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Old 11-26-2010, 10:31 PM   #1
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Dietary supplements before Radiation Therapy

I took a list of questions with us when we went to meet with the surgeon for Irv's pathology report.

One of the questions I asked him was with regards to dietary factors and nutritional supplements. One thing I found puzzling was that, from my list, he recommended a low fat diet, limited red meat and soy, 40 grams, but he advised agains selenium, Vitamin D, Vitamin E, and Lycopenes (30 mg), saying that these items could interfere with radiation and should wait until after.

Have any of you heard about this? I want to work on attacking Irv's cancer as soon as possible and I don't understand how these supplements could have an effect on the radiation.

I'll look forward to as many responses on this as I can get.

Thanks
Rhonda

 
Old 11-27-2010, 11:53 AM   #2
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Re: Dietary supplements before Radiation Therapy

Hi Rhonda-

There is some evidence that low fat limited red meat and no dairy have been beneficial in preventing recurrence, but that is not specifically a radiation issue. As for the supplements, I'll address them each:

Vitamin D -- it seems to be beneficial for preventing and suppressing cancers. In some studies, it has been shown to potentiate the effects of radiation.

Lycopene - some studies show some benefit in preventing PC,other studies show no effect. A big issue is bioavailability -- there seem to be certain enzymes that become active when tomatoes are heated and processed that helps your body to absorb lycopene. Without those enzymes, it is mostly excreted. Much better sources of lycopene are tomato paste, tomato sauce and ketchup. No evidence of benefit or detriment with radiation, but see my comments about anti-oxidants below.

Vitamin E & Selenium - Probably the most studied of all supplements for PC. They have been shown to be of no benefit. In fact, Vitamin E (400iu) has been associated with an increase in PC. If you would like to read more about it, here's a reference:
http://www.cancer.gov/newscenter/qa/2008/selectqa

This also brings up the issue of antioxidants and radiation. There are many unknowns in this area, but it may be useful to understand how radiation works. Much of its effect is due to the creation of what are called "Reactive Oxygen Species (ROS)" which include ionized oxygen-containing molecules and free radicals. These help destroy the DNA of cancer cells so they cannot replicate. Anti-oxidants and free radical scavengers may interfere with what we are trying to achieve. Vitamin E, Selenium, Vitamin C and glutathione may fall into this category, although there hasn't been any real proof. Yet, why take the chance?

What we are looking for in supplements are two qualities: radio-sensitization of cancer cells (i.e, they specifically make cancer cells more sensitive to the ionizing effects of radiation) and radio-protection of healthy cells.What we do not want is to radio-protect cancer cells. Here's my list of top supplements that do this. There may be many more, but in my research these are the best-studied ones.

Exercise - Combined aerobic and resistance seems best. Not really a supplement, but incredibly important when having radiation. Not only does it prevent radiation-induced fatigue and positively affect mood, but it increases oxygenation of all tissues, making healthy tissues healthier, and making cancer cells more prone to destruction by ROS.

Soy Isoflavones - Seems to radio-sensitize cancer cells, and radio-protect many kinds of healthy cells, and may help prevent fibrosis. The combined soy isoflavones seems to work better than Genistein alone.

COX-2 Inhibitors - This includes Celebrex (Rx), ibuprofen, naproxen, and aspirin. They are good radiosensitizers. Also useful for preventing urinary retention that usually occurs with PC radiation.

Statins - (Rx) Low dose statins have improved biochemical outcomes in patients treated with radiation for PC. They also may help prevent fibrosis and protect the intestines. Of course, they lower cholesterol too.

Quercetin - Radiosensitizer that may also protect white blood cells and mitochondria.

Omega-3 - Fish oil, flaxseed oil. Has been shown to be a radiosensitizer for some cancers, but not specifically for PC. Radioprotective of several types of healthy tissues.

This one is popular, but I'm not yet convinced:
Ellagic Acid/ Pomegranate Juice - May help prevent or slow down PC and has demonstrated radiosensitization for cervical cancer. Effect with radiation for PC is unknown. No known radioprotective effects on healthy tissues.

Last edited by Tall Allen; 11-27-2010 at 04:02 PM.

 
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Old 11-29-2010, 03:36 PM   #3
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Re: Dietary supplements before Radiation Therapy

Hi Rhonda (and Allen),

I'm adding a few thoughts to Allen's post about supplements, specifically to the part about vitamin E and selenium. I'll insert text in green.


Quote:
Originally Posted by Tall Allen View Post
Hi Rhonda-

There is some evidence that low fat limited red meat and no dairy have been beneficial in preventing recurrence, but that is not specifically a radiation issue. As for the supplements, I'll address them each:

...
Vitamin E & Selenium - Probably the most studied of all supplements for PC. They have been shown to be of no benefit. In fact, Vitamin E (400iu) has been associated with an increase in PC. If you would like to read more about it, here's a reference:
http://www.cancer.gov/newscenter/qa/2008/selectqa
...
I understand where you are coming from and found the cited article interesting. However, I believe that both vitamin E and selenium are likely to be resurrected in the war against prostate cancer. I've taken both since early 2000 and continue to do so, though I've modified the dosages. I think that's appropriate for me, in view of my track record of PSAs, exams, tests, etc., but I hesitate to recommend either for new patients at this point as they do not have a track record that suggests that at least these elements are not doing any harm.

The trial did not actually show that either had no benefit, but it did fairly strongly indicate that the versions of vitamin E (and dosage) and selenium that were used in the trial lacked benefit. The article Allen cites goes into this in good detail. However, I wish it had gone a little further.

Let's take vitamin E. The form used was alpha tocopherol, the most commonly available vitamin E supplement, rather than a mixed form involving at least a high proportion of gamma tocopherol or also other tocopherols. In the early days of the trial some researchers outside the trial (with me finding their thoughts worrisome) observed that there was already research indicating that gamma tocopherol appeared to be the kind of vitamin E that really helped against prostate cancer, with an additional concern that an excess of alpha tocopherol tended to produce a deficit of gamma tocopherol, a potentially harmful situation. In addition to this issue, the dose - at 400 IU daily, which had been widely considered safe when the trial was launched, was fairly shortly found in one study to create a risk of excessive bleeding, potentially serious for patients facing surgery (especially emergency surgery where the vitamin E could not be stopped in advance), involved in accidents, or suffering a certain kind of stroke.

That created a dilemma for the review board that governed the trial. With
thousands of men involved in the vitamin E and combo Vitamin E/selenium arms of the trial, it was reasonably likely that some men would suffer risky bleeding events due to their participation in the trial. The board had early access to on-going results, and they could not see or project that the trial was likely to meet its success objectives. Therefore, the board shut the trial down.

The form of selenium in the trial was also questionable, as discussed in the article. This too was known as the trial was planned, but the trialists thought they had a superior form of selenium, including longer duration of action in the body, and the trial went forward. As with vitamin E, some prominent researchers were concerned about this and advocating the other form of selenium, and also again I found their views worrisome. Still, I hoped that the trial leaders would turn out to be right after all.

Dr. Phllip Kantoff, a prominent prostate cancer research and physician from the Boston area, has led a team that discovered preliminary evidence of a genetic link that affects the value of selenium. In short, men with certain genes benefit quite substantially from selenium, while men with alternate genes do not. I find this highly encouraging. Hopefully we will be able to have widespread access to a valuable genetic test for selenium within the next few years.

Ideally, we would have a new SELECT trial with a form of vitamin E involving a lot of gamma tocopherol and a dose of 200 IU or lower, which appears quite safe, and a better form of selenium, perhaps also with genetic testing used as an eligibility criterion for the trial. However, especially in this era of budget austerity, that is unlikely to happen. The SELECT trial was funded by the Government, as you would expect in view of the fact that neither vitamin E nor selenium can be patented, a feature important to protecting an investment a company makes in an expensive trial. The Government spent more than $100 million on this trial.

We have also become aware of some potential problems with both vitamin E and selenium, in addition to those noted above. Vitamin E can eliminate the impact of statin drugs for some patients, drugs which many patients take to counter cholesterol issues. There is also weak evidence now that selenium use may be linked to a slightly increased risk of insulin resistance or diabetes. In view of all these concerns, a new patient needs to think carefully whether these drugs make sense for him. I'm confident in using them for myself, as my annual physical lab results and ongoing lab results show no problem with cholesterol control with simvastatin or with insulin resistance/diabetes. As one of the experts in nutrition and prostate cancer notes, we also have antioxidant options now that appear superior to vitamin E and selenium. One of them is curcumin, provided it is in a formulation that is absorbed and bioavailable but without inadvertently boosting bioavailability of other supplements/drugs, which can be a potentially major problem with curcumin supplements. These options decrease the need for vitamin E and selenium to some degree.

I hope this helps.

Jim

Last edited by IADT3since2000; 11-29-2010 at 03:38 PM. Reason: Shifted quote block immediately after posting.

 
Old 11-29-2010, 03:44 PM   #4
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Re: Dietary supplements before Radiation Therapy

Wow, Jim! Your knowledge never fails to impress me. Well, we may not be that ready to deal with that kind of complexity but we were out today and I bought 90% cacao dark chocolate and red wine.....and veggie cheese (soy product) and a couple of other tofu products....and I reminded Irv to take his Vitamin D. Hey, it's a start....and no red meat.

Thanks, Jim.

 
Old 11-29-2010, 03:52 PM   #5
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Re: Dietary supplements before Radiation Therapy

Hi Rhonda,

Your dedication continues to impress me!

About that cocoa - I now stick with dark chocolate that is about 72% cocoa. That's a hefty percentage of cocoa, yet it still has enjoyable taste. For a while I was on the 90% and then 85% stuff, but to me it was sort of like waxy edible cardboard with no real enjoyment - not bad, but neutral. Still, 90% gives you the most bang for your buck.


Quote:
Originally Posted by srhonda61 View Post
Wow, Jim! Your knowledge never fails to impress me. Well, we may not be that ready to deal with that kind of complexity but we were out today and I bought 90% cacao dark chocolate and red wine.....and veggie cheese (soy product) and a couple of other tofu products....and I reminded Irv to take his Vitamin D. Hey, it's a start....and no red meat.

Thanks, Jim.
I think you guys are going to make it!

Take care,

Jim

 
Old 11-29-2010, 03:58 PM   #6
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Re: Dietary supplements before Radiation Therapy

Ok, Jim....now I'm going to cry again. Thank you. You're wonderful. I bought 72% too...but it had a higher sugar content. So, how much of it do you indulge in? I mean, too much of a good thing isn't great either. I told Irv that we should have a nightly ritual with a glass of red wine and dark chocolate nightly...maybe some fruit....clementines or kiwi slices....and ....maybe with candles....

Oh, that Lindt chocolate that's 90%....it isn't too bad. It isn't Belgian milk chocolate by any stretch, but I think it might be ok with red wine.

 
Old 11-29-2010, 04:02 PM   #7
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Re: Dietary supplements before Radiation Therapy

Aw, thanks. Now you're making me feel mushy.

I usually stick to just two squares, sometimes indulging in three. For most of us prostate cancer patients, sugar does not seem to play a significant role in the disease, though there is some controversy. Sugar plays a significant role in a number of other cancers.

Take care,

Jim

 
Old 11-29-2010, 04:38 PM   #8
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Re: Dietary supplements before Radiation Therapy

I have seen the preliminary research on gamma tocopherol in Australia and it looks promising but hardly definitive. Vitamin E is a grab-bag of mixed tocopherols, which has been proven ineffective for PC. Perhaps one tocopherol undoes the possibly good work another does. Such agonist/antagonist effects are common. The fact that it interferes with the effects of statins, and there is a lot of good evidence that statins are good for PCa, is reason enough to refrain from using large doses until more is known. Getting normal amounts from whole grain foods is a great idea.

It's true that there are forms of selenium that may be more effective than what is available at health food stores, which we now know to be ineffective for PC.

Research continues -- there are so many substances that show promise in lab studies but that seldom pan out in real life. With all the nutriceuticals that claim to promote prostate health, it's amazing that any of us have the disease. :-)

The major point I was making are that both of these are powerful anti-oxidants that may interfere with future radiation treatments --we just don't know, and there is no known benefit, so why risk it? Oil soluble vitamins like Vitamin E are stored for a long time, minerals are known to accumulate over time as well. If Irv is possibly facing radiation treatments down the road, I agree with his doctor that these two in particular should be avoided.

 
Old 11-29-2010, 06:42 PM   #9
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Re: Dietary supplements before Radiation Therapy

Okay Tall Allen and Mushy Jim, I think maybe Irv should stick to Vitamin D, soy products, red wine and dark chocolate and stay away from red meat and dairy fat. Are we on the right track???

Hugs, Rhonda

ps I'm guessing morphine and red wine would NOT be a good mix...trying to figure out how long to wait before Irv can enjoy some red wine.

 
Old 11-30-2010, 10:42 AM   #10
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Re: Dietary supplements before Radiation Therapy

Yes, that's a good start. It might help to get at least ten servings containing lycopene (V8, tomato juice, a tablespoon of catsup or cocktail sauce, pizza sauce - but watch the cheese, cooked tomatoes, etc.), a few bags worth of green tea with a little lemon and stirred a few seconds while brewing, and especially some high quality pomegranate extract. Those should all be easy. Moving toward the Mediterranean diet could be a little harder, depending on where you are now.

Jim

 
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