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Simoncini and baking soda: theory vs. science in cancer

That box of Arm & Hammer in your fridge is great for eliminating odors – but when it comes to using baking soda as a cancer treatment, there are some things you need to know.

Baking soda, also known as sodium bicarbonate, has been around since at least 3500 BC, when Egyptians utilized natron as soap and – fun fact! – also used sodium bicarbonate to make mummies.

More recently, Dr. Tullio Simoncini, an Italian oncologist, contends cancer is a fungus that can be treated using baking soda. However, no documented research backs this theory. In fact, at least two cancer patients have died after receiving baking soda injections from Dr. Simoncini. He also was stripped of his medical license in Italy and has been sent to prison for culpable manslaughter.

History of Baking Soda

In 1843, British chemist Alfred Bird concocted the first version of baking powder to help out his wife Elizabeth, who was allergic to yeast. Three years later, John Dwight and Austin Church brought the Arm & Hammer brand of baking soda to market.

In 1931, Good Housekeeping was among the first to promote the usefulness of baking soda in the home, eventually espousing its ability to polish silverware, maintain freshness in your mattress, and even unclog a showerhead.

Fast forward to 1970. Arm & Hammer sponsored the first Earth Day, capitalizing on the opportunity to promote baking soda as an eco-friendly alternative to chemical cleaners. Two years later, the company began marketing a box of baking soda in the refrigerator to help keep food fresh.

Custodians also used baking soda to clean the Statue of Liberty ahead of its 100th birthday. The landmark's inner copper walls were cleaned and restored in 1986, with baking soda scrubbing away a century of grime while leaving the copper undamaged.

But what does sodium bicarbonate – NaHCO3 – have to do with treating cancer?

What is Baking Soda

Baking soda is alkaline with a high pH when in concentrated solutions. When added to water, it breaks down into carbonic acid and sodium hydroxide (lye).

Baking Soda is made from soda ash, also known as sodium carbonate, which is a naturally occurring substance present in all living things; it helps maintain the pH balance necessary for life.

Soda ash can be manufactured by passing carbon dioxide and ammonia through a concentrated solution of sodium chloride (table salt). It is mined in the form of an ore called trona.

The trona near Green River, Wyoming, is the largest known deposit in the world. Trona also is found at Owens Lake and Searles Lake, California; the Makgadikgadi Pans in Botswana; and Egypt’s Nile Valley.

Soda ash is used in manufacturing chemicals, detergents, glass, paper, and textiles. Among other uses, soda ash is used to condition water, remove sulfur from flue gases, to lignite coals, and as a food additive.

Soda ash is dissolved into a solution through which carbon dioxide is bubbled, and sodium bicarbonate precipitates out, forming baking soda. At more than 99% pure, baking soda has been listed in the United States Pharmacopoeia (USP) since 1848.

History of Simoncini Baking Soda Treatment

Dr. Tullio Simoncini believes baking soda can be used for treating cancers of the digestive tract – throat, colon, intestines, and rectal areas. Alkalinity, it is theorized, kills these microbes and reverts cancer cells into healthy cells.

Dr. Simoncini contends growth of a tumor is in no way affected by current oncological treatments. He says science demonstrates cancer is caused by fungal masses (Candida type) and that sodium bicarbonate is the “only useful remedy that is now available for healing the disease.” [1]

There is, however, no documented research to support Dr. Simoncini’s theory that baking soda can revert cancer cells into healthy cells.

Dr. Simoncini was expelled from the Italian Medical Order (Ordine dei Medici e Chirurghi), and at least two of his patients died from sodium bicarbonate treatment.

In 2007, Dr. Simoncini reportedly injected large doses of baking soda into a breast cancer patient, known only as Sylvia. On the fourth day of the therapy, the woman became ill. She was transported to Vrije Universiteit, a university hospital in Amsterdam. Staff members allegedly saw Dr. Simoncini administering injections; Sylvia died the next day.

In 2011, Luca Olivotto, 27, died in a clinic in Tirana, Albania, after he was administered sodium bicarbonate. According to records, his cause of death was “metabolic alkalosis,” a condition in which the pH of tissue rises beyond the normal range, which can be a result of increased bicarbonate concentrations. Dr. Simoncini and his assistant, radiologist Roberto Gandini, were found guilty of culpable manslaughter. Dr. Simoncini also faced a charge of abusive practice of the medical profession.

Dr. Simoncini was sentenced to 5½ years in prison. Gandini received a 2-year sentence.

Baking Soda as a Cancer Treatment 

In vitro (laboratory) and in vivo (animal) studies 

It is well established that cancer cells flourish in an acidic tumor environment that is detrimental to other cells, such as immune cells. In 2015, Pilon-Thomas et al. conducted a study to understand the effects of tumor acidity on the antitumor roles of the immune system. This study utilized pancreatic cancer and melanoma cell lines as well as a genetically modified mouse model with immune deficiencies and cancer. It was reported that tumor acidity neutralized with bicarbonate induced arrest of cancer cell growth. This effect occurred in tumor bearing mice when there was increased activity of a type of immune cell called a T-cell. T-cells were not active in the acidic tumor environment, but when sodium bicarbonate was introduced, the environment was neutralized, thus reactivating the T-cells and targeting the tumor for destruction. When bicarbonate therapy was combined with immunotherapy, significant antitumor responses, including cures, were observed in some mice. Thus, sodium bicarbonate alone did not cause reduction of the tumors in the mice, but paved the way for reactivation of the T-cells that were then able to target the tumor. [2] 

Other studies have harnessed sodium bicarbonate as a neutralizing agent for the acidic tumor environment as well. Studies in colorectal adenocarcinomaCancer that begins in glandular (secretory) cells. Most cancers of the breast, pancreas, lung, prostate, and colon are adenocarcinomas., renal cell carcinoma, hepatocellular carcinoma and immunocompromised mouse models show that sodium bicarbonate neutralizes the tumor environment, thereby allowing the therapeutic agent rapamycin to increase tumor death by causing cancer cell apoptosisA type of cell death in which a series of molecular steps in a cell lead to its death. This is one method the body uses to get rid of unneeded or abnormal cells. The process of apoptosis may be blocked in cancer cells. Also called programmed cell death. and decreasing cancer cell proliferation. [3] 

Tumor hypoxia (lack of oxygen) is a recognized link to poor therapeutic outcomes. It has been observed that pH shifted toward bicarbonate-dependent transport occurs in hypoxia and that the function of this transport/transporters is key to tumor survival. In 2016, McIntyre et al. reported that in 8 of 10 varied cancer cell lines, hypoxic (also acidic) conditions caused the gene expression of a bicarbonate transporter. When a small-molecule inhibitor targeting these transporters was introduced, increased apoptosis (cell death) was observed. Inhibition of these transporters in mice using the same methods solidified this conclusion. An additional study showed reversal of hypoxic effects by neutralizing the pH with sodium bicarbonate. [4,5]  

The ability of tumors to create their own blood vessels is called angiogenesis. This process allows for tumor growth and metastasisThe spread of cancer cells from the place where they first formed to another part of the body. In metastasis, cancer cells break away from the original (primary) tumor, travel through the blood or lymph system, and form a new tumor in other organs or tissues of the body. The new, metastatic tumor is the same type of cancer as the primary tumor. For example, if breast cancer spreads to the lung, the cancer cells in the lung are breast cancer cells, not lung cancer cells. (spread). Studies in colon adenocarcinoma and immunocompromised mouse models exhibited decreased anti-angiogenesis when the tumor pH was neutralized with bicarbonate. [6]

In 2017, Hongtao Zhang with the Department of Pathology and Laboratory Medicine at the University of Pennsylvania studied how baking soda affects cancer cells. He noted that that previous in vitro studies suggested that lactic acidosis, which happens when too much acid builds up in your bloodstream, could protect cancer cells against glucoseA type of sugar; the chief source of energy for living organisms. starvation or deprivation. [7]

By directly injecting sodium bicarbonate into tumors, the targeting-intratumoral-lactic-acidosis (TILA) by transcatheter arterial chemoembolization (TACE) procedure was to increase the pH to ameliorate acidosis (basically calming the lactic acid build up). Zhang said the process should be considered as an interruption for acidosis instead of lactic acidosis.

However, the in vitro study suggested that acidosis – but not lactosis – prolonged the survival time of cancer cells under glucose deprivation. Since acidosis is more critical for the survival of tumor cells, Zhang said it would not be a surprise to see a dramatic effect on tumor apoptosis by merely modulating the pH of the tumor microenvironment with sodium bicarbonate.

Ultimately, the research showed no overall survival advantage was observed for the TILA-TACE treatment. [8] Zhang stated: “TILA-TACE is far from a cure for cancers.” 

Human studies

Baking soda as a cancer treatment has been included in several studies, including a 2014 study led by Nazir Ahmad Dar, Ph.D., Salt tea consumption and esophageal cancer: A possible role of alkaline beverages in esophageal carcinogenesis. [9] Esophageal cancer is the seventh-most frequent malignancy among men in the United States.

A large-scale case-control study was held in Kashmir, India, to investigate the association between salt tea drinking and esophageal squamous cell carcinoma (ESCC). The research showed adding sodium bicarbonate to salt tea was associated with an increased ESCC.  

In 2009, TACE was evaluated as a surgical treatment option for hepatocellular carcinoma (HCC). It was reported that TACE alone did not improve surgical outcome, disease progression, and liver failure. [10]

A pilot clinical investigation was conducted to understand the role of pH and tumor progression with TACE as method of bicarbonate infusion. The trial found that bicarbonate delivery using TACE enhances anticancer activity. [11]

There are two current clinical trials utilizing TILA-TACE (targeting-intratumoral-lactic-acidosis (TILA) by transcatheter arterial chemoembolization (TACE)), one recruiting and one not yet recruiting, for patients with hepatocellular carcinoma. The currently recruiting trial centers on understanding the tumor response rate to TILA-TACE utilizing sodium bicarbonate as an emulsive and pH altering agent (delivery vehicle) for doxorubicin-lipiodol (chemotherapy) infusions.

Previous studies using TILA-TACE have shown promising results by prolonging the overall survival of patients with large tumors. However, sample size was small and resulted in the current clinical trial in order to increase sample size and observations.

The clinical trial that is not yet recruiting also centers on hepatocellular carcinoma (HCC) and use of TILA-TACE. While surgery is typically the primary radical treatment for HCC, it is a narrow treatment option and only suitable for certain individuals. Therefore the use of TACE allows for blockage of tumor blood supply, control of tumor growth, potential necrosis (killing of tumor cells) and subsequent tumor shrinkage. This method allows for delivering targeted chemotherapeutic agents. The goal of this study is to rectify some of the controversies surrounding TILA-TACE by doing a randomized comparison study of surgical resection and TILA-TACE in combination. Lipiodol-epirubicin will be suspended in a 5% sodium bicarbonate solution (vehicle for delivering the chemotherapy) and injected for perfusion into the liver. 

Side Effects of Baking Soda

High doses of sodium bicarbonate may cause headaches, nausea, or irritability.

Harmful reactions to sodium bicarbonate can include:

  • Metabolic alkalosis (the pH of tissue is elevated beyond the normal range of 7.35-7.45).
  • Swelling (edema) due to sodium overload.
  • Congestive heart failure.
  • Hyperosmolar syndrome – a complication of diabetes in which high blood sugar results in high concentration without significantly breaking down fat quickly enough.
  • Hypervolemic hypernatremia – an excessively high sodium intake associated with limited access to water.
  • High blood pressure (hypertension) due to increased sodium.

Sodium Bicarbonate Clinical Trials

A list of currently active (as of 01/21/2020) clinical trials using sodium bicarbonate for cancer for which you may be eligible.

Intra-arterial Infusion Chemotherapy Combined With Sodium Bicarbonate for Unresectable Gastric Cancer
Phase: I
Status: Open as of 01/21/2020
Location:  Zhejiang, China
Gender: Men and women
Age: 18 and over
Disease Criteria: Pathological diagnosis of gastric cancer
[View Trial Details]

TILA-TACE in Treatment of Hepatocellular Carcinoma
Phase: N/A
Status: Open as of 01/21/2020
Location: Zhejiang, China
Gender: Men and women
Age: Children and Adults
Disease Criteria: Hepatocellular carcinoma is confirmed by tissue pathology or in accordance with clinical diagnosis standard
[View Trial Details]

The Efficacy of Hepatectomy or TILA-TACE in Patients With Resectable Hepatocellular Carcinoma
Phase: N/A
Status: Not yet recruiting, as of 01/20/2020
Location:  Zhejiang, China
Gender: Men and women
Age: Over 18
Disease Criteria: Diagnosed HCC patient
[View Trial Details]

Summary of Science

As discussed above, scientific studies utilizing sodium bicarbonate as a potential cancer therapy are limited and show mixed effects at best. It does seem clear that bicarbonate as a pH neutralizing agent enhances the anticancer effects of chemotherapeutics and other treatment modalities. 

Conclusion

Sodium bicarbonate may have health benefits but its potential anticancer properties are still in the early stages of study. As discussed above, there are multiple key details of the mechanisms underlying bicarbonate therapy that remain to be elucidated. Very specific uses of baking soda, namely as a pH neutralizer and vehicle for chemotherapeutic agents seem to hold some promise. However, there is no scientific evidence that injected or ingested baking soda is a safe or effective anti-cancer therapy.

Baking soda is useful – like a water softener, a pH modifier, a cleaning product – but it should not be considered in any manner as a cancer treatment as touted by Simoncini.

According to the U.S. Environmental Protection Agency, sodium carbonate (the starting material used to make sodium bicarbonate) is classified as a chemical substance. [12] The EPA considers sodium carbonate an irritant at concentrations below 15% and caustic above 15%. Without proper medical oversight and continued research, sodium bicarbonate administered as an unregulated therapeutic modality is not recommended for a healthier you while fighting cancer.

What is sodium bicarbonate?

Sodium bicarbonate is commonly referred to as baking soda. It is a naturally occurring, inorganic, alkaline mineral salt that has been used by humans in many ways for millenium.

Is sodium bicarbonate safe to ingest in large doses?

Ingesting high does of sodium bicarbonate could be risky. Stomach rupture and severe changes in electrolyte levels have been reported following long-term or excessive use of sodium bicarbonate. The FDA’s recommended maximum daily dosage is 200 mEq sodium and 200 mEq bicarbonate in people up to 60 years old. For people over 60 years old, the maximum daily dosage – only for up to 2 weeks – is 100 mEq sodium and 100 mEq bicarbonate.

Is sodium bicarbonate an anti-cancer agent?

It is theorized that sodium bicarbonate raises alkalinity in the body which, in turn, will kill cancer-causing microbes and reverts cancer cells back into healthy cells. While some studies suggest that sodium bicarbonate may neutralize tumor acidity and impair the growth of some cancers in vitro, at the time of this writing (01/20/2020) there is no research to support the theory that it can revert cancer cells into healthy cells.

Have there been any human trials done to support the use of sodium bicarbonate as an anti-cancer agent?

There have been no supporting human trials, at the time of this writing. (01/20/2020)

What are the side effects of using sodium bicarbonate as a cancer treatment?

High doses of sodium bicarbonate may cause headaches, nausea, or irritability. More serious reactions include metabolic alkalosis, edema due to sodium overload, congestive heart failure, Hypersmolar syndrome, Hypervolemic hypernatremia, and hypertension.

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References

  1. Is the cause of cancer a common fungus? http://alternativemedicinenis.com.au/Cancer%20Fungus.pdf
  2. Neutralization of Tumor Acidity Improves Antitumor Responses to Immunotherapy. https://cancerres.aacrjournals.org/content/canres/76/6/1381.full.pdf
  3. Acidic tumor microenvironment abrogates the efficacy of mTORC1 inhibitors. https://www.ncbi.nlm.nih.gov/pubmed/27919264
  4. Disrupting Hypoxia-Induced Bicarbonate Transport Acidifies Tumor Cells and Suppresses Tumor Growth. https://www.ncbi.nlm.nih.gov/pubmed/27197160
  5. Acid Suspends the Circadian Clock in Hypoxia through Inhibition of mToR. https://www.cell.com/cell/fulltext/S0092-8674(18)30586-5#secsectitle0020
  6. Acidic pH reduces VEGF-mediated endothelial cell responses by downregulation of VEGFR-2; relevance for anti-angiogenic therapies. https://www.ncbi.nlm.nih.gov/pubmed/27852069 
  7. Central role of lactic acidosis in cancer cell resistance to glucose deprivation-induced cell death. https://www.ncbi.nlm.nih.gov/pubmed/22190257
  8. Will cancer cells be defeated by sodium bicarbonate? https://www.ncbi.nlm.nih.gov/pubmed/28083722
  9. Salt tea consumption and esophageal cancer: A possible role of alkaline beverages in esophageal carcinogenesis. https://onlinelibrary.wiley.com/doi/full/10.1002/ijc.29204  
  10. A prospective, randomized, controlled trial of preoperative transarterial chemoembolization for resectable large hepatocellular carcinoma. https://www.ncbi.nlm.nih.gov/pubmed/19212170 
  11. A nonrandomized cohort and a randomized study of local control of large hepatocarcinoma by targeting intratumoral lactic acidosis. https://www.ncbi.nlm.nih.gov/pubmed/27481188 
  12. Sodium carbonate. https://iaspub.epa.gov/sor_internet/registry/substreg/searchandretrieve/advancedsearch/externalSearch.do?p_type=CASNO&p_value=497-19-8