Natural Supplements in Cancer (Vitamins, Cannabis, Mushrooms)

Dr. Donald Abrams’
Integrative Cancer Therapies

Dr. Donald Abrams, a leading integrative oncologist at the Osher Center for Integrative Medicine at UC San Francisco (UCSF), has also done extensive studies in medicinal mushrooms, Traditional Chinese Medicine interventions, and nutrition. 

Explore below his insights on different kinds of natural supplements and whether he recommends them for cancer patients.

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Do natural supplements slow disease progression and decrease the risk of cancer?

In the American Institute for Cancer Research, World Cancer Research Fund guidelines say don’t use supplements to prevent cancer.

And it turns out that whenever we’ve looked particularly at vitamins with their possible ability to decrease the risk of cancer, not only have they not worked, but sometimes they’ve made the situation worse.

Vitamin A and Vitamin E study

For example, there was a concern that vitamin A or beta carotene, a vitamin A precursor, may decrease the risk of lung cancer in people who smoke cigarettes. They did a large study on 30,000 men. They gave them vitamin A, vitamin E both, or neither.

And at the end of the day, the men getting the beta carotene, the vitamin A precursor, actually had an increased risk of lung cancer. And in that study, they thought that the men getting vitamin E had a decreased risk of prostate cancer. 

That led to another study of 20,000 men over the age of 50 getting vitamin E selenium both or neither to see if they could decrease the risk of prostate cancer. That study was stopped early because the men getting vitamin E actually had an increased risk of prostate cancer.

So if I am a man with a prostate who used to smoke cigarettes, I won’t take a multivitamin because they have vitamin A and vitamin E, and they’re not good for me.

Bad actor: folic acid

I think the bad actor there is folic acid, which is synthetic folate that we get from foliage or green leafy vegetables. Folic acid allows cancer cells to continue to divide and become more aggressive.

So the only vitamin that I like as a vitamin supplement is vitamin D, which comes from the sun. Most of us are actually deficient in because our dermatology friends tell us to avoid the sun or if we go out, put on all those SPF products.

People over the age of 50, overweight and with more pigmentation are also inclined to be vitamin D deficient. I think vitamin D is important for our immunity.

We talk about flu season as if there’s a bank of viruses waiting off the coast to come in November. Well, it turns out we as a herd become vitamin D deficient, and that’s what allows us to be susceptible to viruses. In fact, even Tony Fauci is now saying vitamin D may help protect us from COVID. 

I measure vitamin D levels and try to bring them up to normal because people with low vitamin D levels are at greater risk for cancer. People with cancer, including lymphomas with lower vitamin D levels don’t do as well as people whose vitamin D levels are normal. So with regards to the vitamins, I like vitamin D.

In addition, I like omega-three fatty acids for people over the age of 50. I like calcium and magnesium for bone health. They both also decrease the risk of colon cancer. But calcium may increase the risk of more aggressive prostate cancer, so there’s a little balance there.

Turmeric, I think, is a good anti-inflammatory and may have some anti-cancer activity.

I’m quite fond of mushrooms—medicinal mushrooms.

First of all, all mushrooms must be cooked if they’re going to be eaten because white button mushrooms sliced in a salad actually have a cancer-causing compound in them. So white button mushrooms, and all mushrooms must be cooked.

Edible mushrooms that are good for the immune system are Shiitake, maitake, and enoki. 

But then there are some mushrooms that are not edible that I often recommend patients take in capsule form. But I don’t recommend them for lymphoma patients because mushrooms actually stimulate the immune system, and I feel that lymphoma, the immune system already malignant, doesn’t need to be stimulated anymore.

And then, of course, cannabis for symptom management.

Cannabis is good for decreasing nausea. It’s the only anti-nausea medicine that also increases appetite and works against pain for some people. It’s useful for anxiety, depression and sleep.

I don’t think cannabis, however, cures cancer, which is something that people are claiming on the internet.

Claims about CBD

Cannabinoids are compounds that are found in the plant 21 carbon terpene-phenolic compounds, the most famous of which is Delta nine tetrahydrocannabinol, or THC. That is the most psychoactive component of the plant.

There are about 120 other cannabinoids in the plant, however, that may have medicinal benefits. Cannabidiol, or CBD, has jumped to the top of the most favored cannabinoid list because it is said not to be psychoactive.

Patients say that it helps them with anxiety and sleep, so it must therefore be psychoactive. What we’re saying is that it doesn’t get you high and we live in a society that fears euphoria for some reason.

I think it’s because of our puritanical origin and our Judeo-Christian dominance. That euphoria is not something that we should be seeking. So CBD, which probably is present in the plant to modify the effects of THC, has jumped to the top of the most favored cannabinoid list and THC complexes with these so-called cannabinoid receptors in our brain.

CBD actually changes the shape of that receptor so that it can’t take THC. Why do we even have cannabinoid receptors in our brains? Were we meant to smoke marijuana? No. We make our own endogenous cannabinoids like we make our own endorphins or endogenous opiates.

The body makes these endocannabinoids, and if you’re changing the shape of the receptor that they bind with by THC, by CBD, that might not be a good thing.

I am not a member of the CBD bandwagon. The studies in people who use the relief app show that the whole plan is the best for symptom management and that it’s the amount of THC that is associated with relief of symptoms as well as the adverse effects, whereas CBD does neither. And if you just look at clinical studies or reports in the literature of CBD, people use from five milligrams to 1,000 milligrams in these studies. It means we really don’t know. 

And then a very telling article was a study they did where they gave people CBD or placebo. They told the CBD people that they were either getting CBD or a placebo. And they told the placebo people that they were getting either CBD or placebo. The placebo group that was told that they were getting CBD actually had as much relief of pain as the group getting the CBD. So I am not a big fan.

Now there are CBN cannabidiol, which people say is very good for sleep. There’s Delta 8 THC, which is flooding the market as well, which happens to be psychoactive. So that’s creating a little bit more confusion in the regulatory space as to how that should be handled.

I believe the plant is the medicine, and I like THC as the main component of it.

CBD and THC in breast cancer

Like I said about soy, which is the most potent plant estrogen, if people are fearful that cannabis is a fight of estrogen, it’s much weaker than a woman’s own estrogen. And I’ve never dissuaded my patients with estrogen receptor-positive breast cancer not to use cannabis.

In fact, one of my patients was just on a nova special last week, saying that she could not have tolerated her chemotherapy and her pain without inhaling cannabis. Cannabis Delta nine THC, anyway, is metabolized differently when it’s inhaled versus when it’s eaten.

When you inhale THC, it wreaks a peak concentration in the plasma in two and a half minutes and then dissipates quite rapidly thereafter. When you take it by mouth as an edible, for example, it takes two and a half hours to reach a much lower peak concentration. And when you take the Delta nine THC by mouth, when it goes through the liver in the so-called first-pass metabolism, it gets broken down into an even more psychoactive 11 hydroxy THC. And that’s why people eating edibles get more zonked. 

I always tell people, if you want better control over the onset, the depth and the duration of the effect inhalation is probably better than oral ingestion.

First of all, people eating edibles or gummies, what are they made out of? Sugar. I’m not a big fan of sugar.

When I say inhalation, I like a bong, a cigarette, or a vaporizer. I don’t like vaping oil. I don’t think we’re meant to inhale oils into our lungs. I know the long-term effects of inhaling a plant, but I don’t know what the long-term effects of inhaling and oil are. 

On tinctures or oils in the mouth, when you put something liquid in your mouth, you immediately absorb some from under the tongue, which sort of reproduces the inhalation kinetics, and then you swallow the rest so you reproduce the oral ingestion.

I think oils are tinctures are a good hybrid to give you a quick onset and then a more prolonged duration. 

Mahmoud ElSohly, who grows cannabis for the government that’s used in all the research, does not believe that cannabis and delta nine THC particularly can be absorbed rectally. However, I do have patients who make their own suppositories out of coconut oil who say it sure is absorbed directly.

I think we don’t know yet enough about suppositories, but they do seem to be effective from patients that I’ve spoken with.

Probiotics in cancer treatments

Probiotics are a good thing.

There is prebiotics in some foods and probiotics in other foods. But for people that have had chemotherapy, I consider that to be a potent antibiotic because it’s wiping out cancer, but probably also some bacteria in our colon and the microbiome is felt to be very important. 

So I recommend to patients who have recently had or having chemotherapy that taking a refrigerated probiotic that includes the bacteria lactobacillus and bifidobacterium might be a good thing. Again, I prefer a refrigerated probiotic, and I like it to have those two bacteria. 

Now, interestingly, there is some research that suggests that people who take a probiotic don’t do as well if they get treated with one of the new immunotherapies that are really being widely used nowadays.

Why that is is a little bit unclear to me, but that’s something that I think people need to be aware of if there’s a potential for use of immunotherapy somewhere down the line.

Where should people go to get updates

There are some websites that give you that natural medicine.

I’m working with a company that’s trying to develop such a thing right now. I’m actually a consultant for a company after the reveal, but it’s called, Wellkasa, and they have a website that’s allowing people to look for those interactions that might be useful.

Again, I have to disclose that I’m on there. You know, I have stock they gave me and some money. So but they’re just starting up and I’m helping to guide them, and I think it will be a very useful, user-friendly service for patients and their families.

If you want turmeric to get more of an anti-inflammatory systemic effect, it needs to be modified so that it can be absorbed or it needs to be taken with piperine, which is a component of black pepper.

I asked one of my colleagues what I should take for my arthritis because it was very hot, red, tender, and swollen, i.e. inflamed. He told me to take a turmeric product that included black pepper. And I mentioned that to a naturopath friend of mine. And she said I would be careful because the black pepper is going to increase the absorption of everything else in your stomach a thousandfold.

I only take two prescription medicines, and they’re both aimed at my prostate and one in the morning and one at night. And I took the turmeric twice a day.

After taking it for three days, the heat, swelling, pain, and redness disappeared. But I woke up every night with a headache and I said, Oh my God, do I have a brain tumor? Because I’m an oncologist and everything is until proven otherwise. 

It turned out that the black pepper in the turmeric was increasing the absorption of my prostate medicine, which makes it so that I don’t have to get up and pee four times a night. But it also lowered my blood pressure to the point where I got headaches. 

I learned to separate turmeric from that medicine. Now I only take it in the morning, but even something as simple as black pepper can really have an effect. 

So I tell my patients who want to use turmeric for its anti-cancer activity or anti-inflammatory activity, if they take a lot of prescription meds, I don’t want them taking one of the brands that come with piperine or black pepper. 

Whether or not there are other interactions, radiation therapists tell patients, don’t take turmeric. But studies have shown that turmeric decreases the side effects of the radiation, particularly the skin manifestations. That seems like a good thing.

But if it is decreasing those side effects, is it also decreasing the effectiveness of the radiation therapy? Again, we haven’t done enough randomized, placebo-controlled trials to answer these questions about interactions of botanical supplements and cancer therapies to really know for sure what to say.

Is there such a thing as an overdose on supplement intake?

Yes. If people are taking a supplement in a bottle, I say follow the instructions and take as much as they say to take. Every brand is going to have a different recommended dose.

When I took a week-long seminar in nutrition and cancer at the National Cancer Institute many years ago, and after the lecture on vitamin D, I asked why don’t we just put it in the drinking water?

You make it sound like it’s a panacea. And they said doses over 4000 international units a day can lead to increased absorption of calcium and deposition of calcium in the aorta or the coronary arteries.

I see patients all the time taking five thousand to ten thousand international units of vitamin D a day. And I cautioned them about that because that is a dangerous side effect of taking too much of that vitamin.

How do you figure out a good brand?

There are natural standards that you can find on a website where you can look up the different supplements and different brands and find out how they’re rated. How did they come to those determinations? I don’t know sometimes. 

What are your favorite medicinal mushrooms for cancer?

I don’t recommend medicinal mushrooms for people with lymphoma or other lymphoma proliferative malignancies or for patients who are on the new immunotherapies.

That’s because the mushrooms work by their cell wall resembling the cell wall of a bacterium. So when you ingest these medicinal mushrooms as a capsule or a tincture or powder, the body thinks it’s being invaded by bacteria and mounts a non-specific immune response, which hopefully fights off cancer as well.

Immunotherapy really has the potential to do great good in patients who respond to it, and I don’t want the mushrooms’ immune enhancement to compete with the immune enhancements of the immunotherapy. 

The mushroom that’s been most well studied is turkey tail, known as in the past Coriolus versicolor, now Trametes versicolor. Turkey tail has been studied in an extract called PSK. It has been studied in Japan and PSP in China in conjunction with chemotherapy and radiation for a number of different tumor types. 

I like the whole mushroom, and that’s usually what I recommend. The body doesn’t like to see the same mushroom every day, so I often recommend that patients alternate turkey tail with a blend that contains other immune-enhancing mushrooms, but not turkey tail. 

For example, “reishi” or “lingzhi” is the mushroom of immortality. And I think that has some anti-cancer activity as well. Shiitake does too.

There are other mushrooms that I think are useful for other medical indications. Cordyceps sinensis is a fungus that Paratici parents at Thaiss, a caterpillar that lives in the Tibetan Highland. In 1980, the Chinese Women Relay team broke all sorts of land speed records by taking only cordyceps because it’s oxygenating and energizing.

So for people that are a little bit low in energy, I often recommend Cordyceps.

Lion’s Mane, which is an edible mushroom, has also become popular recently because it may be involved in enhancing brain-derived nerve growth factors. For people who have neuropathy from their chemotherapy or who are suffering from chemo brain, I often recommend taking Lion’s mane or preparation that includes Lion’s Mane.