Chemotherapy Support

Chemotherapy, the systemic use of anti-cancer drugs, is a common treatment for many cancers. Unfortunately, during the process of eliminating cancerous cells, healthy cells are also damaged, and many side effects can develop. Several nutritional approaches show promise for alleviating side effects and/or increasing the effectiveness of chemotherapy treatment.

Malabsorption and weight loss: Chemotherapy often causes nausea, malabsorption, and weight loss. The best way to combat these problems may involve working with a nutritionally oriented doctor or dietitian on an individual basis. A multiple-vitamin/mineral can be a first step in counteracting the decreased absorption of nutrients caused by chemotherapy.

Nausea: At least one trial suggests that N-acetyl cysteine, or NAC, at 1,800 mg per day may reduce nausea and vomiting caused by chemotherapy.¹ NAC is an amino acid-like supplement that produces antioxidant activity. Ginger can also be helpful in alleviating nausea and vomiting caused by chemotherapy.² ³ A reasonable amount is 2-4 grams of the dried rhizome powder two to three times per day. Ginger in the form of tablets, capsules, and liquid herbal extracts are also available, which can be taken in 250 mg amounts every two or three hours, for a total of 1 gram per day.

Mouth sores: Chemotherapy often causes painful mouth sores, a condition called mucositis. Applying 400 IU of vitamin E topically twice per day to the sores can reduce the problem, according to double-blind research.⁴ This can be achieved by breaking a vitamin E capsule and squeezing it onto the sores. It makes sense to use the d-alpha tocopherol form rather than tocopheryl forms of vitamin E, because the tocopheryls may not be active when applied to body surfaces.

Nutritional supplements that may help chemotherapy work: In animal and test-tube studies, individual nutrients—usually antioxidants such as vitamin A,⁵ vitamin E,⁶ and vitamin C^7—have increased the effectiveness of chemotherapy. Although more research is needed in cancer patients, a few human trials suggest similar effects, including increased survival.⁸ Nutritional support for chemotherapy patients should be discussed with an nutritionally oriented doctor.

Nutrients and specific chemotherapy drugs: Methotrexate, a chemotherapy drug, interferes with the metabolism of folic acid—a B vitamin. Cancer patients taking methotrexate should not supplement folic acid beyond the 400 micrograms found in a multivitamin without first discussing it with their oncologist because supplementation might interfere with the action of the drug. Sometimes oncologists supply leucovorin—a special form of folic acid—after methotrexate has done its work in the body. The leucovorin is used to protect against unnecessary side effects caused by methotrexate.

Adriamycin, also called doxorubicin, sometimes causes heart damage. A variety of antioxidants appears to reduce this toxicity. For example, coenzyme Q10 has been used successfully for this purpose.⁹ Nutritionally oriented doctors sometimes recommend 90-120 mg of coenzyme Q10.

In animals, vitamin C protects against Adriamycin-induced heart damage.¹⁰ For this reason, some nutritionally oriented doctors recommend several grams of vitamin C per day to people taking Adriamycin.

In test tubes, vitamin E has been found to enhance the ability of Adriamycin to kill cancer cells.¹¹ Anecdotes have appeared suggesting that hair loss caused by adriamycin may be reduced by taking high amounts (1,600 IU per day ) of vitamin E.¹² In animals, vitamin E protects against heart damage caused by Adriamycin.¹³ Many nutritionally oriented doctors recommend at least 800 IU of vitamin E to people taking Adriamycin.

Under certain circumstances, vitamin B2, or riboflavin, can also have antioxidant activity. In rats, supplementation with vitamin B2 helps protect against Adriamycin-induced heart damage.¹⁴

Cisplatin, another chemotherapy drug, often leads to depletion of magnesium.¹⁵ In some reports, this depletion happens in a majority of cases.¹⁶ People taking cisplatin should have their magnesium status checked by a nutritionally oriented doctor, who will prescribe magnesium supplements when appropriate. Glutathione significantly reduces the toxicity caused by cisplatin and improves quality of life for these patients, but it must be given intravenously by a doctor.^{17 18}

Fluorouracil sometimes causes problems on the skin of palms and soles. Reports have appeared showing that 100 mg per day of vitamin B6 can sometimes eliminate the pain associated with this condition.¹⁹ ²⁰

Are there any side effects or interactions? (Refer to the individual supplement for complete information.) Congestive heart failure patients taking coenzyme Q10 should not abruptly discontinue taking supplements without first consulting a physician. Vitamin B2 is nontoxic, even in very high amounts. Taking too much magnesium can lead to diarrhea. This can happen at doses as low as 350-500 mg per day. People with kidney disease should not take magnesium supplements without consulting a physician. No consistent adverse effects of NAC have been reported in humans.

Vitamin E toxicity is very rare; supplements are widely considered to be safe. Women who are or could become pregnant should take less than 10,000 IU per day of vitamin A to avoid the risk of birth defects. For other adults, intake above 25,000 IU per day can—in rare cases—cause headaches, dry skin, hair loss, fatigue, bone problems, and liver damage.

Although side effects from vitamin B6 supplements are rare, at very high levels this vitamin can damage sensory nerves, leading to numbness in the hands and feet as well as difficulty walking. Vitamin B6 supplementation should be stopped if these symptoms develop. Pregnant and lactating women should not take more than 100 mg of vitamin B6. For other adults, vitamin B6 is safe in amounts of 200-500 mg per day, although occasional problems have been reported in this range.

Some individuals develop diarrhea after as little as a few thousand milligrams of vitamin C per day, while others are not bothered by ten times this amount. However, high levels of vitamin C can deplete the body of copper, an essential nutrient. It is prudent to ensure adequate copper intake at higher intakes of vitamin C (copper is found in many multi-vitamin/mineral supplements).

Herbs that may be helpful: Using herbal adaptogens following chemotherapy can help the bone marrow in the production of white blood cells and help optimize immune function. Three herbs that have proven particularly useful following chemotherapy are astragalus (two to three 500 mg capsules three times per day), eleuthero (Siberian ginseng) (2-3 grams per day of the dried root or 300-400 mg per day of the concentrated solid extract standardized on eleutherosides B and E), and Asian ginseng (100-200 mg per day of the standardized herbal extract).²¹ ²² ²³ Astragalus is often used in combination with another Chinese herb, ligustrum (Ligustrum lucidum).

Are there any side effects or interactions? (Refer to the individual herb for complete information.) Astragalus, eleuthero, and Asian ginseng are generally safe. Astragalus has no known side effects when used as recommended. In rare instances, Ginseng may cause overstimulation and possibly insomnia. Consuming caffeine with ginseng increases the risk of over-stimulation and gastrointestinal upset. Persons with uncontrolled high blood pressure should not use ginseng. Long-term use of ginseng may cause menstrual abnormalities and breast tenderness in some women. Ginseng is not recommended for pregnant or lactating women.

There have been no reports of any side effects with the use of maitake. Shiitake has an excellent record of safety but has been known to induce temporary diarrhea and abdominal bloating when used in high dosages. Its safety during pregnancy has not yet been established. Side effects from reishi can include dizziness, dry mouth and throat, nose bleeds, and abdominal upset; these rare effects may develop with continuous use over three to six months. As it may increase bleeding time, reishi is not recommended for those taking anti-coagulant (blood-thinning) medications. Pregnant and lactating women should consult a physician before taking reishi.

Side effects involving schisandra are uncommon, but they may include abdominal upset, decreased appetite, and skin rash. No adverse effects have been reported with the use of ligustrum.

Nutritional Supplements

Herbs

Multiple-Vitamin/Mineral

Vitamin B2 (riboflavin)

Homeopathic Remedies

Gelsemium 6c

Ipecac 30c

Nux vomica 6c

Cantharis 6c

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