Human Papilloma Virus (HPV): Why Clinical Nutrition is Imperative
Written By Millie Lytle ND, MPH, CNS
The Human Papilloma Virus (HPV) is ubiquitous. Genital HPV is the most common sexually transmitted disease in the United States. An estimated 6.2 million people are newly infected every year1. More than 100 HPV types have been identified; over 40 of which can infect the genital area, causing warts, cellular abnormalities, and even cancer. HPV is not a single condition; instead, it is an umbrella term for a set of more than 100 types of strains. Of these strains, 40 are responsible for genital warts and viruses that can lead to cervical cancer. There are 4 strains responsible for cellular changes that could eventually cause cervical cancer (HPV 6 and 11, which are less harmful than the aggressive HPV 16 and 18). These same strains lead to anal, throat and mouth cancer in sexually active males and females.
Symptoms of HPV
Men are usually silent carriers, meaning they do not know they are spreading this pervasive sexually transmitted disease because they are free of symptoms and there no is no possible testing method. Most women will also never develop any symptoms because the HPV infection is usually self-limiting – this means that the body’s immune system fights the virus on its own. The Papanicolaou, or PAP test, is a necessary exam for females whereby the physician takes a cellular sample from the cervical tissue for cellular analysis to assess for cellular changes, called cervical atypical or cervical dysplasia. While spotting and pain during sexual intercourse are the most common symptoms, the PAP test is the only way to determine actual risk for cervical changes. Having routine PAP tests reduces a woman’s risk of developing a cancer related to the HPV infection. Diagnoses are staged for severity of cervical dysplasia (Cervical Intracellular Neoplasia 1, CIN2, CIN3 and cancers (Carcinoma in Situ, Invasive Cervical Carcinoma). But what determines if person develops a persistent HPV infection, or if it clears up on its own?
What to do about HPV?
Despite high vaccine effectiveness3, the prevalence of infections may be rising. Studies show that vaccine compliance is low, possibly due to lack of public trust on the safety of the vaccine (see incidence reports on deaths and adverse events here: http://www.nvic.org). Data from the American National Health and Nutrition Examination Survey in 2009-2010 found that the prevalence of HPV infections among women is 42.7% in the cervix, and 3.8% in the mouth and throat2. Women with oral HPV infections were 5 times more likely to have a cervical HPV infection as well, which means that HPV infections at these two sites are not independent2. Thus, overall body health and susceptibility, rather than exposure, might be the issue.
Education and Nutrition may be the missing link. Nutrition and lifestyle factors can play either a positive or detrimental role on an individual’s overall level of health. While there has been massive promotion of the HPV vaccine, the population’s health efforts to promote a healthy lifestyle and diet have been minimal at best. A lack of health information on the risk factors of HPV and prevention and lifestyle strategies to treat it leave the public feeling confused and powerless about their options. While research is behind, there are many risk factors and interventions associated with lifestyle and nutrition that the public ought to be informed of so they know how to best prevent and treat their current situation.
GET EDUCATED: How to Reduce your Risk of HPV Infections
- Get tested. Getting examined by the doctor establishes your cervical health.
- Use protection. Unprotected intercourse increases risk for developing tissue abnormalities. While cervical cancer is unlikely with condom usage, genital warts can be contacted, as male and female condoms do not cover the entire area.
- Delay intercourse and be selective. Changing male partners (especially prior to 18 years of age) introduces the virus at a time when the body is still maturing, meaning the cells are most susceptible to viral influences.
- Delay childbirth. Giving birth prior to 22 years of age increases risk for cervical dysplasia due to cellular changes in the cervix.
- Stop smoking. Women who smoke have 2-3 times higher risk for developing cervical abnormalities due to decreased antioxidants and increased free radical damage that lower the immune system’s response to fight the virus. Results from a large prospective study confirmed that tobacco smoking is a major risk factor for the most severe types of cervical dysplasia (CIN3) as well as CIS, and even the more severe ICC4. Quitting smoking is required for recovery from HPV.
- Reconsider your Pill. Long-term use of oral contraceptives (over 5 years, as well as other medications such as Midol, Tylenol, and Ibuprofen) may be responsible for nutrient deficiencies of the crucial antioxidants (Folic Acid, Vitamin C and Zinc) needed to protect soft cervical tissues against conditions caused by HPV.
- Cut down on alcohol. Alcohol damages cells and leaches key nutrients from the body integral for immune health (B1, B12, Folic Acid and Zinc). A link has been established in women who consume two or more servings of alcoholic beverages per day with a persistent HPV infection of the mouth5.
- Fruits, veggies and supplements. Those who eat a poor nutrient diet, meaning insufficient servings of fruits and veggies, are missing key nutrients.
GET HEALTHY: Nutrients Researched for HPV Infections and Immunity
If you have been diagnosed with abnormal cervical cells or cervical dysplasia, rather than waiting to the next PAP test, why not consult one of InVite®’s Naturopathic Doctors or Nutritionists to improve antioxidant protection and boost your immune system? Nutritional programs may include food and supplement suggestions for increasing specific nutrients, as well as improving immunity so the body can fight the virus on its own:
- High nutrient intake. A diet rich with green, yellow, orange, red and cruciferous vegetables has been shown to be the best way to incorporate key nutrients into the diet. When specific antioxidants such as Vitamins A, C, E, folic acid, carotenoids and lycopene are low, HPV is harder to treat. What’s more, cabbage-family vegetables with natural levels of Indol-3-Carbinol and Sulforaphanes have great cancer-fighting abilities.
- Increase alkalinity and decrease acid. You can measure the acidity of your urine using a pH test strip. For more information on Alkalizing your diet, click here .
- Breathe in salt air and eat from the sea. Seafood contains essential minerals such as iodine, magnesium, calcium, boron, selenium and zinc, which are essential for maintaining a healthy immune system, healthy thyroid function, metabolism, and electrolytes. If your whole body is healthier, delicate tissues like your cervix will respond positively.
- Exposure to the sunshine vitamin. Don’t forget Vitamin D is essential for normalizing immune response. The salt water mineral magnesium is required in order for Vitamin D to aid in proper calcium absorption.
- Leave junk food behind. Processed foods are high in sodium, refined sugar, processed white flour, and animal products with hormones and other bad fats, causing inflammation and robbing the body of essential nourishment.
In addition to the diet, there are several key nutrients that have been studied in relation to HPV, cervical dysplasia, and cervical cancer. While there is no guarantee you can recover naturally from cervical cancer, nutrition can be used alone or in combination with medical procedures to improve outcomes and protect one’s response to HPV exposure. Here is how to augment specific nutrition to give your immune system the best defense possible, inspired by the original protocol by Dr. Tori Hudson, ND, here is a 12-month plan to boost your immunity. Supplement levels will vary in each individual.
Dr. Millie's Plan
Folic Acid: Low serum and red blood cell folate are moderately, but not significantly, associated with an increased risk of invasive cervical cancer6. If you are on oral contraception pills, drink alcohol, or take ibuprofen or other pain relievers, you are more likely to have an insufficient supply of folic acid in the body. Several studies have shown that low serum folate levels are linked to cervical dysplasia, and high folate blood levels are linked to the prevention of CIN I (cervical dysplasia).8,9 Improvement in cervical dysplasia outcomes using folic acid supplementation is also well documented10, showing improvement when using up to 10mg per day for 3-6 months.
Indol-3-Carbinol, Sulfurophanes and DIM: Studies show that this extract from cabbage or cruciferous family vegetables, 1-3-C and its active form DIM, have the potential to prevent and even treat a number of common estrogen-related cancers.11 In a double blind, placebo-controlled study, 30 patients with biopsy-confirmed CIN II-III (moderate to severe cervical dysplasia) received either a placebo or 200 or 400mg oral 1-3-C daily for 12 weeks. None of the 10 placebo patients had complete regression of CIN, whereas four out of eight patients in the 200 mg per day group and four of nine in the 400 mg per day group had complete regression.12
Depending on the quality of your diet and lifestyle, a multivitamin and mineral supplement for women that includes antioxidants such as Vitamins A, C, E, CoQ10, Lycopene, Lutein, Selenium and Zinc may be essential for good cervical health. One study found that blood levels of CoQ10 and Vitamin E were significantly lower in patients with diagnosed CIN cervical cancer than in controls.13 Another study revealed that levels of CoQ10 from cervical epithelial cells themselves were significantly lower in women diagnosed with CIN.14
Vitamin C in any form is one of the body’s main antioxidants. It also works to re-circulate Vitamin E, another one of the body’s most important antioxidants. While it’s known that women with cervical dysplasia have low blood levels of Vitamin C15, Vitamin C’s benefits are numerous. One study showed that women with high intake of dietary Vitamin C had a lower risk of cervical dysplasia.16 Another study of Korean women looked at 58 cases of CIN cervical cancer and compared them with 86 women with normal PAP test results – the cancer group had significantly lower blood levels of Vitamin C than the control group.17
Green Tea: Epigallocatechin-3-gallate (EGCG) is the most powerful polyphenol antioxidant from green tea, known to impede the epidermal growth factor receptor, an agent needed for cervical cell growth. A recent study looked at 51 women with HPV-positive cervical dysplasia and divided them into 4 groups, compared to 39 controls. Green tea ointment was applied locally to 27 patients twice a week. 20 out of 27 patients under ointment therapy showed a response. One standardized EGCG capsule was taken every day for 8 to 12 weeks. Six out of eight patients under green tea ointment plus capsule therapy showed a response. Six out of 10 patients under EGCG capsule therapy alone showed a response. Overall, a 69% response rate was noted for treatment with green tea extracts, compared with a 10% response spontaneous improvement rate in the controls. A positive response meant an improvement in cervical dysplasia staging.18
Coriolus Versicolor (Reishi, Shiitake, Cordyceps and Coriolus) is an immune mushroom commonly used for its health-boosting properties. As a known immune-modulator, it has been studied for its immune-enhancing properties. It has been studied for its ability to improve immune response to HPV and to reverse the early stages of cervical cancer.19 In a year-long Portuguese study, Coriolus versicolor cleared high-risk strains of HPV known to cause cervical dysplasia and cervical cancer in 39 women. All of the women had the equivalent of CIN 1 or 2. After one year, 9 of 10 women who supplemented with 3000mg Coriolus versicolor tested negative for HPV, compared with just 1 of 12 placebo women. In addition, 13 of 18 Coriolus patients reverted to normal PAP results, compared with 10 of 21 non-supplemented women.
Resveratrol: In one in vitro study, Resveratrol treatment (150-250 µmol/l) applied for 48 hours increased cell-cycle arrest on HPV18 and HPV16 positive cervical cancer cells.21 Furthermore, a lower dose of resveratrol (50 µmol/ produced a similar effect, suggesting that this effect is not necessarily dose-dependent and that even a low dose of resveratrol treatment changes the expression of the cancer gene on both HPV18 and HPV16-positive cells. This study shows promise that that resveratrol uses different mechanisms to induce the killing of cervical cancer cells.
Topical treatments are important as well. In addition to this vitamin protocol, there is a treatment option involving a rotating series of vaginal suppositories for women with moderate or severe cervical dysplasia. These suppositories would include a combination of antiviral, escharotics and therapeutic herbs, enzymes, and vitamins to treat and heal the local site. These suppositories are capable of killing the virus and healing the local area, and unlike the LEEP procedures, are non-scarring. Suppositories must be performed or taught by a trained alternative health professional.
- Surveillance Manual, 5th Edition, 2011 5 Human Papillomavirus: Chapter 5-1
- Steinau M, Hariri S, Gillison ML, Broutian TR, Dunne EF, Tong ZY, Markowitz LE, Unger ER. Prevalence of Cervical and Oral Human Papillomavirus Infections Among US Women. J Infect Dis. 2014 Jun;209(11):1739-43.
- Markowitz LE, Hariri S, Lin C, Dunne EF, Steinau M, McQuillan G, Unger ER. Reduction in human papillomavirus (HPV) prevalence among young women following HPV vaccine introduction in the United States, National Health and Nutrition Examination Surveys, 2003-2010. J Infect Dis. 2013 Aug 1;208(3):385-93.
- Roura E, Castellsagué X, Pawlita M, Travier N, Waterboer T, Margall N, et al. Smoking as a major risk factor for cervical cancer and pre-cancer: Results from the EPIC cohort. Int J Cancer. 2014 Jul 15;135(2):453-66.
- Chaturvedi AK, Graubard BI, Pickard RK, Xiao W, Gillison ML. High-Risk Oral Human Papillomavirus Load in the US Population, National Health and Nutrition Examination Survey 2009-2010. JInfect Dis. 2014 May 2.
- Weinstein SJ et al. Low serum and red blood cell folate are moderately but not significantly associated with increased risk of invasive cervical cancer. / NUlr. 2001; 131:2040-2048.
- Schiff MA et al. Serum carotinoids and risk of cervical epithelial neoplasia in southwestern American women. Cancer Epidemiol Biomarkers Prev2001; 10: 1219-1222.
- Piyathilake Cj et al. Lower risk of cervical intraepithelial neoplasia in women with high plasma folate and sufficient vitamin B12 in the post-folic acid fortification era. Cancer Prev Res. 2009; 2(7): 658-664.
- Piyathilake Cj et al. Lower red blood cell folate enhances the HPV-16-associated risk of cervical intraepithelial neoplasia. Nutrition. 2007
- Marshall K. Cervical dysplasia: early intervention. Altern Med Rev. 2003; 8(2):156-170.
- Grubbs Cj, Steele VE, Casebolt T et al. Chemoprevention of chemically-induced mammary carcinogenesis by indole-3-carbinol. Anticancer Res. 1995; 15: 709-716.
- Bell MC, Crowley-Nowick P, Bradlow HL, et al. Placebo controlled trial of indole-3-carbinol in the treatment of GIN. Gynecol Oncol. 2000
- Palan PR, Mikhail MS, Basu J, Romney SL. Plasma levels of antioxidant beta-carotene and alpha-tocopherol in uterine cervix dysplasias and cancer. Nutr Cancer. 1991;15:1320.
- Mikhail MS, Palan PR, Romney SL. Coenzyme Q10 and alpha tocopherol concentrations in cervical intraepithelial neoplasia and cervix cancer. Obstet Gynecol. 2001;97:3S.
- Hudson, Tory. Women's Encyclopedia of Natural Medicine. Keats Publishing; 1999,
- Ghosh C et al. Dietary intakes of selected nutrients and food groups and risk of cervical cancer. Nutr Cancer. 2008; 60(3);331-241.
- Lee GJ, et aL Antioxidant vitamins and lipid peroxidation in patients with cervical intraepithelial neoplasia. Journal Korean Med Sci. 2005 Apr
- Ahn WS et al. The protective effects of green tea extract on human cervical lesions. European Journal Cancer Prevention; 2003; 12(5);383-390
- Bogdanova J. Coriolus versicolor - innovation in prevention of oncogynecological diseases, especially HPV. [In Bulgarian.) Akush Ginekol (Soliia). 2008;47 SuppI3:51-53.
- Silva Couto J, Pereira da Silva D. Coriolus versicolor supplementation as immunonutrition in HPV patients with cervical lesions. Clin J Mycol. July 2009;3(1):8.
- García-Zepeda SP, García-Villa E, Díaz-Chávez J, Hernández-Pando R, Gariglio P. Resveratrol induces cell death in cervical cancer cells through apoptosis and autophagy. Eur J Cancer Prev. 2013 Nov;22(6):577-84.
- Hudson, Tory. Consecutive case study research of carcinoma in situ of cervix employing local escharotic treatment combined with nutritional therapy. Journal of Naturopathic Med. 1991.