Manner Metabolic Therapy
Proponents of "metabolic therapy" claim to diagnose abnormalities at the cellular level and correct them by normalizing the patient's metabolism. They regard cancer, arthritis, multiple sclerosis, and other "degenerative" diseases as the result of metabolic imbalance caused by a buildup of "toxic substances" in the body. They claim that scientific practitioners merely treat the symptoms of the disease while they treat the cause by removing "toxins" and strengthening the immune system so the body can heal itself. The "toxins" are neither defined nor objectively measurable. "Metabolic" treatment regimens vary from practitioner to practitioner and may include a "natural food" diet, coffee enemas, vitamins, minerals, glandulars, enzymes, laetrile, and various other nostrums that are not legally marketable in the United States. No scientific study has ever shown that "metabolic therapy" or any of its components is effective against cancer or any other serious disease. The article describes the theories and methods advocated during the 1980s by the late Harold W. Manner, Ph.D., who coined the term "metabolic therapy."
Description of the Treatment
Manner defined metabolic therapy as "the use of natural food products and vitamins to prevent and treat disease by building a strong immune system."  Its objectives, as described in an undated booklet distributed to prospective patients in December 1988, were:
- To provide adequate nutritional support
- Stimulation of detoxification processes
- Support of the basic immunity of the body
- Minimizing the intake of toxic agents from whatever source
- Increasing oxygenation of oxygen-starved tissue .
A similar booklet distributed to professionals at a Manner Seminar in June 1988 stated that its contents had been approved by the Manner Clinic's board of directors and the Metabolic Research Foundation . According to the booklet, "The Clinic is a research institution and the protocol is modified for each patient. However, this protocol forms the basis, and should not be essentially modified." The booklet described three segments of the treatment process:
- Pretreatment. Each patient should have a SMAC-24, complete blood count, hair analysis, C.E.A., and urinalysis. Since "the minerals of patients are usually out of balance . . . measures should be taken to correct the imbalances." According to the booklet, "Six sodium alginate daily for a week should effect removal of surplus minerals; heavy metals may take longer. Three to six daily of the mineral tablets will usually correct deficiencies within two weeks." To interpret the SMAC-24, Manner suggests "optimum" ranges which are narrower than the usual ranges of normal values .
- Treatment, Phase one, 21 Days has the following components:
- A 2-day juice fast, beginning with a blend of apple and carrot juice.
- A goal of two bowel movements a day "must be achieved." If the juice fast does not stimulate bowel movements, "one teaspoon of a herbal laxative in a glass of water should be taken one hour after each meal, followed by another glass of juice or water until regularity is achieved. If this still does not achieve results, soap suds enemas should be initiated."
- For "detoxification," a coffee retention enema should be administered daily (or twice a day if "extreme toxemia" is present). This is done by brewing a cup of coffee, allowing it to cool, injecting it into the rectum with a rectal syringe, and allowing it to be retained for 15-30 minutes. Six Mucozyme tablets should be taken daily to "facilitate absorption of nutrients." If nausea occurs at any time during the treatment, six tablets of Duodenum should be administered daily. If nausea is not relieved in 48 hours, Intrinsotrophic is substituted for Duodenum.
- To ensure proper digestion of food, digestive enzymes (compounds containing hydrochloric acid, pepsin and enterically coated pancreatic enzymes) should be taken with each meal. If the first urine in the morning has a pH higher than 5.5, fruit juice should be discontinued and vegetable juice should be increased.
- "Anti-neoplastic enzymes" are used to remove the "protective shield" around the patient's tumor. For this purpose, three Enzyme T and one Enzyme B tablets are taken together three times daily, one hour before meals. In addition, if the tumor is located in the bowel, vagina or uterus, Enzyme W (a water-soluble form of Enzyme T) is administered as an enema or vaginal douche.
- Vitamin A is given in an emulsified form "to minimize liver involvement." Two drops are given in the morning juice and two drops in the evening juice--for a total of 60,000 IU daily. Every second day an additional two drops should be added morning and evening. If toxicity occurs, the vitamin is discontinued for a week, then given two weeks out of three at a daily dosage 100,000 lower than the one that caused the toxic reaction. Two tablets of Thymus should be administered three times daily in addition to three tablets of Super Oxide Dismutase. All of these measures are intended to "increase the number of circulating lymphocytes."
- Vitamin C is begun at 5 grams daily and increased by 1 gram per day until an acute diarrhea occurs. The dosage is then lowered by 2 grams and continued at this level throughout the treatment period.
- Amygdalin, two 500 mg tablets, three times a day.
- Four Multimineral tablets should be taken morning and evening. Para-15 (six tablets a day) should be taken "to increase the efficiency of oxygen utilization."
- Twelve tablets a day "of the gland or organ tissue primarily affected" should be taken.
- The "natural food" diet should be composed of fruits, vegetables (including 32 ounces of raw vegetable juice per day), whole grains, fish, chicken, eggs (one per day), nuts and seeds, raw milk, yogurt, and herb tea. The diet should contain no red meat, fried foods, alcohol, coffee, carbonated beverages, white flour products, refined sugar, pepper or hot spices, canned fruits or vegetables, or refined fats of any type. Food additives (especially MSG) should be avoided. Most of the vegetables in the diet should be juiced with a juice extractor so that "all of the naturally occurring enzymes, minerals and vitamins will be present."
- Daily infusions of 9 grams of amygdalin, 10 cc of DMSO, and 25 grams of vitamin C in 250 cc of 5% dextrose or Lactated Ringers over a period of 2-3 hours. On days when this is given, amygdalin is not administered orally.
- Other modalities, including Rodaquin and lymphatic infusions are used in "exceptional cases."
Treatment: Phase Two, 21 Days to Three Months, was similar except that some meat, yogurt, cottage cheese and acidophilus milk are allowed, amygdalin is reduced to two 500 mg tablets each morning and evening, and coffee enemas are administered only twice a week.
Manner's approach also called for supplementation with selenium, zinc, homeopathic remedies, and numerous other products. These items were not specified or explained in the protocol.
Participants in Manner's June 1988 seminar also received information on the "Manner 5" program, which Manner said was intended to augment the basic program with 21 days at the clinic plus 69 days of treatment at home. Its components included laetrile, various enzymes and supplements, an "anti-viral compound in the same class of interferon," a "lysing agent . . . designed to dissolve, decompose and disintegrate cancer cells," orange capsules to add oxygen to the blood, white-and-brown "antifermentation" capsules to "keep the carbon dioxide level in the blood low," and white-and-blue "antifibrinator" capsules that "strip cancer cells of their protective cocoon." Although literature referred to Manner 5 as "a new program that we feel will revolutionize cancer therapy," Manner said the program has been used for about five years and that the clinic's medical director, Gilberto Alvarez, recommended it for all cancer patients.
The Manner Clinic also offered a "prevention program," which consists basically of the first week of the cancer therapy, but laetrile was omitted from the slow-drip infusion.
Rationale for Treatment
At the Texas seminar, Manner frequently cited the theories of John Beard, who published a book on the enzyme treatment of cancer in London in 1911, and of Ernst T. Krebs Sr. and his son, Ernst Jr., who embraced Beard's ideas and advocated laetrile therapy.
Manner claimed that in recent years, a significant reassessment of the nature and causes of cancer had taken place:
Cancer was formerly believed to be a localized disease, characterized by a lesion, usually in the form of a growth, which appeared at some specific part of the body. This localized lesion was thought to be the result of activity produced by an invading virus, carcinogenic agent, or some form of trauma such as a blow. Today, there is a growing conviction among researchers and physicians that cancer is a complex disease that is the end result of a disturbed metabolism (body chemistry) . . . The frequent recurrence of a malignancy after treatment with the conventional methods of surgery, radiation and/or chemotherapy results because the basic underlying metabolic cause of the cancer is rarely considered and consequently remains uncorrected .
Manner theorized that the human body is under constant bombardment by carcinogenic chemicals in our food, water and air, and that "each day, in every human being, large numbers of normal embryonic cells become cancerous." Fortunately, he said, most people have an immune system strong enough to neutralize or destroy the cancerous cells.
If the immune system, however, is weakened from poor nutrition, excessive environmental pollutants or a continuing debilitating stress, the cancer cells are uninhibited and will multiply rapidly, forming the symptomatic "growth" of cancer. . . One of the primary objectives of all metabolic therapy is to revitalize the body's immune system, to restore it to a fully functional condition . . . We can remain healthy if we supply the individual cells of the body with the proper amounts of oxygen, nutrients, enzymes, minerals, amino acids and other essential nutrients from both our diet and nutritional supplements. Of equal importance is the ability of the body to eliminate the waste products of cellular metabolism through proper bowel movements, efficient breathing, normal excretion, etc. Treatments must be provided which will help the body detoxify itself by eliminating harmful pollutants.
Conventional treatments, such as radiation and chemotherapy, cause a "complete depression of the immune system" and can "turn a normal person into a zombie," Manner said. "You don't depress the system you need to fight a disease, and that's exactly what they're doing."
His other theories can be summarized as follows:
|Juice fast, enemas, herbal laxatives and natural food diet with goal of two bowel movements a day.||Longer transit time is dangerous because it allows chemical reactions whose end products are carcinogens to occur in the digestive system|
|Coffee enemas||Bile stimulation aids detoxification by helping to restore the alkaline condition of the small intestine.|
||Ensure proper digestion of food|
|"Anti-neoplastic enzymes"||Remove a protective shield so the tumor can be recognized by the immune system. The enzymes help remove a fibrin coat that surrounds tumors, making them vulnerable to the other components of his treatment.|
|Emulsified vitamin A||Stimulates production of white blood cells, which can attack the tumor.|
|Thymosine (in thymus tablets)||Stimulates lymphocytes|
|Superoxide dismutase (SOD)||Enables body to destroy superoxide radicals (caused by radiation and also by buildup of white blood cells), which cause cancer and many other diseases. SOD causes the oxide radicals to combine with hydrogen in the bloodstream, forming hydrogen peroxide, which boosts the blood's oxygen level. Cancer cells thrive on carbon dioxide and die in an atmosphere of oxygen.|
|Vitamin C||Inhibits tumor growth.|
|Amygdalin (laetrile)||Breaks down into: glucose, which gives patients a burst of energy; benzaldehyde, which alleviates their pain; and cyanide, which kills just cancer cells.|
|"Glandulars"||Strengthens corresponding organ or tissue.|
|Massage||Stimulates lymphatic system.|
|Inspirational sessions||Restore hope by convincing patients that they can beat their cancer.|
Manner claimed that there were four general mechanisms by which high amounts of vitamin A can help destroy cancer:
- Lysosomal splitting, which would cause autodigestion of cancer cells
- Enhancing the immune system so that the body can attack the cancer as it would the flu or common cold;
- Disrupting protein synthesis in the cancer cell causing a rapid increase in DNA synthesis and mitosis of the cancer cells.
- This causes "a burnout situation exhausting the material from which the cancer gets its own substance." 
Critique of the Treatment
There is no reason to believe that any of Manner's methods has the slightest basis in reality. Moreover, he described so many versions and variations of what he did that the individual components could not have been tested because there were too many variables.
The leading proponent of "metabolic" treatment, Harold Manner, Ph.D., was born in 1925 in New York and grew up in rural New Jersey. According to a Manner Metabolic Foundation flyer, Manner received his bachelor's degree in science from John Carroll University in 1949, a master of science degree from Northwestern in 1950, and a doctorate in biology from Northwestern in 1952. He taught biology at Utica College of Syracuse University, serving as chairman of the division of science and mathematics from 1963 to 1969, and then chaired the biology department at St. Louis University until 1972. From 1972 to 1978, Manner was chairman of the biology department at Loyola University in Chicago. He continued to teach biology there until 1982, when he resigned under pressure from the school for his unconventional theories .
Manner established the Metabolic Research Foundation in Glenview, Illinois, in 1979, with himself as president, but later moved it to San Ysidro, California, across the border from Tijuana. In 1982, after the Foundation became affiliated with the Cydel Clinic in Tijuana, which changed its name to the Manner Clinic in 1984. Manner also operated the Emerald Isle Clinic, in Montserrat, West Indies.
The clinic brochure called the Manner Clinic the "World leader in disease prevention" and promises treatment based on "the latest scientific and medical information." Clinic employees meet patients at the San Diego airport and take them in a white van across the border into Mexico. Patients do not need passports, but are asked to bring their medical records.
Manner entered the public spotlight in 1977 by announcing at a National Health Federation seminar that he had cured cancer in mice with injections of laetrile, enzymes and vitamin A. The experiment was published in 1978 in a chiropractic journal . What Manner actually did was digest the tumors by injecting digestive enzymes into them, which cannot cure metastatic cancer.
Manner gave contradictory opinions of conventional treatment for cancer and other diseases. One of his brochures said, "The cancer patient should not exclude from consideration other forms of cancer therapy such as radiation, chemotherapy and surgery. Fortunately, the nature of metabolic therapy permits its use in conjunction with conventional therapy." But at his June 1988 seminar, he bitterly attacked standard therapies as ineffective and dangerous.
Manner marketed his methods to chiropractors, naturopaths and physicians. At his 1988 seminar, he said there were nearly 600 "qualified metabolic physicians" worldwide. Many of them made referrals to the Manner Clinic, which referred patients back for follow-up care, which included supplements obtainable from Manner Metabolic Products Inc. Associates paid a fee to join the Metabolic Research Foundation and were promised $200 for every patient referred.
Evaluation of Results
In a 1978 interview in Mother Earth News, Manner claimed he had been harassed by the FDA and that he had stored copies of 17 patient records "in a locked bank vault in Canada . . . known only to me and a few friends. When I have 100 of these files, I'm going to put them in a package, to take them to Washington, D.C., and I think the whole laetrile controversy will be over." However, the alleged files and Manner's intent to send them to Washington were not mentioned again in any of the dozens of subsequently published materials distributed at the Texas seminar.
Manner's claimed success rates for cancer were also contradictory. On a tape recording, he said 74% of the clinic's patients "will never have to worry about that cancer again." But a brochure refers to "a success factor of 68%," with success defined as elimination of either the cancer or its threat to life.
In 1988, Manner said his clinic had served about 4,000 patients and operates at capacity, with about a 2-week waiting list.
One of Manner's biggest boosters was 51-year-old Ginny Davis, of Franklin, Wisconsin, whose testimonial story was distributed at the June 1988 seminar. A pathology report attached to the testimonial indicates that in April 1985, a diagnosis of "infiltrating adenocarcinoma" was made in a polyp that was removed from Ms. Davis's large intestine. According to her testimonial, the surgeon advised Ms. Davis's family doctor that part of her large intestine should be removed, but she refused and chose instead to go to the Manner Clinic. Three years later her colon was described as normal on a colonoscopy report. The term "infiltrating carcinoma" merely means that the cancer had infiltrated below the surface layer of the polyp. Removal of the polyp apparently cured the patient before she went the Manner Clinic.
There is no published evidence that Manner actually kept track of how his patients did after leaving his clinic. Dr. James Lowell says that Manner repeatedly promised to send tabulations of his results to him but never did so. Manner died in October 1988, but various forms of "metabolic treatment" are still available
- Metabolic Research Foundation: Harold W. Manner, Ph.D., Research Scientist, Author, Educator (undated flyer).
- Manner, Harold W.: Facts about metabolic therapy (undated booklet)
- Manner, Harold W.: Facts about metabolic therapy - "C" (undated booklet)
- South, Jeff: The Manner Seminar. Nutrition Forum 5:61-67, 1988.
- Manner Seminar tapes, June 1988.
- Manner, Harold et al.: The Death of Cancer, Advanced Century Publishing Corp., Chicago, 1978, pp. 76-79.
- Manner, Harold: Amygdalin, vitamin A and enzyme induced regression of murine mammary adenocarcinomas. Journal of Manipulative and Physiological Therapeutics, Dec. 1978.