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Supplement Savvy for Cancer: Multivitamins

By Jill Place, MA, RD

If you're eating the Standard American Diet, or the SAD diet, of fast food fare, you're probably long on a lot of fat, salt, and calories and short on the more than 40 nutrients your body needs to work well. Vitamins and minerals do many things for your body. They speed up and slow down metabolism, make cells healthy, and act as antioxidants that protect the body from aging and disease.

We can get all the nutrients that we need from food. In our fast-paced, take-out world, however, many of the foods we eat don't have all the nourishment our bodies need. We also don't choose foods that will give us enough nourishment. For example, we're supposed to eat five-plus servings (nine-plus if we've had cancer) of fruits and vegetables a day and we eat less than two. Fruits and vegetables give us lots of vitamins and minerals. Most of us also don't eat a lot of whole grains, legumes, soy products, and other foods that are very nourishing and cancer-preventive. And things like stress, environmental toxins, and certain medicines can rob our bodies of more nutrients.

If you have cancer, your immune system and metabolism may also not be working the way they should. You may be malnourished. If you've had surgery, you need more of some nutrients for wound healing and your body may not be able to absorb others. Chemotherapy and radiation steal nourishment from your body. And you may eat poorly during these treatments, which makes it even harder to nourish yourself. For these reasons, it might be a good thing to add a multivitamin with minerals to your diet.

Many people use nutritional supplements every day. The medical community also now says that it's okay to use them. A landmark 1998 editorial in the New England Journal of Medicine urged doctors to tell their patients to "Eat right and take a multivitamin". As a matter of fact, taking a good multivitamin with minerals is a better idea than taking a bunch of individual supplements. A quality multivitamin with minerals gives you nutrients in good balance; too much or too little of a nutrient can affect the function and absorption of other nutrients in your body. But it might be wise to wait until you're finished with chemotherapy or radiation to take your multi as the antioxidants contained in it may make your treatment less effective. A good rule of thumb is to stop taking your multi at least one to two weeks before your first treatment and resume one to two weeks after your last treatment.

Multivitamins can serve as a great base upon which to build your supplement regime.

If you're currently taking a multivitamin, check to see if your brand has the suggested forms of the following vitamins, minerals, and other nutrients in bold red type below. If it does, you're taking a quality multivitamin.

Does your multivitamin have these antioxidants?

Antioxidants in your multivitamin can work synergistically together to boost immunity and stop free radical damage that may cause cancer.

Mixed carotenoids

Natural carotenoids, such as natural Beta-carotene, are preferred over synthetics. Synthetic Beta-carotene has been used as a single supplement in some studies that have caused cancer. A variety of carotenoids from fruits and vegetables are the best multivitamin bet for this form of vitamin A. Carotenoid varieties may act synergistically and enhance the actions of other carotenoids and antioxidants. Carotenoids have been shown to possibly protect against many diseases, including cancer. Mixed carotenoids that may be included in your supplement include Alpha-carotene, Cryptoxanthin, Lutein, and Zeaxanthin.

Vitamin A

Vitamin A is a fat-soluble antioxidant. Best forms come from natural sources, such as fish liver. Retinyl acetate and Retinyl palmitate are the forms found in most high-quality multis.

Vitamin C

Vitamin C is the most important water-soluble antioxidant. Vitamin C may prevent cancer by detoxifying cancer-causing substances, blocking cancer-causing processes, scavenging free radicals, and boosting immune response. Studies have shown protective effects with colorectal, stomach, lung, breast, esophageal, and oral cancers. Ascorbic acid and mineral ascorbates, like Calcium ascorbate, are the forms most used in multis.

Vitamin E

Vitamin E is a fat-soluble antioxidant that may inhibit a variety of cancers including esophageal, stomach, lung, and prostate. Natural Vitamin E, d-alpha-tocopherol, is absorbed twice as well as its synthetic cousin, dl-alpha-tocopherol. Most multis contain d-Alpha-tocopheryl succinate, the dry form of Vitamin E, which has been used in many cancer prevention studies. For more information, ask your dietitian or Supplement Savvy Specialist for the individual Vitamin E handout.

Selenium

Selenium is an essential mineral in human nutrition that may protect against a wide variety of tumors including lung, gastric, colorectal, prostate, breast, liver, and skin cancers. Selenium occurs in supplements mostly as high-selenium yeast, L-Selenomethionine, Sodium selenate, and Sodium selenite. Selenium also may be in an amino acid chelate form such as Selenium asparate.

Do you have these extra antioxidants in your multi?

Quercetin

Quercetin is a potent bioflavonoid that is found in abundance in red wine, onions, and green tea. It has been researched as possibly being effective against colon cancer and leukemia. Quercetin in small amounts in multis helps prevent the oxidation of Beta-carotene.

Superoxide Dismutase (SOD) Precursors

SOD is an enzyme produced in your body that is another potent antioxidant. SOD can be produced in your body when you have enough zinc and manganese. Some supplement authorities believe that these minerals shouldn't be in your multi because we get enough from food, but others believe that these minerals should be included because they help make SOD. Good forms of Manganese include gluconate and ascorbate and amino acid chelates such as glycinate. Good forms of Zinc include gluconate, aspartate, and amino acid chelates such as glycinate and histidinate.

Do you have these forms of other vitamins in your multi?

Vitamin D

B-Complex Vitamins

This group of water-soluble vitamins, especially B6, B12, and Folic Acid, may improve immune function and turn off cancer genes. A B12 deficiency might help cancer along by allowing carcinogens to damage your body's tissues. B12 and Folic Acid may also help during can treatment to prevent side effects like pain and tingling in your hands and feet, anemia, and fatigue. Best forms of B6 include Pyridoxine HCl and Pyridoxal 5,1 phosphate. Best forms of B12 include Cyanocobalamin and Methylcobalamin. The best form of Folic acid is Folic acid. For more information about B-Complex Vitamins, read the article on B-vitamins.

Do you have these forms of minerals in your multi?

True amino acid mineral chelates

Most one-tablet-a-day multis have inorganic minerals like carbonates, citrates, gluconates, and lactates. They're convenient, but usually are poorly absorbed, decrease absorption of other minerals from supplements and food, and can cause digestive upset. True amino acid chelates are much better absorbed and don't interfere with the absorption of other nutrients. They also don't cause gut problems. Look for forms such as Calcium in the form of glycinate or Microcrystalline Hydroxyapatite (MCHC), Iron in the form of glycinate, Chromium in the form of Dinicotinate glycinate, and other histindinates, lysinates, and so forth. Look for the name Albion or a patent number on the label as Albion holds most of the patents for these chelates. Chelates are big molecules. Molecules are a bunch of atoms stuck together. Because chelates are so big, you'll probably have to take several pills to get the nutrition you need.

Other things to consider when choosing a multi include:

Toxicity

Make sure that you don't take too much of certain nutrients such as Selenium. Check "What to watch out for..." below to see which nutrients may cause toxicity at higher doses.

Digestive Upset

Inorganic minerals like carbonates, sulfates, lactates, and synthetic ingredients such as talc may upset your gut. Check the label to see that there's none in your multi as you may be prone to digestive upset right after cancer treatment or with gastrointestinal surgery.

Allergy or Sensitivity

People who have had cancer may be more sensitive after treatment and surgery. Make sure that your multi doesn't have things like artificial colors, flavors, sweeteners, or preservatives and other things that may cause allergic reactions such as salt, lactose, milk, eggs, sugar, yeast, soy, or wheat.

Bioflavonoids

These pigments from the skins and rinds of fruits and vegetables are some of the best antioxidants in nature. They can also block the growth of tumors, prevent cancer spread, and stop the growth of blood vessels that feed tumors. Look for standard or undiluted bioflavonoids or citrus bioflavonoid complex. AVOID BIOFLAVONOIDS IF YOU ARE CURRENTLY TAKING TAMOXIFEN.

If your multi has alot of the vitamins, minerals, and other nutrients listed in bold red type above, you've got a great multi. If not, ask your dietitian or Supplement Savvy Specialist to recommend a good one for you. It's really important that you ask an expert to recommend a proper multi for you if you have or have had cancer.

Source: "Build a Better Body" © 2000 Advanced Nutrition Publications, Inc.

What To Watch Out For. . .

Briefly, here's some possible precautions for each nutrient in your multi :

Bioflavonoids have few interactions. If you're taking tamoxifen, however, you want to avoid citrus fruits and juices and the citrus bioflavonoid tangretin. Preparations containing grapefruit bioflavonoids may enhance or inhibit drugs like felodipine, carbamamazapine, lovastatin, simvastatin, saquinavir, nisoldipine, and some chemotherapies.

AVOID MULTIVITAMINS WITH ADDED COPPER as copper may cause angiogenesis, the growth of new blood vessels in tumors that allows them to grow.

Calcium should be taken with food to decrease possibility of kidney stones. If you have kidney stones, don't take supplemental calcium. There are many drugs and nutritional supplements that decrease the absorption of Calcium. Please ask your dietitian or Supplement Savvy Specialist if you're interested in more information. Calcium may also be poorly absorbed from foods like spinach, beans, seeds, nuts, and grains that have a lot of phytic or oxalic acid. Calcium is best taken in the evening with some food that's not oxalate or phytate-rich.

Carotenoids should be avoided by pregnant women and nursing mothers in doses of greater than 6 mg a day and they should attempt to get this nutrient from fruits and vegetables. Smokers should avoid supplementation. Doses of 30 mg or more may cause a yellowing of the skin, which is harmless and reversible if use is discontinued. Drugs like cholestyramine, colestipol, and orlistat, supplements like Lutein and Pectin, and foods like Olestra may decrease absorption.

B Vitamins. Please see B Vitamin article for precautions.

Chromium dosages of greater than 200 mcg a day may be toxic. There are few interactions or precautions. Phytates may decrease absorption.

Some cancer patients should AVOID MULTIVITAMINS WITH ADDED IRON because of hemochromatosis, or possible iron overload. Please as your doctor if you have any problems with iron.

Manganese should be at a dosage of 1 mg or less in your multi to avoid toxicity. Supplementation is not recommended if you have liver failure. Magnesium-containing antacids, laxatives and tetracycline decrease absorption. Supplements such as Calcium, Iron, and Magnesium may also decrease absorption.

Quercetin adverse effects are rare. Avoid usage if you are taking cisplatin. Quercetin decreases absorption of quinolone antibiotics. Bromelain and papain enzymes increase absorption.

Selenium dosages of 200 mcg or greater in your multi may be toxic. Selenium is safe and has no known interactions at normal doses.

Vitamin A dosages of more than 5,000 IU in multis can be toxic. Nursing mothers shouldn't take more than 5,000 IU. Doses of 25,000 IU or more can cause toxicity and 10,000 IU can cause birth defects. Cholestyramine, colestipol, and mineral oil, Vitamin K, and Olestra can decrease absorption.

Vitamin C dosages shouldn't be more than 75 to 90 grams a day if your kidneys aren't working well, if you have too much iron in your blood, or if you have iron-related diseases such as thalassemia or sickle cell anemia. Rare difficulties occur in those who take more than 3 grams a day. High doses of aspirin may impair absorption. Vitamin C enhances the uptake of flavonoids, Iron, and Vitamin C. The protective effect of Selenium may be negated by Vitamin C.

Vitamin D overdosage may cause adverse reactions, but multis rarely have anything but low to moderate doses. Higher doses should be used only under medical supervision. Use with caution when taking digoxin or other cardiac glycosides. Cholestyramine, colestipol, ketoconazole, mineral oil, phenobarbitol, phenytoin, and Olestra may reduce absorption. Calcium enhances Vitamin D absorption.

Vitamin E is an anticoagulant, and shouldn't be used if you have bleeding lesions such as peptic ulcers, a history of hemorrhagic stroke, or inherited bleeding disorders such as hemophilia. Pregnant and nursing mothers should avoid doses of more than 15 and 19 mg a day respectively. Also, you need to stop supplementation about a month before surgery and not resume it until you are recovered. Vitamin E may enhance the actions of drugs like amiodarone. cyclosporin, zidovudine, aspirin, cyclosporin A, verapamil, doxorubicin, and vinblastine, and supplements like Selenium, Vitamin C, and some herbs. Drugs such as phenobarbital, phenytoin, cholestyramine, colestipol, isoniazid, mineral oil, neomycin, orlistat, sucralfate and wayfarin and supplemental lipids such as flaxseed oil, gamma-linolenic acid, DHA, EPA, and CLA may decrease absorbtion of Vitamin E. For a more complete list of precautions, see the individual Vitamin E handout.

Zinc in higher doses may cause digestive disturbances and may suppress your immune system. Drugs such as bisphosphonates, quinolones, penicillamine, and tetracycline may decrease absorption. Many supplements decrease absorption, such as Calcium, Copper, Inositol, Iron, and Phosphates and food components such as caffeine, oxalates, phytates, and tea. Cysteine, Histidine, and NAC may enhance absorption.

© Copyright 2002 Jill Place, MA, RD