Cancer patients are suffering from devastating side effects of chemotherapy, when antioxidants may be the answer
It's morning in the chemotherapy ward. All around us are courageous people undergoing treatment for their cancers. Most of them have lost their hair. Some have nausea and mouth sores so painful they can barely eat. For many, the tingling in their fingers and toes has replaced the feeling that used to be there. And some have had their chemo terminated because their kidney toxicity has become too severe.
One person has been undergoing chemotherapy for well over a year. She still has most of her hair. She hasn't had a day of nausea and has never had a mouth sore. The tingling in her fingers is minimal and easy to ignore, and her kidneys and liver are fine.
Why are the others suffering side effects so much worse and having to discontinue their treatment? Because their oncologists told them that they had to come off all of their herbs and nutritional supplements because you cannot take antioxidants while you are on chemotherapy.
And that is the cruelest lie of modern medicine.
The lie is based on a theory. Chemotherapy kills cancer cells by creating free radicals; antioxidants protect cells from free radicals; therefore, antioxidants will protect cancer cells from the free radicals that are being unleashed on them to destroy them. Antioxidants interfere with the effectiveness of chemotherapy. Or so the theory goes.
But there are three problems with the theory. The first is that it is way too simplistic and probably untrue. The second is that all of the available data refutes it. And the third is that it is utterly hypocritical.
It's Not True
It is true that some chemo drugs produce free radicals. But, although some chemo drugs produce free radicals, most of these produce their anticancer effects in ways that do not involve the free radicals (Cancer Treat Rev 1997;23:209-240; Integr Cancer Ther 2004). Not only do these chemo drugs not work by producing free radicals, Kenneth Conklin, M.D., Ph.D. has shown that there is considerable evidence that the free radicals can actually interfere with the drug's anticancer activity (Nutr Cancer 2000;37(1):1-18; Integr Cancer Ther 2004;3(4):294-300). So, contrary to the theory, antioxidants could actually enhance chemotherapy. Other researchers have also shown, not only that chemo doesn't kill cancer cells by free radical damage, but that antioxidants could actually increase the way they do kill cancer cells (J Pathol 1999;187:127-37). And, finally, since chemotherapy's anticancer effects are not, generally, caused by free radical damage, but their body ravaging side effects are, antioxidants, contrary to the theory, could not only make the chemotherapy work better, but prevent the side effects while they do it. So, the conventional prohibition against antioxidants with chemotherapy is simplistic and likely wrong. Even at the theoretical level, antioxidants could prevent the devastating side effects of chemo without inhibiting effectiveness and even make it work better.
The Data Refutes It
Perhaps even more damning than the theoretical objection to banning antioxidants is the available data. All of it. As cancer expert Ralph Moss, Ph.D., reminded us in an interview with The Natural Path newsletter, data trumps theory every time. And, he says, case by case of instances where antioxidants are used in conjunction with chemotherapy, there is no deleterious effect. When the data does not support the theory, the theory has to be abandoned. Real science does not discard the data to preserve the theory. Keder Prasad, Ph.D., who has published over 45 peer reviewed articles on antioxidants and conventional cancer treatment, sums it up by saying, "Experimental data and limited human studies suggest that use of these nutritional approaches may improve oncologic outcomes and decrease toxicity" (Integr Cancer Ther 2004;3(4):310-22).
When researchers treated people with small cell lung cancer either with chemotherapy and radiation alone or with the addition of a mix of antioxidants, they found that the antioxidants not only allowed the patients to tolerate the chemotherapy and radiation better, they also prolonged their survival time (Anticancer Res 1992;12:599-606). That's certainly not what the theory predicts. In another study, 136 people with non-small cell lung cancer were given either the chemotherapy drugs paclitaxel and carboplatin alone or with the antioxidant vitamins C, E and beta-carotene. The chemotherapy only group had a 33% response rate; the antioxidants raised it to 37%. The antioxidant group had two complete responses to the drug group's zero. And median survival was only 9 months on chemotherapy alone, but 11 months when the antioxidants were added. The authors concluded that "These results do not support the concern that antioxidants might protect cancer cells from the free radical damage induced by chemotherapy (J Am Coll Nutr 2005;24(1):16-21). And in a study that looked at what happens when you add antioxidants to chemotherapy for kids with cancer, researchers found that the antioxidants allowed for fewer chemotherapy drug dose reductions, fewer infections and less toxicity. And, once again, the antioxidants accomplished these benefits with no reduction in effectiveness (Pediatr Blood Cancer 2005;44(4):378-85). Another study of children found that the antioxidant combination of vitamin E and NAC reduced chemotherapy induced toxicity, liver toxicity, blood complications and need for blood and platelet transfusions compared to children on chemotherapy for acute lymphoblastic leukemia who were not given the antioxidant combination (Adv Hematol 2009;2009:689639).
The commonly used chemotherapy drug doxorubicin can lead to irreversible damage to the heart muscles and to congestive heart failure. All kinds of studies have shown that coenzyme Q10 (CoQ10) can prevent the damage without decreasing the chemotherapy's effectiveness (Cancer Treat Rep 1978;62(6)887-91); Gan To Kagaku Ryoho 1982;9(1):116-21; Gan To Kagaku Ryoho 1984;11:1420-7; Biomed Clin Aspects Coenzyme Q 1984;4:231-241). At least one of these studies also found that CoQ10 reduced diarrhoea and mouth sores caused by the drug. Conklin points out that this protection allows people to stay on the drug longer and even increase the dose, enhancing, not inhibiting, its effect.
Another commonly used chemotherapy drug, cisplatin causes nerve damage from tingling, numbness and loss of sensation in the hands and feet to tinnitus and permanent hearing loss. Tons of studies show that the antioxidant glutathione prevents nerve damage as well as other side effects of cisplatin while enhancing the effect of the drug (Cancer Chemother Pharmacol 1990;25(5):355-60; Oncology 1999;57(2):115-20). When people with stomach cancer had either glutathione or a placebo added to their cisplatin, 88.9% of the placebo group had nerve damage caused by the chemotherapy, but only 16.7% of the glutathione group did. Did the antioxidant interfere with the chemotherapy while erasing the side effects? Nope. The chemo + placebo group had a 52% response rate. Adding glutathione increased the response rate to 76% and almost twice as many people on the glutathione had complete remissions (J Clin Oncol 1995;13:26-32). A second study found similar results for the related drug oxaliplatinum (J Clin Oncol 2002;15(16):3478-83).
The same has been found when glutathione is added to the combination of cisplatin and cyclophosphamide: the antioxidant reduces toxicity and enhances response (Ann Oncol 1993;4:55-61). In one study of this combination, nobody given IV glutathione developed any nerve damage (Tumori 1993;79:37-39).
Studies have also found glutathione to significantly improve hemoglobin, while blood cell counts and platelets in people taking cisplatin combined with other chemotherapy drugs (Wien Klin Wochenschr 2000;112(14):617-23). A randomized study of women with ovarian cancer found that adding glutathione allowed more of them to finish their treatment (58% versus 39%) and significantly reduced nausea, hair loss, nerve damage, kidney toxicity and depression. Once again, the antioxidant not only did not interfere with the chemotherapy, it enhanced it: 73% of the glutathione group responded versus only 62% in the control group (Ann Oncol 1997;8:569-573). Another study found a trend towards better response of 72% versus 52% (Int J Gynaecol Cancer 1996;6:415-419).
And glutathione is not the only antioxidant that benefits people on cisplatin. Lipoic acid protects against cisplatin's bone marrow, liver and kidney toxicity (New Mexico Suppl West J Med 1995). Raising glutathione with NAC reduces toxicity and leads to impressive response rates (Cancer Treat Rev 1990). Two studies also found NAC to completely protect against blood in the urine from kidney toxicity caused by an alkylating chemotherapy drug (Semin Oncol 1983). In a placebo-controlled study, adding selenium to cisplatin led to significantly higher white blood cell counts, less blood transfusions and significantly lower kidney toxicity (Biological Trace Element Res 1997;56:331-341). And, when women with ovarian cancer on cisplatin and cyclophosphamide were given either selenium or nothing, the selenium prevented the hair loss, appetite loss, flatulence, abdominal pain, weakness, vomiting and drops in white blood cell counts that happened in the no selenium group (Gynecol Oncol 2004; 93(2):320-7). And when people on cisplatin were given a placebo, 85.7% of them developed nerve damage, while only 30.7% of those given vitamin E did (J Clin Oncol 2003;21(5):927-931). In another study, 73.3% of people on chemotherapy had nerve damage compared to 25% who added vitamin E (Neurology 2005;64(1):26-31). When 30 people on cisplatin added either 600mg a day of vitamin E or nothing, 68.5% of the cisplatin only group developed nerve toxicity compared to only 21.4% of the vitamin E group (Support Care Cancer 2006;14(11):1134-40).
Vitamin E has also been shown to reduce drops in neutrophil count in women receiving chemotherapy for breast cancer (Cancer 2004;101(5):1058-64).
Free radical damage from cisplatin kills hearing cells. But a preliminary study found coenzyme Q10 (CoQ10) administered with a multivitamin--what the researchers called a dietary antioxidant supplement--significantly protected against toxic damage in the ear, including preventing the occurrence of hearing disorders and tinnitus (Heliyon 2017;3(2):e00251).
A pilot study of 27 women with either stage III or stage IV ovarian cancer administered either the chemotherapy drugs carboplatin or paclitaxel alone or with the addition of IV vitamin C. In the women who were getting the vitamin C, the chemo caused less toxicity of the brain, bone marrow and major organs. The women who added the vitamin C also added 8.75 more months to the time they went without relapse or progression of their cancer compared to the women getting the chemo without the vitamin (Sci Transl Med 2014;6:222ra18). In a study of 30 women with breast cancer, the ones who received vitamin C during chemotherapy had twice the response and greater tumour shrinkage than women who didn't get vitamin C (Asian J Surg 1999; 22:333-6).
Melatonin plays a valuable role in cancer partly because of its antioxidant effects. In a study of 100 people with metastatic stage IV lung cancer, the ones who added 20mg of melatonin to their chemotherapy had significantly higher rates of tumour regression and survival than the ones who were on chemotherapy alone. Two years into the study, none of the chemotherapy only people were still alive: nearly 40% of the melatonin group was. The ones on melatonin also had fewer side effects (J Pineal Res 2003;35(1):12-5). A study of metastatic colorectal cancer compared chemotherapy alone to chemotherapy plus 20mg a day of melatonin. Significant tumour shrinkage was achieved in 44% of the chemotherapy group and 86% of the chemotherapy plus melatonin group (Anticancer Res 2003;23(2C):1951-4).
When you turn to antioxidant rich herbs, the results are the same. In the published literature, there are no case reports of negative interactions between herbs and chemotherapy: rather, "[j]udicious combinations of herbs with anticancer drugs can ameliorate the toxicities of those drugs and increase their efficacy . . ." (J Am Herbalist Guild 2007).
A discussion of turmeric concluded by saying that curcumin "increases chemosensitivity of cancer cells to anti-cancer drugs and to radiation, while protecting healthy cells from radiation's effects" (Curr Probl Cancer 2007;31(4):243-305).
In a study of 80 people undergoing chemo for a variety of solid tumour cancers (mostly colorectal, gastric and breast), some were given a placebo while some were given 180mg a day of curcuminoids (bound to phosphatidylcholine). Those given the curcumin had a significant decrease in free radical damage, inflammatory markers and a significant increase in quality of life (J Funct Foods 2014;6:615-622).
A placebo-controlled study included 158 people who were suffering significant adverse events from their chemotherapy or radiation treatment. In the chemotherapy group, compared to the placebo, people on curcumin had significantly less nausea and vomiting, diarrhoea and constipation, malnutrition and weight loss, memory and cognitive problems, infections, low white blood cells and heart toxicity. People taking curcumin also needed significantly less medication to treat adverse events (Phytother Res 2014;28:444-450).
And a discussion of the use of the antioxidant rich milk thistle in oncology concedes that chemotherapy can cause liver damage and toxicity severe enough to reduce or terminate treatment, while noting a double-blind, placebo-controlled study that demonstrated improvement in liver function in children undergoing treatment for leukemia (Integr Cancer Ther 2007). A double-blind study of 50 children with acute lymphoblastic leukemia and liver toxicity found improvement in liver function tests in the milk thistle group (Cancer 2010;116(2):506-13). Several studies have found milk thistle to act synergistically with doxorubicin while preventing its heart toxicity. A group of researchers concluded not only that milk thistle "can result in a strong protective effect" from the toxicity of chemotherapy, but, again contrary to what oncologists tell patients, that an increasing body of evidence indicates that it may even work synergistically with drugs like doxorubicin, cisplatin and carplatin (Integr Cancer Ther 2007).
Research also suggests that Ginkgo biloba, a herb rich in antioxidants, can improve the results of the common chemotherapy drug 5-fluorouracil in people with colon cancer (Phytother Res 2001;15(1):34-8).
A review of studies of grape skin extract or grape seed proanthocyanidins concluded that these antioxidant rich extracts protect normal cells and tissue from some of the toxic effects of chemotherapy, including protecting against chemotherapy induced heart toxicity (Nutr Cancer 2015;67(5):730-40). Resveratrol has also been shown in a research review to protect the heart against doxorubicin induced toxicity while enhancing the drugs anticancer effect (J Cell Mol Med 2015;19(10):2324-8).
The flavonoid antioxidant quercetin has been shown to prevent resistance to chemotherapy (FEBS Lett 1990).
The soy isoflavone genestein has been shown in a small study to ameliorate the side effects of chemotherapy in children. The genestein reduced infection and diarrhoea and eliminated liver and kidney toxicity (Nutr Cancer 2010;62:1001-5).
IP6 is a very promising anticancer nutrient and a potent antioxidant. Two studies--one on colon cancer and one on breast cancer--have demonstrated its powerful ability to reduce chemotherapy side effects (Anticancer Research 2004;24:3393-3698).
Two groups of researchers have done comprehensive surveys of the literature to see if the real data supports the theory. Simone et al surveyed the peer reviewed literature from 1965-2003 (Altern Ther Health Med 2007;13(2):40-7). They found 280 peer-reviewed articles, including 50 clinical studies. Their conclusion? Studies have "consistently shown that non-prescription antioxidants . . . do not interfere with therapeutic modalities for cancer." On the contrary, they enhance the effects of chemotherapy while decreasing the side effects. 47 out of the 50 human studies found that antioxidants and other nutrients improve survival. So much for the antioxidants interfere with chemotherapy theory!
10 studies showed that vitamin A or beta-carotene did not interfere with chemotherapy, often improved survival and response rates and decreased adverse effects. Ten studies of vitamin E and chemotherapy or radiation found no interference with chemotherapy, and several found a reduction in adverse effects and improvement in response rates.
When they looked at 10 studies on antioxidant combinations, instead of single antioxidants, they found the same result: all 10 found no negative interference, but, instead, increased response rates, increased survival time and improved quality of life.
In the second survey, Block et al looked at 845 peer-reviewed articles and identified 19 randomized, controlled clinical studies using various antioxidants that met strict criteria. They concluded that "None of the trials reported evidence of significant decreases in efficacy from antioxidant supplementation during chemotherapy." Like Simone's survey, Block found evidence of precisely the opposite: "many of the studies indicated that antioxidant supplementation results in either increased survival time, increased tumor response or both, as well as fewer toxicities than controls" (Cancer Treat Rev 2007;33(5):407-18).
That review focussed on antioxidants' ability to enhance the effectiveness of chemotherapy. A second review by the same group of researchers focussed on antioxidants' effect on the toxicity of chemotherapy. 33 randomized controlled studies met their criteria. 24 of the 33 studies reported decreased toxicity when antioxidants were taken with chemotherapy. The rest reported no difference with the exception of one vitamin A study (though toxicities reported with the vitamin A were atypical of chemotherapy toxicities reported in other studies: the toxicity may have simply been because of the toxicity of high dose vitamin A and may have had nothing to do with its interaction with chemotherapy). Though the vitamin A group had more toxicity, they also had significantly less risk of disease progression and death compared to the control group. The results were even more convincing when the weaker antioxidants were eliminated. This review again shows that antioxidants reduce the toxic effects of chemotherapy. As for the theory that antioxidants reduce efficacy, in all but one of the studies, the antioxidant group experienced the same or better response. Not one study reported a significantly worse rate of survival or response in the antioxidant group (Int J Cancer 2008;123(6):1227-39). Block has said of his two reviews that "in none of the trials did the antioxidants decrease the effectiveness of chemotherapy; in fact, the antioxidant groups usually had better survival or tumor shrinkage. We also found that antioxidant use was associated with lower risks for neuropathy, low blood counts, kidney damage, and other side effects."
Furthermore, Dr. Ralph Moss pointed out to us his interview with The Natural Path newsletter that plenty of studies show that chemotherapy seriously depletes antioxidants, and that that means that supplementing antioxidants is crucial, not just to prevent the side effects of chemotherapy, but just to maintain the normal levels of antioxidants needed for basic health.
It's Utterly Hypocritical
Finally, the theory is crippled by its own hypocrisy because at least three drugs used in standard oncology to reduce chemotherapy's side effects without reducing its efficacy are synthetic antioxidants, revealing that the theory discriminates unscientifically against natural antioxidant.
So, people are suffering the devastating side effects of chemotherapy when antioxidants could be offering them merciful relief while enhancing, not interfering with, the chemotherapy's effects. The insistence by oncologists that their patients eschew this course is the cruelest lie ever told in modern medicine.
Supporting Research on GreenMedInfo.com
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