Supplements during chemotherapy

Prior to introducing any new supplements to my diet, I check each one with my cancer pharmacist to see whether they are approved or not.

I’m very interested in this question about supplements. When I was receiving chemo I was concerned that adding supplements would put more burden on the liver, which was already working hard metabolize the cancer drugs…but that was just a gut instinct and not per advice of any doctor. Curious what others know about this.

I'm on Gemcitabine + Abraxane + Cisplatin. I just found the email I received from my onco-pharmacist 2 years ago:

For interactions between the extensive supplement list and your chemotherapy, B vitamin components (includes pyroxidine (B6), thiamin (B1), riboflavin (B2), folate (B9), niacin (B3), pantothenic acid (B5)and biotin (B7) are OK. In general, any vitamins or minerals listed a 100% or less of daily recommended requirements are OK.

Avoid any component listed as an antioxidant - this has the potential of reducing the efficacy of cisplatin. These include high levels of Vitamin E, Vitamin C, coenzyme Q, tumeric, and many others. In addition many of these components can add to any bleeding risk, and should be held if your platelets are low (good possibility for any one on gemcitabine, cisplatin and Abraxane).

An additional concern is interaction with enzymes that break down chemotherapy. This does not apply to cisplatin or gemcitabine, but does affect Abraxane. Abraxane is broken down and eliminated from the body with the activity of enzymes 2C8 and 3A4. Quercitin for example inhibits the activity of both these enzymes and could lead to a buildup of the drug (and higher side effects) in your body.

I would recommend holding supplement containing any of these components at levels greater than 100% while receiving gemcitabine, cisplatin, Abraxane.

Thanks for sharing, that is great information. I have a multivitamin which requires two tablets for the full dose and only take one. I will have to check it as I think even at 1/2 dose some of the multi-vitamin components will be over 100%.

Markymarkfl, Thanks for your encouragement to contact the pharmacist. Yesterday I Called the pharmacy which provides the chemo drugs for my infusions and talked with the pharmacist for at least 1/2 hour. He commented on a list of herbs I was wondering about and could not recommend Boswellia or black cumin seed oil. I will forgo it to be cautious but was interested in it due to its anti-inflammatory properties. He did say oncologists have access to more information than he does so they may be able to approve herbs that he cannot. It was an amazing talk, he was so kind, patient, and knowledgeable. We spent at least 1/2 hour talking and he was in no hurry to get off the phone!
My skin rash and itch have resolved just in time for the 2nd treatment. I expect to be tired after it kicks in as my red and white blood cells are now just below normal.
Thanks again for your input!

So much conflicting information everywhere - yes, to checking with one’s immediate care team. Also, we can read clinical study reports to become informed. The trouble is no one person holds all the knowledge so when are we limiting possibility over caution? Rhetorical.

I totally agree with you, it is a shame that more research is not done on combining herbals with standard chemo as a way of limiting side effects from treatment and providing better outcomes.
My goal is to add herbals which won't make the chemo less effective or overburden my kidneys and liver. Integrative Oncologists are tough to find where I live, there is one Naturopathic Oncologist locally who is known for having a God attitude and pushing expensive treatments onto his patients like high dose Vitamin C infusions which I have read are not effective. It would be hard to trust someone with profit as their ulterior motive.

I have read 2 books now about some of the approaches being used in Integrative Oncology - like repurposed medicines, lower dose chemo, etc. Its encouraging to see this area growing. The thinking seems to be that cancer is not only a genetic mutation, but also a metabolic disease. Attacking from both angles makes sense to me and I hope more of the things like adding Claritan to certain chemotherapy regimens to help with Neulasta bone pain (say nothing of the studies on histamines and cancer) and even low dose aspirin which has been shown to promote cell apoptosis and inhibit angiogenesis. We should learn about these things and ask about adding them to our 'standard' regimens.

Ah, the Berberine dilemma. So many good studies about it promoting apoptosis and squelching side effects, and managing glucose that it almost seems a ‘no brainer’….but with chemo? One study (sorry I have a spreadsheet and can’t site right now) says it can promote the oxygen environment that cancer cells don’t like, ..So which way to go? Yes, I know talk to care team…

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Wow, ever considered a chat with the pharmacist mixing up the chemo infusions! Great idea. This has never been mentioned by our team.