How to lessen side effects during radiation

Recently my radiation treatments for breast cancer concluded. With 30 sessions in total and 60 Grays of radiation, I pulled out all the stops to get the best outcome I could. What makes the difference between managing side-effects and being over taken by them?

What is radiation treatment?

One of the most commonly used cancer treatments is Radiation. The idea is that, after surgery to remove the main tumor, there is a chance that some of the remaining cells might also be cancerous. While chemotherapy is often recommended for any free floating cells, radiation treatment shines in the reduction of local recurrence risk. Check out the different types of radiation treatment here.

For my specific case, I also have a genetic mutation called FANCM (Fanconi anemia complementation M) that predisposed me to both thyroid cancer and breast cancer. This gene functions in a similar pathway to the BRCA1 and BRCA2 mutations in that a mutation can promote cancer growth. However, FANCM is responsible for repairing DNA damage, and therefore, people with one or two copies of this mutation are extremely responsive to radiation as a cancer treatment.

Why is this? Radiation works by causing oxidative stress to the targeted area. This results in DNA damage that the cancer cells can not repair and ultimately die from.

Radiation used to be given consecutively from start to finish with no breaks. However, now it is often given 5 days a week for up to 6 weeks. The weekends being the time for your healthy cells to repair themselves. This is great because you have a break from appointments, and the side-effects are typically not as severe over-all.

Each session is called a fraction because it is only a portion of the overall dosage. For example, my daily treatments consisted of a fraction administering 2.0 Grays. Having all 50-60 Grays at once would be enough to kill you, but since it is only 2 Grays at a time and the exposure is only for a few minutes, this treatment is safe in the long run.

What side effects from radiation can you expect?

Skin Damage

The most common side effect of radiation is skin damage. Depending on how deep into your body the radiation is targeting, this may be greater or less. If you are treating melanoma or a breast cancer post mastectomy, the radiation will be targeted very close to the skins surface. Here the side effects are often encouraged as it is a visual sign to the radiologist that the treatment is working.

However, if your radiation is deeper, like with a lumpectomy site or prostate cancer, you would expect less skin irritation because the target is not close to the skins surface. Either way, it is highly recommended to lotion the skin multiple times a day to limit the irritation to the skin.

Skin damage can include: redness, dryness, peeling, irritation, and even breaks in the skin. However, you will be guided through different options for skin care as you progress throughout your treatments. At my radiologist’s office I was schedule to meet with the nurses and radiologist once a week. With the option to be seen by a nurse on any day that I needed.

Inflammation

Inflammation is another side-effect of the treatment. The oxidative stress is caused by the dosage administered to the treatment area. This is what causes the skin to dry out and may also cause elevated levels of dehydration. As my radiologist said “You want to hydrate your skin from the outside and the inside.”

While oxidation is a desired outcome, inflammation is not necessary for the treatment to be effective. Thus, you should avoid supplements containing high antioxidants, but you can include foods and supplements that have anti-inflammatory properties.

Fatigue

Fatigue usually builds up slowly and is more common the further you get into your treatment plan. With multiple fractions, the cancerous cells start to dye off and your immune system will dispose of them. In some cases, this extra work by your immune system can show up as fatigue, and is typical around weeks 4-6.

The level of fatigue you experience can vary from one person to another. Some people work all the way through radiation and others feel zapped of energy very early on and find it hard to work through treatments.

Other side effects

Some other side effects that you might experience include: heart burn, pain at radiation site, lung scaring and trouble breathing. A long-term effect can also be limited mobility and tightness at the treatment area. This actually starts during treatment and can occur up to 18 months after due to the formation of fibrous tissue (scar tissue). However, lifestyle factors can limit the severity of these side effects.

What lifestyle changes can help to reduce side-effects?

If you are going to be starting radiation treatments soon, there are ways to reduce your side-effects to a more manageable level. Prevention ranges from daily skin care, to physical activity, hydration, sleep and nutrition.

Limiting skin damage

The best way to limit skin damage is to take care of your skin. Often radiologists refer to the symptoms as “A bad sunburn.” So the question is, what do you do when you have a sunburn?

You might grab for some aloe or a cooling lotion. We all know how quickly your skin sucks up the moister, typically resulting in the need for multiple applications throughout the day. It is recommended to start applying lotion 2-3x daily from session 1, and going even past the end of treatment.

You also want to limit rubbing and friction of the burned area as much as possible. Wearing loose clothing is usually the go to in this situation, I started this around week 4 of my treatments.

Some of my skin care tips:

1. Try to get an early appointment time so that you can lotion 2-3x daily afterwards.
2. Start with a natural, chemical free lotion like calendula cream or coconut based lotion for the first 4 weeks while the skin is intact. Make sure that there is little to no alcohol in the lotion as that can cause excess drying.
3. Upon breaks in the skin, see your nurse for advice. Mix equal parts Aquaphor (a thick healing ointment) and Zinc oxide together in your palm and use in place of normal lotion. Silicone bandages can be a lifesaver when it comes to covering breaks between sessions. At this point you may not be able to go all natural with your products, although I was able to the all natural “Hello Bello” brand for the zinc oxide (diaper rash cream).
4. Return to normal natural lotion, with nightly Aquaphor applications while the skin is healing up.

Hydration

The usual recommendation for hydration is to drink:

Your body weight (lbs)/ 2 = # ounces of water per day

However, with radiation treatments, you may need more. A better recommendation is to base hydration on the color of your urine. Adequate hydration occurs when your urine is a light straw color. If it’s clear you are over hydrating and should reduce your liquid consumption. Up to 128 ounces a day is considered safe. While above this amount may cause you to be low in electrolytes.

Hydration is one of our Eat for Health – 7 daily habits. If you want to learn more about what the different colors of urine mean, check out this in-depth article by Healthline.

Intermittent Fasting

When your body is digesting food, it requires a lot of energy and is less able to make repairs. This is why fasting or even intermittent fasting may have some benefits when it comes to radiation treatments.

We usually stop eating food by 8pm nightly and don’t have breakfast the next day until 8 am. However, once I started treatment, I noticed that I wasn’t hungry until after my radiation appointment. This meant that I was fasting for 13-14 hours each 24 hour period.

In a recent review article, intermittent fasting (alternate day fasting (≥16 hours) or 48 hours of fasting/week) and periodic fasting (minimum of 3 days of fasting every 2 or more weeks) have been examined in the oncology setting. “Studies demonstrate that dietary interventions can reduce tumor incidence and potentiate the effectiveness of chemo- and radiotherapy in different tumor models, highlighting dietary manipulation as a possible adjunct to standard cancer therapies. Among the many diet regimens that have been assessed, caloric restriction (CR) and fasting are the methods under intense investigation in oncology.” ScienceDirect Source: Autophagy and intermittent fasting: the connection for cancer therapy?

While human clinical trials are still currently underway, reducing your eating window may help to limit side-effects including heart burn. If you choose to undergo periodic fasting, make sure to consult with your oncologist as there is a concern for weight loss during cancer treatments.

Foods to limit damage to healthy cells

Throughout my treatments, I had weekly x-rays to make sure that everything was lining up correctly. X-rays bring an extra dose of radiation that often includes vital organs such as your lungs and heart. So in order to protect these, I would increase my intake of foods that protect you from DNA damage.

You can also continue a single cup of green tea daily throughout your treatment. Oxidation is the goal of radiation treatment. Multiple cups of green tea a day have the potential to build up. PubMed Article: Antioxidant effects of green tea.

Anti-inflammatory Foods

Previous posts cover foods that strengthen your immune system and a brain healthy diet. Here we feature some foods specific to fighting inflammation. In addition, the basis for an anti-inflammatory diet is centered around fruits and vegetable. It is just like Michael Pollan said:

Turmeric:

• Available as a fresh root or powder. Serving = 1 inch peeled fresh root, or 1/2 tsp per day
  • To aid in absorption, turmeric is best prepared with black pepper (1-2 cracks of fresh ground) and fat (1 tbsp olive oil, coconut oil, or flax seed)
• The active compound in turmeric is curcumin, a potent anti-inflammatory and can help strengthen your immune system. With the reduction of inflammation at the treatment site, taking turmeric daily can result in decreased cracking of the skin nearing the end of treatment.
  • “The clinical trials also support the benefit of curcumin in the treatment of acute and chronic inflammatory problems including advanced chronic kidney disease with hemodialysis, cardiovascular diseases, rheumatoid arthritis, migraine, premenstrual syndrome (PMS), mastitis, radiation dermatitis, postmenopausal syndrome, ulcerative colitis, chronic pulmonary complications of sulfur mustard (CPC-SM), metabolic syndrome (MeS), knee osteoarthritis (KOA), and chronic SM-induced pruritic skin lesions via suppressing the production of cytokines including IL-1β, IL-4, IL-6, IL-8, and TNF-α.”
  • Pubmed Sources: Curcumin, Radiation and Curcumin

Ginger:

• Best as a fresh root. Serving = 1 inch peeled root per day
  • Peel ginger and add to your daily smoothie, or make a ginger tea.
  • For ginger tea: In a small pot, bring 1.5 cups of water to a boil and add 1 inch of peeled, sliced ginger. Lower the heat and bring to a slow simmer for 5 -10 minutes (the longer you boil it the stronger the flavor will be). Allow the tea to cool, add 1 tbsp of apple cider vinegar and honey if desired, enjoy!
• The active compound in ginger are gingerols, anti-inflammatory, anti-oxidant, and support a healthy immune response. Ginger is also anti-bacterial which can be helpful during treatments as openings in the skin can be susceptible to infection.
  • “Gingerols can alleviate inflammation given their ability to inhibit the activation of protein kinase B (Akt) and nuclear factor kappa B (NF-κB) signaling pathways, causing a decrease in proinflammatory and an increase in anti-inflammatory cytokines.”
  • Pubmed Source: Ginger

Flax seed:

• Available in whole seed or ground. Serving = 1-2 tbsp ground flax seed per day
  • To release the healthy oils, always ground flax seed before consuming. We recommend adding 1 tbsp of flax seed to your daily smoothie or to overnight oats, it can also be used in baking as an egg replacement.
  • 1 egg = 1 tbsp ground flax seed + 3 tbsp water, stir and let sit for 5-10 minutes before adding to rest of ingredients. (Note: Golden flax seed is lighter in color and in flavor so may be a better substitute than brown flax, although they have similar health benefits)
• The active compound in flax-seed are omega 3’s, these are healthy fats that help to balance out your omega 6/3 ratio. Omega 6’s cause inflammation when they are consumed in high quantities such as in meat, dairy, and vegetable oils. The addition of omega 3’s to your diet helps to lower your omega 6/3 ratio, resulting in less inflammation. To learn more about omega fatty acids, check out our post “Taking eating for health to the next level”.
  • Pubmed Source: Omega 3s

Naturopathic Alternatives

During my healing journey, I focused on an integrative approach. Using the best that modern medicine has to provide and also adding in some alternative treatments. These treatments may not be for everyone. Always use under the guidance of a Naturopath and get approval from your Radiologist.

Supplement – BQC

One of them was the supplement BCQ, commonly used by the Cancer Treatment Centers of America for patients undergoing radiation. It contains “Boswellia and Curcumin extracts with Quercetin, a potent flavonoid, and Bromelain, a proteolytic enzyme derived from the pineapple plant.” This supplement is all natural and capitalizes on the anti-inflammatory properties of these 4 plants.

Boswellia is more commonly known as frankincense. It inhibits the release of inflammatory cytokines and can potentially limit the aggressiveness of certain breast cancer cell lines (Pubmed: Boswellia).

Curcumin we mention in the previous section on foods for inflammation and has similar qualities in powdered form.

Quercetin is a polyphenol, commonly found in blueberries, that is an anti-inflammatory. Preliminary studies in cell lines have also shown it’s ability to potentially limit metastasis (Pubmed: Quercetin).

Bromelain is an enzyme that helps to aid the absorption of Quercetin. Together they are often used as a treatment for leaky gut. They reduce inflammation and preventing particles from entering the blood-stream. In addition, Bromelain has anti-bacterial, anti-fungal, and immune modulating qualities which can be helpful when undergoing treatment (Pubmed: Bromelain).

IV vitamin C

Contrary to popular belief, more research has come out over the past few years about the safety of IV vitamin C for those undergoing cancer treatment. A simple blood test to check your G6PD (glucose-6-phosphate dehydrogenase) levels, will determine whether your body can tolerate high doses. The concern with G6PD is that it can cause cell lysis (breaking open of blood cells) if the dosage is too high. Although, if even if you have this deficiency, low doses around 20-25 grams per session may be tolerable.

Not only is IV vitamin C safe, according to the National Cancer Institute, it has the potential to work synergistically with radiation treatment. In certain cancer types that tend to be resistant to radiation effects, adding IV vitamin C “radiosensitizes” the cancer cells so that the treatment works more effectively.

It is important that this be IV vitamin C rather than oral vitamin C! Orally, we are limited on how much we can absorb, so vitamin C acts as an anti-oxidant and counteract the radiation. However, when it is administered through IV, a much higher dose can be achieved. This shifts the vitamin C from an anti-oxidant to a pro-oxidant, amplifying the effect of the radiation. AACR source: Pharmacological Ascorbate Radiosensitizes Pancreatic Cancer.

High levels of Vitamin C trigger a false increase in blood sugar measurements. Diabetics should consult with their physician as it may be difficult to determine insulin needs during treatment.

My experience

I started weekly IV vitamin C on week 3 of radiation treatments through a Naturopathic Doctor’s office. The first dose was 25 grams, followed by 50 grams a week later, and ultimately 75 grams. My tolerance was testes via blood glucose before and after the IV. I continued the IV vitamin C through 2 weeks post radiation because the effects of the treatment are still active during that time.

Increased protein intake

For recovery from my mastectomy and for during radiation treatments, my doctor’s recommend increased protein. This doesn’t mean overload on meat, but instead is as simple as adding a scoop of plant-based protein powder to your daily smoothie. The recommendation for recovery is 10 grams/day more than your basic requirement. The extra protein is used to repair and rebuild damaged healthy cells during treatment.

https://www.calculator.net/protein-calculator.html

To learn more about where you can get your protein, check out our article about plant based sources here “The Complete Protein Myth”. While some animal protein can be acceptable (the size of a deck of cards), large quantities can cause additional inflammation that your body will need to work to overcome.

Rest and Sleep

Listen to your body! Rather than just pushing through, it is best to listen to your body when it comes to sleep. Sleep is necessary to repair and regenerate damaged healthy cells as well as eliminate debris from dead cancer cells.

At first during my radiation treatments, I allowed myself to rest for 30 mins to 1 hour a day. I wouldn’t fall asleep at all, but it would be quiet time where I could just relax. This seemed to be enough for me to get up and be on my way for the rest of the day without feeling like I was low on energy.

Once I hit the final week of radiation, this rest time turned into actual nap time. Radiation effects tend to build up in your body overtime, so it’s no wonder that this happened as I was approaching the finish line. However, since I had already has set aside that time in my schedule, this wasn’t that big of an adjustment.

Other than daily rest breaks, I make sure to keep a consistent bedtime as much as possible. Sometimes you will be out of town and it may throw off your groove, but when you are home prioritize consistency. Also, it is important to know that the hours before midnight are often higher quality sleep than afterwards. We are usually in bed by 9:30 -10pm and don’t mind getting up with the sun the next day.

Physical Activity

Physical activity is a great way to fight fatigue from radiation treatments. While it’s helpful to rest when you need to, working out or going on a short walk can often leave you feeling more energized than when you started.

“A meta-analysis reported that exercise during adjuvant radiotherapy for breast cancer was more effective in reducing fatigue than a control intervention”. PubMed Source: Cancer Related Fatigue: Causes and Current Treatment Options.

Stiffness in the treatment area is common, but stretching can help to push back against this side-effect. During my treatments, I attended weekly physical therapy sessions and continued to exercise at home. Whether it was yoga, a walk in the park, or a trip to the gym, I always felt better afterwards.

Long-term physical activity can also prevent the formation of fibrous scar tissue that may limit mobility. It is important to stay active as this can form any time within the first 18 months after treatment ends.

Lymphedema

Swelling in your arm, often referred to as lymphedema. It can be a side-effect of surgery including lymph node removal or radiation. Resistance exercise, rather than heavy weight lifting, has been shown to be helpful in reducing the risk of developing lymphedema after breast cancer treatments. PubMed Source: Resistance exercise and breast cancer–related lymphedema—asystematic review update and meta-analysis.

My surgeon and physical therapist noted that it is important to wear a sleeve during exercise, when flying, and during extreme temperatures. Three months out of surgery, I wear my sleeve during exercise, IVs, and avoid blood pressure and blood draws on the affected arm. So far I have experienced no signs of lymphedema and my arm measurements are equal or less than the pre-surgery measurements.

My overall side-effects of Radiation

Throughout my radiation treatments, my diet and lifestyle limited my side-effects. Limited breaks in skin: Lotion consistently, wear loose clothing, proper hydration, BCQ. Reduced Inflammation: Anti-inflammatory foods and BCQ. Fatigue was minimal: IV vitamin C, daily smoothies, time to rest, physical activity, extra protein intake. No heart burn: High fiber, low fat plant based diet. Limited tightness: Weekly physical therapy, yoga, and gym workouts. No lymphedema: Physical therapy, compression sleeve, proper hydration. Overall, I had a quick recovery from radiation treatments. When I had breaks in the skin, they healed within a week and did not occur again. I was able to manage part-time work and I drove myself to almost all my appointments 20 minutes away. But most importantly, I had the confidence that I was doing everything that I could to reduce the risks and support healing throughout my treatment.

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