Chemotherapy patients face an intimidating list of side effects, especially those with advanced disease who must go through multiple regimens. At the Block Center, using supplements is one of the ways that we help patients avoid chemotherapy-induced fatigue and improve their overall quality of life.
A large number of supplements have published clinical trial data that supports their use in chemotherapy patients, and these are among the ones we most frequently recommend to our patients:
- Curcumin reduced inflammation, which can stimulate drug resistance and fatigue. When given along with Taxotere,® curcumin helped shrink tumors and drop PSA in prostate cancer patients.
- Fish oil reduced neuropathy, fatigue and appetite loss in lung cancer patients, and omega-3 fats, found in fish oil, also reduced neuropathy in patients receiving Taxol.® Fish oil also improved chemo effectiveness in lung cancer patients.
- Ginger can be used to relieve nausea and vomiting in chemotherapy patients, alongside the standard anti-nausea medications patients receive.
- Ginseng – both the variety grown in Wisconsin and the variety typically grown in Asia – has been shown in clinical trials to improve fatigue, a common side-effect in cancer patients.
- L-glutamine is an amino acid supplement that is used to promote healing of the intestines and to prevent mouth sores in chemo patients. An analysis of 9 clinical trials showed that it also helped reduce diarrhea, supported the immune system and helped with wound healing after surgery in cancer patients.
- Milk thistle is typically used for liver problems. A controlled study in children receiving intensive chemotherapy regimens, as well as a published case study, showed it can reduce the signs of liver damage that some chemos cause.
- The Chinese herb Astragalus is given to cancer patients along with formulations that include other specific Traditional Chinese medicine herbs. 34 studies of herbal formulas containing Astragalus given along with chemo showed that it helped shrink tumors, reduce mortality, and improve ability to perform daily activities.
There are,though, a few instances in which supplements can have a negative effect when taken concurrently with certain drugs. These are called supplement-drug interactions, and are similar to the drug-drug interactions that your doctors and pharmacists help you to guard against.
- Because of grapefruit’s effect on your body’s drug detoxifying enzymes, grapefruit juice can substantially increase, or, in some cases significantly decrease levels of specific drugs in your body – a food-drug interaction. This interaction is well known and patients taking drugs affected by grapefruit juice are warned not to drink it.
- Saint John’s wort lowers the level of drugs that grapefruit juice increases and increases the levels of drugs that grapefruit juice lowers. Because this herb affects about 50% of drugs commonly used, we discourage use of Saint John’s wort by our patients who are on medications, including chemotherapy.
- Coumadin® is notorious for being susceptible to interactions with supplements, foods and other drugs than almost all other drugs. Patients taking Coumadin are counseled to maintain a consistent daily intake of leafy green vegetables as well as several other types of food, since Coumadin’s effect is counteracted by vitamin K, widely found in leafy greens, as well as in supplements. Day-to-day fluctuations in vitamin K intake could lead to inconsistent Coumadin effects. In addition, a large number of herbs and supplements have anticoagulant effects themselves. Taking large doses of too many of these could magnify Coumadin’s effects and cause patients to have abnormal bleeding.
- Anticoagulant herbs pose another problem for cancer patients since they often experience low levels of blood platelets as a side effect of chemotherapy. Taking too many anticoagulant herbs when blood platelets are low could also lead to bleeding or excessive bruising.
Block Center medical and nutrition staff members are very familiar with these and other possible interactions, and regularly alert patients to reduce supplement doses or stop them altogether if there are any concerns.
Based on good research, one issue that we believe does not raise concern about supplement-drug interactions is taking antioxidants during chemotherapy. We published a review article in 2009 in which we analyzed 19 randomized trials in which antioxidants were given with chemotherapies. There was no evidence that antioxidants decreased the efficacy of chemo drugs. Interestingly, a 2016 publication from a group of researchers in Japan analyzed 49 trials of antioxidants given with chemotherapy or radiotherapy, and were similarly unable to find any evidence for unwanted interactions, except for one trial in which smokers receiving radiation therapy, who also took antioxidants, had worse outcomes.
We have researched the supplements that Dr Block has formulated or that we frequently recommend, and know which of them have potential interactions with drugs: (our supplements actually have few if any negative interactions with drugs besides Coumadin). For our patients who have interaction questions or who want information on supplements that Dr Block does not currently recommend, we can provide special research services to answer their questions.
So while supplement-drug interactions can definitely be of clinical concern in some cases, there are only a limited number that are really significant for patients. Most supplement-drug interactions, like drug-drug interactions, can be avoided. All it takes is a small dose of correct information at the right time from a concerned and educated clinician!