The Chemo-Vitamin Debate

A common challenge for people battling cancer is how to stay strong and healthy while subjecting their bodies to the toxins of chemotherapy and radiation treatments. Although some research has shown that vitamins -- and antioxidants in particular -- help prevent cancer, other studies show that antioxidants' protection of cells against damage actually can work against chemotherapy's intentionally destructive actions. So, what's the truth? And what's a cancer patient to do?

To learn more, I spoke at length with Timothy Birdsall, ND, a naturopathic physician who is vice president of integrative medicine at the highly regarded Cancer Treatment Centers of America, a hospital-based program that blends conventional treatment with integrative medicine. Here's what he told me...

TARGETING WHICH CELLS TO KEEP OR KILL

According to Dr. Birdsall, "The essential issue here is that many chemotherapy drugs attack cancer cells through the mechanism of oxidation, which is precisely the mechanism that antioxidants defend against. However, most chemotherapy drugs have multiple agents of action, not just oxidation. And the flip side of the coin is that many studies have shown that malignant cells metabolize the typical dietary antioxidants very differently from normal cells." Dr. Birdsall explained that studies have shown that more antioxidants wind up in healthy cells than in the cancer cells. "The cancer cells appear to metabolize antioxidants a bit differently from healthy cells," he said. "This would appear to be a good thing, but there is very little clinical data to support either side."

Dr. Birdsall explained the very special challenges presented in treating cancer patients. Cancer is a very complex disease. It's an umbrella term that refers to more than 200 different diseases. They have some common elements, but are very different. Because something is very good for prostate cancer does not mean that it's good for breast cancer. Furthermore, there are no "intermediate markers" for cancer to see if a treatment is working. The only time doctors know, for example, whether giving antioxidants was good or bad is if the person's disease regresses or progresses. Every time it progresses (gets worse), you lower the chance of response to another treatment. It's not like heart disease or diabetes, where you can try something and then take some measurements a few weeks or months later to see if it's working.

Cancer is also a disease in which it is extraordinarily difficult to extrapolate from cells studies and animal studies to humans. "If we could extrapolate from those studies, we would have known how to cure cancer 20 years ago. We can do it in cells, and with cancers created in the laboratory. But ultimately, we have to track the results in people, not in Petri dishes," says Dr. Birdsall. He told me about a study last year in which two groups of lung cancer patients were treated, one with chemo by itself and one with chemo plus a combination of antioxidants. The group with the antioxidants fared marginally better, but the response was not statistically significant. "It still doesn't answer the question," Dr. Birdsall said.

ANTIOXIDANTS AND CHEMO SIDE EFFECTS

There is another issue regarding the use of antioxidants and chemotherapy -- that of managing side effects. "There is clear evidence of protection by antioxidants against some side effects of the chemotherapy -- in particular the protection of the liver and gastrointestinal tract as well as reduction in malaise, nausea and diarrhea," Dr. Birdsall said. "But just because something lowers side effects does not mean that it's necessarily good for that patient. We have to know that it reduces side effects without interfering with the treatment."

"What if," Dr. Birdsall asked, "a patient using antioxidants and chemo together gets 50% tumor shrinkage? At first you think that's great. But the underlying question is, might she have gotten 75% shrinkage without the antioxidants? We just don't know."

WHAT'S A PATIENT TO DO?

"The general advice that most patients are given -- don't use any antioxidants -- is a blanket condemnation often used by people who don't know or don't understand them," Dr. Birdsall said. "If people are interested in using antioxidants, there are safe ways to do it -- and questionable ways as well. It's a complex area, and one that is changing so fast that anything I tell you today may be outdated by the time someone reads this."

This leaves a puzzling dilemma, but one in which there is still a hopeful message. "The appropriate thing to do is to find a naturopathic physician who is well trained in oncology," Dr. Birdsall said. Two highly reputable sources: The Oncology Association of Naturopathic Physicians (www.oncanp.org)... and the Cancer Treatment Centers of America ( www.cancercenter.com).

"In most situations I think a daily multiple vitamin is absolutely safe during chemo," Dr. Birdsall concluded. "And in most situations 1,000 mg of vitamin C and 400 IUs of vitamin E are safe as well. But each situation needs to be evaluated by someone who does this every single day. That's where a naturopathic oncologist can really be of service."

Be well, Carole Jackson, Bottom Line's Daily Health News June 2, 2006

Sources:

The Chemo-Vitamin Debate

Timothy Birdsall, ND, vice president, integrative medicine, Cancer Treatment Centers of America. A graduate of Bastyr University, he served on the faculty of Bastyr for five years and was a member of the board of directors for the American Association of Naturopathic Physicians. He was the founding editor-in-chief of Alternative Medicine Review. Cancer Treatment Centers of America can be reached at 800-615-3055 or www.cancercenter.com.

Restless Legs Syndrome May Be in Your Head, Barbara A. Phillips, MD, FCCP, chairman, National Sleep Foundation, and professor of pulmonary and critical care medicine, University of Kentucky College of Medicine, Lexington.