Supporting Patients Through Chemo & Radiation

The Other Side of the Coin

Chemotherapy and radiation save lives. They also damage the body profoundly — by design. These treatments exploit the vulnerability of rapidly dividing cells, but they cannot distinguish perfectly between cancer cells and healthy tissue. The collateral damage shows up as nausea, fatigue, neuropathy, mucositis, immune suppression, cardiotoxicity, and cognitive decline.

Functional medicine does not ask patients to choose between treatment and quality of life. It asks: how do we armor the healthy tissues while the oncologist wages war on the tumor? Think of it as reinforcing the castle walls while the siege engines do their work.

Every intervention below should be coordinated with the oncology team. Timing matters. Dosing matters. Drug interactions matter. This is not DIY medicine.

Chemotherapy Side Effects by System

Nausea and Vomiting

Chemotherapy-induced nausea remains one of the most feared side effects, despite improvements in antiemetic drugs. Functional support works alongside standard antiemetics (ondansetron, dexamethasone, aprepitant):

• Ginger: Ryan’s 2012 NCI-funded RCT of 576 patients demonstrated that ginger 0.5-1.0g daily for 3 days before chemotherapy reduced acute nausea by 40% compared to placebo. Dose: 250 mg capsule 4 times daily starting 3 days before chemo. Use powdered ginger root, not extract. Caution with anticoagulants.
• P6 Acupressure: Stimulation of the Pericardium 6 point (inner wrist, 2 inches proximal) reduces nausea. Sea-Bands provide continuous P6 pressure. Multiple RCTs support efficacy as adjunct.
• Peppermint aromatherapy: Inhaled peppermint essential oil reduces nausea intensity. Simple, no drug interactions.

Oral Mucositis

The lining of the mouth turns over rapidly — chemotherapy attacks it viciously. Severe mucositis can prevent eating, require hospitalization, and delay treatment cycles.

• L-Glutamine: Sayles’ 2016 systematic review confirmed glutamine (oral swish-and-swallow, 10g 3x/day starting day 1 of chemo) reduces severity and duration of mucositis. Glutamine fuels enterocyte and mucosal cell repair.
• Zinc Carnosine: 75 mg twice daily. Protects mucosal lining, promotes healing. The zinc-carnosine complex is more effective than either component alone.
• Oral care protocol: Soft toothbrush, baking soda rinse (1/4 tsp in 1 cup warm water), avoid alcohol-based mouthwash.

Chemotherapy-Induced Peripheral Neuropathy (CIPN)

Platinum drugs (cisplatin, oxaliplatin), taxanes (paclitaxel, docetaxel), and vinca alkaloids cause dose-limiting peripheral neuropathy — numbness, tingling, burning, and pain in hands and feet. This can persist for months or years after treatment ends.

• Alpha-Lipoic Acid (ALA): 600 mg/day. Neuroprotective antioxidant that regenerates other antioxidants. The ALADIN trial established its efficacy in diabetic neuropathy; clinical experience supports benefit in CIPN. Time away from chemo infusion (24-48 hours).
• Acetyl-L-Carnitine (ALCAR): 1,000 mg twice daily. Supports mitochondrial function in nerve cells, promotes nerve regeneration. Evidence mixed — some studies show benefit, the Hershman 2013 trial raised concerns about worsening with taxane-induced neuropathy specifically. Best used for platinum-induced neuropathy.
• B Vitamins: B1 (benfotiamine 300 mg), B6 (P5P 50 mg — caution: high-dose pyridoxine can itself cause neuropathy), B12 (methylcobalamin 1,000-5,000 mcg sublingual). Address deficiencies, support nerve metabolism.
• L-Glutamine: 10g 3x/day. Small trials show reduced oxaliplatin-induced neuropathy.

Cancer-Related Fatigue

The most common and debilitating side effect. It persists well beyond treatment in many patients.

• Exercise: This is THE intervention. The Cramp and Byron-Daniel Cochrane review across 56 trials confirms that aerobic exercise reduces cancer-related fatigue more effectively than any pharmaceutical. Even 15-20 minutes of walking during treatment cycles helps. Resistance training preserves lean mass lost to cancer cachexia.
• CoQ10: 200-300 mg/day (ubiquinol form). Supports mitochondrial ATP production. Chemotherapy depletes CoQ10.
• L-Carnitine: 2-3g/day. Shuttles fatty acids into mitochondria for energy production. Deficiency common in cancer patients, especially those losing weight.
• Adaptogens: Ashwagandha 600 mg/day (Biswal 2013 — reduced fatigue in breast cancer patients during chemo), Rhodiola 200-400 mg, Eleuthero 300-400 mg. These modulate the HPA axis stress response. Time adaptogens carefully — discuss with oncology team.

Immune Suppression

Chemotherapy drives down white blood cells, particularly neutrophils and lymphocytes, increasing infection risk.

• Medicinal Mushrooms: Turkey Tail (3-6g/day), Maitake D-fraction, Reishi (1-3g/day). These are immunomodulators, not immunostimulants — they train and balance immune response rather than blindly amplifying it. PSK from Turkey Tail has been used alongside chemotherapy in Japan for decades precisely because it supports immunity without interfering with treatment.
• Astragalus (Huang Qi): 2-4g/day of standardized extract. Used in Traditional Chinese Medicine for centuries to support Wei Qi (protective energy). Research shows enhanced NK cell activity and reduced infection rates during chemotherapy. Avoid in active autoimmune disease.
• Vitamin D: Maintain 40-60 ng/mL. Immune cells have vitamin D receptors. Deficiency is nearly universal in cancer patients and worsens immune suppression.
• Zinc: 30-50 mg/day (with copper 2 mg to prevent depletion). Essential for T-cell function, thymic health.

Radiation Support

Radiation creates localized tissue damage through oxidative stress. The skin, mucous membranes, and gut lining are most vulnerable.

Radiation Dermatitis

• Calendula cream: Pommier’s 2004 RCT demonstrated calendula ointment significantly reduced grade 2+ radiation dermatitis compared to the standard trolamine-based cream in breast cancer patients. Applied 2-3 times daily to irradiated skin.
• Curcumin: Ryan’s 2013 RCT showed oral curcumin (6g/day during radiation) reduced radiation dermatitis severity in breast cancer patients.
• Aloe vera: Topical application, widely used though evidence is mixed. Choose pure aloe gel without alcohol or fragrance.

Radiation Enteritis

Pelvic and abdominal radiation damages the intestinal lining, causing diarrhea, cramping, and malabsorption.

• Probiotics: VSL#3 and L. rhamnosus GG reduce radiation-induced diarrhea. Start 1 week before radiation begins.
• Glutamine: 10g 3x/day protects intestinal mucosa.
• Zinc carnosine: 75 mg twice daily for mucosal protection.

Cardiotoxicity Prevention

Anthracyclines (doxorubicin, epirubicin) and trastuzumab cause dose-dependent cardiotoxicity — cardiomyopathy, heart failure, arrhythmia. This is one of the most serious long-term consequences of cancer treatment.

• CoQ10: 200-400 mg/day (ubiquinol). Iarussi’s 1994 study demonstrated CoQ10 protected cardiac function in children receiving anthracyclines. CoQ10 is essential for mitochondrial energy production in cardiac muscle — the most mitochondria-dense tissue in the body. This is a critical supplement for any patient on anthracyclines.
• L-Carnitine: 2-3g/day. Supports cardiac mitochondrial fatty acid oxidation.
• Omega-3 fatty acids: 2-3g EPA+DHA. Anti-inflammatory, cardioprotective.
• Monitoring: Echocardiogram (ejection fraction), troponin, BNP before, during, and after anthracycline therapy.

Hepatoprotection During Chemotherapy

The liver metabolizes most chemotherapy agents and bears significant toxic burden.

• Milk Thistle (Silymarin): 200-400 mg standardized extract, 3x/day. Silymarin protects hepatocytes, promotes glutathione synthesis, and has demonstrated hepatoprotective effects in multiple clinical contexts. Time away from chemotherapy (discuss timing with oncology team — theoretical concern about CYP450 interaction, though clinical evidence of interference is limited).
• NAC (N-Acetyl Cysteine): 600-1,200 mg/day. The glutathione precursor. Hepatoprotective in acetaminophen overdose and studied in chemo-induced liver injury. Time 24+ hours from chemo.

Gut Protection

The gastrointestinal tract is a frontline casualty of chemotherapy. Protecting the gut protects immunity, nutrition, and quality of life.

• Probiotics: L. rhamnosus GG and Saccharomyces boulardii reduce chemotherapy-induced diarrhea. Multi-strain probiotics support mucosal immunity. 20-50 billion CFU/day.
• Glutamine: 15-30g/day in divided doses. The primary fuel for enterocytes (intestinal lining cells). Prevents increased intestinal permeability.
• Zinc: 30 mg/day. Supports tight junction integrity.
• Bone broth: Rich in glycine, proline, glutamine, and gelatin. Supports mucosal healing. 1-2 cups daily. Simple, nourishing, well-tolerated even when appetite is poor.

Cognitive Protection — “Chemo Brain”

Up to 75% of patients report cognitive impairment during and after chemotherapy — memory loss, difficulty concentrating, word-finding problems. The mechanisms involve neuroinflammation, oxidative damage, blood-brain barrier disruption, and reduced neurogenesis.

• Omega-3 DHA: 1,000-2,000 mg/day. DHA is the predominant fatty acid in brain cell membranes. Anti-inflammatory, promotes neuroplasticity.
• Lion’s Mane Mushroom (Hericium erinaceus): 1-3g/day. Promotes Nerve Growth Factor (NGF) synthesis. Preclinical and early clinical evidence for neuroprotection and cognitive enhancement.
• Exercise: Aerobic exercise increases BDNF (brain-derived neurotrophic factor), promotes neurogenesis, and improves cerebral blood flow. Even 20-minute walks help.
• Meditation: MBSR improves attention, working memory, and cognitive flexibility. Reduces neuroinflammation markers.

Lymphedema Prevention and Management

Surgical lymph node removal and radiation to lymphatic basins create risk for lymphedema — chronic swelling that significantly impacts function and quality of life.

• Manual Lymphatic Drainage (MLD): Specialized massage technique by certified lymphedema therapists. Gold standard for treatment.
• Compression: Custom compression garments, worn during exercise and air travel.
• Exercise: Progressive resistance training is safe and does not worsen lymphedema (Schmitz 2009 PAL trial). It may actually reduce incidence.
• Selenium: Micke’s 2003 study demonstrated sodium selenite 500 mcg/day reduced lymphedema volume and improved quality of life in patients with radiation-induced lymphedema. Dose: 200-500 mcg/day.
• Anti-inflammatory diet: Reduce systemic inflammation that exacerbates lymphatic congestion.

Timing Is Everything

The most important concept in integrative oncology support is timing. The body has different needs at different phases:

Pre-treatment (1-2 weeks before): Optimize vitamin D, start probiotics, begin exercise habit, address nutrient deficiencies, build glutathione stores.

During treatment (day of and 24-48 hours surrounding infusion/radiation): Minimize supplementation to avoid interactions. Ginger for nausea, probiotics away from treatment, hydration, gentle movement. Avoid high-dose antioxidants.

Recovery window (48 hours to next cycle): Full supplement protocol, exercise, anti-inflammatory diet, stress management, sleep optimization.

Post-treatment: Transition to survivorship protocol — immune reconstitution, detoxification support, metabolic optimization.

The body fighting cancer is a body under extraordinary stress. Supporting it through treatment is not about heroic doses of supplements — it is about strategic, timed, evidence-informed interventions that protect healthy tissue, reduce side effects, maintain quality of life, and keep patients strong enough to complete their full course of treatment.

What would it mean for your patients if completing treatment felt less like surviving a shipwreck and more like crossing a difficult river with a strong rope to hold?