Supplements 101: The Basics

Tina 0:00

Welcome to episode 20 of the cancer pod. On today's episode, we're talking about nutritional supplements. Should you use them? Should you not? We're here to help you figure it out in this. Supplements 1 0 1. I'm Dr. Tina Kaczor and I'm a little bit country.

Leah 0:15

And I'm Dr. Leah Sherman, and I'm a little bit rock and roll,

Tina 0:18

and we're to naturopathic doctors who practice integrative cancer care.

Leah 0:23

but we're not your doctors

Tina 0:25

This is for education, entertainment and informational purposes. Only

Leah 0:29

Do not apply any of this information without first speaking to your doctor,

Tina 0:34

the views and opinions expressed on this podcast by the hosts and their guests are solely their own.

Leah 0:40

Welcome to The Cancer Pod. Hey Tina,

Tina 0:59

Hey, Leah.

Leah 1:00

how's your road trip going

Tina 1:01

It is lovely. I'm down in the desert in Borrego Springs, California, highly recommended.

Leah 1:08

nice.

Tina 1:09

I have to let you know though the wifi is a little more glitchy than at home. So hopefully this episode comes off without a hitch.

Leah 1:16

Well, if it cuts out entirely, I'll just, I'll just take over. Do the whole thing.

Tina 1:21

This

Leah 1:21

pod is about supplements. We're calling it supplements 1 0 1 and because there are supplements that patients take that they want to know if it's good for them, they want to know if it's safe, you know, is it appropriate? All of that kind of stuff. And I just figured that we would talk about how we kind of go through our process on determining whether or not a patient should take us.

Tina 1:44

So it's like the equivalent of teaching people to fish instead of giving them a fish. Yeah.

Leah 1:50

Just kind of giving them that a little bit of self-empowerment so that they can kind of, you know, at least for the quality

Tina 1:55

control. Yeah. A conceptual framework to make decisions from. Cause people are out there and making their own decisions if they don't have a naturopath or an integrative practitioner. So helping them prioritize. How to do that. How do, to figure out which supplements you should take and which ones you don't need. Yeah,

Leah 2:13

So I think first and foremost, you and I both agree that food comes first.

Tina 2:19

Always. Yeah. We have yet to be able to recreate the actual complexity of plant based foods. what I'm saying is you can't encapsulate everything we need, it's not possible. So you have to eat the whole foods and the plant-based foods. And in particular, because even though we have identified essential vitamins and minerals, we'll just put that under the heading of nutrients, there's clearly other things in the foods that are essential.

Leah 2:48

Right. I mean, and they all work synergistically together. Like the benefit of something like. Broccoli can't really be replicated in,

Tina 2:56

in a tablet. Right. You know, I, you know what I did once I printed all of the known chemical compounds in a potato. This was way back in the day. It was late in the 1990s, just to show people the complexity of a food. There was well over 10,000 compounds in that potato and potatoes aren't known as particularly complex. I mean, we don't think of them like we do broccoli or kale or these other ones that we kind of put on a pedestal, so to speak, but it was 14 pages. I would bring it to lectures just to show people like, this is why you can't just take a pill and think you're getting what you need. There's way more in food than we really even talk about.

Leah 3:35

So we should talk about some of those nutrients that are essential. The ones that you know can lead to those nutrient deficiency diseases.

Tina 3:46

Right? You mean the blatant ones, like. Scurvy

Leah 3:51

rickets. So scurvy is from a vitamin C deficiency. Rickets is from vitamin D deficiency. Pellagra is a vitamin B3 niacin deficiency. And then beriberi is from thiamine deficiency and that's

Tina 4:08

vitamin B one. Yes. And so overt deficiencies like that are at least in the United States. And most of the world that's done not seen in our clinical practices very often at all.

Leah 4:21

Right. But they do still occur. And that is the reason we don't see them so much is because processed foods are fortified with these nutrients to prevent

Tina 4:29

these diseases. Yeah, they put back just enough to keep you from getting a gross deficiency in the nutrient, but it's not the idea of processed foods, which are probably the primary food source for a lot of people, at least in the United States is not ideal,

Leah 4:44

right. Because they don't have those nutrients innately.

Tina 4:48

Right. And they're missing all those other 9,998 chemical compounds. They're 14

Leah 4:55

pages. Those are, those are the 13 and a half pages of nutrients. And then there are the kind of those like preventing, or at least delaying some of those other chronic conditions. Like I, the first thing I think of is like osteoporosis, right? I mean, you ideally, aren't waiting until you have bone loss to address your bone loss. Doing things preventively, whether it's eating the right foods, obviously exercising, but also possibly supplementing with calcium, magnesium vitamin D type

Tina 5:26

things. Yeah. Yeah. And we'd had that whole episode on bone health and what to do and how to prevent bone loss. Interestingly, if people are replete in their calcium intake, especially in the first three decades of their life, they build up a better bank of bone. You know, it's a nice strong bone. And then of course, repletion, repletion being the opposite of depletion. Right? So I use the word repletion just to mean people have a sufficient amount of something. So if they can continue to get their calcium intake through food and if needed. Through food and supplement. So someone who doesn't drink dairy, for example, or eat cheeses, or do any of that. If for whatever reason, aren't able to get it from vegetables, because of course, a lot of greens are high in calcium. If they can't do that and they have to supplement, that's fine. Making sure that they're replete in their calcium intake, prevents the bone from being, if we're going to call the bone of banks and you don't have to take any withdrawals,

Leah 6:20

right. Cause your body will take the calcium from your bone if it's not getting

Tina 6:24

it anywhere else. Absolutely. And low calcium will not show up on blood work because your bone is such a large amount of calcium that's been stored. Your bloodstream will just always keep it tightly controlled within the parameters on that laboratory work, unless something is awry. So that's another little tidbit. If your calcium is off high or low, something's going on because your body does not like.

Leah 6:48

Right. Cause yeah, I mean, low calcium does show up on blood work, but that's like, that's major. That's not like, oh, I have a little osteoporosis. That's like something's going on.

Tina 6:56

Well, yes. And just usually in cancer care, low calcium follows low lb. Because if the albumin is low, the calcium may look low because it has to do with low albumin will show up like low calcium on there, but not be real., right? That's

Leah 7:13

the corrected calcium correct? The calcium, right?

Tina 7:15

If you have, there's a corrected calcium equation you can use when the person's albumin is low. The third

Leah 7:20

reason for taking. Or being recommended to take a supplement would be more of that sort of green pharmacy thing. Like, you know, I guess the first thing that comes to my mind is like ginger capsules for nausea. Right?

Tina 7:35

You don't have a ginger deficiency. Yes.

Leah 7:38

You know, and you're just kind of using it in place of, or in addition to a medication yes.

Tina 7:45

To address

Leah 7:46

a symptoms. So I think that's like the easiest thing that pops

Tina 7:48

up. Yeah. And I think that is the easiest thing. It's like basic programming it's if this, then that loops, if nausea then ginger, if osteoarthritis then glucosamine, you know, we call it green pharmacy because we're just using it in lieu of some drug that otherwise would be used or

Leah 8:06

in

Tina 8:06

conjunction. Or in conjunction with

Leah 8:09

yeah. As long as there's no interaction. Right,

Tina 8:12

right. Which we'll get to. So the way I would put this is there's three ways to prioritize the supplements. When I'm looking at someone in my office, I think to myself, what do we need for repletion to make sure they're not deficient like given this person's scenario, whatever's going on in their life. Out of treatment history, absorption, like taking that case, what do we need to replete them with? You know, what nutrients are they not getting? You know, living up in the Northwest. I think of vitamin D a lot of people don't get enough of that. So we often end up having to supplement vitamin D and then I think of the second priority is problem solving. You know, if you're constipated, then what can you take to relieve that nutrient wiser? And then the third is the more global picture of taking who they are, their family history, maybe their history of cancer, And saying, what can we do to change that using supplements? Right. So that, that's my priority. make sure there's no deficiency, then go to problem solving or symptom management and then go to weaknesses of organ systems and that person or their family history. So that's how, of how I think that one, two and three. Okay.

Leah 9:20

And I guess. Kind of similar. I think of it a little differently just because of having worked in hospitals, like I have to be hypervigilant about checking for interactions. And so what I usually do is, you know, the patient comes in and they've got their supply of supplements and I will go through, I'm sure you do the same. You go through each one and. Learned the hard way I asked them, why are you taking this? I don't say, oh, this is for your heart. You know, like, I don't assume anything. I just ask them, why are you taking this? And the answer can be, oh, my doctor told me I need that for my eyes. Or I heard so-and-so on TV recommended and it sounded good. My friend, my relative recommended it. You know, it could be something that I would not have thought that. So I had a patient who I was going through their supplements and they were taking vitamin E capsules. And I had assumed it was for one thing. I don't know, like heart health or something. I didn't know why they were taking it. And they said, oh no, I take it for skin. I heard it was really good for wrinkles. So that's not what I hear typically as a use for vitamin E. So I think it's always good. Ask, why are you taking this? How often do you take it? That sort of thing. And then, like you said, do they need it? Is it something where they're a vegetarian or vegan? And so maybe they do need those extra B vitamins. Do they have a history of malabsorption? If they're inactive treatment? Are they not getting enough nutrients because they are. Having vomiting and diarrhea, lack of appetite. If somebody doesn't have an appetite, I don't necessarily want them taking pills because those can contribute to nausea as well. But, you know, just kind of like keeping all of those things in mind, making sure that people are nutrient replete

Tina 11:08

during their treatment and food always does come first because supplements are called that because they're supplement. Exactly. Exactly.

Leah 11:17

And so that's like my next part, can we take this as food instead of taking these, can it be fruits and vegetables, grains, those kinds of things. So that would be like my next part. And then how safe is it? Is it going to interact with their active treatment or any other medications that they take? If they're taking blood pressure medication or, you know, anything, is it going to interact with that? As we know there are some supplements that are contraindicated if

Tina 11:44

you are a smoker. Right, right. Yeah. That's important to remember. There is definitely some clearly contra-indicated supplements. If someone is smoking, I'll put carotinoids under that heading like beta carotene, especially there's been evidence that that actually increases the risk of lung cancer in smokers specifically. And the other one that comes to mind. That research came out more recently is there was an association of lung cancer in smokers who took a B complex, right? Yeah. And that was high dose B complex. It wasn't just repletion of B vitamins. It was a big dose of fever. Right. And

Leah 12:21

then the next part that I talked to them about is how to look at a label. And if you look at something and it has a super high dose amount of any sort of vitamin or mineral question that like, do you really need that much? And then the other thing is that sort of kitchen sink supplement, where it's got everything in it, it's like a one horse pill and. Have all of the vegetables and fruits you ever needed. And it's got all these herbs for your immune system and mushrooms and all of this. And you just have to take one pill a day. That unlike question that

Tina 12:55

doesn't,

Leah 12:56

it, it doesn't make like you're not getting any true

Tina 13:00

value from it. You know, that reminds me as you're talking, I'm having this visual. I have, I can recollect with people. I do the same thing. I'll go through all their supplements and. Like a grocery bag full or a couple of boxes. I mean, some people are taking suitcases. I will often put them up on the table and have them choose the ones they think they feel the most. Like, which of these do you feel some relief from, for any, some like, I would need to know which ones you're truly married to taking so that we put those to the side and then I'll ask them what they get from those. If they pull out one of these in one of them, I remember this, it came in, something looked like a wine bottle and it was a liquid. And I had more than one person put that aside and say, I might, arthritis goes away. I have less pain. And then I look at the ingredients and I can tell you, there was nothing in there that warranted that strong of an anti inflammatory effect. My suspicion with a company like this, that puts in a litany of different. Quote, unquote, whole foods. I don't know what they're putting in it. Exactly. And then they put it into a liquid. It's very hard to deconstruct this. Right? You can't tell what the heck is in there. Really. My suspicion is that they're also adding a little bit of ibuprofen or a little bit of something that is truly reliable because they're charging, you know, 30 or $40 per. The contents, don't warrant, that kind of cost, but it worked. And I thought, well, you know, the unfortunate truth is they could put anything they want in there in the end as a liquid. And in particular, I think you can get away with a lot. So you could have adulterated.

Leah 14:36

Right. And that makes me think of, I had a patient that was taking a, B vitamin for, I think it was for their neuropathy and they picked it up in Mexico and they were like, this is great. This really works. And I looked at the ingredients and it, it had a medication. I can't remember what it may have had Gabapentin in it or something. It had some medication, it said it was a B vitamin and it was listed on the label. Or maybe it had a steroid. I can't

Tina 15:04

write. Now that we're getting into labels. Stay tuned because I have a story about someone who actually was hospitalized due to something they took. Okay. So when we

Leah 15:13

come back, we're going to talk about how to interpret and supplement label.

Tina 15:37

Okay. So I had one experience that actually did land a patient in the hospital. Not because of anything. I recommended something they were taking on their own and they actually didn't even divulge it to me. Far too late. They went online. They heard about, I think it was lay a trill, otherwise known as vitamin B 17, which is a whole nother controversy. That's decades, long vitamin, not vitamin. In any case, they thought that after what they read, they thought that this was going to be helpful for their cancer. So they procured Leah trill from outside the country. And of course they got sent these pills. They took these pills. Turns out that they were extremely high doses of vitamin D. This person was hospitalized due to high calcium and heart palpitations, I think had had a dysrhythmia their vitamin D level was over 800. Oh my gosh.

Leah 16:34

Yeah. What's considered a normal vitamin D level is 30. Yeah, you don't want it anymore. Close to, oh my

Tina 16:41

gosh. So they had 10 times the upper limit of how much vitamin D should be circulating. So this led to high calcium high calcium led to heart a arrhythmias, and that's what landed them in the hospital. of course I was on record as the naturopathic physician. So I don't know if fingers were pointed or not. Cause I wasn't privy to any discussions behind the scenes. All I know is. I've never, haven't seen it. It was pretty obscure. So I haven't seen anyone else do that, but it's buyer beware out there in ag can say it was specially if you're getting it from anywhere outside your own country in knowing your own country's regulations, which is what we're going to talk about now. Yeah, for

Leah 17:16

sure. You know, you hear about people who are bodybuilders and they take those supplements. I mean, they can be adult. Steroids or, you know, other things, I mean, it's important that somebody knows how to find a good quality supplement. Yes. And I think the first thing is if a supplement promises you some sort of health benefit by. Yeah. If it's going to cure everything and you hear that, right? I mean, we get these liquids and powders and it's like, oh, but this will help with my arthritis, my heart disease and my diabetes and my cancer. And it'll make my hair grow longer. You know, like

Tina 17:55

be suspicious. Well, I say you should be suspicious of anyone or anything that says that they care. Oh done mic drop. Right?

Leah 18:07

You're talking like supplements and like out, I mean, outside of an oncology. Yeah.

Tina 18:13

Yeah. Oh, okay. Yeah. I would just, oh yeah. I mean, yeah. When we're talking about supplements, cause I've seen this and this is the most unethical. Gross example of buyer beware is there are, I can name some prodo sell is one of them protocol. Was this another liquid on the market that had a bunch of stuff in it that doesn't have anything at all? It's gone through a lot of iterations. It used to be called, can sell, and it was can Tron. The FDA pulls it off the market. They come back with the same liquid and a different name. They promise to cure cancer. They charge hundreds and hundreds of dollars. The whole thing is a scam. And. Blatantly tell people what you're reading is bunk it's crap. It's not real. I wish it were, if it were clearly, we wouldn't be working so hard to bring in integrative medicine and help people with much more complicated ways of optimizing health and living as long as possible. If they're way to. You wouldn't be able to suppress that. I know that cause there's too many people with boots on the ground that are too good hearted to let that happen. It's not gonna happen,

Leah 19:19

right? There's no big conspiracy.

Tina 19:21

No, no. They're definitely are people

Leah 19:23

who prey on that. I mean, there are a lot of supplements out there that are targeting. Cancer

Tina 19:31

patients. Right. And in order to have prey, that means you're being predatory. Right? So like just the word itself, like you don't want to go to a predatory company who's preying on anyone with a false promise. Right.

Leah 19:43

So beware of false promises, how do we go about finding a supplement that's. That's appropriate to take let's let's say vitamins, right? Okay. So you want to take a multivitamin? You're looking at the label. You've talked with your dietician. You've talked with your oncologist. You've talked with your family practice, doctor, your naturopath. It's okay to take a multivitamin. So what are you looking for on a label?

Tina 20:07

there are some designations on the label you can look for to at least see that minimal quality control has been done. One of them is C G M P, which is certified good manufacturing practice. And in other countries you can find N S F or NSF international stamp on some supplements. And that's meeting manufacturing practices that meet the national science foundation certification. So those are a couple of levels. And then there's also in the United States. There's U S. So USP may be a stamp that signifies better quality.

Leah 20:41

Right? So at the hospital, we had a whole process that if we brought in supplements, To be sold, you know, they had to be guaranteed for their quality control and all of that, that they were the appropriate quality. What was in the pill was

Tina 20:56

on the label.

Leah 20:57

And there was a time when I was seeing a patient, she was in survivorship. She was taking his spirit in, which is a supplement. You know, she was taking that for her hot flashes and it was working great. And she was out of state. And ran out of the pills. Couldn't pick it up at the hospital. And so she ordered some through Amazon and the, his spirit in didn't seem to work anymore. And we kind of figured out that, you know, there are companies out there who are printing these labels that look like a recognized company and it's what's in the capsule is not actually. What is on the label. And so she switched back to the one that was sold at the hospital and yeah, I worked again

Tina 21:46

interesting. Yeah. I had a similar scenario. The wholesaler that I would buy products from would get in a certain enzyme from Germany called Wolf enzyme and wovens. I'm went through a time where whatever reason their manufacturing plant was down and what happened. I don't know who or how they did this, but even to the wholesaler, the wholesaler went out and found it out there in the world and ended up buying it. It looked exactly the same and the label dispensed it to all of us. The. And then follow that up with, oh no. What we sent out, although it looks exactly like the stuff from Germany is not coming from Germany. It's a complete, it's a fraud, it's a fraudulent product. So of course I go to the shelf, I pull it off. I happen to have some of the old stuff and because this is an enzyme, it breaks down proteins on contact. I took a knife, I cut both in half cause they're enterically coated. So you have to cut them in half. I stuck each half on my. Oh, and just for the record, if you put strong pancreatic enzymes on your tongue, it starts to digest it. One for the team. Tina, I did ensure enough the fraudulent stuff did nothing. And then one, the actual one from Germany left me with basically a little Burnside on my tongue. Yeah.

Leah 22:59

Were you being a vegetarian doesn't work gov

Tina 23:03

on the fridge and taken out a piece of

Leah 23:04

Turkey and done the same thing it's to your poor tongue. That

Tina 23:08

story is kind of great. Yeah. I mean, it's not great, but it's kind of great. Well, I had to confirm that it was fraudulent because I wasn't sure, of course, like I said, took one for

Leah 23:20

the team. Yeah. So be aware of where you're purchasing these products as well.

Tina 23:27

Yeah. Yeah. You're best off making sure that it comes from a good wholesaler. Someone who, if they make a mistake will tell you so or finds out something out or get it straight from the company. If. There's a big difference out there here. And there's another story. I'm going to be one more story about quality control. We use a company that sells to doctor's offices does not sell over the counter necessarily. There was a time where there was years. This is years ago. It was really difficult to find a clean curcumin on the market. Most, all of the curcumin that was out there was adulterated and it had high lead levels. So we couldn't get it from our favorite source, which this particular company tests, every batch, when it comes into their place. So they get, let's say they order one ton of curcumin powder. They take a little bit, they send it to a lab. If it doesn't pass their quality control, their interior company, quality control tests. This is way above and beyond USP, NSF or GMP. If it doesn't pass, they reject it. There was three, if not six months where I couldn't get any curcumin from them at all. So I asked them what happens to that curcumin? What do you do with that powder? And they say, we send it back to the company, that company overseas, I don't know if it was India or China, where they were getting it, but that company then turns around and dispenses it again. And it ends up as a cheap curcumin on the shelf through some company that doesn't retest it when they get it in. Right. So I'm saying that still made it to the. It just now is out there in the world as a curcumin with a little lead in it that nobody has retested for. And that's probably going to be a cheaper product. so you're going to find that in a discounted retailer of supplements.

Leah 25:07

that brings up a really good point of you can call. A supplement company and you can ask them if their products undergo third party testing, because it's easy for a company to say, oh yeah, we have the highest quality in-house testing, but finding a company that gets a third party, not affiliated with them at all and have them. Assess their product is a sign of a better

Tina 25:31

product. Absolutely. It should undergo third-party testing and let's put that bar higher. It should be every batch. Every time that's hard to do because legally that's way above and beyond what they're expected or required to do. And don't let them send you. What's called a certificate of analysis. The certificate of analysis is being given to them by the very company. Sold them the raw product. So that curcumin came with a certificate of analysis that said, no, our lead isn't very high at all. And then upon retesting, the company found out the lead was too high. So certificate of analysis is from the raw ingredients seller. And that's pretty close to you.

Leah 26:10

I think this is all good information that a lot of people aren't familiar

26:13

with.

Tina 26:14

Yeah. Yeah. And again, it's buyer beware. There are some regulations and there's more now than there was 10 years ago. And I'm going to guess 10 years from now, we're going to have more regulations on quality control, but for now this is what we would need to do to make sure that. Taking in clean supplements when you are buying them.

Leah 26:51

Okay. So safety issues, safety issues, and supplements. I think a lot of people have heard about it was in the news like six years ago, six, seven years ago, where a bunch of supplements were tested. It was like echo, Neisha, and some other things. From like stores like Walmart target and they were found to not have the ingredient that was listed on the label at all. So I don't know, it was a completely different ingredient than what was advertised. And so that's kind of a really important thing with what we were saying in terms of knowing what is in the supplement in the first place. Right.

Tina 27:32

Right. And I believe those were all. Botanical medicine. So they were all plants and they used a plant DNA kind of thing. They were looking for DNA fragments from particular plants that were the label claim. And I can't remember which ones they were, which plants in particular. But I did talk to somebody who specializes this in the industry and another discussion that we can link to. Maybe we should make that into a podcast and just make it.

Leah 27:55

Oh, yeah. Oh, so it's someone who their whole job is quality control.

Tina 28:01

Yeah. Supplement quality control. And I think he used to be in pharmacy business. Now for the last two decades, plus has done nutritional supplements or supplements. So, yeah, we can link to that. I think he goes into great detail in that discussion. I know some of it had to do with the fact that these were extractions that were pulled from the shelf. And sometimes when you extract a plant, you no longer have any physical material, the DNA shouldn't be in the end product,

Leah 28:26

but they did things in the product that also that should not have been in there. So I think it would be a really interesting conversation. So yeah, maybe we'll find the interview

Tina 28:36

and link. Yes, it's from 2018, but I think it's still is very relevant. So we'll do that. And he's, uh, he's an expert on the topic. So he told me a lot of things.

Leah 28:46

Nice. Yeah. The other big concern would be the interactions with medications. And this is again, more with herbal supplements than it would be with vitamins and minerals. But I do want to mention one particular vitamin that does have interactions and that's biotin. So biotin interferes with certain labs. And so people take buy a tin for you, its inherent nail formulas. And a lot of patients after their cancer treatment will take it because they feel it helps with growing their hair back. I always advise patients to check their supplements, to see if there is biotin and I have them hold it for at least three days. I usually say a week, cause it's just easier. But at least three days prior to getting. Lab draws. So when they come for their three month checkup a week before they come out, I just say, hold that supplement because of this potential for interaction, I think thyroid hormone is one of the labs that it interferes with. And I think it can also interfere with tumor markers. Oh, okay. So it doesn't interfere with the tumor marker itself. It interferes with the lab that. The level of tumor

Tina 30:01

marker. Right, right. Yeah. That's a big one.

Leah 30:05

Yeah. So by a 10 is really the only one I can think of offhand that would have like that sort of interaction.

Tina 30:12

Yeah. The only other one that I can think of that people might use is a glucometer vitamin C can show up on there. So I'm in seek and throw off a glucose meter. True. When someone does blood stick can throw up glucose readings on that particular way, though, not on the lab, not when you see glucose on a lab, but when you just do a finger prick test, and of course, people are already told this, but before giving any kind of stool sample, you withhold nutrients. And if you're going to get a test for any occult blood in the stool, you hold off on iron supplements, that kind of thing. And vitamin C for that matter, vitamin C. I think

Leah 30:46

iron is a really good mineral to mention also because again, cancer patients will start to feel tired. They're told they're anemic and they will start taking iron pills and pretty much don't take an iron pill unless you actually have been told to take an iron pill.

Tina 31:06

Right. I have to identify iron deficiency before supplementing with iron. Otherwise it can be. Yeah,

Leah 31:14

I mean, iron, if you don't need it can deposit in other areas in the body and it can be inflammatory.

Tina 31:22

And not all anemia is iron deficiency, anemia. There are several types of anemia and iron deficiency is only one of several ways of having anemia. So just

Leah 31:31

because you hear the word that, oh, you're anemic does not mean that you're iron deficient. And so that, that would be another thing that I would, I would caution patients about. Yeah. The big concern with taking herbal supplements is the potential. They may interfere with how the body processes, prescription medications, chemotherapies, or just day-to-day medications. I think of things like, you know, off the top of my head, what can interfere with Tamoxifen or opioids, right? So our body metabolizes drugs through our digestive system, through our liver, through our gut and. There are these enzymes, these ISO enzymes that help to metabolize anything that we inject. So taking certain herbal medicines may actually alter the way a medication is processed causing that medication to either speed through your body faster or to hold it back. So you get a greater effect.

Tina 32:34

Yeah, the enzymes you're referring to are those cytochrome P four 50 enzymes, right. Right.

Leah 32:39

The often has that sip CYP before it it'll say like sip 3, 8, 4, 2 D six. Those are the kind of the most common ones. There's also two C 9, 180 2.

Tina 32:51

Yeah. Yeah. I think the example that most people are familiar with. Is a, well, it's a plant. It's not a botanical plant. It's a food stuff. Grapefruit juice and blood pressure medications. Right. So everyone's maybe heard of that. I think it's the most common. Example of this, where there's a plant that affects these enzymes in a way that changes the efficacy of that medication.

Leah 33:15

Right? So if a person takes certain heart medications, they're cautioned against taking or eating or drinking grapefruit juice at all, because of the fact that it will enhance the effect of those medications, because it slows down that process. That is also a contra-indication with Tamoxifen, no grapefruit juice because

Tina 33:33

of that. Yeah. So grapefruit juice affects that cytochrome P four 50 that's that you mentioned, which is three, a four and three, a four is the cytochrome P four 50 enzyme that the majority of drugs do go through at some point. So the vast majority, I don't remember it's two-thirds or three-quarters of drugs. Use that enzyme as part of their pathway to either be activated or to be broken down depending on.

Leah 33:59

Another known herbal supplement. Another plant that does this very similar thing is, and I believe we've mentioned this before is St. John's wort. So that's the one that is kind of like the textbook when talking about herbs and interactions. So St. John's wort also can interact with, with

Tina 34:18

those. Yeah. And back to what you originally said, plants in general are more likely to enter. With drugs because some plant stuffs are drug-like right. St. John's ward is a good example of a plant that we use. And it net effect is very much like some of the antidepressants that are used. So some plants are just shy of being a drug. That's why their interaction likelihood is much higher than a nutrient, like vitamin C or magnesium, or what. That said, I know it's not our topic, but drug, drug interactions also happen. So people, once they have three medications, four medications, I always advocate one pharmacy, one pharmacy system to have all your medications. So that interactions will be flagged.

Leah 35:05

Yeah. That's a really good point because I've even seen recently on social media where. there are cancer patients who are on certain medications that interact that was never caught by their oncologist or their pharmacist. So I think that is a really good point. Yeah. Yes. And you have

Tina 35:22

to actually ask them, everyone's in a hurry these days and no one's going to say anything. So you might want to say, can you just do an interaction checker? I mean, you can do it online yourself, but you're best off doing it with a pharmacist whose license is really on the line to look for those things, right?

Leah 35:36

Right. And there are like positive interactions and there are negative interactions. And so just because something isn't interaction doesn't necessarily make it a bad thing. It just means that somehow it is being affected right. In some way. So there are some websites on some you have to pay for, but there are some free websites where you can kind of look at least for herbal medicines. And, um, I'll just put links to those in our show notes. Oh yeah. Great. I do want to say that because it is very popular that there is potential for certain cannabis products to interact with medications too. And hopefully nobody is smoking cigarettes, but cigarettes. Tobacco it's an herb. It can interact and it can interact with treatments for cancer.

Tina 36:22

Yeah. You know, the other thing we should mention besides those enzymes is just absorption of oral medications. So if someone takes a fiber supplement, especially fibers can often adhere to the compounds. It's called adsorption a D Zaption. adsorption is when a molecule. Is next to the medication, binds to it and keeps it from being absorbed in the first place. So it'll stay in the gut and be processed that way. So making sure you don't take anything at the same time as the medication that might add absorb to that medication and hold it in your gut is important.

Leah 36:57

Right? So avoiding taking fiber, avoiding taking calcium with certain things. Thyroid medicine is the one most people think of, not everybody remembers getting that advice. Some people probably never were given that advice to not take calcium with thyroid medication. Um, so yeah, just, just being aware that there are things that can block the absorption of medication.

Tina 37:22

All right. Well, I think this brings us to the point where we get to talk about our song. Did you pick a song for us?

Leah 37:28

Oh, I picked a song. The song for this episode is vitamins by queen Herbie.

Tina 37:38

Nice. Okay. Vitamin a vitamin B.

Leah 37:41

I'm not going to say it, but, and I'm probably not going to do a reel. Maybe I'll do a reel. It's really popular because everybody's doing reels with it.

Tina 37:50

But yeah, it's a fun song. And for the non Instagram aficionados out there, a real is an Instagram. Just so, you know, I forget that

Leah 38:00

there are people who aren't on Instagram, but

Tina 38:02

yeah, I think the vast majority of the world is not on Instagram. It just seems like everybody.

Leah 38:07

Yeah. If you're on Instagram, it seems like everyone's on Instagram. Anyways. It is a social media popular song, and I thought it would be kind of fun for

Tina 38:15

this episode. It's my kind of song. I like it. Well, and, and that, that means a lot. I'm just saying I like it.

Leah 38:24

Well, cause you're a little bit country and it's not a country

Tina 38:27

song. No, but I'm just a little bit country, a little bit. I'm a little bit eighties, new Yorker. Yeah. And

Leah 38:36

that we have a lot in common. We do. Yeah. So that brings us to the end of the first episode of our supplements. 1 0 1 pod. We're going to continue talking about supplements in the next episodes. Just things that patients ask us about quite

Tina 38:52

often. So we're going to start out with fish oil, right? Yep. Omega three

Leah 38:57

fatty acids is

Tina 38:58

our next episode. All right. And as always like us subscribe. Follow

Leah 39:05

or whatever it says on your podcast. Streamer, the episodes can come to you straight without having to look from, and if you need to look for them, you can always find all of these episodes on our website, the cancer pod.com and follow us on social media. We're on Facebook, Twitter, and on Instagram. And it's always the cancer

Tina 39:27

pod. We keep it simple, easy

Leah 39:29

to find. So on that note, I'm Dr. Leah

Tina 39:33

Sherman and I'm Dr. Tina Kaeser, and this is the cancer. Until next time.

Leah 39:39

Thanks for listening to the cancer pod. Remember to subscribe, review and rate us wherever you get your podcasts. Follow us on social media for updates, and as always, this is not medical advice. These are our opinions. Talk to your doctor before changing anything related to your treatment. The cancer pod is hosted by me, Dr. Leah Sherman, and by Dr. Tina Kaczor editing by Brogan Molloy music is by Kevin McLeod. See you next time.