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Nutritional Support

The following information comes in part from the clinic of Drs. Gary and Rayne Klepper in their work of supporting cancer patients undergoing chemotherapy and radiation therapy.

Supplement Smoothie
There are many times when it is necessary to minimize the amount of oral supplementation prescribed to a patient.  During cancer therapies such as chemotherapy and radiation, this may be essential due to chronic gastrointestinal irritation.  For some patients it is a matter of convenience, or possibly a simple overwhelm of capsules and tablets to swallow. 

Supplements taken in the form of a smoothie will not only address these issues, but also deliver a concentrated form of nutrition that requires very little digestion.  The chronically ill patient is typically compromised, and will need to use valuable digestive energy very efficiently.  

To mix a smoothie, first, determine a liquid base:  water, coconut milk or water, goat or sheep yoghurt or milk, blended whole fruits, or almond milk.  Do not use fruit/ vegetable juices, or rice milk, due to the high glycemic index of these liquids.  Most juices are very concentrated sugars. Do not use soymilk due to the high copper content of soy.   

You can use hormone-free cow’s milk or yoghurt if not allergic.  This does not concern the whey portion, but the casein protein fraction.  Many patients develop a hypersensitivity during aggressive oncological treatment, even if it was not present prior to therapy.

Whole fruits that are blended with water as a base should include organic berries for the extra resveritrol content.  Add only one half of a banana, again for glycemic index considerations. 

Chemotherapy and radiation produce cold injury, and as a result, the patient must not take in cold liquids.  The easiest approach is to blend the mixture until the outer casing of the blender jar is warm to the touch, rather than chilled. 

The following are general supplement recommendations.

Support Supplement Smoothie

PaleoMeal :
This is the main protein powder based drink mix that we use in practice, having replaced all previously recommended products, as PaleoMeal has them all outclassed.  This is basically a well-tolerated liquid multiple with immune and digestive support.  PaleoMeal combines really clean, high quality whey protein with phospholipids, CLA, antioxidants, digestive enzymes, flax lignans, taurine, vitamins and minerals, fiber, etc. without the addition of soy, rice polish or powder, fructose, non-organic oils, or genetic mutants.  The whey globulin fraction has been proven in clinical studies to support bone marrow regulation, particularly the production of stem cells.   Dosage will be 1-2 scoops, up to 2 x/day.

Note:  if you have a very, very weak digestion, and is exhibiting the pattern of spleen cold/damp, PaleoMeal may not be well tolerated and could cause nausea.  In these cases, substitute Whey Cool protein powder for the PaleoMeal in the supplement smoothie recipe.  As the digestion improves, add part PaleoMeal and part Whey Cool.

Whey Cool:
We add additional Whey Cool to the PaleoMeal if a patient is undergoing chemotherapy with an alkylating agent such as Melphalan or Cytoxan in high dose, for the regulating effects on the bone marrow and erythrocyte count.  To increase protein intake, we give 1 scoop of Whey Cool and 1 scoop of PaleoMeal 2x/day.  One scoop of Whey Cool provides 24 grams of protein from 30 grams of whey.  

Glutamine Powder:
Glutamine has a calming effect on the nervous system and small intestine membranes, as well as supporting the mucous lining of the digestive tract.  It also has specific anti-cancer properties, and will support metabolic energy production. 

With mucositis, mix ½ teaspoon Glutamine with ½ teaspoon Probiotic synergy in water, swish in the mouth and then swallow.  Glutamine is contraindicated in glioma type brain tumors.  Dosage:  2 teaspoons up to 2 tablespoons over the day.

Brain Vitale or Brain Vibrance Supreme:
This is a powder of primarily Acetyl carnitine and Phosphatidyl Serine that is imperative to protect the brain and central nervous system, and prevent neuropathy.  It also contains GPC. 

This is a convenient combination, with dosage ranging from ½ to 1 teaspoon.  This provides 240 mg of Phosphatidyl Serine.  We sometimes use individual Phos Serine powder if a higher dose is needed for corticosteroid detoxification, but build up slowly as it is a cholagogue.

Phosphatidyl Choline:
A major phospholipid that will regulate the cell membrane, and increase the surface area for detoxification in the liver mitochondria.  There is 840 mg per scoop of PaleoMeal, which represents about 1/3 of the appropriate dose during chemotherapy and radiation, so add 1-2 teaspoons to the smoothie.  

Quercitin Ascorbate powder, Quercitin and Nettles capsules:
Quercitin is a flavenoid that acts as an antioxidant, stabilizes mast cell release of histamine, and has numerous cancer protective effects.  Many patients develop allergic reactions to the pre-treatments for chemotherapy, especially the taxanes.  The contrast media used for imaging scans also causes histamine reactions.  We routinely add 1.5 teaspoons of the powder, or open 5-6 capsules of Quercitin and Nettles into the smoothie.

MSM Raspberry, or Lemon:
This is a source of sulfur for phase 2 Liver detoxification, an anti-inflammatory, and a mild copper chelator.  A rounded teaspoon provides 500 mg of vitamin C, which is not chilling to a cold-injured patient.  We do not generally add powdered C to the smoothie since it is very cold in nature, and MSM provides a meaningful dosage.

Taurine will protect the heart, particularly with antibiotic forms of chemotherapy such as adriamycin, that cause extreme cardiotoxicity.  It will also raise the kidney threshold for magnesium excretion, prevent and reverse macular degeneration, and is necessary for the production of bile salts.  During chemotherapy, the dosage will be 1000-2000 mg, with ¼ teaspoon providing 1.5 grams.  We generally give ½ teaspoon, particularly to those patients undergoing antibiotic chemotherapy.   
Probiotic Synergy:
Dosage will range from ½ teaspoon to 2 teaspoons, depending on the presence of mucositis.

GI Revive:  
This can be a miracle for a patient in aggressive oncological therapies.  If the patient likes the taste of licorice, we add it to the smoothie in a dosage of one rounded teaspoon.  If not, they take it separately.  It is also very useful as a first aid using ½ teaspoon every 2-3 hours usually in the first 2-3 days after a chemo or radiation treatment to alleviate nausea and CNS and GI irritation.  GI Revive is like smoothing chilled aloe vera onto burned skin.

Paleo Energy Cocktail
PaleoGreens, PaleoReds, VitaVescence
We often have cancer patients make a “cocktail” of these three supplements with 1 teaspoon of PaleoGreens, ½ teaspoon PaleoReds, and ½ teaspoon Vitavescence for a tonifying, liquid multiple with tasty phytonutrients, flavenoids, pigments and a host of other supportive ingredients. 

We recommend serving the tonic in a margarita or nice red wine glass, garnished with a slice of lime and a paper umbrella, to be enjoyed while others are drinking alcohol, or simply to watch the sunset.  Two times a day may be essential to mental and emotional, as well as physical health!

Brain and Nervous System Protection, Prevention of Neuropathy
These are basically the same task. 

Neuropathy can be devastating to a patient’s quality of life.  This is a highly painful condition that usually manifests in the hands and feet as pain and numbness.  Symptoms may include skin peeling, itching, and possibly rash, especially with Doxcil, and the Taxanes, due to histamine release. 

Neuropathy occurs as a result of injury to the nerves from chemical exposure.  The best treatment is prevention, as it is difficult to heal and regenerate injured nerve tissue, although we always try. Start the nutritional therapies as far in advance of the first chemo or radiation treatment as possible.

The very same nutrients and remedies that prevent and treat neuropathy, also protect the brain and nervous system.  In essence, CNS protection is the whole point of nutrient support during cancer therapy.  Every patient must have this protection. 

Cellular mitochondria in the nervous system are very susceptible to DNA damage and poisoning.  Mitochondrial DNA is ten times more sensitive to free radical injury as is nuclear DNA, because the mitochondria have very few DNA repair enzymes. 

Damaged and poisoned mitochondria are at the root of many degenerative diseases, including Alzheimer’s, Parkinson’s, and ALS.  One of the earliest changes in Parkinson’s disease is a 42% loss of mitochondrial function in the substantia nigra. 

Chemotherapy and radiation cause substantial injury to the mitochondria in the nervous system, as well as the rest of the body.  Although many oncologists will still insist that chemotherapy drugs do not cross the blood brain barrier, this has been disproven.  There are many disease states that increase the permeability of the blood brain barrier, and cancer is one of the worst. 

Fever, hypertension, certain medications, Parkinson’s, radiation to the head and neck, and ongoing aging, all cause increased permeability of the blood brain barrier, allowing drugs, toxins, environmental chemicals, and heavy metals to enter the brain.  

For certain chemotherapeutic agents, like Adriamycin, it is imperative that support nutrients be ingested regardless of nausea, vomiting, or other side effects.  These may be added to the supplement smoothie until the patient is able to swallow oral supplementation again.  

CoQ10 is ubiquinone, a coenzyme used in the mitochondrial electron transport chain for the synthesis of ATP.  The damaging effects on the mitochondria are often manifested through the reduction of CoQ10 in the involved tissues.  The classic example is cardiotoxicity from Adriamycin.  

Q avail is a rice bran oil base, while the powdered form must be taken in hot liquid in the presence of a fat to be absorbed.      
200-300 mg/day, with dosage increased to 400-600 mg with treatment using antibiotic chemotherapies such as Adriamycin or Daunorubicin due to cardiotoxicity.  

Acetyl L-Carnitine:
Most patients will receive adequate levels using Brain vitale in the smoothie.  Required dosage will be 500-1000 mg 2x/day.  Plays a major role in mitochondrial energy production, protection of the CNS, chelation of free iron, regulation of fatty acid metabolism and cell membrane dynamics, improves DNA enzyme repair, and protects the heart secondary to the nervous system.

R- Lipoic Acid:
This is one of the workhorse nutrients of the universe.  Alpha Lipoic Acid generates cellular glutathione, is a strong antioxidant, decreases insulin resistance, protects the brain from excitotoxin damage and injury as well as being central to cellular energy production. It is also a mild and safe chelating agent.  At the level of the mitochondria, it is probably the best single antioxidant for decreasing the activity of free radicals and reactive oxygen species.  The dosage will range from 100-600 mg/day.

Essential Fatty Acids:
Functional medicine literature contains volumes on the benefits of omega 3 fatty acid supplementation for virtually any disease. There are also mountains of information on the regulation of immune and inflammatory functions directly related to fatty acid status.  Chronically ill patients will generally show a low omega 3:6 fatty acid ratio, and literally every patient requires some form of supplementation.
Cancer cells avoid cell regulation by detaching themselves from normal cell communication, usually by inhibiting the connexins that form gap junctions.  Cellular adhesion molecules, known as ICAM, VCAM, and integrins, tend to be overexpressed in cancer.  EPA and DHA have been proven to improve gap junction functions, and inhibit integrin over-expression.
The essential fatty acids, particularly marine lipids, confer more protection from acid chemical exposure to the ovaries, pancreas, and thyroid than any other group of remedies or nutrients.  

As an anti-angiogenic, improvement of the omega 3:6 ratio inhibits invasion enzymes that erode the vascular basement membrane, and will also inhibit vascular endothelial growth factor (VEGF) production.  Omega 3’s will normalize vascular permeability, and inhibit leukotriene stimulated cell proliferation.  Essential fats are key to regulation and normalization of the insulin regulation.
Generally, it is best to get as much marine lipid into the patient as possible, balancing the dose to stomach tolerance.
Omega Ultra Marine is the workhorse of fatty acid supplements, and contains EPA and DHA in a highly concentrated form that decreases the daily dose needed.  The Omega Marine liquid has a lower dosage.

Krill Oil
may be the best of all of the available supplements due to its ratio of omega 3s to phospholipids.  This has fantastic anti-inflammatory and antioxidant effects.

Omega Synergy
contains EPA and DHA, with some GLA thrown in.  This is the best long term maintenance product, since supplementation with high levels of Omega 3 fatty acids can suppress omega 6 production causing a deficiency of GLA.  

Organic Flax Seed Oil
Is the cheapest and easiest on the stomach, but does not have significant EPA and DHA.  If the stomach is too weak to handle any marine lipids, we generally prefer to handle this issue by using Krill Oil along with harmonizing Chinese herbs.  

During oncological treatment, we have had good success with 2 Krill oil perles and 2 Omega Ultra Marine perles in divided doses.  Omega synergy is used if the patient does not tolerate the Ultra Marine.  We will add Omega Marine liquid to the smoothie if necessary.

conjugated linoleic acid, is probably a great anti-cancer substance, having anti-angiogenic properties, along with central obesity fat loss implications.    It truly shines in the prevention of cachexia, the severe weight loss in cancer patients, as well as autoimmune disorders, chronic infections, and age-related muscle loss.  

Most cachexia is caused by tumor necrosis factor alpha (TNFa), which is released as a result of the inflammatory cascade.  

As a preventive for cachexia, CLA must be given at a dosage of 4-6 capsules/day, with each cap containing about 800 mg of CLA.  Do not substitute CLA for Krill oil and Omega Ultra Marine…this is an addition if the patient can handle more supplementation.  

UltraTrienols Plus:
This is perhaps the most important fraction of the vitamin E complex.  All of the early research with vitamin E and cardiovascular health were probably significantly influenced by the presence of this so-called “impurity” in the vitamin E used.  Virtually all cancer clinical research has used either alpha-tocopherol or the succinate form of vitamin E.  We consider tocotrienols to be the Lexus of vitamin E supplementation.  Expect far better clinical results than the studies would indicate using inferior forms. 

Typical dosage would be 1-2 per day.  With chemotherapy, the dosage will have to be 2/day.

Ultimate Antioxidant HS and LS:
These are our two favorite antioxidant supplements, and along with Lipoic Supreme, form the basis of nervous system and brain protection as well as neuropathy prevention. 

The LS (lipid soluble) contains flavenoids, carotenoids, high gamma E, CLA, and a kiss of CoQ10.  The HS (herbs and spices) contains 1000 mg vitamin C, garlic, curcurmin, gingko, quercitin, and a host of other herbs and spices.  Don’t even think of allowing a patient to undergo chemotherapy or radiation without the support of these supplements. 

Typical dose is 2-4/ day, or 2 of each 2-4x/day.

N-Acetyl Cysteine (NAC):
This must be considered in every case of decreased mitochondrial function.  It is converted to glutathione intracellularly, and is also a natural anti-inflammatory.  It is mucolytic, and will repair the GI membranes.  GI Revive contains 1000 mg of NAC.   Dosage will start at one capsule and build up to four, even if it has to be opened into the smoothie.  

B Supreme
is an excellent coenzyme form of the B complex.  Many patients require IM B vitamins, particularly B1 if neuropathy is present.  We also add the Super Folate liquid.   

We use a lot of Magnesium Malate Chelates for cancer patients.  Work up to 4/day if possible.  Magnesium is a cofactor for so many enzymes that no metabolic pathway can operate properly in a deficiency state.  For CNS and Heart protection, it is essential.  

Pre-mature Menopause:
Alkylating agents, such as Cytoxan and the Platinums, are associated with secondary cancers, induction of neuropathy and also induction of menopausal symptoms regardless of age.  Most women will stop menstruating during chemotherapy.

Do not use soy products as hormone regulators as they are very high in copper, which is angiogenic.  Do not use glandular based supplements for the same reason.  In addition to tocotrienols, Krill oil, and marine lipids,   

4 caps/day which contains DIM 30 mg, with B vitamins, phytoestrogens, and lots of the flavenoid, Chrysin.

Individual dose, possibly 2-4/day.

This is especially crucial with Antibiotic types of chemotherapy such as Adriamycin. 

This is a repeat list:
CoQ10, Taurine, UltraTrienols plus, Magnesium, Krill oil, Omega Ultra Marine, the Carnitines.

Carnitine tartrate may be added to the Acetyl L-Carnitine already included in the protocols for CNS protection at a dose of 3 grams, or a heaping teaspoon of powder. 

CarniClear liquid should be used at 2 teaspoons, even though each teaspoon contains 2.5 grams.  

For a patient being treated with Adriamycin, do not ever give supplemental vitamin C within 2 days of the treatment, on either side due to the cardiotoxic effects of free radical oxidation.  Do not ever supplement this type of patient with iron or copper under any circumstances.  

Immune Compromise/flues and colds:
All patients benefit from the addition of Allicillin, at least one capsule per day, for immune support.  The new drops may be very easy to use frequently.

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