Should Cancer Patients Take Supplements?

Does Supplementation Interfere With Cancer Treatment?

Author: Dr. Stephen Chaney

SupplementationSupplementation for cancer patients is a controversial topic.

  • Dr. Strangelove and his friends promote a variety of herbal ingredients, vitamins, and minerals as a cure for various kinds of cancer.
  • Unscrupulous supplement companies hype their cancer “cures”.
  • Doctors often tell their patients to avoid all supplements while they are being treated for cancer.
  • Nutrition experts and some doctors tell us that a good diet and basic supplementation help normal cells recover from cancer treatment and improve patient outcomes.

Where is the truth? For this article I will break it down into three questions:

1) Does supplementation improve outcomes for cancer patients? That is the topic of the study (AL Shaver et al, Cancers, 13: 6276, 2021) I will review today.

2) Does supplementation interfere with cancer treatment? I will provide a perspective and practical advice on this question based on my 40 years of cancer research.

3) Does supplementation prevent (reduce the risk of) cancer? I have covered this topic in previous issues of “Health Tips From the Professor”. Just put cancer or breast cancer in the search box to find the relevant articles.

But before I answer these questions, I should cover my favorite topic as a Biochemist, “Metabolism 101”. Specifically, “Does Stress Increase Our Need For Supplementation?”

Metabolism 101: Does Stress Increase Our Need For Supplementation? 

professor owlLet me start out by saying that there are two kinds of stress.

  • Psychological stress is our body’s response to a hectic day or a stressful work environment.
  • Metabolic stress is our body’s response to trauma or a major disease.

Dr. Strangelove and his buddies will tell you that psychological stress increases your nutritional needs. And they just happen to have the perfect blend of vitamins and minerals for you. However, this is a myth.

Psychological stress has relatively little effect on your nutritional needs. If you have a nutritional deficiency, supplementation can help you cope with psychological stress, but psychological stress doesn’t create nutritional deficiencies.

Metabolic stress, on the other hand, has a major effect on your nutritional needs.

  • Trauma and major diseases put you in a catabolic state. Catabolism literally means “breaking down”. You are breaking down your body tissues at an alarming rate. This affects every aspect of your health, including your immune system.
  • Trauma and major disease also increase your need for certain micronutrients. Plus, there are often loss of appetite and mobility issues that prevent you from getting the nutrients you need.
  • Research in the 60s and 70s showed that providing hospitalized patients with protein, energy in the form of healthy fats and carbohydrates, and micronutrients significantly shortened hospital stays and improved outcomes. Today, nutritional support is the standard of care for severely ill hospital patients.

Cancer is the poster child for metabolic stress.

  • It forces the body into a catabolic state to provide nutrients the cancer needs to grow.
    • That is why cancer patients often experience dramatic weight loss and weakness from muscle loss.
    • Catabolism also weakens the immune system, which is one of the most important tools in our fight against cancer.
  • To make matters worse:
    • Cancer treatment destroys normal cells as well as tumor cells. Because of this cancer patients sometimes die from the treatment, not the cancer.
    • Cancer treatment often causes nausea and/or suppresses appetite, which makes it even harder for cancer patients to get the nutrients they need from their diet.

Because of this, you would think that nutritional support would be the standard of care for cancer patients, but it isn’t. Because of fears that nutritional support might “feed cancer cells” or interfere with chemotherapy, there have been very few studies of supplementation in cancer patients. That is what makes this study so important.

How Was This Study Done?

Clinical StudyThis study took advantage of the fact that supplementation is prevalent among cancer patients even though their doctors may not have recommended it.

This study drew on data from the 2011-2012 National Health and Nutritional Examination Survey (NHANES). NHANES is a yearly survey that monitors the health and nutritional status of non-institutionalized adults in the US population.

NHANES participants were asked to respond to a medical condition questionnaire in their homes by a trained interviewer. In one portion of the interview, they were asked if they had ever been told they had cancer, arthritis, diabetes, congestive heart failure, chronic obstructive pulmonary disease (COPD), or hypertension. The participants were also asked if they had been hospitalized with one of those diseases.

The study consisted of 14 million people who answered ‘yes’ to the question, “Have you ever been told you had a cancer or malignancy?” The participants were selected to give an equal number of supplement users and non-users who were closely matched for age, sex, race, and other demographics.

All NHANES participants were asked to fill in two 24-hour dietary recalls separated by 3-10 days. The dietary recalls included supplement use but did not identify the kind of supplements used.

Finally, participants in the NHANES survey were asked to rate their physical and mental health on a scale from 1 (excellent health) to 5 (poor health). Participants were also asked to indicate on how many days in the past 30 days their physical or mental health was not good. A quality-of-life score was calculated from these data.

Does Supplementation Improve Outcomes For Cancer Patients?

good newsThe study found that for cancer patients:

  • Hospitalization rates were 12% for supplement users versus 21% for non-users.
  • This is important because:
    • Cancer patients who have been hospitalized have 6-fold higher odds of all-cause mortality than those who do not require hospitalization.
    • Health care costs the first year after cancer diagnosis average $60,000 versus an estimated $350-$3,500 yearly cost of supplementation.
  • The self-reported quality of life score was significantly higher for supplement users versus non-users.

This study strongly supports the idea that supplementation significantly improves quality of life and health outcomes in cancer patients.

  • This finding is consistent with previous studies showing that nutrition support significantly improves health outcomes for hospitalized patients admitted with trauma or other major diseases.
    • A major strength of the study is the large sample size (> 14 million US adults).
    • A major limitation of this study is that the NHANES survey does not record which supplements people were using.

The authors concluded, “Adequate nutrition provides a cost-effective strategy to achieving potentially optimal health [for cancer patients]. Further studies are needed to determine the effects of specific nutrient doses and supplementation on long-term outcomes for different kinds of cancer…Given the overall cost-effectiveness of dietary supplementation, there is a need for better provider education about how to talk with cancer survivors about their nutrient status and filling nutrient gaps through both food and supplements. Immune-supportive supplementation may prove to be a clinically effective and important tool that is accessible via telemedicine.”

Does Supplementation Interfere With Cancer Treatment?

Question MarkThe reason that supplementation is not more widely recommended for cancer patients is two-fold.

1) There is a fear among many doctors that improved nutrition will feed the cancer cells and promote tumor growth.

    • This thinking is like the famous quote from a general during the Vietnamese war that, “It was necessary to destroy the village in order to save it [from the Viet Cong]”.
    • We need healthy normal cells to fight the cancer and for good quality of life while we are fighting the cancer. We need to protect these cells while we are destroying the cancer cells. We cannot afford to destroy the whole “village”.
    • For example, both cancer treatment and the catabolism associated with the cancer weaken the immune system, and a strong immune system is essential to successfully fight the cancer.

2) There is also a fear that supplementation will interfere with cancer treatment. This is a more legitimate fear and deserves a more in-depth analysis.

    • There are some instances where supplementation can clearly interfere with treatment. For example,
      • Radiation treatment relies on the production of free radicals. High-dose antioxidants have been shown to interfere with radiation treatment.
      • Some drugs act by suppressing folate levels in cells. High-dose B complex or folic acid supplements would clearly interfere with these drugs. However, high-dose folic acid supplementation is often used before and after drug treatment to “rescue” normal cells.
    • There are other cases where supplementation is likely to interfere with treatment.
      • A few drugs depend in part on free radical formation. High-dose antioxidants have the potential to interfere with these drugs.
      • Some herbal supplements activate enzymes involved in the metabolism of certain anti-cancer drugs. While these interactions are rare, they could interfere with the effectiveness of these drugs. [Note: This concern only applies to certain herbal supplements. It does not apply to vitamin-mineral supplements.]
    • Most other fears about supplement-drug interactions are theoretical. There are neither potential mechanisms nor evidence to support those fears.

However, there is a strategy for minimizing the potential for supplement-drug interactions based on the science of pharmacokinetics. Simply put:

  • Most cases of supplement-drug interactions can be avoided by assuring that high doses of anti-cancer drugs and nutrients that might interfere with those drugs are not present in the bloodstream at the same time.
  • Pharmocokinetic studies tell us that most anticancer drugs and nutrients are cleared from the bloodstream in 24-48 hours.
  • So, my standard recommendation is to avoid supplementation for a day or two prior to cancer treatment and wait to resume supplementation for a day or two after cancer treatment. This recommendation does not apply to radiation treatment since it is done on a daily basis.

However, there are a few drugs that are cleared from the bloodstream more slowly, so it is always best to check with your pharmacist or doctor before deciding on the appropriate window to avoid supplementation. The goal is always to protect normal cells without interfering with the drug’s ability to kill cancer cells.

Should Cancer Patients Take Supplements?

SupplementationWith the information I have shared above in mind, I am now ready to answer the question I posed at the beginning of this article, “Should cancer patients take supplements?” The answer is a qualified, “Yes”.

Let me start with the yes, and then talk about the qualifications.

  • This study makes clear that cancer is like every other major disease that can land you in the hospital. Nutritional support, including protein supplements, vitamins, and minerals, can reduce your risk of hospitalization, get you out of the hospital quicker, and improve your quality of life.
  • A strong immune system is important for fighting cancer, so immune-supporting supplements may also be important for cancer patients.
  • Note I did not say that supplementation can cure cancer. There is little evidence to support that claim.
  • The role of supplementation in preventing cancer is complex. I have covered this in previous issues of “Health Tips From the Professor”. Let me summarize by saying that supplementation can play a role in preventing cancer when nutrient levels are suboptimal. However, the evidence that megadoses of nutrients can prevent cancer is scant.

The qualifications mostly revolve around taking supplements while undergoing cancer treatment. To summarize what I said above:

  • There are a few cases in which supplements clearly interfere with cancer treatment.
  • There are other cases in which supplements are likely to interfere with cancer treatment.
  • However, in most cases supplement-treatment interactions are only theoretical.
  • In most cases any interaction between supplements and anti-cancer drugs can be minimized by avoiding supplementation for a day or two prior to cancer treatment and waiting to resume supplementation for a day or two after cancer treatment.
  • However, there are exceptions to this rule, so it is always best to consult your pharmacist or doctor if in doubt.

The Bottom Line

A recent study looked at the effect of supplementation for patients with cancer. The study found that for cancer patients:

  • Hospitalization rates were 12% for supplement users versus 21% for non-users.
  • This is important because:
    • Cancer patients who have been hospitalized have 6-fold higher odds of all-cause mortality than those who do not require hospitalization.
    • Health care costs the first year after cancer diagnosis average $60,000 versus an estimated $350-$3,500 yearly cost of supplementation.
  • The self-reported quality of life was significantly higher for supplement users versus non-users.

This study strongly supports the idea that supplementation significantly improves quality of life and health outcomes in cancer patients.

  • This finding is consistent with previous studies showing that nutrition support significantly improves health outcomes for hospitalized patients admitted with trauma or other major diseases.

The authors concluded, “Adequate nutrition provides a cost-effective strategy to achieving potentially optimal health [for cancer patients]. Further studies are needed to determine the effects of specific nutrient doses and supplementation on long-term outcomes for different kinds of cancer…Given the overall cost-effectiveness of dietary supplementation, there is a need for better provider education about how to talk with cancer survivors about their nutrient status and filling nutrient gaps through both food and supplements. Immune-supportive supplementation may prove to be a clinically effective and important tool that is accessible via telemedicine.”

For more details, a discussion on the effect of supplementation on cancer treatment, and a summary of what this study means for you, read the article above.

These statements have not been evaluated by the Food and Drug Administration. This information is not intended to diagnose, treat, cure or prevent any disease.

Does Olive Oil Help You Live Longer?

Which Fat Is Healthiest?

Author: Dr. Stephen Chaney

If you believe the headlines, olive oil is a superfood. It is often described as the star of the Mediterranean diet. It is referred to as the healthiest of dietary fats. Is this true, or is it hype?

Olive oil’s resume is impressive:

  • It is rich in monounsaturated fatty acids, which…
    • Are less susceptible to oxidation than polyunsaturated oils.
    • Make our arteries more flexible, which lowers blood pressure.
    • Lower LDL-cholesterol levels, which reduces the risk of heart disease.
  • Extra-virgin olive oil contains phytonutrients and tocopherols (various forms of vitamin E), which…
    • Have anti-inflammatory properties.
    • Improve insulin sensitivity and blood sugar control.
  • Olive oil consumption is also associated with healthier gut bacteria, but it is not clear whether this is due to olive oil or to the fact that a Mediterranean diet is also richer in fresh fruits, vegetables, and whole grains.

Several recent studies have shown that olive oil consumption is associated with a lower risk of heart disease. However, these studies were conducted in Mediterranean countries where the average intake of olive oil (3 tablespoons/day) is much greater than in the United States (0.3 tablespoons/day).

The current study (M Guasch-Ferré et al, Journal of the American College of Cardiology, 79: 101-112, 2022) was designed to test whether:

  • The amount of olive oil Americans consume decreases the risk of heart disease.
  • Whether olive oil consumption had benefits beyond a reduction in heart disease risk.

How Was This Study Done? 

Clinical StudyThis study combined data from 60,582 women enrolled in the Nurses’ Health Study and 31,801 men enrolled in the Health Professionals Follow-Up Study). The participants:

  • Were free of heart disease and diabetes at the start of the study.
  • Were 56 at the start of the study with an average BMI of 25.6 (Individuals with BMIs in the 25-30 range are considered overweight, so they were at the lowest end of the overweight range).

The Nurses’ Health Study and Health Professional Follow-Up Study are both association studies, meaning they looked at the association between olive oil consumption and health outcomes. They cannot directly prove cause and effect. However, they are very strong association studies because:

  • Every 2 years, participants filled out a questionnaire that updated information on their body weight, smoking status, physical activity, medications, multivitamin use, and physician-diagnosed diseases.
  • Every 4 years, participants filled out a comprehensive food frequency questionnaire.
  • In other words, this study did not just rely on the participant’s lifestyle, dietary intake, and health at the beginning of the study, as so many association studies do. It tracked how each of these variables changed over time.

The participants were followed for an average of 28 years and their average olive oil intake over those 28 years was correlated with all-cause mortality and mortality due to specific diseases.

  • Deaths were identified from state vital statistics, the National Death index, reports by next of kin, or reports by postal authorities.
  • Causes of death were determined by physician review of medical records, medical reports, autopsy reports, or death certificates.

Does Olive Oil Help You Live Longer?

During the 28 years of this study:

  • Olive oil consumption in the United States increased from an average of ~1/3 teaspoon/day to ~1/3 tablespoon/day.
  • Margarine consumption decreased from 12 g/day to ~4 g/day.
  • The consumption of all other fats and oils remained about the same.

As I mentioned above, olive oil consumption was averaged over the life of the study for each individual. When the investigators compared people consuming the highest amount of olive oil (>0.5 tablespoon/day) with people consuming the least olive oil (0 to 1 teaspoon/day):

  • Mortality from all causes was decreased by 35% for the group consuming the most olive oil.

However, the group consuming the most olive oil also was more physically active, had a healthier diet, and consumed more fruits and vegetables than the group who consumed the least olive oil.

  • After correcting for all those factors, mortality from all causes was decreased by 19% for the group consuming the most olive oil.

The authors concluded, “We found that greater consumption of olive oil was associated with lower risk of total…mortality… Our results support current dietary recommendations to increase the intake of olive oil…to improve overall health and longevity.” (I will fill in the blanks in this statement once I have covered other aspects of this study)

The authors also said, “Of note, our study showed that benefits of olive oil can be observed even when consumed in lower amounts than in Mediterranean countries.”

Are There Other Benefits From Olive Oil Consumption?

Mediterranean dietThe study didn’t stop there. The investigators also looked at the effect of olive oil consumption on the major killer diseases in the United States and other developed countries. When they compared the effect of olive oil consumption on cause-specific mortality, they found that the group who consumed the most olive oil reduced their risk of dying from:

  • Cardiovascular disease by 19%.
  • Cancer by 17%
  • Respiratory disease by 18%.
  • Neurodegenerative disease (cognitive decline and Alzheimer’s disease) by 29%.
    • The reduction in neurodegenerative disease was much greater for women (34% decrease) than for men (19% decrease).

With this information I can fill in one of the blanks in the author’s conclusions: “We found that greater consumption of olive oil was associated with lower risk of total and cause-specific mortality… Our results support current dietary recommendations to increase the intake of olive oil…to improve overall health and longevity.”

Which Fats Are Healthiest?

Good Fat vs Bad FatThe sample size was large enough and the dietary information complete enough for the investigators to also estimate the effect of substituting olive oil for other dietary fats and oils.

They found that every ¾ tablespoon of olive oil substituted for an equivalent amount of:

  • Margarine decreased total mortality by 13%.
  • Butter decreased total mortality by 14%.
  • Mayonnaise deceased total mortality by 19%
  • Dairy fat decreased total mortality by 13%.
    • The same beneficial effects of substituting olive oil for other fats were seen for cause-specific mortality (cardiovascular disease, cancer, respiratory disease, and neurodegenerative disease).
    • There was a linear dose-response. This means that substituting twice as much olive oil for other dietary fats doubled the beneficial effects on total and cause-specific mortality.
  • However, substituting olive oil for polyunsaturated vegetable oils had no effect on total and cause-specific mortality.

Now I can fill in the remaining blanks in the author’s conclusion: “We found that greater consumption of olive oil was associated with lower risk of total and cause-specific mortality. Replacing other types of fat, such as margarine, butter, mayonnaise, and dairy fat, with olive oil was also associated with a lower risk of mortality. Our results support current dietary recommendations to increase the intake of olive oil and other unsaturated vegetable oils in place of other fats to improve overall health and longevity.”

What Does This Study Mean For Us?

ConfusionAs I said above, this is an association study, and association studies do not prove cause and effect. However:

1) This is a very strong association study because:

    • It is a very large study (92,383 participants).
    • It followed the participants over a long time (28 years).
    • It utilized a very precise dietary analysis.
    • Most importantly, it tracked the participant’s lifestyle, dietary intake, and health at regular intervals throughout the study. Most association studies only measure these variables at the beginning of the study. They have no idea how they change over time.

2) This study is consistent with several previous studies showing that olive oil consumption decreases the risk of dying from heart disease.

3) This study draws on its large population size and precise dietary analysis to strengthen and extend the previous studies. For example:

    • The study showed that increased olive oil consumption also reduced total mortality and mortality due to cancer, respiratory disease, and neurodegenerative disease.
    • The study measured the effect of substituting olive oil for other common dietary fats.
    • The study showed that increased olive oil consumption in the context of the American diet was beneficial.

I should point out that the headlines you have seen about this study may be misleading.

  • While the headlines may have depicted olive oil as a superfood, this study did not find evidence that olive oil was more beneficial than other unsaturated vegetable oils. Again, this is consistent with many previous studies showing that substituting vegetable oils for other dietary fats reduces the risk of multiple diseases.
  • The headlines focused on the benefits of increasing olive oil consumption. However, they neglected the data showing that increasing olive oil (and other vegetable oils) was even more beneficial (35% reduction in total mortality) in the context of a healthy diet – one with increased intake of fruits, vegetables, whole grains, nuts, legumes, and long-chain omega-3s and decreased intake of red & processed meats, sodium, and trans fats.

So, my recommendation is to follow a whole food, primarily plant-based diet and substitute extra-virgin olive oil and cold pressed vegetable oils for some of the animal fats in your diet.

Some vegan enthusiasts recommend a very low-fat whole food plant-based diet. They point to studies showing that such diets can actually reverse atherosclerosis. However:

  • Those studies are very small.
  • The overall diet used in those studies is a very healthy plant-based diet.
  • The studies did not include a control group following the same diet with olive oil or other vegetable oils added to it, so there is no comparison of a healthy vegan diet with and without vegetable oils.

If you have read my book, Slaying the Food Myths, you know that my recommendations encompass a variety of whole food, primarily plant-based diets ranging all the way from very-low fat vegan diets to Mediterranean and DASH diets. Choose the one that best fits your food preferences and the one you will be most able to stick with long term. You will be healthier, and you may live longer.

The Bottom Line

A recent study looked at the effect of olive oil consumption on the risk dying from all causes and from heart disease, cancer, respiratory disease, and neurodegenerative diseases. When the study compared people consuming the highest amount of olive oil (>0.5 tablespoon/day) with people consuming the least olive oil (0 to 1 teaspoon/day):

  • Mortality from all causes was decreased by 19% for the group consuming the most olive oil.

They also found that the group who consumed the most olive oil reduced their risk of dying from:

  • Cardiovascular disease by 19%.
  • Cancer by 17%
  • Respiratory disease by 18%.
  • Neurodegenerative disease (cognitive decline and Alzheimer’s disease) by 29%.

They also found that every ¾ tablespoon of olive oil substituted for an equivalent amount of:

  • Margarine decreased total mortality by 13%.
  • Butter decreased total mortality by 14%.
  • Mayonnaise deceased total mortality by 19%
  • Dairy fat decreased total mortality by 13%.
  • However, substituting olive oil for polyunsaturated vegetable oils had no effect on total and cause-specific mortality.

The authors concluded, “We found that greater consumption of olive oil was associated with lower risk of total and cause-specific mortality. Replacing other types of fat, such as margarine, butter, mayonnaise, and dairy fat, with olive oil was also associated with a lower risk of mortality. Our results support current dietary recommendations to increase the intake of olive oil and other unsaturated vegetable oils in place of other fats to improve overall health and longevity.”

For more details and a summary of what this study means for you, read the article above.

These statements have not been evaluated by the Food and Drug Administration. This information is not intended to diagnose, treat, cure or prevent any disease.

Health Tips From The Professor