organic strawberry, blue cheese, raspberry vinegar. Estimated Weight Watcher points = 4.

Tasty chicken supper:

Grilled chicken marinated in orange juice and tarragon, pan-braised asparagus with rosemary, baked organic sweet potato slices, organic catsup. Estimated Weight Watcher points = 6.

Good X-Ray Report

At my last doctor visit I mentioned a slight ache in my left upper arm, and the oncologist ordered an x-ray just to rule out a plasmacytoma, which can surprise any myeloma patient at any time. The results are in: NO PROBLEM. That's a relief, and it helps with another decision.

I have a tooth that's rather iffy - hemi-section and root canal years ago, and now starting to get weak at the root. My dentist has suggested it's time to take it out. No pain, though, and no relation to myeloma.

EXCEPT: myeloma attacks bones, and that usually requires treatment by bisphosphonate drugs such as Aredia (pamidronate) or Zometa (zoledronic acid). These are the heavy-duty cousins of Fosamax (alendronate) and similar drugs used to treat osteoporosis. Aredia and Zometa can help rebuild the myeloma-weakened bones, but they can also cause a serious side effect called osteonecrosis of the jaw (ONJ), a very unpleasant and somewhat dangerous condition. ONJ often starts when a person taking Zometa or Aredia has dental surgery.

I've been holding off the removal of that bad tooth while waiting for these x-ray results. If the x-ray had disclosed a problem in the bone, I would have been headed for heavy-duty bisphosphonate treatment and would not want an open hole in my jaw. But with this all-clear signal, I'm going to get that sucker out and get the jaw healed right away.


Supper:

Free-range bison, no-hormone no-antibiotic beef, organic sweet potato, organic carrots, onion, organic catsup. Estimated Weight Watcher points = 6.

Next-day's lunch:

"Take and Bake" organic honey whole grain bread, cold roast free-range bison and anti-biotic-free hormone-free beef, organic bread and butter pickles, organic nectarine, organic cashews. Estimated Weight Watcher points = 7.

Busy bee on the Garden Tour.

Family Means Garden Tour

Every year an organization called Family Means in Stillwater, Minnesota, organizes a "garden tour" of several local prize gardens. I had a little fun taking some pictures on the tour and made a slide show of them.

Click on the photo below to go to the slide show, then click "start" at the bottom of that page.

Too Many Food Pix

Either I'm eating too well or not blogging enough, because there are too many food pictures in the queue. So here are a few, just for no reason at all.



Chicken/feta/spinach bratwurst, whole wheat bread, Roquefort mustard, blackcurrant jam, organic plum. Estimated Weight Watcher points = 7.


Jim's super-fresh beans, watermelon, half of a chicken/feta/spinach bratwurst. Estimated Weight Watcher points = 2.


Blueberries, orange, leftover July 4 party brownie ("No Pudge" fat-free fudge brownie mix plus organic yogurt, Hershey's chocolate chips, vanilla extract). Estimated Weight Watcher points = 3.


Organic whole-wheat spaghetti, grass-fed bison & spiced ground hormone- and antibiotic-free pork, organic spaghetti sauce, organic parmesan cheese, jumbo olives. Estimated Weight Watcher points = 7.


Organic romaine lettuce, organic cucumber, organic celery, Danish blue cheese, avocado, organic strawberries, raspberry vinegar, "Take and Bake" organic honey whole grain bread. Estimated Weight Watchers points = 3.

Two Weeks on Curcumin

So far so good. No problems, and in fact I can't really tell that I'm taking it. Some people have reported that it fixed symptoms other than the myeloma, but so far it hasn't cured my plantar fasciitis or my chronic headaches.   :-)   I still treat those in other ways.

I have gained a little weight, maybe two pounds, but I can probably point at the plantar fasciitis as the culprit because I can't run and therefore don't get quite as much exercise.

I ramped up rather quickly on the curcumin: two days at two grams, two days at four, three days at six, then eight grams, all the while looking for problems and finding none. The recommended ramp-up is much slower, taking three weeks. Some people take the whole 8-gram daily dose at one time, though, and I take only two grams at a time, four times per day.

Test results in about six weeks; appointments for labs and doctor are not made yet.

Tonight's dinner:

Farmed pan-fried tilapia (Honduras), broccoli, "mango salsa" including organic apricot, organic plum, mango, watermelon, cucumber, and pineapple, with juice of organic lemon on the fish and broccoli, juice of organic lime on the salsa, a little salt on the fish. Sunshine liked this plate enough that she posted a photo of it on her blog too, with more details.

Myeloma's Relentless March

We stopped thalidomide two months ago, and I have had no treatment since. Blood tests were a week ago, and today I saw my doc, an oncologist/hematologist.

IgG, M-spike, and free light chains were all up from a month ago, though none by a surprising amount. I didn’t get a copy of a B2M result; I don’t yet know if it was done. Actual values from key tests are displayed graphically in the charts and numerically in the test result table. In short, it appears that the cancer is still advancing slowly and relentlessly. That’s what it does.

I started a curcumin regimen on June 27. I also asked my doc to think about low-dose naltrexone (LDN) as another complementary treatment, and he agreed to check into it. We both understand that if the myeloma makes a sudden jump, we will probably go back to “conventional” treatment such as Revlimid.

Despite their inexorable climb, my cancer numbers are still so low that it is barely considered “smoldering” myeloma. This is good. Nevertheless, I have recently felt an occasional ache in my left upper arm which I cannot pinpoint by palpation. When I suggested to the doctor that my numbers were too low for that to be a bone problem, he pointed out that a plasmacytoma can occur anywhere. He has ordered an x-ray of that bone.

In one month we will check liver and kidney function, and in two months we will do another full set of tests. Meantime, I figure on living life to the fullest. Live one day at a time and make it a masterpiece!

Related links, also listed on the right sidebar:

• My Myeloma A discussion of my myeloma, not very technical.
• My Treatment History Not technical.
• My Lab Test Charts Graphic displays of several key test results over time.
• My Lab Test Table Best with a wide browser window. Very “technical.”

Hormone- and nitrate-free ham, organic red grapes, Jarlsberg cheese, Roquefort mustard, Dove dark chocolate. Estimated Weight Watcher points = 8.

Starting Curcumin Regimen

Food Pictures:

You may notice the food pictures on this blog; they're on my running blog too, different ones. I just wrote a post about the food pictures on my running blog here if you're interested.

Curcumin Ramp-up:

So far so good! I've now taken two grams of curcumin for each of two days, and four grams per day for two more days, with no detectable side effects except possibly one (1) hive. Just one place on one shoulder, gone a day later, quite likely not caused by the curcumin, though hives and rash are side effects that have been described by others. Next trick is six grams, which I will do today. If there are side effects I'll back off, otherwise I will hold at this dosage for a few days before increasing to eight grams per day.

I feel good though; a general sense of well-being. That could be in my head, the product of a nice Sunday afternoon heading toward the Fourth of July. But maybe the curcumin plays a part too. It is, after all, an anti-inflammatory and who knows what else. For much more about the benefits of curcumin, in fact ANYTHING about curcumin, see Margaret's Corner.

The Plan:

• Single dose: Two grams of curcumin and one gram of oil:
  • One gram of "Doctor's Best" curcumin with bioperine
  • One gram of "NSI" turmeric extract with bioperine, and
  • One gram of "Member's Mark" organic flaxseed oil or another beneficial oil.
• Four of those 2-gram doses per day, between meals:
  • Midnight. I get up a few times in the night for BPH anyway.
  • 5:00 or 6:00 am, before morning coffee or breakfast.
  • 10:30 am, well before lunch.
  • 4:30 pm, well before dinner.
• Empty stomach when possible. Experts say this works best. Some bottles of curcumin say to take it with meals, however, so I won't be a stickler.
• If a dose is missed, double up on the next one. Some people take all eight grams at once anyway. I'm spreading it out so that the curcumin is in the blood more of the time, though it might actually work better to take it all at once so that the peak concentration goes higher; I don't know.
• No aspirin. I have been taking an 81-mg aspirin daily for years, but curcumin thins the blood so I will stop. But if I were taking Revlimid or thalidomide, I would certainly want to discuss this with my doctor.
• Two brands, an equal amount from each, on the off-chance that one brand is not up to its advertised standards.
• Margaret also takes quercetin with her curcumin. I don't yet, but may start.

I am not a doctor. Curcumin in these dosages is NOT benign; if it were benign it wouldn't help. No one knows the long-term effects of curcumin in these dosages; I am taking a calculated risk. If you are considering curcumin, please consult with your oncologist or primary physician first, and be sure that you monitor the effects often enough.

The curcumin brands mentioned above are described in greater detail in a previous post. A single dose is pictured below, curcumin 2 grams and flaxseed oil one gram.




Organic oatmeal, organic fat-free milk, blueberries, organic strawberries, organic nectarine, organic plum, pecans. Estimated Weight Watchers points = 5.

Low Dose Naltrexone

I'm starting a curcumin regimen now, but I have a friend who is trying another "alternative" therapy called low-dose naltrexone (LDN). Naltrexone is an existing prescription drug, FDA approved for treatment of certain addictions, but no longer in widespread use. It acts by blocking opioid receptors in human cells, but in small doses it can also double or triple the body's production of natural opioids, called endorphins.

In some people with certain diseases, including as cancer, those endorphins may be suppressed. According to theory, LDN taken at bedtime restores them during sleep and thereby restores the body's immune system to its normal function. Proponents of LDN actually claim that it can at least halt the progression of a large number of diseases, including myeloma, multiple sclerosis, and HIV/AIDS. For some people, those diseases may be cured. According to those same proponents, there are no significant negative side effects. The cost is modest, less than $50 per month.

Three doctors seem to be the primary proponents of LDN: Dr Bernard Bihari, Dr David Gluck, and Dr Ian S. Zagon. Their names appear at the bottom of their web site, ldninfo.org. If they are correct, LDN has halted a lot of disease, cured some, and saved a lot of lives.

Naltrexone is now in the public domain, because the patents are expired. Therefore, drug companies have no interest in funding the multi-million dollar clinical trials that might prove the efficacy of LDN one way or another, and apparently the US government hasn't been sufficiently tempted either. So it's up to us again; we can try it and see if it works.

Which is pretty much what we do with the expensive, trial-tested drugs that we otherwise take, like Revlimid and Velcade. We take them and see if they work. I wish my friend well, and will let you know whatever he tells me about his results with LDN.


Organic apple, organic plum, organic nectarine, all regular size. Organic strawberry, whopper size.

Labs Today

Off to see the wizard, toting a jug with 2.1 liters of urine collected over the previous 24 hours. Wait in the waiting room for about 15 minutes. Arm stick, five little vials of blood, the nurse tells me that the total quantity is about two tablespoons. I doubt it's that much, the vials are so small. She's quick and efficient. I ask her to wrap the cotton ball onto my arm, since I'm allergic to adhesive, and she's glad to do it.

I'll see the real wizard, my oncologist/hematologist Dr AP, on July 5. Then we'll find out what has happened since I stopped taking thalidomide a couple of months ago.

Meantime, the curcumin regimen starts NOW. Two grams today, ramping up carefully to eight grams per day over the next two or three weeks.



Dessert: Organic strawberries, blueberries, blackberries, slight drizzle of honey. Estimated Weight Watcher points = 1.

Curcumin and Nanotechnology

"Colloidal silicon dioxide" is an ingredient in the AFI brand of curcumin with bioperine. So what, silicon dioxide is sand. But a quick search shows that colloidal, in this context, means that this is sand with particle sizes of less than 100 nanometers. A nanometer is one billionth of a meter, which is one millionth of a millimeter. 100 nanometers is considerably shorter than the wavelength of visible light, and only one twenty-fifth the size of a human red blood cell. This is so tiny that it is well within the realm of nanotechnology. Is that a problem?

Maybe so. Three recent press releases by Consumer Reports (here, here, and here) suggest that the jury is still out on nanoparticles for human use. Other consumer groups have also issued warnings. The FDA has not taken a position, nor does it require that manufacturers describe their nanotechnology ingredients as such. Therefore, nanosized colloidal silicon dioxide may be described on the label as "silicon dioxide" or simply "silica."

Well it's just sand, don't we all eat a peck of dirt? Probably so, but everyone who discusses nanotechnology agrees that the properties of materials change when particle size becomes so extremely small. To quote Consumer Reports, "carbon becomes 100 times stronger than steel, aluminum turns highly explosive, and gold melts." In fact, particles this tiny may be able to traverse cell walls and enter cells, possibly affecting DNA or inducing cell death. We already know that breathing silica dust can trigger an often-fatal disease called silicosis. What about ingesting it? One expert has said that nanotechnology has the potential for health risks similar to those of asbestos.

I'm as far from expert as you can get on nanotechnology and how it may affect human cells. But I'm pretty sure that nanoparticles can't hurt me if I don't consume them, breathe them, or spread them on my skin.

Personally, I'm going to stay away from supplements, including curcumin, with ingredient lists that include silicon dioxide or silica. Another likely nano-material is titanium dioxide, used as a whitening pigment and also to be avoided. No doubt there are more. Technology is moving faster than our overwhelmed and underfunded FDA is able to react, so we have to look out for ourselves.

Your comments are invited, pro or con.



Organic baby spinach, organic apples in key lime juice, blue cheese, organic pecans marinated in pomegranite juice and roasted, all in a pretty new 79-cent glass salad bowl from Ikea. Estimated Weight Watchers points = 3.

Rethinking Proactive Myeloma Treatment

My myeloma is still in a early stage, barely even smoldering. Thankfully, it has not grown rapidly; it seems to double about every 18 months. Nevertheless, I have asked my doctor to be very proactive in two ways: (1) Testing for potential problems, and (2) Treating the disease before symptoms develop. Although studies have shown that early treatment does not result in longer survival, my theory has been that early treatment should at least yield a higher quality of life by delaying symptoms like broken bones and failed kidneys.

Mayo clinic, on the other hand, has recently published a new consensus statement outlining a treatment algorithm for newly-diagnosed myeloma patients titled "Treatment of Newly Diagnosed Multiple Myeloma Based on Mayo Stratification of Myeloma and Risk-Adapted Therapy (mSMART". The abstract is here and the full text is here. It divides newly-diagnosed patients into two groups, high-risk and standard risk, and further divides both of those groups again into a class with active (symptomatic) myeloma and another with smoldering (non-symptomatic myeloma).

Lucky for me, I seem to be in the standard-risk group with smoldering myeloma. For this group, Mayo's algorithm suggests NO treatment. If I had started my doctoring at Mayo Clinic, I would very likely never have taken thalidomide, unless as a participant in a clinical trial. I don't know if that would have been good or bad; I took the thalidomide with my eyes wide open and was glad that my doctor was treating me aggressively. But now I'm thinking I'll ask him to be a little more conservative in treatment. Here are some reasons:

• All treatments have side effects. For example, with thalidomide I had rash, low heart rate, erectile dysfunction, slow bowel, weight gain, and possibly a minor deep-vein thrombosis and peripheral neuropathy. Happily, none of those were show-stoppers, and all but the rash are gone now. However, the next step for me is Revlimid with dexamethasone, which could easily cause more-serious side effects.
• To some extent, each treatment may be thought of as an arrow in the quiver. Once it's been shot, it's gone. Thalidomide seemed to work at first, but not any more, and it will most likely be unavailable later when I might need it more.
• Treatments can cause the myeloma to mutate and become more aggressive. I suppose this is why early treatment doesn't actually extend survival. Since my myeloma is progressing slowly now, maybe I'm better off not provoking it unnecessarily.
• Treatments can cause other cancers. I think that applies mostly to the older, standard chemotherapy treatments like melphalan, but those treatments may be all that remain for me if I use up the other arrows in the quiver too soon.
• Treatments can even cause the very symptoms that we are most trying to avoid from the myeloma. I know a man whose kidneys are failing because of treatments, not because of the myeloma.

I'm quite content to try curcumin next. It's an unconventional treatment, to be sure, but there is good reason to believe that it might work, more than speculation. Further, it does not seem to carry the risks inherent in most of the prescription treatments. I'm taking two months of NO treatment after discontinuing thalidomide, then getting tests done June 26, for the final report card on the thalidomide. I will start the curcumin later that same day.

I am very interested in opinions of anyone else who reads this. If you see an error in my facts or my thought process, or even if you agree, I would value your opinion. I'm thinking about my life here. Thanks!

Sunshine and Sweet Pea were out a few nights ago. Incompetent at cooking, I had to make do:
A banana, an orange, organic strawberries, blueberries, organic yogurt, pistachios, asiago cheese, organic red wine. Estimated Weight Watchers points = 11. The cheese alone is six points.

Curcumin Arrived

I ordered modest quantities of each of three different brands of curcumin, just to see what they were like. See previous post. I'll start taking it in a few weeks, and by then will necessarily order quite a bit more from one or more of these sources.

Per Caplet: 1000 mg Curcumin c3 Complex 5 mg Bioperine From: Doctors Trust.

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Per TWO capsules: 1054 mg Turmeric Root Extract 6 mg Bioperine From: Club Natural

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Per TWO capsules: 1160 mg Turmeric Extract 5 mg Bioperine From: vitacost.com

The proposed amount per day is 8 grams (8000 mg), divided into two or more doses. I may decide to alternate two or three brands, on the off chance that the quality of one brand is not as high as advertised. I already do that with my multivitamin.

The capsules from Doctor's Best brand are sufficiently distinguishable from the capsules from NSI brand that I think they do come from different manufacturing sources. The caplets from AFI are quite different, more dense, and clearly not from the same manufacturing process. All of the capsules and caplets weigh significantly more than the amount of curcumin they purport to contain, a good sign.


Thin-cut pork chops, corn, oven-roasted rutabaga, two kinds of oven-roasted sweet potatoes, strawberry garnish.

Curcumin Sources in the USA

In a few weeks I'll be taking eight grams (8000 mg) of curcumin daily, with bioperine to enhance "bioavailability." I did a quick search to find sources. NOW has a nice 665-mg tablet, which I have been taking for some time, just one per day, but it does not contain bioperine. I could take the bioperine separately, but curcumin containing bioperine is readily available.

This was NOT an exhaustive search. Nothing is guaranteed, especially the prices and quantities. The following five sources include four different brands of curcumin with bioperine, in a variety of dosages per capsule. In the table below:

• "mg" is the milligrams of curcumin per capsule,
• "Qty" is the number of capsules per bottle,
• "$Cost" is the cost per bottle, somewhat dependent on quantity purchased,
• "$/8 gm" is the cost per eight grams, the daily dose,
• "Doses" is the number of 8-gm doses per bottle, and
• "Bioperine" is the amount of bioperine per capsule in mg.

Curcumin Brand	Web Site	mg	Qty	$Cost	$/8 gm	Doses	Bioperine
Proprietry C3 Complex	agelesscures	1000	100	26.95	2.16	13	5
AFI C3 Complex	doctorstrust	1000	60	14.09	1.88	8	5
Doctors Best	clubnatural	500	120	15.00	2.00	8	3
NSI Extract	vitacost	550	120	18.99	2.30	8	2.5
Super Curcumin	lef	800	60	18.68	3.11	6	5

I ordered from three of these sources this week, and received curcumin from VitaCost; the others should arrive next week.


Romaine, cucumber, fennell, avocado, strawberries, blackberries, blue cheese, raspberry vinegar. Estimate: Two Weight Watchers points.