TOPICS
Amino Acids | Curcumin | Fish oil | Immune stimulants | Licorice |
Iron | NAC | St. John's Wort | Vitamin A | Vitamin C | Vitamin D

Here we list known interactions and cautions about supplements and treatments for NHL. We strongly recommend that you consult with your doctor about the use of any  supplements, especially when receiving treatment.

Amino Acids: Arginine, Glutamine and Whey Protein

Despite the potential of amino acids to protect the patient from side effects and wasting while receiving chemotherapy treatment, there is a general concern that some amino acids might stimulate the growth of malignant cells.  More research is needed.

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Curcumin (Turmeric) and Chemotherapy Alert

The following study indicates that curcumin can inhibit some chemotherapy agents. While the study is for breast cancer, the JNK pathway for chemo-induced cell death described in this abstract might also apply to lymphoma according to our research. 

	Dietary curcumin inhibits chemotherapy-induced apoptosis in models of human  breast cancer. Cancer Res. 2002 Jul 1;62(13):3868-75. PMID: 12097302  PubMed | More
	"Exhibits antiplatelet activity. May enhance effects of anticoagulant medications such as warfarin and  potentiate bleeding." - Nagi B. Kumar, PhD, et. al.  Medscape

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Fish oil 

High doses of fish oil might interfere with the maturation of key immune cells. 

Supplement Safety and Biological Activity Also Alerts and Resources to Check for Interactions and Product Quality Last Update: 04/14/2010
TOPICS Interaction Checker | Resources | Specific Alerts and Interactions TOPIC SEARCH:  ASCO | FDA Medwatch | Medscape | Web Drug/Supplement  Interaction Checker Check Drug/Vitamin Interactions DrugDigest.org 125 Fake Cancer 'Cures' Consumers  Should Avoid FDA.gov ConsumerLab Independent testing of  health and nutrition products consumerlab.com  "Consumer Reports, the bible of independent consumer ratings, has introduced a new database of information on thousands of herbs, dietary supplements and other natural medicines, a response to the enormous growth in the use of these products."  Source "First, the internet is largely a horrible place for information on natural medicine choices. Misinformation outweighs objective truth 99 times out of 100 (no exaggeration). Most internet sites are written to sell you a product and make you think you are getting “scientific” information." Terra Sigillata  Factors that Influence Supplement Safety  and Potential Biological Activity Safety Biological Activity Was independent testing done on the product to determine quality, purity, strength, composition? Supplements may have wrong ingredients too much or too little of a dietary ingredient improper packaging improper labeling contamination problems due to natural toxins, bacteria, pesticides, glass Interactions with drugs Reduce or exaggerate drug effects? toxic interactions Dose and frequency of administration Bioavailability - do the relevant compounds reach the blood to a degree to be active?   Is it merely excreted?   Has a therapeutic window* or  recommended daily allowance been established?   * Therapeutic window: Level in blood that safely produces treatment effect. Is evidence for bioavailability based on  not established - limited to test tube (in vitro) evidence (petri dish, cell culture)?    animal studies? (weak - poor model) case reports/testimonials (weak)   clinical human study?  (better, but not reliable) controlled clinical trial (reliable)   Dose  and frequency of administration - is it sufficient to influence health or a disease process? Clearance rate - how fast the body breaks down active ingredients   Too much or little of the ingredients in the product can affect potency and toxicity.   News   Green Tea May Negate the Effects of a Common Cancer Therapy sev.prnewswire.com/   "the team was surprised to find that the EGCG compound seemed to prevent bortezomib (Velcade) from fighting the disease by blocking its proteasome inhibitory function -- the two compounds effectively contradicted one another in the cell, leaving nearly 100 percent of the tumor cells intact." Dietary flavonoids inhibit the anti-cancer effects of the proteasome inhibitor Bortezomib (Velcade) Dietary flavonoids, quercetin and myricetin, which are abundant in plasma, inhibited Bortezomib-induced apoptosis of primary CLL and malignant B-cell lines in a dose-dependent manner.  Blood First Edition Paper, prepublished online  July 16, 2008; DOI 10.1182/blood-2008-04-150227. Sources of flavonoids: http://lpi.oregonstate.edu/infocenter/phytochemicals/flavonoids/ Purity? Unfortunately,  the risk of ingesting inferior or contaminated herbal products is significant and well documented. NEWS: Final Rule Promotes Safe Use of Dietary Supplements FDA.gov  Under the final rule, manufacturers are required to evaluate the identity, purity, quality, strength, and composition of dietary supplements. Quackery: Life Rife Frequency Generator healthwatcher.net  Although unanimously condemned as worthless by mainstream scientists and banned in at least two American States, the highly profitable Rife industry is flourishing in Australia because of a lack of effective regulation, says John Dwyer, the head of medicine at Prince Henry and Prince of Wales teaching hospitals in Sydney. He blames this on "buck-passing" among no fewer than five government agencies supposedly responsible for protecting health consumers (see "Nothing to do with us, say agencies") which have failed to act against promoters of Rife machines and other "cures" he regards as quackery Clinical Relevance of Drug–Drug and Herb–Drug Interactions Mediated by the ABC Transporter ABCB1 (MDR1, P-glycoprotein)  theoncologist.alphamedpress.org  Furthermore, CAM use, like herbs, food, and vitamins, by patients has increased significantly in recent years. Surveys have shown that the prevalence of CAM use among cancer patients receiving conventional therapy is 54%–77%, and that about 72% of patients do not inform their treating physician. CAM use significantly increases the risk for interactions with anticancer drugs, especially because of the small therapeutic range and steep dose–toxicity curve of these drugs.  .... High Doses Of Phytochemicals In Teas And Supplements Could Be Unhealthy Science Daily  "The report cites specific examples of toxic effects, including reports of liver, kidney, and intestinal toxicity related to consumption of high doses of green tea-based dietary supplements. The risk of such toxicity may be greater in individuals taking certain medications, or with genetic traits, that increase the bioavailability of phytochemicals, the researchers said." Resources Consumer Report on Herbs and Supplements consumerreports.org FDA Food and Drug Recalls, Market Withdrawals and Alerts (includes supplements) FDA.gov Food Additives  PAL Safety Issues in Using Complementary and Alternative Medicine jco.org 2006 full text "While many forms of CAM are associated with no or minimal risk to a patient, this is not true for all such therapies. This brief report provides a broad overview into the potential toxicities associated with CAM, including the risk to the patient who uses CAM to avoid or delay established, effective treatment in the management of malignant disease." Supplements Consumerlab news on supplements- independent review consumerlab.com  Generally Recognized as Safe (GRAS) - FDA Summary of GRAS Notices FDA.gov Herb information with drug interactions www.uspharmacist.com  Longwood Herbal Task Force longwoodherbal.org Massachusetts College of Pharmacy and Health Sciences in Boston. Natural Medicine comprehensive databases www.naturaldatabase.com (requires subscription) Supplement Recall Info Consumer Labs A vitamin a day may do more harm than good msnbc.msn   Of 21 brands of multivitamins on the market in the United States and Canada selected by ConsumerLab. com and tested by independent laboratories, just 10 met the stated claims on their labels or satisfied other quality standards. ... "I was definitely shocked by the amount of lead in [this] woman's product," he said. "We've never seen that much lead in a multivitamin before." Use of Complementary/Integrative Nutritional Therapies During Cancer Treatment: Implications in Clinical Practice,  Nagi B. Kumar, PhD et. al. Cancer Control 9(3):236-243, 2002. © 2002 H. Lee Moffitt Cancer Center and Research Institute, Inc. Medscape (free login req.)
Known Interactions and Cautions
	Fish oil consumption may increase the risk of bleeding in susceptible individuals.
	Loss of natural killer cell activity after murine tumor transplantation appears as a consequence of dietary lipid administration.  Anticancer Res. 2001 Jul-Aug;21 (4A):2697-702

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Immune stimulants: Mushrooms, Echinacea

There is a theoretical concern that immune stimulants might increase the growth of lymphoma cells, which are immune cells.

• Polysaccharide isolated from the radix of Platycodon grandiflorum selectively 
  activates B cells and macrophages but not T cells. Int Immunopharmacol. 2001 Oct;1(11):1969-78. abstract

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Licorice (Glycyrrhiza glabra) 

"May impair action of drugs that cause potassium loss. May enhance action of corticosteroids. May counteract effectiveness of drugs used to treat hypertension. Contains glycyrrhizic acid, which can affect the hormone aldosterone that helps regulate blood pressure. For patients with high blood pressure, edema, or electrolyte imbalance, use of licorice root or its products can lead to sodium retention, excessive potassium excretion, and water retention. Some licorice products have the glycyrrhizic acid removed and are sometimes sold as deglycyrrhizic licorice. Nagi B. Kumar, PhD, et. al.  Medscape

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Iron

... is essential. Excessive iron, however, may promote tumor growth.
 

Hann HW, Stahlhut MW, Menduke H.  *Related Articles Iron enhances tumor growth. Observation on spontaneous mammary tumors in mice. Cancer. 1991 Dec 1;68(11):2407-10. PMID: 1657354

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NAC (N-acetyl-L-cysteine)

... is an important natural supplement. However, for individuals with NHL, it may prudent to avoid this supplement for the following potential reasons. 

	NAC enhances IkappaB degradation and inhibits apoptosis PMID: 10661865, UI: 20125507
	NAC stimulates IL-1 beta production PMID: 10609880, UI: 20075993
	NAC protects cancer cells against cytotoxicity PMID: 10925209
	NAC inhibits apoptosis and supports NF-kappaB activation PMID: 10867640

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St. John's Wort 

... Study shows St John's Wort Interferes with Chemotherapy www.bmj.com

St. John's Wort Weakens Cancer Drug's Effect  www.activeherb.com

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Vitamin A

Excessive vitamin A increases the risk of broken bones www.sciencenews.org  

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Vitamin C

... in high doses can act as an oxidant instead of an antioxidant.  Vitamin C also increases the absorption of copper. 

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Vitamin D-3

... while beneficial in many respects, Vitamin D-3 might interfere with the maturation of key immune cells and therefore should be avoided when you are receiving immune-based therapies, such as vaccines.

A Practical Approach to Hypercalcemia - http://www.aafp.org/afp/20030501/1959.html   

	1-alpha,25-Dihydroxyvitamin D3 (1,25(OH)(2)D(3)) hampers the maturation of  fully active immature dendritic cells from monocytes. Eur J Endocrinol. 2001 Sep;145(3):351-7. PMID: 11517017
	lymphoma patients may metabolize vitamin D differently than healthy people, potentially leading to hypercalcemia (a serious condition involving too much calcium in the blood). Therefore, any vitamin D supplementation should be discussed with your doctor.  Caution cited in multiple articles on the topic:

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