Supplements in the context of cancer care are a complicated topic. There is a lot of information but much of it is distracting, and people tend to come out in extremes.
Advice can be cautious and coded in vague generalizations or obvious statements- get your nutrients from food. On the other end of the spectrum, panels of blood work and dozens of supplements are marketed as VITAL.
In my experience, traditionally trained cancer dietitians tend to be conservative, integrative providers may come out guns a blazing. Oncologists, with limited time for lifestyle conversations may say, just get calories in, stop everything just in case, don’t add any supplements, eat a clean diet. Patients and caregivers are typically left unsatisfied, either getting crossing guard arms or a do whatever guidance depending on who and how they interface with various practitioners.
Recently a patient, Emily, and her caregiver came to see me. The patient was a 35-year-old with bowel cancer. The caregiver was her mother, who did the food shopping and meal preparation. The patient had bowel surgery, infectious complications from surgery, and was on active therapy. Because of surgery, she was at risk for small bowel obstructions and because of the infectious complications, she had several rounds of antibiotics. Her therapy caused taste change, nausea, food aversions, fatigue. Both the patient and her mother wanted concrete suggestions toward being more active and feeling better through nutrition, exercise, and better sleep. Previously, they addressed this with their oncologist, the dietician, and the pharmacist. The oncologist told them to focus on getting calories. The dietician had concerns about fiber because of the small bowel obstruction. The pharmacist told her to stop her probiotic and eat fermented food. Emily and her mom felt defeated.
Another patient, William, had used supplements throughout his life and came specifically to talk about what supplements he could take now. He has prostate cancer, had completed radiation and hormone therapy and was being observed. His diet was not comprehensive; he knew that and didn’t think that was a lever of change for him. He never had liked vegetables, and he and his wife were set in their ways for how they shopped for and prepared meals. He had irritable bowels after radiation and also had questions about bone health, joint pain, muscle loss, fatigue. He had also asked his oncologist and the dietician and was advised to eat “a balanced diet” and try “daily movement.”
I have a system that I discuss with patients like these; those asking for advice about supplements with larger holistic goals toward feeling better and getting stronger. The system is based on supplements with solid evidence for strength and recovery and customized for the needs and sensitivities faced by people with cancer, either historically or in active treatment.
For Emily, we talked about a probiotic, something easy and affordable with 10-12 million colony forming units (CFUs), and organisms of at least Lactobacillus. There is data for diarrhea, and it also is dose that does not risk infection. I told her to take on an empty stomach in the morning with a full glass of water and try it out for a month, tracking her bowels, bloating, nausea. I suggested she add some supplemental fiber. She knows her goal is dietary fiber but a gentle dissolvable powder, snuck into her morning coffee or tea, gives her an extra 6-7 grams and could also help regulate her bowels. She was also advised to try this for a month and track GI symptoms.
She was already taking Vitamin D, but we decided to check her level, if it was low she could try a formula with Vitamin K or a liquid to possibly help with absorption. She had been using a high sugar protein shake, I suggested a high quality, non-flavored and third party tested whey protein to make her own smoothies with just Greek yogurt and frozen berries. Lastly, because sleep and rest were an issue, I suggested magnesium glycinate at night, a premium product that was USP tested, 90 minutes before bed. We also talked through a gentle stretching and wind down routine.
For William, I also suggested the probiotic, the fiber, the D. I recommended omega 3 fatty acids, a well sourced, lightly flavored product with at EPA and DHA for heart, eye, brain and joint benefits. Omega 3 Fatty acids have been part of healthy diets for centuries. It’s worth considering that low quality brands may taste of fish with softgels so large that they are not palatable. Also, for William, we talked about adding 5 g or creatinine, which could also dissolve in his morning coffee or tea for convenience. He was referred to an exercise therapist to begin a strength training program designed to lead to him sustaining it on his own at his local gym.
I find that all or parts of this system, probiotic, omega 3 fatty acids, vitamin D, magnesium, and a trio of powders—fiber, creatine, and protein can be personalized for most people looking to supplement their diets to promote strength, recovery and self-propel to a healthier lifestyle based on routine, control, and agency. It’s also what I have tweaked for my own personal use.
These are not exotic or boutique; they are basic on purpose, with decades of safety data and a growing body of oncology specific evidence. When someone in my clinic asks about supplements, I don’t hold our a stop sign or hand them a shopping list. I start with their goals: less diarrhea, fewer sleepless nights, steadier energy, the strength to pick up a grandchild. I acknowledge the powerful element of control and autonomy. Then, if supplements fit, we build a tight system with clear goals, document it, and keep revisiting as their disease—and their life—changes
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