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UNDERSTANDING CHEMOTHERAPY AND COPING WITH ITS SIDE EFFECTS
Albert Grazia, Ph.D.
Clinical Nutritionist
The purpose of this article is to provide you with information about chemotherapy and to help you better tolerate the
effects of your cancer treatment through nutrition. Of course, you should always consult with your oncologist.
Chemotherapy, which literally means treating a disease with chemicals, is now almost exclusively associated with modern
day cancer treatment. Chemotherapy involves a category of cytotoxic (cell killing) drugs that was originally synthesized from
mustard gas. After this form of chemical warfare was declared illegal, a large amount of it remained in storage. Since it
was too toxic for normal disposal methods, our government provided grants to research groups for pharmaceutical studies. In
the early 1940's, mustard gas was stabilized by combining it with nitrogen to make it into a water and alcohol-soluble liquid.
When it was discovered that it depressed bone marrow function, it was tested on a mouse with lymphoma. The tumor showed regression
and the rest is history. These first classes of cytotoxic drugs became known as alkylating agents. Their main function is
to destroy the genetic material (DNA) in tumor cells.
Another type of chemotherapeutic drug is one that substitutes itself for a nutrient such as a vitamin or amino acid.
These types of drugs are termed anti-metabolites and one of the more common is called methotrexate. Being a chemical analog,
it can effectively masquerade as folic acid, one of the essential B Vitamins. Once this substance is substituted for folic
acid by the cell, cellular function is disrupted and the cell is ultimately destroyed. Some problems may occur when normal
cells also absorb this anti-metabolite instead of folic acid. Studies are beginning to show that supplementing with folic
acid does not interfere with the actions of this drug.
A third type of cancer drug therapy is related to antibiotics, but these were found to be too toxic to be used against
bacterial infections in humans. One of the more widely used is Doxorubicin (Adriamycin). It is used to disrupt DNA synthesis
within the cell. A dose-limiting factor common with this particular drug is cardiac toxicity. Adriamycin damages the heart,
leading to congestive heart failure or cardiomyopathy, because it depletes levels of CoEnzyme Q10 in the heart muscle. Studies
have shown that supplementing with this nutrient can help avert this serious side effect. Oncologists may therefore be able
to administer therapeutic doses of this drug.
One of the newer types of cancer drugs is known as the platinum analog. These drugs interfere with DNA by binding with
it and causing it to actually change its shape. One of the more toxic of these is called Cisplatin and it is also known to
cause kidney and nerve damage. A recent study published in The Journal of Clinical Oncology suggests that supplementing with
glutathione may protect against this nerve damage, without reducing the efficacy of the drug.
The next generation of chemotherapeutic drugs is now being developed from herbs. One that has received attention recently
is Taxol (Paclitaxel). This is an alkaloid derived from the Pacific Yew Tree (Taxus brevifolia). This substance interferes
with cell division and may also help in preventing metastasis (spread of cancer to other parts of the body). The toxic affect
of this drug is nerve damage that contributes to numbness and tingling in the hands and feet. It has also been known to produce
abnormal heart rhythms in some patients.
Chemotherapeutic drugs are used in cancer therapy because they effectively target rapidly dividing cells in the body.
The theory is that since tumor cells have a more active metabolism, they will absorb these substances more aggressively than
other cells. Unfortunately, these drugs sometimes cannot distinguish between tumor cells and normal cells in the body that
also divide rapidly. This is what may contribute to some of the side effects commonly experienced by caner patients.
Some of the normal cells in the body adversely affected by cancer drugs are bone marrow cells. They are responsible for
not only producing red blood cells, but also provide the foundation of our immune system. This can account for the anemia
and decreased immune response contributing to fatigue and risk of secondary infections.
The cells lining the entire gastrointestinal tract are also rapidly dividing since they normally shed and replace themselves
approximately every four days. When these cells absorb cancer drugs, patients may experience nausea, vomiting, loss of appetite,
and painful mouth sores. Destruction of the parietal cells found in the stomach lining can also present a problem. These are
the cells responsible for secreting the hydrochloric acid that is essential for activating pepsin, the enzyme necessary for
protein digestion. In addition, damage to the chief cells in the stomach lining may interfere with secretion of a substance
known as intrinsic factor, which is necessary for vitamin B12 absorption. Lesions in the small intestine can interfere with
digestion and subsequent nutrient absorption. This may account for what is known as cachexia, or the wasting syndrome often
associated with cancer. Destruction of the cells lining the colon can cause disruption of bowel function. Often constipation
is a main complaint, but diarrhea can also manifest.
Universally, one of the more feared consequences associated with chemotherapy involves the complete loss of hair. This
commonly occurs because hair follicles also belong to the group of rapidly dividing cells that are sensitive to the effects
of these drugs. Cancer patients are often counseled to buy a wig or wear a cap in public. Usually, hair growth resumes once
chemotherapy is concluded.
There is some medical assistance for side-effects such as a drug called Zofan, used to reduce the nausea and vomiting
secondary to chemotherapy. This medication may be produce side effects such as headaches and constipation.
With nutrition, I have helped many cancer patients to better tolerate the effects of chemotherapy. Furthermore, supplementing
with certain nutrients and nourishing normal cells may make chemotherapy not only better tolerable, but also more selectively
toxic to the tumor cells. There is growing evidence that certain supplements do not interfere with the cytotoxic effects of
chemotherapeutic drugs, and may actually enhance their efficacy. The benefit of proper nutrition can be a discernible improvement
in quality of life while undergoing conventional cancer treatments.
Now that you understand the mechanism of chemotherapy's actions, we can better deal with its side effects. Starting with
a proper nutritional foundation can help the body to better cope with illness. Tumor cells are very active metabolically and
most of their energy requirements are diverted to the sole purpose of mitosis (cell division). A source of quick energy for
tumor cells is provided by glucose. That explains why tumor cells are voracious sugar feeders. Another nutrient they need
is fat, in the form of fatty acids, to maintain the structure of their cell membranes. An omega-6 fatty acid called arachidonic
acid is particularly essential to tumor cells. Since they lack the enzyme to synthesize it, tumor cells may obtain it from
your dietary intake. Arachidonic acid is found in animal products. If this fatty acid is not provided, tumor cells must substitute
other forms of fatty acids from the omega-6 family. This can result in a weakened tumor cell membrane that may be less resistant
to drug therapy. It is also important to note that tumors do not efficiently utilize the omega-3 essential fatty acids commonly
found in flaxseed oil and cold water fish such as salmon. Studies have described the benefits, to cancer patients, of supplementing
with flaxseed oil or fish oil.
A strong tumor cell membrane can be one of the contributing factors leading to what is termed chemo-resistant tumors.
In an attempt to avoid this, a combination of cancer drugs is often prescribed. Unfortunately, well-nourished cancer cells
have several other mechanisms to protect themselves from chemotherapy. Besides a strong cell membrane blocking the drug's
entrance, it also has the ability to use its efflux pump to pump out the drugs. In addition, it can produce a substance known
as glutathione to detoxify the drugs and make them harmless. Tumor cells also have the ability to use proteins and enzymes
to either bind with the drug or reduce its effectiveness. Finally, even if the drug manages to penetrate into the nucleus
to disrupt the genetic material, a cancer cell has the ability to repair its own DNA. I believe that poorly nourished tumor
cells will have a diminished ability to utilize these defense mechanisms to protect themselves from cancer drugs.
A diet of junk food, which is high in sugar (simple carbohydrates) and saturated fat, will provide your tumor with the
nutritional requirements it needs to continue thriving. Instead, you should treat your tumor as you would any other unwanted
guest in your home. Would that guest ever get off your couch and leave your home if you continued to provide him with all
the beer, chips and pizza he desired? Instead, a predominately vegetarian diet of fresh (preferably organic) fruits and vegetables,
along with the high fiber and complex carbohydrates provided by whole grains and legumes will serve to nourish your healthy
cells rather than your tumor. Salmon or other cold water fish can also be consumed in place of other animal products. Using
a whole food supplement containing the super green foods such as spirulina, alfalfa, barley and wheat grasses from organic
sources may also be beneficial.
The digestive problems often plaguing chemotherapy patients provide another reason to avoid animal products. With a reduced
amount of hydrochloric acid in the stomach to activate the protein digesting enzymes, meat and dairy products will remain
in the stomach for hours longer than necessary. This can contribute to bloating, nausea, and loss of appetite. If food is
not properly digested and absorbed, it serves no benefit to the body. One quick and efficient way of getting optimal nutrition
into the body is by consuming fresh, organic juices. Fresh vegetable juices provide a concentrated source of nutrients that
are easily assimilated. Carrot and beet juice in particular may help the body restore its red blood cell production. Also,
beets contain a high amount of organic iron that the bone marrow can easily utilize. This may help counter the anemia and
resulting fatigue that are secondary to cancer drug therapy.
Cancer patients in South American hospitals are given Pau D'Arco tea because it is effective in relieving certain side
effects. For example, many patients have found relief from nausea by drinking up to five cups of this tea per day. An added
benefit of drinking this much tea is that it helps hydrate the body. Dehydration is another dangerous problem for cancer patients
when the mouth sores and nausea prevents them from being able to drink enough water.
One possible method of dealing with the mouth sores is to use licorice extract. This herb has been used in China for centuries
and has been shown to help heal ulcerations in the stomach. More importantly, it can also be effective to soothe and heal
lesions in the mouth.
Another important nutrient that is crucial for helping the intestinal tract to heal itself from the effects of chemotherapy
is an amino acid called L-Glutamine. Studies have shown that supplementing with L-Glutamine provides protective benefits because
it is needed by the intestines to grow new cells. In addition, some patients have even reported an elevation in mood after
taking L-Glutamine. Probiotics may also help support the colon by providing a source of Butyrate.
Maintaining a strong immune system is crucial to surviving both this disease and its treatment. Chemotherapy may contribute
to decreased immune function, and low white blood counts can make cancer patients susceptible to secondary infections. Besides
protecting you from bacteria and viruses, your white blood cells also have another crucial function. It is their responsibility
to remove debris from your body, including the dead tumor cells killed by cancer drugs. Low white blood counts are often one
of the reasons oncologists are forced to discontinue chemotherapy.
To stimulate the immune system, some use an herb called Echinacea. This is one of the most widely prescribed herbal extracts
in Germany. Studies in Europe have shown its effectiveness at increasing white blood cell count, particularly T-lymphocytes
(T-Killer cells) and Natural Killer (NK) cells. (Just be aware that not all herbal products are created equal. Depending on
the manufacturer, some extracts may be more diluted than others and will not produce the desired results. Therefore, it is
important to find a good quality herbal extract). Another herb receiving increased attention as an immune stimulator is an
extract from the Maitake mushroom, specifically called the Maitake D-Fraction. Research is showing that this mushroom may
have the ability to increase the activity of NK cells. An herb called Astragalus is currently being studied for its possible
role in improving platelet counts, and in helping to protect the liver.
Cancer cells, being highly active metabolically, give off many toxins that can place undue stress on the body. For example,
one of the main differences between normal cells and tumor cells is that tumor cells prefer an anaerobic (non-oxygen) form
of metabolism. A byproduct of this metabolism is a substance called lactic acid. Incidentally, this is the same lactic acid
released by your muscles after a strenuous workout that contributes to muscle pain. Cancer pain may also be related to elevated
lactic acid levels. Helping the liver to reduce lactic acid may also help eliminate some of the physical pain from cancer.
(I have helped many cancer patients significantly reduce their pain and even wean off of pain medications, including morphine).
Lactic acid may also play a role in providing an optimal environment conducive to cancer growth. Tumor cells prefer the
acidic (lower pH) terrain that lactic acid provides. In addition, lactic acid stimulates the secretion of angiogenic factors.
This substance enables the tumor to develop new blood vessels to continue its growth. This is similar to how muscle cells
utilize the angiogenic properties of lactic acid to stimulate increased muscle growth after a workout.
The hair loss following chemotherapy can be more emotionally upsetting than a physical problem. I have found that proper
nutrition along with assisting the body in its detoxification attempts may minimize the amount of hair loss. For some people
who are already bald, hair loss is not a problem. Interestingly, I saw a client who had been bald for almost thirty years
before undergoing chemotherapy. Several months after starting my nutritional program, he pleased was to report that he began
noticing significant new hair growth on his head. Incidentally, he tolerated his chemotherapy very well and was able to continue
working throughout his therapy sessions. More importantly, his lymphoma went into complete remission.
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