10 Tips for Cancer Patients Taking Supplements

Shayne RobinsonBy Shayne Robinson, RD, CSO, CDN

As an oncology dietitian, I always encourage patients to eat a balanced diet of “whole unprocessed foods.” However, there are times when some patients need to use supplements along with conventional treatments in partnership with their physician. Below are 10 tips for cancer patients who have decided to use supplements (after consulting with their healthcare team).

1. Speak up! Report all supplement use to your healthcare team.

2. Have a reason. Patients should only take supplements to prevent a deficiency, manage side effects or co-manage a medical condition.

3. Be informed. Many supplements are metabolized through the same pathway as medications you may be taking. As a result, they may carry a risk for interaction with medication (including oral chemotherapy). Know the evidence to support the supplements you choose, and ask your doctor, registered dietitian and pharmacist about potential interactions.

4. Look over the label – thoroughly. Choose a supplement with the seal of approval from US Pharmacopeia, Consumer Lab, or NSF International to get the best product possible. Make sure you read the fine print and all the disclaimers on the bottle.

5. Ask questions, if your supplement does not provide the expected benefit. There may be significant differences in the quality of various supplements. For example, if you are taking a magnesium supplement for a low magnesium level, and your magnesium level is not increasing, you should question the product.

6. Know your body. Be aware that supplements can be contaminated with drugs, pesticides and heavy metals. If you have an adverse event after starting a new supplement, stop taking it, and report the reaction to your doctor.

7. Be skeptical! If it sounds “too good to be true,” it probably is. “Bad” supplements are sold via multi-level marketing schemes, have exaggerated claims and a price that is often unwarranted.

8. Not all supplements are created equal. Make sure you know exactly what you are getting in your supplement. Supplements stating they are proprietary blends may not disclose how much of each ingredient they contain and may contain sub-par levels of ingredients.

9. Don’t mix and match. Consider the combination of your supplements. If you are taking a multi-vitamin and other supplements containing a nutrient in the multi-vitamin, you may be exceeding the tolerable limit.

10. Supplements aren’t substitutes. Most importantly, remember that a supplement is never a replacement for a healthy diet.

Shayne Robinson, RD CSO CDN is an oncology dietitian formerly with WCM/NYP’s Ambulatory Care Network’s Outpatient Practice. To see a dietitian at our outpatient nutrition practice call (212) 746-0838. Physician referral required.

Supplement Safety: What’s in a Supplement? 

Shayne RobinsonBy Shayne Robinson, RD, CSO, CDN

The first question a cancer patient often asks is, ‘Will this supplement help?’ but an equally important (and often overlooked) question is, ‘What’s in this supplement?’

While many scientific studies have questioned the benefit of nutritional supplements in cancer prevention, others have questioned the integrity of the supplements themselves. They have raised serious questions about the quality and consistency of the contents inside the bottle and how these may differ from what the label says.

It’s important to know that dietary supplements are exempt from the Federal Drug Administration (FDA) enforced safety and efficacy laws that regulate prescription and over-the-counter medications. This means that a manufacturer does not have to prove the safety and effectiveness of a supplement before it is put on the market! If a supplement on the market is suspected of being unsafe, then the burden is on the FDA to prove that the supplement is unsafe before it can be taken off the shelves.

There is also little assurance that the labels of the supplements provide accurate information. In 2013, an unpublished abstract looked at the best practices of 12 different supplement manufacturers with reasonable reputation’s as quality providers of supplements. While all 12 companies claimed to be operating in full compliance with FDA regulations, three had received warning letters from the FDA for manufacturing violations, two had a product recalled within the last five years, four reported that their products failed Consumerlab.com’s standards for potency or purity, one did not have any product specifications, one was found by the FDA to have inadequate testing, one was found to have a lack of sufficient controls throughout the supply chain to guard against microbiological contamination (a potentially fatal oversight for any patients with compromised immune systems), and two had melamine contamination or lacked melamine testing.

Another reason to steer clear of supplements is the lack of data to support expiration dates, material discrepancies between claims and actual practice, and failure to change the Universal Product Code numbers when active ingredient formulas change. Unknown formula changes are especially concerning for allergy sufferers. The study concluded there was considerable variation in the quality of dietary supplements, raising concerns for patient safety. These concerns were reinforced by a report from the New York State Attorney General in 2015, which found that supplements sold across the state at major retailers were routinely mislabeled and did not contain their purported ingredients.

So, as an oncology dietitian, I encourage my patients to be weary of supplements and instead to eat a balanced diet of whole, unprocessed foods.

Shayne Robinson RD CSO CDN is an oncology dietitian at NewYork Presbyterian Weill Cornell’s Ambulatory Care Network’s Outpatient Practice.  To see a dietitian at our outpatient nutrition practice call (212) 746-0838 (physician referral required).

Previous Post: Supplements

What are the Guidelines for Cancer Patients?

Supplements: What are the Guidelines for Cancer Patients?

Shayne RobinsonBy Shayne Robinson, RD, CSO, CDN

As an oncology dietitian, I encourage my patients to eat a balanced diet of whole unprocessed foods. To quote the author Michael Pollan, “Eat food, not too much, mostly plants.” So where do supplements fit in the treatment of a cancer patient?

The latest National Comprehensive Cancer Network (NCCN) Guidelines on Cancer Survivorship does not recommended supplements for most survivors except, when there are nutritional deficiencies, or concurrent conditions like osteoporosis or cirrhosis. Furthermore, there is little data to support using vitamins or other dietary supplements to either prevent cancer, control cancer, or prevent the reoccurrence of cancer after treatment. Taking vitamin supplements does not replace the need to maintain a healthy diet. It is better to get these nutrients straight from the source, and all efforts should be made to obtain nutrients naturally. Survivors of certain cancers are at risk for vitamin deficiencies based on their cancer treatment, and supplements should be recommended by a healthcare professional on a case-by-case basis.

The American Cancer Society (ACS) and The American Institute of Cancer Research (AICR) also review nutrition research to develop guidelines for cancer prevention and cancer survivors. The ACS guidelines on nutrition and physical activity for cancer prevention clearly state, “Can dietary supplements lower cancer risk? Present knowledge indicates no. While a diet rich in vegetables, fruits, and other plant-based foods may reduce the risk of cancer, there is little evidence that dietary supplements can reduce cancer risk.” The AICR’s guideline on supplements states, “Don’t use supplements to protect against cancer. To reduce your risk of cancer, choose a balanced diet with a variety of foods rather than taking supplements.” These guidelines do acknowledge that there are special individual situations where supplements would be appropriate, but these do not include cancer prevention, treatment, or survivorship.

So remember moderation is key, and a diet rich in fruits, vegetables, and other plant based sources is best.

Shayne Robinson RD CSO CDN is an oncology dietitian at NewYork Presbyterian Weill Cornell’s Ambulatory Care Network’s Outpatient Practice. To see a dietitian at the outpatient nutrition practice, call (212) 746-0838 (physician referral required).