My Unexpected Guide; learning from cancer: Increasing effectiveness of radiotherapy part two

Todays lunch!

Read part one before you read this (i); that blog looks at other things that I am considering in preparation for radiotherapy. This blog continues that look with a focus on nutrition and supplements.

Nutrition

Nutrition is crucial to healing. Heck do I even need to write that! I know I still haven’t done a blog on my diet but basically it is mainly the Rainbow diet - largely organic vegan, very, very minimal processed foods (exceptions incl very occasionally that vegan cheese), no gluten (with exception of sourdough when out and no decent gluten-free alternative), no refined sugars and reduced carbohydrates. I know you could write a blog on each of those but that is another time…some US cancer centres perhaps not surprisingly recommend similar while doing radiotherapy ie avoiding dairy, animal fats and refined sugars.

So diets; low or high fibre? Cancer Research UK (ii) say: "People advised to have a high fibre diet during their pelvic radiotherapy had fewer immediate and long term side effects than those who had their usual diet. Advice to have a low fibre diet during pelvic radiotherapy has no evidence and should not be given to people in this situation."

Certainly I will also need to avoid 'wind inducing foods’ as evidence these impact on effectiveness of radiotherapy; so will keep the kale and beans to a Friday night or Saturday so that I can reduce wind Monday to Friday during radiotherapy treatment!?

There is also a suggestion to replace all chocolate, coffee and tea drinks with green tea. The Green tea I understand, and have noted previously that I supplement with green tea (iii), but evidence around coffee is more complex - see my previous blog (iv). I can’t find any research about coffee and radiotherapy but it makes sense to reduce coffee drinking during radiotherapy as caffeine can irritate the bowel linings and also act as a diuretic - this can then impact on treatment and it is already hard to maintain a full bladder for the radiotherapy.

In terms of other drinks, peppermint, ginger tea or slippery elm powder dissolved in a non dairy milk and hot water, may help calm the stomach and reduce any nausea. Boldo tea (v) and dandelion can help eliminate toxins from the liver. I’d not come across Boldo before - it has a positive effect on digestive system - you steep for 10-12 minutes and it is somewhat bitter but very OK! Boldo tea is recognised as safe by the US Food and Drugs Administration but does contain ascaridole which can be toxic to the liver so check out more before using (vi).

Plus in terms of drinks...drink plenty of clean water.

Supplements

Now these can be tricky as doctors will often tell you to stop completely. The theory used to be, as Dr Geo (vii), writes: “...radiation works by producing oxidative stress (free radicals) in an effort to kill cancerous cells. So, in theory, if you take, say, 500mg of vitamin C, an antioxidant, that would protect the cancerous cells from radiation treatment. The premise that antioxidants from dietary supplements protect cancerous cells from radiation therapy is a lousy theory”.

Dr. Conklin acknowledges that radiation kills cells by generating high levels of free radicals, but he argues this does not necessarily mean you should exclude the use of antioxidants as a dietary supplements during treatment (viii). Antioxidants improve blood flow and therefore promote the normal oxygenation of tissues, thereby rendering tumors more, not less, susceptible to radiation. In a 2007 review of research found that “antioxidants and other nutrients do not interfere with chemotherapy or radiation therapy and can increase kill and increase survival” (ix). However a fair few doctors will still advise strongly against any supplementation.

The Alliance for Natural Health point out that the media also have a go every so often at supplementation, often based on very little evidence; they have some useful questions to ask ourselves about whetehr to take supplements (ixa).

Chris Woollams at CANCERactive (x) writes: "The very latest research from both MD Anderson and UCLA confirms that it is advantageous to keep taking all the supplements. Cancer cells lose their ability to regulate uptake of antioxidants and the antioxidants and the radiotherapy work together to kill more cancer cells, whilst simultaneously the supplements protect the healthy cells."

Dr Geo (vii) agrees: "Numerous studies have shown that vitamin E and selenium protect against radiation-induced cancers. A precise combination of antioxidants can help decrease damage expected from radiotherapy, including the formation of other cancer, especially in high-dose radiation since RT reduces tissue antioxidants.” He goes onto say: "Seek the help of a nutritionally oriented healthcare expert who works with an oncologist….Synthetic alpha-tocopherol vitamin E should NOT EVER be used for cancer regardless of treatment for cancer. There is no reason to use anything other than mixed tocopherol. Vitamins with antioxidant capacity should be used in combination with others. For example, vitamin C, vitamin E, zinc, and alpha lipoic acid work synergistically and prevents too much pro-oxidation. If your radiation oncologist digs her heels into the ground and not allow you take dietary supplements, and you are not working with a nutritionally oriented doctor, take curcumin, about 1000mg to 3000mg a day with food”.

Before going further I wanted to just note again the concern I raised in an earlier blog about how to starve cancer (xi). In that, Jane McLelland suggests that antioxidants like Vitamin C could help cancer and some are useful for prevention, like low oral doses of Vitamin C and E. However she argues there is a tipping point in cancer progression when, in Jane’s words, they ‘switch allegiance and support the enemy; they help promote and fuel cancer’s resistance to apoptosis (death)'. This may explain why research has indicated that antioxidants could spur the diseases’s spread (xii). Jane argues we all need a combination strategy to tackle cancer. Well I’ve read Jane's book, joined the websites but still need to find a way to put together a more comprehensive protocol - but more of that another time.

So what else is suggested in the research? Well too many supplements to list but here are a few ideas I’ve come across…of course hold in mind that a lot of the research quoted is done on animals or in labs but in my view still give a useful indication of potential…of course I will need to narrow this down to a manageable protocol. I can also see that if you are trying to take many supplements you won’t have an idea of how they impact with each other; indeed there are all sorts of possible reactions so as always the advice is to talk to your doc. Once again do your own homework as one study says one thing, another seems to say the opposite. It is as always a challenge to find a way through....anyway here’s the list in no particular order:

Golden Flaxseeds

1. Flaxseeds - In 2011 the University of Pennsylvania found that a diet for mice that was rich in flaxseed could significantly reduce harm and even repair tissues after damage (xiii).

2. Probiotics - Washington State Medical School showed that taking probiotics when radiotherapy was administered near to the gut area could reduce damage to the intestines and the intestinal lining (xiv) (xv). More research is being done on impacts but with more research showing benefits every other day I think this is one to focus on. In the latest addition of ICON by CANCERactive Chris Woollams notes that a good probiotic needs to contain: Lactobacillus acidophillus makes lactic acid as the gut needs to be acid to keep pathogens in check. He also suggests L.rhamnosus as it can heal holes in the gut wall. Plus strains of Bifidobacteria as they make B vitamins and can attack the bad bacteria. One strain B.Infantis has been shown to correct IBS and several gut problems. Chris also says you need to feed them properly ie pectins and inulins - raw vegetables - high natural soluble fibre. And never take them with hot liquids and much to some folks surprise, never keep them in the fridge (xvia). It is also worth a mention that they may not be best taken with cancer immunotherapy; one small study raised some concerns (xvi).

3. Vitamin D - This apparently has been recommended by some US and UK hospitals and also seems to improve the success of the treatment programme. It activates the immune system and has an anti-inflammatory effect on the stomach and gut. I’ve blogged before on this key vitamin which is actually a hormone (xvii). Professor Holick at Boston Medical School says those of us with cancer should aim for 75ng/ml and tell patients to take 5,000IUs a day if they cannot be in the sun for four hours (xviii)! Those on chemo should double the dose. Indeed Holick and others have publicly criticised bodies like Cancer Research UK for advising folks to reduce sun exposure and even call for warnings on sunscreen. Anyhow there is some research with mice to show that Vitamin D boosts radiation treatment for breast cancer. I’ve not found specific research around prostate cancer. Of course the impact of the sun is now more strong than years ago so I am not so sure his advice about sun is so helpful as it is so important to avoid burning - and be very careful of the sun when receiving radiotherapy. It is also worth noting that significant sun exposure can cause a “recall” of the radiation skin reaction, even after the acute skin reaction has resolved. However this is less likely too be the case with prostate cancer due to the site of the radiotherapy - unless of course you are a naturalist?

4. Curcumin - Research shows curcumin (turmeric) has loads of benefits, see my previous blog (xix), and can reduce damage to our bodies from radiotherapy. In one study those taking curcumin had much milder urinary symptoms compared with the placebo group. However there was no bowel symptoms or sexual function difference noted. It is also thought that curcumin has a radiosensitive effect on cancer cells making them more vulnerable during treatment. I've been interested in this 3min video here by Dr Michael Gregor who suggests that Tumeric might be just as good, if not better, than curcumin. Tumeric has over 200 active ingredients but only Curcumin has been studied in any depth (xxa) and we too often forget the benefits of synergy of all those 200 ingredients. Maybe Tumeric is better (certainly cheaper!). Another study showed that curcumin improves the antioxidant status of patients with prostate cancer without compromising the therapeutic efficacy of radiotherapy (xx).

5. Beta glucans - this is a sort of immunomodulator which helps make your immune system smarter and has over 140,000 published studies on it!! It can help our body fight off and kill cancer. So it is not like echinacea that is an immune stimulator, beta glucans modulates but never over stimulates. Immiflex, for example, has been clinically proven to boost the immune system and there is research into it’s impact on radiotherapy (xxia). Indeed I’ve found links to several bits of research and trials looking at beta glucans and its impact including a great link by Chris Work (xxi). This seems to be another must in my protocol.

6. Selenium - mixed research on whether supplementation is useful re radiation but could be important for folks that have tested selenium deficient (xxii).

7. Isoflavones (citrus or soy) - could be helpful with prostate cancer - plus there was a small study to receive 200 mg soy isoflavone or placebo daily for six months beginning on the first day of radiation therapy. Results showed the soy-treated group had a higher overall ability to achieve erections (77% vs. 57.1%) and less urinary leakage, rectal cramping, diarrhea, and pain with bowel movements than the placebo group (xxiii). I like the sound of that!

8. Astragalus - a Chinese herb used in Chinese medicine for over 2,000 years, has been found in peer reviewed studies to increases the body’s production of white blood cells and double survival rates of cancer patients undergoing radiation therapy (xxiv). That sounds amazing - although I can’t find the original research only references to it? Update 22.10.20: just learnt astragalus has some oestrogenic affects although Ayurvedic doctor advised me that the jury is out on whether this means to stop taking this as it has such good other effects. However I've not taken this herb.

Black Garlic

9. Garlic - fresh or supplements - lots of claims that it acts acts as a radioprotector and immune enhancer interesting article although not sure you need to buy the particular supplement they are pushing. It is also worth a mention that black garlic has been shown to be twice as effective as ordinary garlic in treating cancer (xxv) - but more of that in another blog!

10. Vitamin B - complex with 400 mcgs of folic acid - the latter helps protect healthy cells - see my previous blog (xxvia). Supplementation seems particularly important after radiation as the treatment can impact strongly on levels - but I have a question regarding choline levels as these are often high in Vitamin B. Should I be worried as choline levels are linked to prostate cancer? It is also worth noting a Norwegian study with people following a heart attack, found amongst those supplementing with folic acid, a slight increase in lung cancer and folks more than twice as likely to have prostate cancer than those taking a placebo. Those with adequate amounts of folic acid had lower prostate cancer rates (xxvi). So supplement only if low seems to be the message?

11. N-Acetyl Cysteine - comes from the amino acid L-Cysteine and contains glutamine (which stimulates the liver to produce glutathione, which repairs damaged healthy cells) - I’ve blogged before on this supplement (xxxiv) but now see one report that shows it protects against ionizing radiation-induced DNA damage but not against cell killing in yeast and mammals (xxv). In another study results revealed it reduced chemotherapy and radiotherapy toxicity (xxvi). In that study they conclude that vitamin E and NAC have been shown to be effective as antioxidant adjuvant therapy in children with acute lymphoblastic leukaemia to reduce chemo-/radiotherapy-related toxicities during the initial period of treatment. There are various other studies that suggest it could be a useful addition to managing the radiation. Life Extension also say research indicates it can inhibit growth and block the metastasis of prostate cancer (xxvii). Update 27/11/19: Just read that it can be helpful with radiation treatment but can interact unfavourably with some chemo drugs (xxxx).

12. MGN-3 Biobran - some science to show impacts on cancer but also it is often recommended to keep white cells levels up when chemotherapy and radiotherapy are doing their worst (xxviii).

13. Green tea - I’ve already noted Green tea’s role in tackling cancer (iii) - it can also have a protective effect on healthy cells and enhances radiotherapy’s success with cancer cells. A small study shows it is also effective in decreasing the frequency and severity of radiotherapy induced diarrhea (xxix). Extracts used topically can also play a role in reducing skin toxicity (xxx).

14. Aloe vera - this is useful for for radiation burns (xxxi). Wash the area only in cold water and apply the cooling aloe vera gel. However there is some research that suggests aloe vera isn’t so useful (xxxii); I guess you have to see what works for you?

Update 7/02/2020: it has been suggested by one practitioner to take this instead of probiotics during radiotherapy but I am also aware that Aloe Vera has oestrogen in it...I have an oestrogen sensitive cancer...so ‘seemingly harmless’ Aloe Vera juice may not be so harmless to my specific cancer?

15. L-Carnitine - doctors have identified the cause of fatigue during radiotherapy as low levels of carnitine circulating in the blood stream so it maybe that carnitine supplementation can help (xxxiii)?

16. Cat’s claw - the Readers Digest say that some doctors prescribe cat’s claw to stimulate the immune response in cancer patients, many of whom may be weakened by chemotherapy and radiation (xxxiv). As noted already I personally question the value of using too many of these supplements that work on the immune system but can see a huge value in rotating them after a couple of months or so?

17. Milk Thistle - I’ve covered this previously (iii) but it lists here as it can have a key role in detoxing, reducing the accumulation of dead cells and reducing side effects of radiotherapy to the liver (xxxv). Chris Woollams notes that magnesium will also help strengthen the liver and 3gms of soya lecithin a day will help the liver break down the excess fats lying there.

18. Medicinal mushrooms - I am hoping to do a blog on these at some stage - they look like they are great for cancer in many ways although my recent taking of them didn’t seem to produce results. I will still look at them as there is also evidence they reduce side-effects of radiotherapy and chemotherapy (xxxvi).

19. Grape seed extract - has been shown to impact on cancer but can also play a role in reducing the side effects of chemo/ radiotherapies (xxxvii).

20. Pine bark extract - will boost immune system and may play a role in reducing side effects of radiation (xxxviii).

Update 22/11/19: