Navigating Supplements in Cancer Treatment: Insights from a Harvard Expert
What should cancer patients know about supplement intake during treatment? Expert Dr. Jennifer Ligibel from Harvard Medical School discusses advice about taking supplements during cancer treatment, communicating with healthcare providers, interactions with cancer medications, and improving the gut microbiome for optimal absorption.
Related Resources:
How Does Nutritional Screening and Assessment Impact Cancer Care? |
|
|
Transcript:
Lisa Hatfield:
It’s essential to understand which supplements can support your health and which ones to avoid to maximize treatment effectiveness and overall well-being. With so much misinformation, are there evidence-based studies that can provide clarity? Find out next on this Patient Empowerment Network RESTORE program.
Dr. Ligibel, what are the essential guidelines for taking supplements during cancer treatment, and how can patients and their care partners select the right supplements without affecting treatment?
Dr. Jennifer Ligibel:
This is such a great question, Lisa, and one that my patients are asking me all the time. There is so much information and misinformation out there about supplements that it can make it really hard for people to know what they should be doing, to worry that they might be missing out on something important. And so, I think it’s really important to talk about supplements and how they factor into cancer treatment.
The first thing I will say is that if you are considering taking a supplement, please talk to your medical oncology providers about this. I think there have been studies that have shown that a lot of people who take supplements don’t talk to their oncology team about the supplements they’re taking. And this is so important, because there can be interactions that occur. I think it’s just so important that as an oncologist that I know the medicines that my patients are taking, whether they’re over-the-counter medicines or medicines that I or another physician prescribe.
I will be honest that most guidelines from groups like the American Cancer Society, the Oncology Nursing, the Oncology Nutrition Society really recommend that people get their nutrients from food. And the reason for this is that your body absorbs nutrition much better from food than it does from supplements. And it can be difficult to get to a dangerous level of a nutrient from food as opposed to from a supplement. Now this is for the average patient who has good nutrition and is able to eat.
The situation is quite different if people are not able to eat a balanced diet because of their cancer treatment or because of some kind of mechanical issue that’s related to the cancer or the surgery they’ve had. And in that situation, it is so critical that patients work with an oncology nutrition specialist, someone who really understands oncology treatment to make sure that they’re getting the nutrients that they need, because nutrition during cancer is such an important thing.
I think sometimes it is very tempting to want to take supplements as an alternative to treatment or an enhancement. And I think what’s very tricky about this is that supplements are not regulated as medicines in the United States. And so, that means that people can say things about supplements on their advertisements that may not be supported by the same kind of clinical trials that lead to the approval of a medicine, for example.
And so, that can make it really complicated for people to know what is really based on kind of fact and what may not be. I think another piece that’s so important is making sure if you’re somebody who’s actively receiving a cancer treatment, and this is especially true with a lot of the new targeted treatments, many of which are oral that if you are going to take a supplement that you make sure that it’s not going to interact with the cancer treatment that you’re taking.
A lot of supplements use the same cellular machinery to metabolize or break down the supplements that are used to metabolize cancer medicines. And so, what can happen is if you have two things that use some of the same machinery, sometimes you can end up with really high levels of a medication in your system or really low levels. So if you are interested in taking a supplement, it’s critical that you talk to your oncology team about it, so they can just make sure that it’s not going to impact the effectiveness of the cancer treatment.
There are also supplements that may have hormonal properties, things like an estrogen-like effect, and that can be of concern if you have breast cancer. So again, just really important to review all supplements with your oncology team. A lot of my patients take supplements and, you know, my perspective on all of this is that people are going to make their choices and do the things that feel best for them. My role as an oncologist is just making sure that things are safe and that I really want to have an open dialogue with my patients and just make sure they feel comfortable telling me about the medicines they’re taking so that I can make sure that they wouldn’t have any effect on the treatments that I was prescribing to the patient.
Lisa Hatfield:
Okay. Thank you. So, are there any supplements in particular that cancer patients should avoid or that they really need to be closely monitored?
Dr. Jennifer Ligibel:
So I am not an expert in different supplements, and this is a place where there is a growing workforce in oncology that focuses on integrative medicine. There are many places that have integrated medicine services or pharmacists within their cancer center where they could really answer that question much more concretely, because sometimes it depends on what medicines the patients are receiving. A lot of this is about interactions and changing the effectiveness of cancer treatment. For people that are not on therapy, I think that the concerns are generally much lower.
The other thing though that sometimes can happen, and that it really can be difficult, is that supplements and these more alternative treatments are not supported by insurance. And cancer itself has such financial toxicity that I do think that sometimes when people are worried about their outcome and their health, they can be more susceptible to, unfortunately, ending up spending thousands and thousands of dollars on these products.
And I do think, again, it’s just important to really look at the level of evidence when people are saying that this, whatever the supplement is, would maybe treat your cancer, to kind of think about sometimes if things sound too good to be true, they can be. So I just really also just want to make sure that people are aware of what the level of evidence is and the cost of many of these products.
Lisa Hatfield:
I appreciate you pointing that out, because I think sometimes us cancer patients feel desperate to take care of this cancer, and so we’ll go to great lengths to do that. So thank you for mentioning that. Always, always talk to your healthcare team for advice on supplements.
Dr. Jennifer Ligibel:
There is a group called the Society for Integrative Oncology which is an international group that does a lot of research and work focused on integrative therapies and supplements in cancer. And that’s also a really nice resource for people looking for more information about supplements in cancer that’s evidence-informed. But I think really nicely balanced and recognizing the importance for people to feel autonomy in their health balanced with the safety and the financial pieces, so that’s a good resource for people.
Lisa Hatfield:
And I do have one last question. Hopefully, there’ll be a quick one for you. It’s regarding probiotics, because sometimes the chemotherapy or any medications we’re taking can wreak havoc on our system. I did consult with a local dietician she recommended, similar to you. She said, use whole foods to get those pro- and prebiotics, that was her suggestion. Unless she said, unless you have a vitamin D deficiency, then that’s an okay supplement.
But what are your thoughts on that, if a patient wants to take a probiotic or wants to improve their gut microbiome because of the side effects of treatment?
Dr. Jennifer Ligibel:
That is such a good question. And the microbiome is such a hot topic, and there’s just so much we don’t understand about the microbiome. You know, it’s interesting, there were studies, there have been studies that have actually shown that the composition and health of the microbiome is directly related to how well patients with some kinds of cancers respond to immunotherapy, which is kind of fascinating when you think about that connection with gut health and effectiveness of treatment.
But in that situation, people who took antibiotics and probiotics actually had less diversity of their gut microbiome, and that was related to not having as good of an outcome. Now that is a very small study, and I think there’s a lot that we don’t know, but I think what the dietician had suggested that your food is a better way to populate your microbiome, I think is important. And there are some foods that are very, very, very rich in active bacterial species. I mean, simple things like yogurt and then more complicated foods, things like kimchi really have some interesting impacts on your microbiome.
And consuming those types of foods I think really contribute to having a diverse bacterial kind of the…a lot of different species seems to be related to better outcomes in some cancers. And so, again, this is like really, really early. Some of it feels like science fiction where they’re taking someone’s gut microbiome and transplanting it into someone else. But I think this is a really interesting area. But again, as much as you can get your nutrition from food, I think the better for people’s overall health and their gut health.
Lisa Hatfield:
You’ve heard it here straight from the expert. Thanks for joining us on this RESTORE program. I’m your host, Lisa Hatfield.
