Some Supplements May Aid Cancer Growth – A Few Might Stop

One would naturally assume keeping in good health through supplements would help your fight with cancer. Turns out, cancers may like supplements too…

Frightening is the finding that certain supplements may not be great in cancer prevention (and likely in active cases).

Concerning vitamins as a whole, a doctor study found decreased cancer rates by 7%. It only helped those with NO family history of cancer.  Prostate, Colon/Rectum and Bladder cancers were not helped and it had no effect on cancer mortality.
Gaziano JM, Sesso HD, Christen WG, et al. Multivitamins in the prevention of cancer in men: the Physicians’ Health Study II randomized controlled trial.
JAMA. 2012;308:1871-1880.
as per:
Gaziano, J. M., H. D. Sesso, and W. G. Christen.
Multivitamins and Cancer Prevention: Using the Data.” (2012).
Medscape
http://www.paramed.ch/paramed-webseite/uploadfiles/85b433d6-0da8-4c31-bf9d-e66e30bae42c.pdf

This study also suggested that there could be a 27% reduction in cancer among men with cancer:
Postgrad Med. 2015 Jan;127(1):107-16.
Multivitamin/multimineral supplements for cancer prevention: implications for primary care practice.
Hardy ML(1), Duvall K.
http://www.ncbi.nlm.nih.gov/pubmed/?term=25584933

article did caution that individual vitamins might be detrimental.

However,  prostate cancer may progress more rapidly in mulitvitamen users:
“For prostate cancer, some preliminary evidence indicates that excess consumption of one or a combination of components in a multivitamin/multimineral may accelerate cancer progression and increase fatality.”
Role of Vitamin and Mineral Supplementation and Aspirin Use in Cancer Survivors
Edward Giovannucci and Andrew T. Chan
JCO September 10, 2010 vol. 28 no. 26 4081-4085
http://jco.ascopubs.org/content/28/26/4081.abstract

Part of this comment may be from this study:
Lawson, Karla A., Margaret E. Wright, Amy Subar, Traci Mouw, Albert Hollenbeck, Arthur Schatzkin, and Michael F. Leitzmann.
Multivitamin use and risk of prostate cancer in the National Institutes of Health–AARP Diet and Health Study.
Journal of the National Cancer Institute 99, no. 10 (2007): 754-764.
http://jnci.oxfordjournals.org/content/99/10/754.full

“Results:  No association was observed between multivitamin use and risk of localized prostate cancer. However, we found an increased risk of advanced and fatal prostate cancers (RR = 1.32, 95% CI = 1.04 to 1.67 and RR = 1.98, 95% CI = 1.07 to 3.66, respectively) among men reporting excessive use of multivitamins (more than seven times per week) when compared with never users. The incidence rates per 100000 person-years for advanced and fatal prostate cancers for those who took a multivitamin more than seven times per week were 143.8 and 18.9, respectively, compared with 113.4 and 11.4 in never users. The positive associations with excessive multivitamin use were strongest in men with a family history of prostate cancer or who took individual micronutrient supplements, including selenium, β-carotene, or zinc.”

1) Known vitamin hazards started out with Beta- carotene:

Heinonen, Olli P., and Demetrius Albanes.
The effect of vitamin E and beta carotene on the incidence of lung cancer and other cancers in male smokers.”
The New England journal of medicine 330 (1994).

http://agris.fao.org/agris-search/search.do?f=1995/US/US95103.xml;US9509590

“Unexpectedly, we observed a higher incidence of lung cancer among the men who received beta carotene than among those who did not (change in incidence, 18 percent; 95 percent confidence interval, 3 to 36 percent).”

2) Folic acid:
Multiple studies have demonstrate folic acid reduced colon cancer rates.

However,  a folic acid prostate cancer trial found supplementation (but not food received) folic acid may promote prostate cancer:
Figueiredo, Jane C., Maria V. Grau, Robert W. Haile, Robert S. Sandler, Robert W. Summers, Robert S. Bresalier, Carol A. Burke, Gail E. McKeown-Eyssen, and John A. Baron.
Folic acid and risk of prostate cancer: results from a randomized clinical trial.
Journal of the National Cancer Institute 101, no. 6 (2009): 432-435.
http://jnci.oxfordjournals.org/content/101/6/432.full.pdf  

Folic acid – 9.7 risk over 10 years
Placebo – 3.3% over 10 yrs
age adjusted hazard ratio 2.63

Also, a Norwegian study of cardiac patients taking folic acid and B12 found increased cancer risks:
Cancer Incidence and Mortality After Treatment With Folic Acid and Vitamin B12
Marta Ebbing et al
JAMA. 2009;302(19):2119-2126
http://www.elsevierbi.com/~/media/Images/Publications/Archive/The%20Tan%20Sheet/17/048/05170480020_b/091123_jama_folic_acid_cancer_study.pdf

A total of 136 (4.0%) who received folic acid plus vitamin B12 vs 100 (2.9%) who did not receive such treatment died from cancer (HR, 1.38; 95% CI, 1.07-1.79; P=.01). A total of 548 patients (16.1%) who received folic acid plus vitamin B12 vs 473 (13.8%) who did not receive such treatment died from any cause (HR, 1.18; 95% CI, 1.04-1.33; P=.01).

Also disturbing are epidemiological studies in USA, and Chile finding colon cancers rose after folic acid was introduced into flour to help prevent neural tube birth defects:

A Temporal Association between Folic Acid Fortification and an Increase in Colorectal Cancer Rates May Be Illuminating Important Biological Principles: A Hypothesis
Cancer Epidemiol Biomarkers Prev July 2007 16; 1325
Joel B. Mason1, Aaron Dickstein, Paul F. Jacques, Paul Haggarty, Jacob Selhub, Gerard Dallal and Irwin H. Rosenberg
http://cebp.aacrjournals.org/content/16/7/1325.full.pdf

Hirsch, Sandra, Hugo Sanchez, Cecilia Albala, María Pía de la Maza, Gladys Barrera, Laura Leiva, and Daniel Bunout. .
Colon cancer in Chile before and after the start of the flour fortification program with folic acid.
European journal of gastroenterology & hepatology 21, no. 4 (2009): 436-439.
http://journals.lww.com/eurojgh/Abstract/2009/04000/Colon_cancer_in_Chile_before_and_after_the_start.7.aspx

This rise appears to be real but was possibly just a transient rise as found by Women’s Health Initiative:
Zschäbitz, Stefanie, Ting-Yuan David Cheng, Marian L. Neuhouser, Yingye Zheng, Roberta M. Ray, Joshua W. Miller, Xiaoling Song et al.
B vitamin intakes and incidence of colorectal cancer: results from the Women’s Health Initiative Observational Study cohort.
The American journal of clinical nutrition 97, no. 2 (2013): 332-343.
“Our study provides new evidence that the increased folate intake during the early postfortification period may have been associated with a transient increase in CRC [cancer colon rectum] risk.
http://www.researchgate.net/publication/233958781_B_vitamin_intakes_and_incidence_of_colorectal_cancer_results_from_the_Women’s_Health_Initiative_Observational_Study_cohort/file/32bfe51390c8c994b3.pdf

There is often a 5 year lag between initiation of colonic polyps and its discovery – could it be that already developed polyps progressed in certain genotypes while 5 years in, one saw the actual prevention?

Confirming that increases do not exist now is a recent analysis that found NO association between folic acid and onset of colon cancer:
Effects of folic acid supplementation on overall and site-specifi c cancer incidence during the randomised trials: meta-analyses of data on 50 000 individuals
Stein Emil Vollset, Robert Clarke, Sarah Lewington, Marta Ebbing, Jim Halsey, Eva Lonn, Jane Armitage, JoAnn E Manson, Graeme J Hankey,J David Spence, Pilar Galan, Kaare H Bønaa, Rex Jamison, J Michael Gaziano, Peter Guarino, John A Baron, Richard F A Logan,
Edward L Giovannucci, Martin den Heijer, Per M Ueland, Derrick Bennett, Rory Collins, Richard Peto,
Lancet 2013; 381: 1029–36
http://www.srhsb.com/media/79270/folic%20acid%20meta-analysis%202013.pdf

However, there is a concern that excessive folic acid may be carcinogenic in general:
Baldauff, Regine L.
The Relationship Between Unmetabolized Folic Acid and Serum Folate Concentrations and Cancer Risk in Older US Adults.” (2013 Thesis ).
http://scholarworks.gsu.edu/cgi/viewcontent.cgi?article=1044&context=nutrition_theses&sei-redir=1&referer=http%3A%2F%2Fscholar.google.ca%2Fscholar%3Fstart%3D20%26q%3DEffect%2Bof%2Bfolic%2Bacid%2Bsupplementation%2Bon%2Bthe%2Bprogression%2Bof%2Bcolorectal%2Baberrant%2Bcrypt%2Bfoci%26hl%3Den%26as_sdt%3D0%2C5%26as_ylo%3D2013
“Results: men and women without unmetabolized folic acid were 0.7 times less likely to develop cancer. Those over the age of sixty with the highest concentration of serum folate [i.e. excessive] were 1.4 times more likely to have cancer than participants with lower serum folate concentrations. Women over the age of sixty with the highest concentration of serum folate were 1.8 times more likely to have breast cancer compared to women with lower serum folate concentrations.

However another article found no association between high intake and increased colon cancer and a trend to the opposite:
Stevens, Victoria L., Marjorie L. McCullough, Juzhong Sun, Eric J. Jacobs, Peter T. Campbell, and Susan M. Gapstur.
High levels of folate from supplements and fortification are not associated with increased risk of colorectal cancer.
Gastroenterology 141, no. 1 (2011): 98-105.
http://www.ncbi.nlm.nih.gov/pubmed/21586288

More disturbingly, a study from Toronto suggests folic acid may promote growth of abnormal colonic polyps:
http://carcin.oxfordjournals.org/content/30/9/1536.full.pdf

An older JAMA article also found a trend in that manner:
JAMA. 2007 Jun 6;297(21):2351-9.
Folic acid for the prevention of colorectal adenomas: a randomized clinical
trial.
Cole BF, Baron JA, Sandler RS, Haile RW, Ahnen DJ, Bresalier RS, McKeown-Eyssen
G, Summers RW, Rothstein RI, Burke CA, Snover DC, Church TR, Allen JI, Robertson
DJ, Beck GJ, Bond JH, Byers T, Mandel JS, Mott LA, Pearson LH, Barry EL, Rees JR,
Marcon N, Saibil F, Ueland PM, Greenberg ER; Polyp Prevention Study Group.
http://www.ncbi.nlm.nih.gov/pubmed/17551129
“incidence of at least 1 advanced lesion was 11.6% for folic acid (n = 35) and 6.9% for placebo (n = 21)”

However, another study suggested folic acid might be protective in colonic adenoma recurrence:
Jaszewski, Richard, Sabeena Misra, Martin Tobi, Nadeem Ullah, Jo Ann Naumoff, Omer Kucuk, Edi Levi, Bradley N. Axelrod, Bhaumik B. Patel, and Adhip PN Majumdar. (from Detroit – not third world)
Folic acid supplementation inhibits recurrence of colorectal adenomas: a randomized chemoprevention trial.
World journal of gastroenterology: WJG 14, no. 28 (2008): 4492.
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2731275/pdf/WJG-14-4492.pdf
“High dose folic acid supplementation is associated with a significant reduction in the recurrence of colonic adenomas suggesting that folic acid may be an effective chemopreventive agent for colorectal neoplasia.”

However, a randomized trial found no better-no worse:
Wu, Kana, Elizabeth A. Platz, Walter C. Willett, Charles S. Fuchs, Jacob Selhub, Bernard A. Rosner, David J. Hunter, and Edward Giovannucci.
A randomized trial on folic acid supplementation and risk of recurrent colorectal adenoma. The American journal of clinical nutrition 90, no. 6 (2009): 1623-1631.
http://ajcn.nutrition.org/content/90/6/1623.full.pdf

In established colon cancer one article suggested:
” excessive folic acid in patients with established cancer may be harmful
Role of Vitamin and Mineral Supplementation and Aspirin Use in Cancer Survivors
Edward Giovannucci and Andrew T. Chan
JCO September 10, 2010 vol. 28 no. 26 4081-4085
http://jco.ascopubs.org/content/28/26/4081.abstract

2) Omega 3 in prostate cancer:
Peskin, B. S.
Why Fish Oil Fails: A Comprehensive 21st Century Lipids-Based Physiologic Analysis.
Journal of Lipids 2014 (2014) 1-15.
http://downloads.hindawi.com/journals/jl/2014/495761.pdf

prostate cancer victims at time diagnosis were found to have higher omega 3 metabolite levels in blood.

Plasma Phospholipid Fatty Acids and Prostate Cancer Risk in the SELECT Trial
Theodore M. Brasky, Amy K. Darke, Xiaoling Song, Catherine M. Tangen, Phyllis J. Goodman, Ian M. Thompson, Frank L. Meyskens Jr, Gary E. Goodman, Lori M. Minasian, Howard L. Parnes, Eric A. Klein and Alan R. Kristal
JNCI J Natl Cancer Inst (2013) 105 (15): 1132-1141.
http://jnci.oxfordjournals.org/content/105/15/1132.short

3) Magnesium and Calcium during chemotherapy (this is contraversial)
Hochster, Howard S., Axel Grothey, and Barrett H. Childs.
Use of calcium and magnesium salts to reduce oxaliplatin-related neurotoxicity. Journal of Clinical Oncology 25.25 (2007): 4028-4029.
http://jco.ascopubs.org/content/25/25/4028.1.full.pdf
“those patients who received calcium and magnesium salts reported a significantly lower response rate than the placebo group.”

Then there is the question whether calcium supplementation causes coronary artery calcium buildup:
Bolland, Mark J., et al.
Calcium supplements with or without vitamin D and risk of cardiovascular events: reanalysis of the Women’s Health Initiative limited access dataset and meta-analysis.” BMJ: British Medical Journal 342 (2011).
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3079822/

4) And now Vitamin E and N-acetylcysteine (NAC)

– found to dramatically increases tumor progression in mice and human lung tumor cells by “reducing ROS, DNA damage, and p53 expression in mouse and human lung tumor cells”

Sci Transl Med. 2014 Jan 29;6(221):221ra15. doi: 10.1126/scitranslmed.3007653.
Antioxidants accelerate lung cancer progression in mice.
Sayin VI, Ibrahim MX, Larsson E, Nilsson JA, Lindahl P, Bergo MO.
http://www.ncbi.nlm.nih.gov/pubmed/24477002

5) Anti-oxidants might promote cancers – both chemotherapy and radiotherapy work through excessive oxidation. Cancers make considerable oxidants and seemingly adding anti-oxidant may be just helping them out..

Recent discussion about this here:
How antioxidants can accelerate cancers, and why they don’t protect against them
http://www.eurekalert.org/pub_releases/2014-07/cshl-hac070914.php

4) B12 – any B12 in excess of that in an multivitamin, in smokers is assocated with increased lung cancer risk:
Extra B12 – Lung Cancer Link for Men
http://painmuse.org/?p=6393

Comment – so what can one do?

  • Number one would be what NOT to eat – obesity significantly increases cancer rates and speeds progression of cancer. Sugar is particupl;arly bad and consuming over 2 bottles of sweetened pop a day will increase cancer progression odds by 2.22 times:
    Research Article Sugar-Sweetened Beverage Intake and Cancer Recurrence and Survival in CALGB 89803 (Alliance)
    Michael A. Fuchset al
    PLOS ONE  1 June 2014 | Volume 9 | Issue 6 | e99816
    http://www.plosone.org/article/fetchObject.action?uri=info%3Adoi%2F10.1371%2Fjournal.pone.0099816&representation=PDF
  • Advice from the calcium -coronary artery field suggested eat a good diet and leave it at that – that sounds reasonable all round. Saturated fat is potentially carcinogenic.
  • Statins – cholesterol lowering statin  drugs can reduce cancer progression (though came across one study that suggested maybe moreso in first 2 years) – Should one take coenzyme q 10 to deal with the deficiency it causes? – how do we know if that is not how it helps? Some benefits after  though better if took before:
    J Clin Oncol. 2014 Jan 1;32(1):5-11. doi: 10.1200/JCO.2013.49.4757.
    Use of statins and the risk of death in patients with prostate cancer
    Yu O, Eberg M, Benayoun S, Aprikian A, Batist G, Suissa S, Azoulay L.
    http://www.ncbi.nlm.nih.gov/pubmed/24190110Note: there are negative studies after radiotherapy:
    Urology. 2009 Jan;73(1):158-62. doi: 10.1016/j.urology.2008.02.055.
    No effect of statins on biochemical outcomes after radiotherapy for localized
    prostate cancer.
    Soto DE, Daignault S, Sandler HM, Ray ME.
    http://www.ncbi.nlm.nih.gov/pubmed/18722651and negative after radical prostatectomy:
    BJU Int. 2013 May;111(6):954-62. doi: 10.1111/j.1464-410X.2012.11639.x.
    Use of statins and prostate cancer recurrence among patients treated with radical
    prostatectomy.
    Chao C, Jacobsen SJ, Xu L, Wallner LP, Porter KR, Williams SG.so don’t bank on it alone…
  • Metformin -Diabetics can get a significant reduction in cancers from taking metformin.
    Metformin Boosts Survival in Diabetic Cancer Patients
    Roxanne Nelson
    Medscape Family Medicine November 25, 2013
    http://www.medscape.com/viewarticle/814948
    “When analyzed by cancer subtype, the reduction in risk for death was significant in patients with pancreatic, colorectal, breast, prostate, and other cancers, but not for lung cancer.”An Ontario study found that prostate cancer victims waiting for surgery had smaller prostate cancers if on metformin during the preop period. Study used 500 mg three times daily.Recently metformin using patients had less prostate cancer progression:
    Metformin Use and All-Cause and Prostate Cancer–Specific Mortality Among Men With Diabetes
    David Margel, David R. Urbach, Lorraine L. Lipscombe, Chaim M. Bell, Girish Kulkarni, Peter C. Austin and Neil Fleshner
    JCO September 1, 2013 vol. 31 no. 25 3069-3075
    http://jco.ascopubs.org/content/31/25/3069.short
  • One prostate cancer gene activation analysis found a Mediterranean diet (fish and poultry only); 1 hour stress reduction (meditation, yoga, guided imagery,stretching, breathing, progressive muscular relaxation);  1/2 hour  walking/exercise; and a weekly 1 hour support group could be helpful ( and leaves people with longer telomeres (anti-aging) as well…)
    Ornish, Dean, Mark Jesus M. Magbanua, Gerdi Weidner, Vivian Weinberg, Colleen Kemp, Christopher Green, Michael D. Mattie et al.
    Changes in prostate gene expression in men undergoing an intensive nutrition and lifestyle intervention.
    Proceedings of the National Academy of Sciences 105, no. 24 (2008): 8369-8374.
    http://www.w4lp.com/changes-in-prostate-gene-expression-in-men-undergoing-an-intensive-nutrition-and-lifestyle-intervention.pdf

    Ornish, D., Lin, J., Chan, J. M., Epel, E., Kemp, C., Weidner, G., … & Blackburn, E. H. (2013).
    Effect of comprehensive lifestyle changes on telomerase activity and telomere length in men with biopsy-proven low-risk prostate cancer: 5-year follow-up of a descriptive pilot study.
    The lancet oncology, 14(11), 1112-1120.
    http://press.thelancet.com/lifestyletelomeres.pdf

Addendum – one study found prostate cancer slightly elevated with poultry use:

Knuppel, Anika, Keren Papier, Georgina K. Fensom, Paul N. Appleby, Julie A. Schmidt, Tammy YN Tong, Ruth C. Travis, Timothy J. Key, and Aurora Perez-Cornago.
Meat intake and cancer risk: prospective analyses in UK Biobank.
medRxiv (2019): 19003822.
https://www.medrxiv.org/content/medrxiv/early/2019/08/02/19003822.full.pdf
“Poultry intake was positively associated with risk for malignant melanoma (HR per 30 g/day increment in intake 1.20, 95% CI 1.00–1.44), prostate cancer (1.11, 1.02–1.22) and non-Hodgkin lymphoma (1.26, 1.03–1.55)”

  • Aspirin
    “Use of aspirin is proven to lower risk of colorectal cancer, and recent evidence suggests that aspirin use in patients with colorectal cancer improves cancer-specific and overall survival, especially in patients with tumors that express cyclooxygenase-2 (COX-2).”
    Role of Vitamin and Mineral Supplementation and Aspirin Use in Cancer Survivors
    Edward Giovannucci and Andrew T. Chan
    JCO September 10, 2010 vol. 28 no. 26 4081-4085
    http://jco.ascopubs.org/content/28/26/4081.abstractrecent study found
  • Vitamin D – “Breast cancer patients with high levels of vitamin D in their blood are twice as likely to survive the disease as women with low levels of this nutrient”
    http://health.ucsd.edu/news/releases/Pages/2014-03-06-vitamin-D-and-breast-cancer-survival.aspxThere is also evidence high levels help with colorectal cancer:
    Lee JE, Li H, Chan AT, Hollis BW, Lee IM, Stampfer MJ, et al.
    Circulating levels of vitamin D and colon and rectal cancer: the Physicians’ Health Study and a meta-analysis of prospective studies.
    Cancer Prev Res 2011;4:735–43.
    Ma Y, Zhang P, Wang F, Yang J, Liu Z, Qin H. Association between vitamin D and risk of colorectal cancer: a systematic review of prospective studies.
    J Clin Oncol 2011;29:3775–82.A review of vit D and cancer was done recently:
    Circulating 25-hydroxyvitamin D Levels and Prognosis among Cancer Patients: A Systematic Review
    Adetunji T. Toriola, Nhi Nguyen, Kristen Scheitler-Ring, et al.
    Cancer Epidemiol Biomarkers Prev 2014;23:917-933

    Help with ovarian cancer was a “maybe” as low levels had 1.8 times odds versus low vit D cases:
    Eur J Cancer. 2010 Jan;46(2):364-9.
    Serum 25-hydroxyvitamin D and the risk of ovarian cancer.
    Toriola AT,  Surcel HM, Agborsangaya C, Grankvist K, Tuohimaa P, Toniolo P,
    Lukanova A, Pukkala E, Lehtinen M.
    http://www.ncbi.nlm.nih.gov/pubmed/19713101

  • That would take 2000 iu/day as 1000 barely gets normal levels.

    Melatonin – Recent studies have shown melatonin supplementation might help in breast cancers:
    Jardim-Perassi, B. V., Arbab, A. S., Ferreira, L. C., Borin, T. F., Varma, N. R., Iskander, A. S. M., … & de Campos Zuccari, D. A. P. (2014). Effect of melatonin on tumor growth and angiogenesis in xenograft model of breast cancer. PloS one, 9(1), e85311
    http://www.plosone.org/article/info%3Adoi%2F10.1371%2Fjournal.pone.0085311

    Having total darkness at night might stimulate your own melatonin secretion:
    “Total darkness at night key to success of breast cancer therapy, study shows”
    http://www.sciencedaily.com/releases/2014/07/140725080408.htm

    The above reference makes it very clear”Exposure to light at night, which shuts off nighttime production of the hormone melatonin, renders breast cancer completely resistant to tamoxifen, a widely used breast cancer drug, says a new study. Melatonin by itself delayed the formation of tumors and significantly slowed their growth, researchers report, but tamoxifen caused a dramatic regression of tumors in animals with either high nighttime levels of melatonin during complete darkness or those receiving melatonin supplementation during dim light at night exposure.

    Take note an patients on tamoxifen…

  • Vitamin A – when pre-cancerous cells in culture are exposured to a certain concentration of retinoic acid, chemoprotective changes occur. Doesn’t help at higher dose.
    All trans-retinoic acid (ATRA) induces re-differentiation of early transformed breast epithelial cells
    Maria F. Arisi, Rebecca A. Starker, Sankar Addya, Yong Huang, Sandra V. Fernandez
    INTERNATIONAL JOURNAL OF ONCOLOGY 44: 1831-1842, 2014
    http://www.spandidos-publications.com/ijo/44/6/1831/download
    don’t know what that means in real life.
  • ? Zinc, Vitamin C, and grapeseed have beeen suggested but need more to go on here.

Addendum – Creatine, a supplement used by muscle builders was found to aid cancer killing T cell lymphocytes. This was investigated after high levels of creatine receptors were found on the surface of these t cells. Manipulating mouse types demonstrated positive effects of creatine “at muscle building doses”

Creatine powers T cells’ fight against cancer
http://newsroom.ucla.edu/releases/creatine-powers-t-cells-fight-against-cancer

JEM October 7, 2019 Volume 216, No. 10; 1-14
Creatine uptake regulates CD8 T cell antitumor immunity
Stefano Di Biase et al
http://jem.rupress.org/content/early/2019/10/17/jem.20182044
http://jem.rupress.org/content/jem/early/2019/10/17/jem.20182044.full.pdf

  • suggests in does that “by storing and distributing energy.”

 

Any advice ( with documented studies) out there?

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