Interactions with Dietary Supplements
Acetyl-L-carnitine
Acetyl-L-carnitine in the amount of 1,000 mg three times per day for eight weeks has been shown to improve nerve damage (neuropathy) caused by cisplatin.1
Antioxidants
Chemotherapy can injure cancer cells by creating oxidative damage. As a result, some oncologists recommend that patients avoid supplementing antioxidants if they are undergoing chemotherapy. Limited test tube research occasionally does support the idea that an antioxidant can interfere with oxidative damage to cancer cells.2 However, most scientific research does not support this supposition.
A modified form of vitamin A has been reported to work synergistically with chemotherapy in test tube research.3 Vitamin C appears to increase the effectiveness of chemotherapy in animals4 and with human breast cancer cells in test tube research.5 In a double-blind study, Japanese researchers found that the combination of vitamin E, vitamin C, and N-acetyl cysteine (NAC)—all antioxidants—protected against chemotherapy-induced heart damage without interfering with the action of the chemotherapy.6
A comprehensive review of antioxidants and chemotherapy leaves open the question of whether supplemental antioxidants definitely help people with chemotherapy side effects, but it clearly shows that antioxidants need not be avoided for fear that the actions of chemotherapy are interfered with.7 Although research remains incomplete, the idea that people taking chemotherapy should avoid antioxidants is not supported by scientific research.
Beta-carotene and Vitamin E
Chemotherapy frequently causes mouth sores. In one trial, people were given approximately 400,000 IU of beta-carotene per day for three weeks and then 125,000 IU per day for an additional four weeks.8 Those taking beta-carotene still suffered mouth sores, but the mouth sores developed later and tended to be less severe than mouth sores that formed in people receiving the same chemotherapy without beta-carotene.
In a study of chemotherapy-induced mouth sores, six of nine patients who applied vitamin E directly to their mouth sores had complete resolution of the sores compared with one of nine patients who applied placebo.9 Others have confirmed the potential for vitamin E to help people with chemotherapy-induced mouth sores.10 Applying vitamin E only once per day was helpful to only some groups of patients in another trial,11 and not all studies have found vitamin E to be effective.12 Until more is known, if vitamin E is used in an attempt to reduce chemotherapy-induced mouth sores, it should be applied topically twice per day and should probably be in the tocopherol (versus tocopheryl) form.
In a preliminary study, the addition of oral vitamin E (300 IU per day) to cisplatin chemotherapy significantly reduced the incidence of drug-induced damage to the nervous system (neurotoxicity).13 A similar protective effect was seen in another trial in which 600 IU of vitamin E per day was used.14
Calcium and Phosphate
Cisplatin may cause kidney damage, resulting in depletion of calcium and phosphate.15
Glutamine
Though cancer cells use glutamine as a fuel source, studies in humans have not found that glutamine stimulates growth of cancers in people taking chemotherapy.16 17 In fact, animal studies show that glutamine may actually decrease tumor growth while increasing susceptibility of cancer cells to radiation and chemotherapy,18 19 though such effects have not yet been studied in humans.
Glutamine has successfully reduced chemotherapy-induced mouth sores. In one trial, people were given 4 grams of glutamine in an oral rinse, which was swished around the mouth and then swallowed twice per day.20 Thirteen of fourteen people in the study had fewer days with mouth sores as a result. These excellent results have been duplicated in some,21 but not all,22 double-blind research. In another study, patients receiving high-dose paclitaxel and melphalan had significantly fewer episodes of oral ulcers and bleeding when they took 6 grams of glutamine four times daily along with the chemotherapy.23
One double-blind trial suggested that 6 grams of glutamine taken three times per day can decrease diarrhea caused by chemotherapy.24 However, other studies using higher amounts or intravenous glutamine have not reported this effect.25 26
Intravenous use of glutamine in people undergoing bone marrow transplants, a procedure sometimes used to allow very high amounts of chemotherapy to be used, has led to reduced hospital stays, leading to a savings of over $21,000 for each patient given glutamine.27
Glutathione
High-dose cisplatin therapy is associated with kidney toxicity and damage, which may be reduced by glutathione administration.28 29 30 31 Nerve damage is another frequent complication of high amounts of cisplatin. Preliminary evidence has shown that glutathione injections may protect nerve tissue during cisplatin therapy without reducing cisplatin’s anti-tumor activity.32 33 34 There is no evidence that glutathione taken by mouth has the same benefits.
Magnesium and Potassium
Cisplatin may cause excessive loss of magnesium and potassium in the urine.35 36 Preliminary reports suggest that both potassium and magnesium supplementation may be necessary to increase low potassium levels.37 38 Severe magnesium deficiency caused by cisplatin therapy has been reported to result in seizures.39 Severe magnesium deficiency is a potentially dangerous medical condition that should only be treated by a doctor. People receiving cisplatin chemotherapy should ask their prescribing doctor to closely monitor magnesium and potassium status.
Melatonin
Melatonin supplementation (20 mg per day) has decreased toxicity and improved effectiveness of chemotherapy with cisplatin plus etoposide and cisplatin plus 5-FU.40
Multivitamin-mineral
Many chemotherapy drugs can cause diarrhea, lack of appetite, vomiting, and damage to the gastrointestinal tract. Recent anti-nausea prescription medications are often effective. Nonetheless, nutritional deficiencies still occur.41 It makes sense for people undergoing chemotherapy to take a high-potency multivitamin-mineral to protect against deficiencies.
N-acetyl cysteine
NAC, an amino acid–like supplement that possesses antioxidant activity, has been used in four human studies to decrease the kidney and bladder toxicity of the chemotherapy drug ifosfamide.42 43 44 45 These studies used 1–2 grams NAC four times per day. There was no sign that NAC interfered with the efficacy of ifosfamide in any of these studies. Intakes of NAC over 4 grams per day may cause nausea and vomiting.
The newer anti-nausea drugs prescribed for people taking chemotherapy lead to greatly reduced nausea and vomiting for most people. Nonetheless, these drugs often do not totally eliminate all nausea. Natural substances used to reduce nausea should not be used instead of prescription anti-nausea drugs. Rather, under the guidance of a doctor, they should be added to those drugs if needed. At least one trial suggests that NAC at 1,800 mg per day may reduce nausea and vomiting caused by chemotherapy.46
Selenium
In one human study, administration of 4,000 mcg per day of a selenium product, Seleno-Kappacarrageenan, reduced the kidney damage and white blood cell–lowering effects of cisplatin.47 The amount of selenium used in this study is potentially toxic and should only be used under the supervision of a doctor. In another study, patients being treated with cisplatin and cyclophosphamide for ovarian cancer were given a multivitamin preparation, with or without 200 mcg of selenium per day. Compared with the group not receiving selenium, those receiving selenium had a smaller reduction in white blood cell count and fewer chemotherapy side effects such as nausea, hair loss, weakness, and loss of appetite.48
Spleen extract
Patients with inoperable head and neck cancer were treated with a spleen peptide preparation (Polyerga) in a double-blind trial during chemotherapy with cisplatin and 5-FU.49 The spleen preparation had a significant stabilizing effect on certain white blood cells. People taking it also experienced stabilized body weight and a reduction in the fatigue and inertia that usually accompany this combination of chemotherapy agents.
Sodium
Cisplatin may cause depletion of sodium due to kidney damage which sometimes occurs in people treated with cisplatin.50
Taurine
Taurine has been shown to be depleted in people taking chemotherapy.51 It remains unclear how important this effect is or if people taking chemotherapy should take taurine supplements.
Thymus peptides
Peptides or short proteins derived from the thymus gland, an important immune organ, have been used in conjunction with chemotherapy drugs for people with cancer. One study using thymosin fraction V in combination with chemotherapy, compared with chemotherapy alone, found significantly longer survival times in the thymosin fraction V group.52 A related substance, thymostimulin, decreased some side effects of chemotherapy and increased survival time compared with chemotherapy alone.53 A third product, thymic extract TP1, was shown to improve immune function in people treated with chemotherapy compared with effects of chemotherapy alone.54 Thymic peptides need to be administered by injection. People interested in their combined use with chemotherapy should consult a doctor.
Vitamin A
A controlled French trial reported that when postmenopausal late-stage breast cancer patients were given very large amounts of vitamin A (350,000–500,000 IU per day) along with chemotherapy, remission rates were significantly better than when the chemotherapy was not accompanied by vitamin A.55 Similar results were not found in premenopausal women. The large amounts of vitamin A used in the study are toxic and require clinical supervision.
Zinc
Irradiation treatment, especially of head and neck cancers, frequently results in changes to normal taste sensation.56 57 Zinc supplementation may be protective against taste alterations caused or exacerbated by irradiation. A double-blind trial found that 45 mg of zinc sulfate three times daily reduced the alteration of taste sensation during radiation treatment and led to significantly greater recovery of taste sensation after treatment was concluded.58
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