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no antioxidant supplements during chemo?


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My Dad started chemo a few weeks ago - SCLC with mets to liver, taking cisplatin and VP16. We were told by the doctors that although antioxidants are good for you normally, my father should not take any antioxidant supplements during his chemo. As I understand it, some chemos work by producing free radicals to kill off the cancer cells, and antioxidants kill free radicals. So, the antioxidants might reduce the side effects of chemo, but will also interfere with its effectiveness. Does anyone have any info about this?

Thanks,

a.

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My Dad started chemo a few weeks ago - SCLC with mets to liver, taking cisplatin and VP16.

We were told by the doctors that although antioxidants are good for you normally,

my father should not take any antioxidant supplements during his chemo.

So, the antioxidants might reduce the side effects of chemo, but will also interfere with its effectiveness.

The advice given by your Docs is what the bulk of clinical/academic research supports today.

To undergo & endure chemo/rads and have ANYthing potentially DEcrease its effectiveness would be...simply horrible, cruelly horrible.

Far too much at risk at far too high a cost to NOT follow those simple and temporary directives.

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From the Townsend Letter for Doctors and Patients:

High Doses of Antioxidants Including Vitamin C Do Not Decrease the

Efficacy of Chemotherapy

Editor:

The idea that the use of antioxidants decreases the efficacy of

chemotherapy is being used more and more by orthodox oncologists. It is

based upon their hypothesis that anything which decreases the oxidant effect

of drugs will decrease the efficacy of chemotherapy. More and more I hear

this from my patients after they are diagnosed and chemotherapy is discussed

with them by their oncologists. This opinion is not universal, but my guess

is that about 75% of oncologists hold this view.

Their view is that chemotherapy destroys tumor tissue because it

introduces powerful oxidation products, free radicals, and that anything

which decreases that must interfere with treatment. They know they are using

sub-lethal amounts of toxic compounds which would never pass FDA standards

in any different context. The aim is to kill all the tumor tissue without

killing all the other tissues in the body. This is always a close call.

Therefore, since vitamin C is a good antioxidant it must not be given with

chemotherapy. One of my patients was told by his oncologist that if he took

vitamin C he would not be given any chemotherapy.

Well, what are the facts? The first fact is that there are no clinical

series which show that patients given vitamin C and chemotherapy fare worse

than those not given this vitamin. On the contrary, all the published series

show just the opposite. I have treated over 1,100 cases with large doses of

vitamin C and most of them had chemotherapy.1-4 I have examined the follow

up data and find that the mean difference on prolongation of life was

heavily in favor of the use of the vitamins. In the first series I published

with Linus Pauling those patients on my program lived 10 to 20 times as long

as the patients not receiving the vitamin.

Recently Kedar N. Prasad et al.5 after reviewing 71 scientific papers,

found no evidence that antioxidants did interfere with the therapeutic

effect of chemotherapy and, on the contrary, suggest the hypothesis that it

would increase the efficacy. He is properly cautious, but anyone reading his

paper knows that it is clear the probability that these antioxidants prevent

the therapeutic activity of chemotherapy is very low, and the probability

that they do the opposite, i.e enhance the action of these toxic drugs, is

relatively high. Prasad et al.6 concluded, "Antioxidants such as retinoids,

vitamin E, vitamin C and carotenoids inhibit the growth of cancer cells.

These antioxidants individually, and in combination, enhance the effects of

x-irradiation, chemotherapeutic agents, and certain biological response

modifiers such as hyperthermia, sodium butyrate and interferon, on cancer

cells. Antioxidants individually protect normal cells against some of the

toxicities produced by these therapeutic agents. Therefore, the fear of

oncologists and radiation therapists that these antioxidants may protect

cancer cells against free radicals that are generated by these agents is

unfounded. It should be pointed out that other antioxidants such as

sulfhydryl compounds will protect cancer cells at least against radiation

damage. This is not true for any of the proposed antioxidant vitamins and

carotenoids."

Even earlier Charles B. Simone et al.7 on the basis of a large number of

clinical studies (he also examined 71 scientific papers) came to the same

conclusion. He reported, "In a recent study of 50 patients with early-stage

breast cancer I evaluated the treatment side effects of radiation alone, or

radiation combined with chemotherapy, while the patients took therapeutic

doses of nutrients. Patients also followed the Simone Ten Point Plan.

Patients were asked to evaluate their own response to the treatment in terms

of its impact on their quality of life. The results of the study were

impressive: "More than 90% of both groups noted improvement in their

physical symptoms, cognitive ability, performance, sexual function, general

well-being and life satisfaction. Not one subject in either group reported a

worsening of symptoms." He concluded, "...cancer patients should modify

their lifestyles using the Ten Point Plan, which included modifying

nutritional factors and taking certain vitamins and minerals especially if

they are receiving chemotherapy, and/or radiation." (my emphasis)

Labriola et al.8 concluded that vitamin C may prevent the therapeutic

effect of chemotherapy if given concurrently and recommended that

antioxidants be withheld until after the chemotherapy is completed. It is

not clear whether they meant that the antioxidants should be withheld

throughout the entire series of chemotherapy sessions or that it should be

withheld only for the day that chemotherapy is being given. If the latter is

his suggestion, there is no harm done to the patients. Most of them cannot

take anything, including vitamins, during these sessions. He based his

conclusion on one case which suggested this had happened and upon a

hypothetical examination of the role of free radicals and antioxidants on

the action of chemotherapy on cancer cells.

His report elicited two rebuttals, Reilly9 and Gignac.10 I will not repeat

the arguments, but it was evident that Dr. Labriola was not convinced by the

points put forward by Reilly and Gignac. I think the factoid repeated by Dr.

Labriola would have a much better chance of becoming a fact if he had

considered the following points:

(1) What is the therapeutic value of chemotherapy without any

antioxidants? Even within the field of standard oncology there is a debate

whether chemotherapy has any merit except for a small number of cancers

(Moss).11 Before one can claim that a treatment has been inhibited, surely

there must be pretty good evidence that the treatment has any merit to begin

with. It is possible (we do not know the probability for this) that

chemotherapy interferes with the therapeutic value of the antioxidants.

Almost all the studies testing large doses of vitamin C yielded positive

results while there is no such unanimity with respect to chemotherapy.

(2) The difference between possibility and probability. Most people do not

distinguish between these two. Theoretically anything is possible, and it is

certainly possible that taking vitamin C might prevent the toxic

"beneficial" effect of chemotherapy. In the same way when one buys a

lottery ticket, it is possible they may win. People confuse these two terms,

which is why lotteries are so popular. The real statistic is the

probability. What is the probability that patients receiving vitamin C

during their chemotherapy will not fare as well? The lottery ticket may give

one a probability of winning of one in a million, and the possibility that

vitamin C may prevent the therapeutic effect of chemotherapy may be equally

low. We can only assume from the literature reviewed by Simone, by Prasad,

by Lamson and Brignall, and more recently by Moss12 that the real

probability must be extremely low. As I have pointed out earlier, I have

seen no evidence that adding vitamin C inhibited the therapeutic effect of

chemotherapy. Just the opposite. Patients on my orthomolecular program live

substantially longer and about 40% achieved over four year cure rates.13

(3) If he had not tried to bolster his argument by referring so frequently

to the peer-reviewed journal in which his paper appeared. This is certainly

no guarantee of fact. The first factoid that vitamin C caused kidney stones

appeared in eminently peer-reviewed journals. All the factoids regarding

vitamins appeared first in peer-reviewed journals. You may recall Linus

Pauling's joke that peers are people who pee together. I can assure you that

articles attacking the use of vitamins have very ready access to

peer-reviewed journals, but they would not have accepted their report had

they tried to conclude from one patient that vitamin C taken during

chemotherapy was therapeutic. This would not even be sent to the peer review

committee because they do not accept anecdotes - unless of course they

become scientific when they contain something adverse against vitamins.

(4) Moss points out that oncologists have no objection to using xenobiotic

antioxidants during chemotherapy. This includes Amifostine which decreases

the toxicity of radiation but is too toxic on its own and is not used;

Mesna, a drug used around the world to protect against the toxic side

effects of ifosfamide which damages the urinary system; and Cardiozane,

which counters Adriamycin's toxicity. There are over 500 papers showing the

safety of the latter drug. In one clinical trial using a drug similar to

Adriamycin, one-quarter of the patients suffered damage to their hearts.

When given Cardiozane concurrently only 7% did. Thus it appears that only

orthomolecular or natural antioxidants are potentially dangerous. Synthetic

antioxidants protect against the toxic effect of drugs but do not increase

their therapeutic value. In sharp contrast, natural antioxidants not only

protect against the toxic effect of drugs but also increase their efficacy

in destroying cancer cells.

(5) Dr. Labriola emphasizes that long term studies must be used. I agree,

and for this reason I followed up my patients since 1977. In my series,

hardly any patients receiving chemotherapy but not antioxidants survived

very long. But chemotherapy is used by many oncologists who know it will not

extend life, because there is nothing else that they can do and they feel

they have to do something.

A. Hoffer MD PhD FRCP©

Suite 3 - 2727 Quadra Street

Victoria, British Columbia V8T 4E5 Canada

250-386-8756

Fax 250-386-5828

References

1. Hoffer A & Pauling L: Hardin Jones biostatistical analysis of mortality

data for cohorts of cancer patients with a large fraction surviving at the

termination of the study and a comparison of survival times of cancer

patients receiving large regular oral doses of vitamin C and other nutrients

with similar patients not receiving those doses. J Orthomolecular Medicine

5:143-154, 1990. Reprinted in, Cancer and Vitamin C, E Cameron and L

Pauling, Camino Books, Inc. P.O. Box 59026, Phil. PA, 19102, 1993.

2. Hoffer A & Pauling L: Hardin Jones biostatistical analysis of mortality

data for a second set of cohorts of cancer patients with a large fraction

surviving at the termination of the study and a comparison of survival times

of cancer patients receiving large regular oral doses of vitamin C and other

nutrients with similar patients not receiving these doses. J of

Orthomolecular Medicine, 8:1547-167, 1993.

3. Hoffer A: Orthomolecular Oncology. In, Adjuvant Nutrition in Cancer

Treatment, Eds. P Quillin & RM Williams. 1992 Symposium Proceedings,

Sponsored by Cancer Treatment Research Foundation and American College of

Nutrition. Cancer Treatment Research Foundation, 3455 Salt Creek Lane, Suite

200, Arlington Heights, IL 60005-1090, 331-362, 1994.

4. Hoffer A. One Patient's Recovery From Lymphoma. Townsend Letter for

Doctors and Patients #160:50-51, 1996.

5. Prasad KN, Kumar A, Kochupillai V & Cole WC. High Doses of Multiple

Antioxidant Vitamins: Essential Ingredients in Improving the Efficacy of

Standard Cancer Therapy. Journal American College of Nutrition 18:13-25,

1999.

6. Prasad KN, Cole WC & Prasad JE. Multiple Antioxidant Vitamins as an

Adjunct to Standard and Experimental Cancer Therapies. Z.Onkol/J. of Oncol

31:1201-1078, 1999.

7. Simone CB, Simone NL & Simone CB. Nutrients and Cancer Treatment.

International Journal of Integrative Medicine 1:20-24, 1999.

8. Labriola D & Livingston R. Possible Interactions Between Dietary

Antioxidants and Chemotherapy. Oncology 13:1003-1008, 1999, and Editorial to

Townsend Letter for Doctors and Patients, November 1999.

9. Reilly P. Dr. Labriola's Editorial on Antioxidants and Chemotherapy,

Townsend Letter for Doctors and Patients Feb/Mar 2000, 90-91.

10. Gignac MA. Antioxidants and Chemotherapy. What You Need to Know Before

Following Dr. Labriola's Advice. Townsend Letter for Doctors and Patients

Feb/March 2000, 88-89.

11. Moss RW. Questioning Chemotherapy. Equinox Press, Brooklyn, New York.

12. Moss RW. Antioxidants Against Cancer. Equinox Presss Inc. Brooklyn,

New York, 1999.

13. Hoffer A. Vitamin C and Cancer. Quarry Press, Kingston, ON 2000.

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© 1983-2002 Townsend Letter for Doctors and Patients

All Rights Reserved.

Bill Asenjo, PhD, CRC

Writer; Consultant

www.billasenjo.com

basenjo@a...

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