Herb-Nutrient-Drug Column

Chemotherapy Support and Cautions
By Karolyn A. Gazella

According to the American Cancer Society, of the more than 2.5 million people diagnosed with cancer each year in the United States, most of them are given one or morechemotherapy drugs at some point in their treatment [1, 7]. Presently, there are more than50 different chemotherapy drugs used to treat cancer [2, 3, 7]. While the type ofchemotherapy used depends on the type of cancer, some of the more commonchemotherapy drugs include carboplatin, cisplatin, paclitaxel, fluorouracil, anddoxorubicin [#4].
Simply stated, the goal of chemotherapy is to kill rapidly dividing cells, which is a common characteristic of cancer development. Unfortunately, chemotherapy drugs alsokill other rapidly dividing healthy cells resulting in side effects [2, 7]. In some cases,chemotherapy can even cause secondary cancers [2, 7].
“Side effects of chemotherapy vary depending on the agent used and the person’s sensitivity to the drug,” explains Dr. Lise Alschuler who is the Director of NaturopathicMedicine at Midwestern Regional Medical Center, a Joint Commission accreditedregional hospital specializing in comprehensive integrative cancer care. “Side effects canrange from mild and manageable to severely debilitating and in some cases life-threatening.”[#2, #4] Common side effects of many chemotherapy drugs include: [2, 4, 5, 6]• nausea and vomiting• hair loss• mouth sores or dry mouth• constipation or diarrhea• fatigue and weakness• bleeding, blood count issues, or anemia• taste impairment or loss of appetite• cardiovascular damage• infection• neuropathy (numbness and tingling)Quality of life issues associated with chemotherapy have received special attention from conventional medicine researchers and have always been an issue withnatural medicine proponents. In the past, chemotherapy dosing was primitive andimprecise. Chemotherapy was given at the highest dose the body could tolerate, bathingthe cancer cells and the patient in the toxic substance. While the cancer cells died,sometimes so did the patient. Today, lower and pulsed doses are more frequently used, aswell as drugs that are designed to target a specific cancerous cellular action, making thema little easier to tolerate and hopefully more effective [4, 6].
“Advances in chemotherapy research has created drugs and dosing strategies that are better tolerated, however, side effects still often occur,” explains Dr. Alschuler. “The incorporation of natural complementary therapies can help make chemotherapy moretolerable and less frightening and dangerous.” As with any drug, a cautious and individualized risk-to-benefit analysis is important. Given the risks associated with most chemotherapy drugs, it makes sense tofind ways to reduce those risks, as well as ease uncomfortable side effects. This is a newand exciting area of interest among integrative oncology researchers. Many studies existto support the use of some herbs and nutrients during chemotherapy [7]. Some examplesinclude: [7] • Coenzyme Q10 and L-carnitine can help protect the heart • Coenzyme Q10 can help with fatigue• Vitamin E, L-glutamine, and vitamin B6 can help prevent nerve damage • Fish oil can help prevent malnourishment and cachexia, a wasting syndrome associated with cancer and chemotherapy usage • Vitamin E, L-glutamine, honey, and deglycyrrhizinated licorice (DGL; glycyrrhizin in licorice can potentially raise blood pressure so it is important to takeDGL) can help ease the discomfort of mouth sores • Acupuncture and ginger may help reduce nausea• L-glutamine and probiotics can alleviate diarrhea• Zinc can help minimize changes in the sense of taste• Melatonin can help reduce cancer-related sleep disturbancesAnemia is a common side effect of chemotherapy, however, it is typically not related to low iron levels. While supplemental iron is very effective at correcting anemiadue to iron deficiency, it won’t be helpful if iron deficiency is not the cause and it mayeven be harmful if taken with some chemotherapy drugs [5, 7].
“Too much iron can promote tumor growth and can actually worsen chemotherapy side effects,” warns Dr. Alschuler. “Supplemental iron is onlyrecommended when iron deficiency has been confirmed by blood tests.” Dr. Alschuler says you should not assume your anemia is caused by an iron deficiency. Unless recommended by your oncologist, you should not take supplementaliron [4].
For more information on some of the most commonly used chemotherapy agents, Interactions
Use of herbs and nutrients to support chemotherapy has great potential but this is an extremely complex area of study that requires more research. It is absolutely critical toinform all of your doctors about every nutritional supplement you are taking.
Preliminary research shows us that some herbs and nutrients can interfere with some chemotherapy drugs [7]. Here are some examples: • N-acetylcysteine can interfere with the anticancer effects of several • While vitamin B6 can help prevent neuropathy, dosages higher than 300 mg • Curcumin and quercetin are strong anti-cancer flavonoids, but they may interfere with the anti-tumor activity of cyclophosphamide There are not a lot of studies demonstrating conclusive safety regarding the use of herbs with chemotherapy drugs. For this reason, some herbs should be used with cautionwhen taking chemotherapy. Examples include silymarin, kava, willow bark, and St.
John’s wort. Herbs should be avoided completely with irinotecan, etoposide, anddoxorubicin.
For more information on some of the most commonly used chemotherapy agents, Chemotherapy Support And Interaction Chart
Note: The information in this chart has been adapted with permission from the
book Definitive Guide to Cancer: An Integrated Approach to Prevention, Treatment,
and Healing
(Celestial Arts 2007)
Chemotherapy = carboplatinTrade Name = ParaplatinCancer(s) Treated = ovarian, testicular, bladder, lungHelpful Nutrients and Herbs = alpha-lipoic acid to reduce nerve toxicity and protecthearing; ginger to reduce nausea; vitamins C, E, and D to support anticancer effectsNutrients and Herbs to Avoid = N-acetylcysteine, L-glutathione, silymarin (used withcaution) Chemotherapy = cisplatinTrade Name = Platinol, Platinol-AQCancer(s) Treated = ovarian, testicular, bladder, lung, cervical, breast, stomachHelpful Nutrients and Herbs = magnesium to reduce kidney and muscle toxicity; L-carnitine to reduce damage to nerves and kidney and may help with fatigue; astragalus tohelp prevent decreased blood cell counts; PSK (from Coriolus versicolor mushroom) toreduce kidney damageNutrients and Herbs to Avoid = black cohosh, N-acetylcysteine, doses of B6 above 300mg, ginkgo in combination with regular-strength aspirin, silymarin Chemotherapy = doxorubicinTrade Name = Adriamycin, Doxil (liposomal Adriamycin)Cancer(s) Treated = breast, ovarian, bladder, lymphoma, sarcoma, multiple myelomaHelpful Nutrients and Herbs = L-carnitine and CoQ 10 to protect the heart; green tea(especially concentrated to theanine) to protect healthy tissue and enhance anti-tumoreffects; melatonin to reduce side effectsNutrients and Herbs to Avoid = N-acetylcysteine Chemotherapy = fluorouracil, capcetibineTrade Name = 5-FU, Xeloda Cancer(s) Treated = colon, breast, stomach, head and neckHelpful Nutrients and Herbs = melatonin to improve treatment tolerance; vitamin B6 toprotect against hand-foot syndrome; aged garlic extract to protect the digestive tract;probiotics to help prevent digestive tract toxicityNutrients and Herbs to Avoid = beta-carotene; probiotics should be avoided in patientswith low white blood cell counts Chemotherapy = methotrexateTrade Name = Amethopterin, Folex, MexateCancer(s) Treated = breast, bladder, colon, blood, bone, lymphoma, head and neckHelpful Nutrients and Herbs = soy and folic acid from food sources may protect againstdigestive tract toxicity; fish oil and vitamin E may increase anticancer effectNutrients and Herbs to Avoid = kava and willow bark Chemotherapy = paclitaxel, docetaxel (taxanes)Trade Name = Taxol, TaxotereCancer(s) Treated = breast, ovarian, lung, stomach, bladder, head and neckHelpful Nutrients and Herbs = vitamin B6 and L-glutamine to prevent nerve damage;melatonin, fish oil, and green tea to enhance anticancer actionsNutrients and Herbs to Avoid = all herbal supplements during treatment; quercetin mayinterfere with anticancer activity 1. American Cancer Society Cancer Facts & Figures 20062. Murphy, G.P., L.P. Morris, and D. Lange. 1997. Informed Decisions: The Complete Book of Cancer Diagnosis, Treatment, and Recovery. New York:Viking.
// 4. Alschuler, L., personal interview 4/24/075. Murray, M., T. Birdsall, J. Pizzorno, and P. Reilly. 2002. How to Prevent and Treat Cancer with Natural Medicine. New York: Riverhead Books. 7. Alschuler L., and K. Gazella. 2007. Definitive Guide to Cancer: An Integrative Approach to Prevention, Treatment, and Healing. Berkeley: Celestial Arts.



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