Integrative Oncology – Focus on the whole

Potential interactions:

Generally considered safe in moderate amounts. However, high doses can potentially increase the risk of bleeding, especially in patients taking blood-thinning medication (e.g., warfarin).

There is also a theoretical possibility of interaction with certain chemotherapies at very high doses, but this is rarely relevant with normal use as a dietary supplement.

No known significant interactions with radiation therapy at normal doses. High doses may increase bleeding risk, which should generally be considered regardless of treatment type.

Caution: For underweight individuals, ginger should be consumed in limited quantities until it is ensured that it does not affect metabolism and thus risk leading to further weight loss.

Can, however, cause heartburn when consumed in larger quantities.

Pregnant women should avoid taking supplements, as the effect on the fetus is not fully disclosed.

Dosage: There is no universally established standard dose for ginger for cancer patients within integrative oncology. Recommendations may vary depending on the specific situation, the purpose of use (e.g., nausea relief, anti-inflammatory effect), the patient’s individual circumstances, and any other medication.

Although there is no standard dose, research and clinical guidelines point to the following general recommendations for adults:

• Nausea relief (e.g., in chemotherapy-induced nausea):
  • 0.5 to 1 gram of powdered ginger daily, divided into several doses (e.g., 250 mg 2-4 times daily), has proven effective in some studies. It is often recommended to start a few days before chemotherapy.
  • In some studies, doses of 1 gram daily have also been used.
  • Be aware that some studies have used doses from 170 mg to 1 g, 3-4 times daily.
• General use as a supplement (raw ginger):
  • Many dietitians recommend no more than 4 grams (approx. 1 tablespoon) of raw, fresh ginger per day. This is generally considered safe for most adults.
• General use as a supplement (powdered ginger):
  • Since powdered ginger is more concentrated, it is often recommended not to exceed 2 teaspoons per day.

In what forms is ginger found:

• Form of ginger: Different forms of ginger (raw, powder, capsules, tea) contain varying concentrations of active substances. Raw ginger is often considered the safest form.
• Quality: Choose products that state they contain “real ginger” and are of good quality.
• Side effects: Although ginger is generally considered safe in moderate amounts, high doses can cause gastrointestinal issues, heartburn, or diarrhea in some people. Ginger also has a blood-thinning effect, which must be taken into account before surgery or when using blood-thinning medication.

Conclusion: There is no fixed standard dose for ginger within integrative oncology. The doses that have shown promise in research for nausea relief typically range between 0.5 and 1 gram of powdered ginger daily. For general use of raw ginger, it is often recommended not to exceed 4 grams daily. It is absolutely necessary that cancer patients considering the use of ginger as part of their integrative treatment consult their oncologist or a specialized healthcare professional for individual advice on safe and appropriate dosage.

Important: Talk to your healthcare provider if you take blood-thinning medication or are considering high doses of ginger.

Priority: Very high

Many cancer patients have a Vitamin D deficiency, which can affect their general well-being and potentially their response to treatment. Supplements can correct a deficiency and support these functions.

Potential interactions:

Vitamin D interacts primarily with medication that affects calcium absorption or bone metabolism. In the doses typically used to correct deficiency, there are rarely problems with chemotherapy or radiation therapy. However, very high doses can be harmful and potentially interact with certain treatments.

There are no known direct interactions between Vitamin D supplementation in normal doses and radiation therapy. However, an adequate Vitamin D level is important to support general health and immune function during any cancer treatment, including radiation therapy. Some studies are also investigating Vitamin D’s potential role in reducing certain side effects of cancer treatment, but this is still research.

Important: Have your Vitamin D level checked by your healthcare provider, who can recommend the correct dose. Overdosing should be avoided.

Priority: High

Potential interactions:

No strong evidence of direct negative interactions with the radiation itself. Some early research areas are investigating whether omega-3 can affect radiation sensitivity in cancer cells, but this is not yet clinically established. High doses can increase the risk of bleeding, which is relevant to consider also during radiation therapy.

Potentielle interaktioner:

Bleeding risk: High doses of omega-3 fatty acids can increase the risk of bleeding, especially if you take blood-thinning medication such as warfarin (Marevan), aspirin, or clopidogrel (Plavix).

Chemotherapy: There is a theoretical possibility that high doses of omega-3 fatty acids may affect the efficacy of certain chemotherapies, for example, cisplatin (shown in an older animal study).
This is, however, primarily based on theoretical considerations from laboratory and animal studies, and clinical studies in humans have not confirmed these interactions at normal doses.

Blood sugar: High doses of omega-3 supplements can potentially affect blood sugar control in diabetics.

Other drugs: There is a theoretical risk of interactions with other drugs that affect blood coagulation or the immune system, but documentation is limited.

No strong evidence of direct negative interactions with the radiation itself. Some early research areas are investigating whether omega-3 can affect radiation sensitivity in cancer cells, but this is not yet clinically established. High doses can increase the risk of bleeding, which is relevant to consider also during radiation therapy.

Important: If you take blood-thinning medication or plan to take high doses of omega-3, it is important to inform your healthcare provider.

Priority: High

Potential interactions:

Antidepressant medication: Since saffron affects the brain’s serotonin system, there is a theoretical risk of serotonin syndrome (a potentially serious condition with too much serotonin in the body) if taken with other antidepressant medication (especially SSRI and SNRI drugs).

Blood-thinning medication: Saffron can theoretically have a mild blood-thinning effect. Caution is advised if you take medication such as warfarin (Marevan), clopidogrel (Plavix), or high doses of aspirin.

Blood pressure medication: Studies suggest that saffron can lower blood pressure. If you take blood pressure-lowering medication, the combination could potentially lead to excessively low blood pressure (hypotension).

Chemotherapy: Interactions are not fully mapped. Some laboratory studies suggest that saffron may increase the efficacy of certain types of chemotherapy (e.g., cisplatin), but this has not been confirmed in larger human studies. As the effect is uncertain, dialogue with the oncologist is crucial. Other studies show a beneficial effect when using saffron concurrently during chemotherapy.

Blood sugar medication: Saffron can affect blood sugar levels. Diabetics or individuals taking medication to regulate blood sugar should be extra attentive.

Radiation therapy: There is no strong evidence for direct negative interactions with radiation therapy. This research area has not been thoroughly investigated, and therefore the general precautionary principle applies.

Important: Although saffron is one of the most well-documented natural remedies for depression, it is not without risks. Very high doses (several grams) are toxic. Do not start saffron supplementation without talking to your healthcare provider, especially if you are in active treatment or taking other medication.

Priority: High

Potential interactions:

There is limited knowledge about direct interactions with chemotherapy and radiation therapy.

Reishi can potentially affect platelet function and should be used with caution by patients taking blood-thinning medication.

Shiitake can, in rare cases, cause a skin rash (Shiitake dermatitis).

There are no immediately known or strongly suspected interactions with radiation therapy that necessitate a specific addition under “Potential interactions” at this time.

Important: Inform your healthcare provider about the use of medicinal mushrooms if you take blood-thinning medication, are undergoing chemotherapy, or experience side effects.

Priority: Medium

Potential interactions: Generally considered relatively safe. There is limited documentation of significant interactions with chemotherapy or radiation therapy.

There are no immediately known or strongly suspected interactions with radiation therapy that necessitate a specific addition under “Potential interactions” at this time.

Important: For safety’s sake, inform your healthcare provider about the use of turkey tail if you are undergoing chemotherapy.

Priority: Medium

Some laboratory studies suggest potential in inhibiting cancer cell growth and spread. Used with the aim of reducing inflammation and pain. However, absorption in the body is often low, so be aware of the quality of the product (I use MCS-Formulas myself).

Potential interactions:

Curcumin can potentially interact with certain chemotherapies primarily by affecting liver enzymes (the CYP450 system) and transport proteins (e.g., P-glycoprotein), which are involved in the breakdown and transport of many drugs, including certain forms of chemotherapy. This could theoretically either increase or decrease the efficacy of the chemotherapy or increase the risk of side effects.

The chemotherapies where there is the greatest theoretical risk of interaction with curcumin include:

• Taxanes: Such as paclitaxel (Taxol) and docetaxel (Taxotere). Curcumin can potentially affect the metabolism of these substances.
• Vinca alkaloids: Such as vinblastine and vincristine. Similar effects on liver enzymes may be relevant.
• Anthracyclines: Such as doxorubicin (Adriamycin) and epirubicin. There are some in vitro (laboratory studies) and animal studies suggesting potential interactions, but the clinical significance in humans is not clear.
• Capecitabine (Xeloda): Curcumin can potentially affect metabolism.
• Cyclophosphamide (Sendoxan): There is limited research, but potential interaction via liver enzymes cannot be ruled out.

Additionally, high doses of curcumin can have a blood-thinning effect and therefore potentially interact with chemotherapies that themselves can affect the platelet count or increase the risk of bleeding.

Some preclinical studies have suggested that curcumin may potentially affect radiation sensitivity in cancer cells, either by increasing or decreasing it. The clinical relevance of this in humans is still unclear and requires more research.

Important: It is crucial to emphasize that the majority of this information comes from laboratory and animal studies. The clinical relevance and scope of these interactions in humans taking normal doses of curcumin as a dietary supplement during chemotherapy have not yet been fully clarified.

Talk to your healthcare provider before taking turmeric/curcumin if you are undergoing chemotherapy or taking blood-thinning medication.

Priority: Medium

Potential interactions:

High concentrations of green tea extracts can potentially interact with certain chemotherapies by affecting their transport mechanisms.

The chemotherapies where there is the greatest theoretical risk of interaction with high concentrations of EGCG primarily involve drug transport proteins, especially P-glycoprotein (P-gp) and breast cancer resistance protein (BCRP).

These proteins help pump drugs into and out of cells, and EGCG can potentially inhibit their function and thus affect the concentration of chemotherapy in the cancer cells. Some of the chemotherapies known to be substrates for these transport proteins and therefore theoretically could be affected by high doses of green tea extracts include:

• Doxorubicin (Adriamycin)
• Epirubicin
• Mitoxantrone
• Paclitaxel (Taxol)
• Docetaxel (Taxotere)
• Vincristine
• Vinblastine
• Irinotecan (Camptosar)
• Topotecan (Hycamtin)

Additionally, EGCG can potentially interact with enzyme systems in the liver (CYP enzymes), which are also involved in the metabolism of certain chemotherapies, although this mechanism is considered less pronounced than the effect on transport proteins.

Some preclinical studies have investigated EGCG’s potential to affect radiation sensitivity, but the results are not consistent. The clinical significance is unclear.

Important: It should be emphasized that this information primarily comes from laboratory studies (in vitro) and animal studies where very high concentrations of EGCG were used, which are rarely reached by normal intake of green tea as a beverage. Concentrated green tea extracts in supplements can, however, potentially reach these levels.

Consume green tea in moderate amounts. If you are considering highly concentrated extracts, you should talk to your healthcare provider.

Priority: Fine to supplement (requires dialogue)

Potential interactions:

Milk thistle contains the substance silymarin, which can affect the activity of certain CYP450 enzymes in the liver. These enzymes are responsible for metabolizing (breaking down) many different drugs, including certain types of chemotherapy and hormone therapy. By affecting these enzymes, milk thistle could theoretically either increase or decrease the concentration and thus the effect or side effects of the drugs in the body.

The types of chemotherapy and hormone therapy with the greatest potential risk of interaction with milk thistle include drugs primarily metabolized by the following CYP450 enzymes:

• CYP3A4: This is one of the most important enzymes in the liver and is involved in the metabolism of many drugs, including certain:
  • Chemotherapies: Taxanes (e.g., docetaxel, paclitaxel), vinca alkaloids (e.g., vinblastine, vincristine), anthracyclines (e.g., doxorubicin), cyclophosphamide, ifosfamide.
  • Hormone therapies: Aromatase inhibitors (e.g., anastrozole, letrozole), tamoxifen, certain progestogens.
• CYP2C9: Involved in the metabolism of, among others:
  • Chemotherapies: Capecitabine.
  • Hormone therapies: Certain forms of anti-estrogen treatment.
• CYP2C19: Metabolizes certain chemotherapies (some of the above to a lesser extent).

There are no known direct interactions between milk thistle and radiation therapy. Milk thistle is traditionally used to support liver function, which may potentially be relevant for patients receiving radiation therapy, as the treatment can strain the body in general.

Important: It is crucial to understand that the extent and clinical significance of these potential interactions can vary significantly from person to person and depend on the dose of milk thistle, the type and dose of the other medication, and individual differences in liver enzyme activity.

Inform your healthcare provider about the use of milk thistle if you are taking other medication.

Priority: Fine to supplement (requires dialogue)

Potential interactions:

Melatonin can interact with certain drugs, including blood-thinning medication and antidepressants.

• Blood-thinning medication:
  • Warfarin (Marevan): Melatonin can potentially increase the blood-thinning effect of warfarin, which could theoretically increase the risk of bleeding. It is recommended to monitor the INR value closely if melatonin is taken concurrently with warfarin.
  • Other blood-thinning drugs: There may be a theoretical increased risk of bleeding with the concurrent use of melatonin and other blood-thinning or antiplatelet drugs such as aspirin, clopidogrel (Plavix), and non-steroidal anti-inflammatory drugs (NSAIDs), especially at higher doses of melatonin.
• Antidepressants:
  • Selective serotonin reuptake inhibitors (SSRIs): Certain SSRIs, such as fluoxetine (Prozac) and fluvoxamine (Luvox), can potentially increase levels of melatonin in the body by inhibiting its metabolism in the liver. This can lead to increased drowsiness or other melatonin-related side effects.
  • Tricyclic antidepressants (TCAs): There may be a theoretical risk of interactions, but documentation is more limited.
  • Monoamine oxidase inhibitors (MAOIs): Concurrent use of melatonin and MAOIs is generally not recommended due to the potential risk of increased side effects.
  • Serotonin-norepinephrine reuptake inhibitors (SNRIs): There is limited information about interactions, but caution may be advisable.
• Other potential interactions:
  • Benzodiazepines: Melatonin can enhance the sedative effect of benzodiazepines.
  • Beta-blockers: Certain beta-blockers can reduce the body’s own production of melatonin.
  • Cimetidine (Tagamet): An acid inhibitor that can increase melatonin levels.
  • Certain antipsychotics: There may be potential pharmacodynamic interactions.

Some studies are investigating melatonin’s potential ability to increase radiation sensitivity in certain cancer cells, while potentially protecting normal tissue. This is, however, still under research.

Important: It is important to emphasize that the scope and significance of the above-mentioned interactions can vary.

Priority: Fine to supplement (requires dialogue)

Potential interactions:

There is limited knowledge about direct interactions with chemotherapy and radiation therapy. Cordyceps can potentially affect blood sugar and should therefore be used with caution by diabetics.

There are no immediately known or strongly suspected interactions with radiation therapy that necessitate a specific addition under “Potential interactions” at this time.

Important: Inform your healthcare provider about the use of cordyceps if you have diabetes.

Priority: Fine to supplement (requires dialogue)

Potential interactions:

There is limited knowledge about significant interactions with conventional cancer treatment at normal doses.

Some preclinical studies suggest that sulforaphane can affect radiation sensitivity, but the clinical relevance is unclear.

Important: Inform your healthcare provider if you are considering using broccoli sprout extract in concentrated doses.

Priority: Fine to supplement (requires dialogue)

Potential interactions:

Quercetin is a flavonoid that can affect the activity of certain CYP450 enzymes in the liver, similar to milk thistle. These enzymes are involved in the breakdown of many drugs, including certain forms of chemotherapy and blood-thinning medication. By affecting these enzymes, quercetin could theoretically either increase or decrease the concentration and thus the effect or side effects of the drugs in the body.

The types of chemotherapy and blood-thinning medication with the greatest potential risk of interaction with quercetin include drugs primarily metabolized by the following CYP450 enzymes:

• CYP3A4: This is one of the most important enzymes in the liver and is involved in the metabolism of many drugs, including certain:
  • Chemotherapies: Taxanes (e.g., docetaxel, paclitaxel), vinca alkaloids (e.g., vinblastine, vincristine), anthracyclines (e.g., doxorubicin), cyclophosphamide, ifosfamide.
  • Tyrosine kinase inhibitors (TKIs): A type of targeted cancer treatment, e.g., imatinib, gefitinib, erlotinib.
• CYP2C9: Involved in the metabolism of, among others:
  • Chemotherapies: Capecitabine.
  • Blood-thinning medication: Warfarin (Marevan). Quercetin can potentially increase the blood-thinning effect of warfarin.
• CYP1A2: Metabolizes certain chemotherapies like topotecan.

Some preclinical studies have investigated quercetin’s potential to affect radiation sensitivity, with varying results depending on the cancer cell type. Clinical evidence is lacking.

Notice: It should be emphasized that the scope and clinical significance of these potential interactions can vary significantly from person to person and depend on the dose of quercetin, the type and dose of the other medication taken, and individual differences in liver enzyme activity.

Important: Talk to your healthcare provider before taking quercetin if you are undergoing chemotherapy or taking blood-thinning medication.

Priority: Fine to supplement (requires dialogue)

Potential interactions:

High doses of selenium can be toxic and may interact with certain chemotherapies. Some studies are investigating selenium’s role in protecting normal tissue during radiation therapy, but this is still research.

Important: Only take selenium supplements if you have a proven deficiency and/or upon recommendation from your healthcare provider. Avoid high doses.

Priority: Fine to supplement (requires dialogue)