NATURAL PRODUCTS TO SUPPORT CHEMOTHERAPY
For many people the very thought of chemotherapy evokes horrific images of debilitating nausea, vomiting, diarrhea and weakness. In fact chemotherapy can induce those symptoms and many more, however newer medications have made most chemotherapy regimens much better tolerated than in the past. Nonetheless, chemotherapy can produce a wide range of undesirable side effects. Which side effects will occur has much to do with the type of chemotherapy, the dosage and timing of the treatments, the general health of the patient and the history of prior chemotherapy.
One of the problems with chemotherapy is that it is active against any actively dividing cell whether it is cancerous or not. This means that cells lining the intestines, those in the bone marrow and those in the hair follicles, all of which are also continuously dividing, will also be damaged by chemotherapy. Fortunately, there are natural products that can be used to protect against the damaging effects of chemotherapy while simultaneously increasing the effectiveness of the chemotherapy. The natural measures that I am recommending are definitely worth incorporating into your cancer treatment plan and may mean the difference of life or death.
Along with some basic dietary guidelines, there are five key supplements that can be used to support any form of chemotherapy or radiation:
- A high potency multiple vitamin and mineral
- Regular consumption of "greens" drinks
- Maitake D- or M,D-fraction
- Proteolytic enzymes
In addition, it is important to take coenzyme Q10 if you are taking doxorubicin (Adriamycin) or any other chemotherapy agent known to damage the heart.
What are the general dietary guidelines to follow?
Because of the problem of nausea and vomiting caused by cancer itself as well as many chemotherapy agents and/or radiation therapy, many cancer patients develop anorexia – the loss of appetite or desire to eat. This situation is not good at all because it can lead to a condition known as cancer "cachexia" – a wasting syndrome characterized by weakness and a noticeable continuous loss of weight, fat, and muscle. It is estimated that roughly 40% of cancer patients actually die of malnutrition rather than their disease itself. The importance of high quality nutrition in the battle against cancer cannot be overstated. Cancer patients who have higher nutritional status are better able to stand therapy and its side effects. Poor nutritional status can lead to progressive wasting, weakness, exhaustion, lower resistance to infection, problems tolerating cancer therapy, and finally, death.
The following dietary suggestions can help improve nutritional status in cancer patients
- Eat small frequent meals (every 1-2 hours).
- Drink a high-protein smoothie containing 20 to 30 grams of whey protein twice daily.
- Get a juice machine and drink 18 to 24 ounces of fresh fruit or vegetable juice daily.
- Use extra seasonings, spices, and flavorings, but avoid flavorings that are very sweet or very bitter. A higher sensitivity to the taste of food may cause them to taste flavorless or boring.
- Eat soft or moist foods while avoiding hard, dry foods.
- Take small bites and chew completely.
- Drink at least 48 ounces of water daily in addition to the 18 to 24 ounces of fresh fruit or vegetable juice
Should antioxidants be avoided during chemotherapy treatments?
One of the most controversial recommendations to support chemotherapy (as well as radiation therapy) is the recommendation to use antioxidant nutrients during the active phase of the treatment. While there is little concern with using antioxidant nutrients after the completion of a course of chemotherapy or radiation treatment the concern that many oncologists have is that antioxidant nutrients will interfere with the effectiveness of conventional therapies. Is this fear valid? According to many experts, the answer is no.1,2
Dr. Kedar Prasad and his colleagues at the Center for Vitamins and Cancer Research at the University of Colorado Health Science Center’s Department of Radiology in Denver are among the most knowledgeable experts in this field. Dr. Prasad has stated that the concerns over the use of high dosage antioxidants during chemotherapy and radiation "are not valid." Dr. Prasad feels that "based on results of our studies and others, we have proposed a hypothesis that supplementation with high doses of multiple antioxidant vitamins, together with diet modification and lifestyle changes may improve the efficacy of standard and experimental cancer therapies by reducing their toxicity on normal cells and by enhancing their growth-inhibitory effects on cancer cells."
The bottom line is that in addition to countless animal studies, the majority of human studies have shown patients treated with antioxidants during chemotherapy and/or radiation tolerate standard treatment better, have a better quality of life, and most importantly, live longer than patients receiving no supplements. For example, the conclusion in a study in patients with small-cell lung cancer using combination chemotherapy of cyclophosphamide, Adriamycin (doxorubicin), and vincristine with radiation and a combination of antioxidants, vitamins, trace elements, and fatty acids was that the nutritional support significantly prolonged the survival time of patients.3
But, my oncologist told me scientific evidence shows that antioxidants interfere with chemotherapy, what should I do?
When oncologists cite "scientific evidence" that antioxidants interfere with chemotherapy and radiation, they tend to ignore the fact that the majority of these sorts of studies show predominantly beneficial effects. The scientific evidence that oncologists often refer to consist primarily of animal studies where they fed animals (usually via an injection into the intestines) dosages of an antioxidant that far exceed the amount normally recommended or in vitro (test tube) studies that used concentrations of antioxidants not achievable in living systems. For example, when vitamin E is given to mice at dosages not likely to be achieved with normal supplementation in humans (e.g., dosage greater than 35,000 IU) it can reduce the effectiveness of radiation therapy.4 However, based upon human and animal studies, vitamin E at commonly used dosages does not interfere with radiation therapy or chemotherapy and actually appears to enhance the success of these treatment.5,6 The same can be said with CoQ10 and many other antioxidants. The only real exception is N-acetylcysteine – a derivative of the naturally occurring amino acid cysteine. NAC has not been shown to significantly effect treatment outcome and carries with it some risk of inhibiting chemotherapy agents (e.g., cisplatin).7,8 So, I do not recommend it being used during active treatment with any chemotherapy agent. After chemotherapy is over, then NAC may be of benefit in reversing any kidney or nerve damage.
As far as what to do, I think that it is extremely important to develop a relationship with an oncologist or cancer treatment center that you have confidence in and that you can communicate with. That may seem like a difficult task, but it can be done. I encourage you to discuss any supplement use with your physician. If your physician is not familiar with the scientific literature that supports the use of antioxidants during chemotherapy and radiation treatments, then I would refer them to the review article written by Dr. Kedar Prasad and his colleagues: High Doses of Antioxidant Vitamins: Essential Ingredients in Improving the Efficacy of Standard Cancer Therapy published in the Journal of the American College of Nutrition (see reference #1). Hopefully, when your oncologist becomes more familiar with the facts they will support your use of the recommendations I am making here.
Why is it important to take a high potency multiple vitamin and mineral if you are on chemotherapy?
Since the immune system requires a constant source of virtually every nutrient, it only makes sense that a high-potency multiple-vitamin and mineral formula is the first step in supporting the immune system with nutritional supplementation in patients on chemotherapy. Deficiencies of virtually any nutrient can result in significantly impaired immune function especially deficiencies of vitamins C, E, A, B6, B12, and folic acid. Minerals that are especially important are zinc and selenium. The multiple vitamin and mineral formulas that I recommend, the MultiStart products from Natural Factors, are designed to meet the different nutritional needs of different ages and gender. These formulas contain not only gender and age specific levels for vitamins and minerals, but also appropriate digestive factors and herbal extracts based on gender and/or age.
What do you mean by regular consumption of "greens" drinks?
Green drinks is the term that we are using to describe green tea and a number of commercially available products containing dehydrated barley grass, wheat grass, or algae sources such as chlorella or spirulina that are then "rehydrated" by mixing with water. The product that I recommend, Enriching Greens, is packed full of phytochemicals, especially helpful in fighting against cancer. Greens drinks should not be used in patients taking coumadin (Warfarin) – a drug that blocks blood clotting by interfering with the actions of vitamin K. Since greens drinks can be a good source of vitamin K, it is important for people taking coumadin to avoid these drinks.
What is Maitake D- or M,D-fraction?
The maitake mushroom (Grifola frondosa) is the source of immune enhancing compounds that are being shown to offer significant health benefits. In the early 1980s, Dr. Hiroaki Nanba of Japan was researching the immune enhancing properties of mushrooms when he came to the conclusion that maitake extracts demonstrated more pronounced antitumor activity in animal tests than other mushroom extracts. One of the key benefits to maitake was the ability to be quite effective when given orally. In contrast, the other mushrooms Dr. Nanba was studying such as shiitake were only effective when injected into the bloodstream.
In 1984, Dr. Nanba identified a fraction of maitake that possessed a significant ability to stimulate white blood cells known as macrophages (literal translation "big eaters"). These specialized white blood cells phagocytize or engulf foreign particles including cancer cells, bacteria, and cellular debris. Dr. Nanba termed his discovery maitake D-fraction. Further purification of the D-fraction yielded the M,D-fraction (U.S. Patent #5,854,404), which is even more bioactive than the D-fraction.
Maitake beta-glucan fractions appear to help reduce the side effects of conventional chemotherapy (and radiation) while at the same time enhancing its effectiveness. In 1994, a group from China published findings from a pilot study on 63 cancer patient reporting a total effective rate against solid tumors at higher than 95% and the effective rate against leukemia higher than 90%.9 In a preliminary study conducted by Dr. Nanba, 165 patients with advanced cancer were given maitake extract.10 In the patients who were also on chemotherapy, 90% of the patients experienced a reduction in the side effects common to chemotherapy including hair loss, decreased white blood cell counts, nausea, vomiting, and loss of appetite. Maitake was shown to effectively reduce pain levels in 83% of the patients. The results were best in breast, lung, and liver cancers. Dr. Nanba reported significant improvement in symptoms or regression of tumors in 73.3% of patients with breast cancer, 66.6% in lung cancer, and 46.6% in liver cancer.
The dosage of maitake extracts is based upon the level of the D- or M,D-fraction. The therapeutic dosage range is based upon body weight, 0.5mg to 1.0 mg for every 2.2 pounds (1 kg) of body weight per day. That translates to a dosage of approximately 35-70 mg of the D- or M,D-fraction. The dosage recommendation for prevention is typically 5 to 15 mg of the D- or M,D-fraction. For best results take 20 minutes before meals or on an empty stomach.
What are proteolytic enzymes?
Proteolytic enzymes (or proteases) refer to the various enzymes that digest (break down into smaller units) protein. These enzymes include the pancreatic proteases chymotrypsin and trypsin, bromelain (pineapple enzyme), papain (papaya enzyme), fungal proteases, and Serratia peptidase (the "silk worm" enzyme).
Proteolytic enzymes have a long history of use in cancer treatment. The clinical research that currently exists on proteolytic enzymes suggests significant benefits in the treatment of many forms of cancer. Clinical studies have shown improvements in the general condition of patients, quality of life, and modest to significant improvements in life expectancy.11 Studies have consisted of patients with cancers of the breast lung, stomach, head and neck, ovaries, cervix, and colon; and lymphomas and multiple myeloma. These studies involved the use of proteolytic enzymes in conjunction with conventional therapy (surgery, chemotherapy and/or radiation) indicating that proteolytic enzymes can be used in conjunction with these conventional therapies.
Proteolytic enzymes should be taken on an empty stomach when being used for effects other than as a digestive aid. The following recommendations reflect dosages for cancer patients undergoing active treatment for their cancers. For maintenance, use the lowest dosage. I recommend starting at the lower dosage level and working up to the upper dosage level in weekly increments.
- Pancreatin: The dosage recommendation for full-strength 8X USP pancreatic enzyme is typically 300-900 mg three times a day immediately before meals.
— Chymotrypsin (1 mg = 1,000 USP units): 180 to 540 mg three times a day immediately before meals.
— Trypsin (1 mg – 25,000 USP units): 3-9 mg three times daily immediately before meals.
- Bromelain (1,200- to 1,800-mcu): 250 to 750 mg three times per day between meals.
- Fungal proteases: The dosage is based upon the activity based upon the USP method: 15,000-45,000 USP three times daily.
- Papain (1 mg = 30,000 USP units): Papain is rarely used alone as a cancer adjunct, it is normally combined with other proteolytic enzymes at a dosage of 50 to 150 mg three times daily.
- Serratia peptidase: For Peptizyme SP®, 50 to 150 mg three times daily
Because the animal and vegetarian-derived enzymes have slightly different effects, I recommend using formulas such as Zymactive and Wobenzyme that contain a combination of both pancreatin and vegetarian enzymes for maximum benefit.
What is curcumin and how does it help the cancer patient?
Curcumin is the yellow pigment of turmeric (Curcuma longa) – the chief ingredient in curry. It has demonstrated significant activity in many experimental and clinical studies involving inflammation and anticancer properties. It exerts a complex set of actions beneficial for the prevention and treatment of cancer.
The anticancer effects of turmeric and curcumin have been demonstrated at all steps of cancer formation: initiation, promotion, and progression.12 The protective effects of curcumin are only partially explained by its direct antioxidant effect. Other anticancer effects noted include the ability to: inhibit the formation of cancer-causing nitrosamines; enhance the body’s levels of anticancer compounds such as glutathione; promote the proper detoxification of cancer-causing compounds by the liver; and prevent the over expression of the enzyme cyclo-oxygenase 2 (COX-2). This enzyme produces pro-inflammatory and cancer promoting derivatives of essential fatty acids (prostaglandins of the 2 series).
Curcumin has demonstrated significant antitumor results in a number of experimental models of prostate, breast, skin, colon, stomach and liver cancers. Its effects are thought to be the result of several mechanisms:
- Inhibiting angiogenesis. The growth of tumors is dependent on developing new blood vessels to feed it.
- Inhibiting epidermal growth factor (EGF) receptor sites. About two-thirds of all cancers overproduce EGF receptor sites thereby increasing the sensitivity of the cancer cells to this substance that stimulates cellular proliferation.
- Inhibiting fibroblast growth factor. (BGF). This growth factor promotes angiogenesis – the formation of new blood vessels to feed the growing tumor.
- Inhibiting nuclear factor kappa beta (NF-kb). Many cancers over produce this growth factor to escape arrest of cellular proliferation.
- Increasing apoptosis (cellular suicide) of cancer cells.
- Inhibiting enzymes within tumor cells that promote growth.
The recommended dosage for curcumin is 200-400mg three times a day.
Why do you recommend coenzyme Q10 for people taking doxorubicin?
This drug is especially harmful to the heart and can produce serious damage to the heart (cardiomyopathy). In fact, the damage to the heart is often life threatening. A number of studies have shown CoQ10 can prevent the cardiac toxicity associated with doxorubicin without reducing the anti-tumor effect.13,14 For best results, I recommend using Clear Q™ by Natural Factors. In order to enhance the absorption and utilization of CoQ10, some manufacturers have looked to synthetic compounds to enhance the solubility of CoQ10. Instead of following this approach, Natural Factors has chosen to utilize nature instead. Using a patent pending process known as Lipcom® (short for lipid compression), they dissolved CoQ10 in the purest form of natural vitamin E (Clear Base™ Vitamin E; pure, 100% natural d-alpha tocopheryl acetate). The result is that the CoQ10 is biologically enhanced due to increased absorption, utilization, and function. In a preliminary study, blood levels of CoQ10 at six hours after taking Clear Q produced an increase that was 235% greater than the increase achieved with standard CoQ10. Equally impressive is the fact that blood levels of CoQ10 after six hours from taking a loading dosage of Clear Q can reach above 2.5 mcg/ml – considered the blood level required in order to achieve consistent results with CoQ10.
By providing the CoQ10 dissolved in the vitamin E, absorption is not only enhanced, but also the likelihood that the CoQ10 will remain in its active form. CoQ10 is present in the blood in both oxidized (inactive) and reduced (active) form. During times of increased oxidative stress or low vitamin E levels, more CoQ10 will be converted to its oxidized (inactive form). Thus, by providing high levels of pure vitamin E the biological activity and function of CoQ10 is enhanced. In addition, the CoQ10 actually enhances vitamin E activity as well. For people on doxorubicin, I recommend taking two capsules of ClearQ daily. Like CoQ10, vitamin E prevents the negative effects of doxorubicin without decreasing its therapeutic effects.6,15
Do you have any special supplement recommendations for breast and prostate cancer?
Yes, there are two other supplements that I recommend to these patients: indole-3-carbinol (I3C) at a dosage of 300 to 400 mg daily and calcium D-glucarate at a dosage of 400 to 1,200 mg daily. IC3 is one of the chief anticancer compounds from cabbage family vegetables. IC3 is especially protective against breast, prostate, and cervical cancer because of a number of actions including an ability to increase the breakdown of estrogen. Preliminary studies have also shown that taking I3C as a dietary supplement significantly increased the conversion of estrogen from cancer-producing forms to non-toxic breakdown products.16,17
Calcium D-glucarate is also important because it inhibits an enzyme in the gut that interferes with the elimination of excess estrogen.18 One of the key ways in which the body gets rid of estrogen is via attaching glucuronic acid to the estrogen in the liver and then excreting this complex in the bile. Glucuronidase is a bacterial enzyme that uncouples (breaks) the bond between excreted estrogen and glucuronic acid. By inhibiting this enzyme calcium D-glucarate promotes the excretion of estrogen.
Another important recommendation in breast or prostate cancer is to consume ground flaxseeds. Flaxseeds contain an important group of anticancer compounds known as lignans. Flaxseeds are easy to grind with a coffee grinder, food processor or blender. I recommend one or two tablespoons daily added to foods such as hot cereals, salads, or smoothies.
While it is better known that flaxseed lignans can prevent and even shrink breast cancer, flaxseed lignans also bind to male hormone receptors and promote the elimination of testosterone. In a study of men with prostate cancer, a low-fat diet (= 20% of total calories) supplemented with 30 grams of ground flaxseed (roughly two tablespoons) reduced serum testosterone by 15%, slowed the growth rate of cancer cells, and increased the death rate of cancer cells after only 34 days, according to a study conducted at the Duke University Medical Center and Durham Veterans Affairs Medical Center.19
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