Cancer patients work through the vitamin maze

As if choices about what to eat from a nutritional standpoint are not difficult enough given often-conflicting or changing information, those who have faced cancer have perhaps the most difficult decisions of all to make.

To that end, the Breast Cancer Survival Group invited Patrick Corbett, a pharmacist and medication safety officer at Norwalk Hospital, to its meeting April 8 at Wilton Library. Mr. Corbett spoke to a group of women about what vitamins and herbal supplements would be safe and beneficial for them to use.

“I want to empower you to make the best decisions on the evidence available,” he said.

The biggest caveat for breast cancer survivors is “just say no to soy,” he said. “You want to avoid high doses of pure soy products.”

When selecting protein supplements or shakes he advised women to read product labels.

“Does it have a lot of soy protein?”

An occasional bowl of miso soup with tofu is not cause for concern “if it’s the exception and not the rule,” he said. “Soy does replicate estrogen,” which has been implicated in the growth of certain cancers.

“Excessive use of soy is what I’d avoid, especially products advertised to post-menopausal women to avoid hot flashes,” he said. He also warned against black cohosh, red clover and dong quai, which are big estrogen compounds.

At the other end of the spectrum, calcium D-glucarate is thought to lower estrogen levels, but Mr. Corbett warned it can impair liver metabolism.

“You can get it from broccoli, Brussels sprouts and cabbage” among other vegetables, and plant sources are OK, he said. It’s the “intensive” amounts that can do more harm than good.

Indole-3-carbinol, also known as I3C, is also found in cruciferous vegetables and may modulate the body’s production of estrogen, but high amounts, such as you would get in a supplement, can cause drug interactions with headache medications. It is usually mixed in with antioxidants, he said.

Vitamin D

Of all the vitamins Mr. Corbett spoke about, Vitamin D is one of the ones he recommends most often. Known as the sunshine vitamin, its production in the body is triggered by exposure to sunlight, but because of weather in the Northeast and the tendency for people to spend many hours indoors, deficiencies are not uncommon.

“It is suggested that 2,000 units daily is the normal range,” he said, but there are 50,000-unit pills available by prescription for people “who need a boost.”

He recommends that breast cancer survivors get their levels checked.

“People in this area need Vitamin D,” he said. He suggests starting with 2,000 units. “Less does not cut it in this area.”

Some chemotherapy regimens leave patients with neuropathies that cause weakness, numbness and pain, usually in the hands, arms and feet, a situation that can be exacerbated by a Vitamin D deficiency.

“Vitamin D3 has been shown to decrease some neuropathies,” he said. “It’s an inexpensive option for one of the worst side effects,” he said, adding that when shopping for vitamins, the most expensive choice is not necessarily the best. When asked for a recommendation he said the Kirkland brand from Costco and the CVS store brand are both good choices.

Vitamin D also helps in the absorption of calcium, a mineral women are often told to make sure they get enough of. There are many good natural sources, such as milk and yogurt, fish, and vegetables.

“When I think of calcium, I think of it in its elemental form,” he said, “and you need 1,200 to 1,400 mg.

There are several types of calcium available, but he took calcium carbonate as an example.

“Calcium needs a vehicle to get into your body,” he said. “Carbonate is the vehicle. If a calcium carbonate supplement is 1,250 mg, 500 mg of that is elemental calcium.

“The body can only absorb 500 mg of elemental calcium at a time,” he added.

It is stomach acid that breaks the calcium-carbonate bond, which is not a problem unless someone is taking drugs like Nexium or Xanax to reduce stomach acid.

One of the women in the audience asked if juices with added calcium are of any benefit, and Mr. Corbett said the levels are not that great.

Vitamin A/betacarotene can reduce the risk of breast cancer in pre-menopausal women at risk, he said, or those who drink excessive amounts of alcohol. It is not known if that protection extends to post-menopausal women.

Vitamin E is a popular antioxidant, but a study last year indicated high doses can increase the risk of heart problems.

Green tea is a popular, healthy drink that contains EGCG (epigallocatechin-3-gallate), a potent antioxidant.

“Some studies show EGCG can reduce tumor growth, but usually in Asian-American women,” he said. The studies involve consumption of three to five cups of green tea daily, which contains significant caffeine.

“There are some studies that drinking green tea can reduce the progression of tumors in stage 1 and 2,” but no evidence of the same beneficial effect for later stages of cancer, he said. “I can’t recommend green tea supplements because there is no reliable evidence” of their effectiveness, Mr. Corbett added.

Two of the most common drugs given to breast cancer patients are tamoxifen and aromatase inhibitors, both of which cause menopausal symptoms in women, including bone pain.

Weight-bearing exercises and yoga can help, Mr. Corbett said.

“I am a big proponent of yoga,” he said, adding, “Many patients find healing from meditative practices” as well as acupuncture, all of which have no drug interactions.

Some women taking these drugs suffer depression, but Mr. Corbett said it is difficult to differentiate between effects of the drug and effects of the fact they have had to face cancer and its aftermath.

“All of this is about quality of life,” he said. “You have to live the best life you can. It’s all about you.”

With the amount of research being done, he said, “tomorrow we might find out all the things we said tonight are lies. We learn more each day.”

The support group will meet again at the library on Tuesdays, May 13 and June 10, at 6. Meetings are free and a light supper is provided. After June, meetings will resume in September.

For more information, call organizer Nina Marino at 203-857-7304.