Chemo Brain - Supporting Brain Health in Cancer Survivors

Linda J. Dobberstein, Chiropractor, Board Certified in Clinical Nutrition

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Chemo Brain - Supporting Brain Health in Cancer Survivors
There is an estimated 14.5 million cancer survivors in the U.S. in 2015. Surviving cancer and its treatment brings challenges of its own. The challenge of brain fog and cognitive impairment from chemotherapy and radiation treatments amongst cancer survivors has led to the recognition and validation of a newer phenomenon, chemo brain. Chemo brain is estimated to affect 10-40 percent of all cancer survivor patients. It is an emerging area of research with no clear guidelines for the clinical assessment and management of chemo brain. The medical community is grappling with how to help and protect patients from long-lasting adverse effects of cancer treatment. Despite the lack of guidelines, there are potentially many natural options that offer hope for improving brain function post cancer treatment.

Signs and Symptoms of Chemo Brain


Chemo brain or “cancer treatment–related cognitive impairment” signs and symptoms may include trouble remembering conversations or trouble with visual memory such as forgetting items on a list or forgetting where something was placed. There may be problems with attention span and short-term memory. Mental fogginess, fatigue, poor concentration and disorganization may be present. Trouble learning new skills or information, finding the right word, or trouble multitasking may occur. These brain symptoms may occur with chemotherapy or radiation treatment and can last for weeks, months, or longer after treatment is done.

Future Risks?


The immediate post-treatment chemo brain is just one concern. There is added concern of how well a person ages with brain health after chemotherapy and radiation treatment. This is a growing concern as cancer survivors are aging and increasing in number. The looming question is -- does the cancer history increase the risk for dementia or Alzheimer’s disease? Research is unclear as to whether or not this is true, as evidence is mixed. What is known is that there are inflammatory neurochemicals released and other changes that impact brain health as a result of the cancer treatment leading to chemo brain.

Brain Inflammation


Scientists in Singapore published a study on April 28, 2015 that measured inflammation markers in breast cancer patients with chemo brain. Several pro-inflammatory cytokines (interleukins, interferon-gamma, and TNF-alpha) were measured and compared to healthy individuals. Patients who had the most trouble with cognitive speed or brain fatigue had high levels of IL-6 and IL-1 beta. The cytokines were still elevated for several weeks after the treatment which led to poor attention, poor memory recall, and slower processing speed, i.e. - the higher the elevation, the worse the function.

In other research unrelated to chemo brain studies, it has been revealed that when there are high levels of IL-6 and IL-1 beta present in the brain, the microglial cells are very active. This reflects brain inflammation and neurodegeneration. The increased cytokine levels and high microglial cell activity can progress and lead to production of tau protein or beta amyloid protein in the brain. The build-up of this damaged protein disrupts nerve cell connections or synapses leading to tangled nerve tissue and disrupted function. This is seen as problems with word finding, loss of memory, cognitive skills and function i.e. neurodegeneration and the onset and progression of Alzheimer’s disease. Is this the same process that cancer survivors face as they age? Scientists are undecided, but the inflammatory process and potential correlation is alarming!

Inflammation and Gene Signals


Another group of researchers believes that the cancer treatment provokes brain inflammation. This triggers a cascade of biological changes that disrupts long-term cognitive health. The hypothesis is that inflammatory cytokines (brain inflammation) activates persistent changes in the gene signals within the brain. The up-regulated gene signals negatively change the metabolic and neurological activity of the brain leading to persisting trouble with cognition function. Researchers are studying whether or not this leads to the development of dementia or Alzheimer’s disease in the future.

Antioxidant Depletion


A December 2014 publication revealed what scientists have learned about radiation treatment effects in rodents. They measured the amount of oxidative stress and found the brain tissue depleted of several powerful, fundamental antioxidants like superoxide dismutase (SOD) and glutathione. The omega-3 fish oils EPA and DHA levels were depleted in the brain tissue. Neurotoxic excitatory compounds like aspartate and glutamate were elevated. Serotonin levels were depleted.

The study strongly demonstrated that supplementing EPA and DHA helped reduce severity of radiation-induced oxidative stress in animals. The animals that were treated with the fish oil before and during radiation treatment had far less oxidative stress or brain tissue injury than those that had no treatment. The fish oil inhibited the aspartate and glutamate levels and improved serotonin levels that were low in this animal study. The scientists’ concluded that EPA/DHA reduced the severity of chemo brain caused by the radiation. Even though this is an animal study, there are many valid points to work with and address within the human population for, both young and old who suffer from chemo brain. DHA has an immensely long track record for brain health and rejuvenates aging brain cells.

Glutathione and Chemo Brain


Glutathione functions as the most powerful antioxidant system in the body known to date. It protects the survival of nerves, acts as a neurotransmitter, and helps modulate nerve cell function. It is the mother of all antioxidants fundamental to mitochondria, immune cells, detoxification and nerve cell life and survival. Without adequate glutathione, dysfunction and cell death occurs. As we saw in the aforementioned study, chemotherapy and radiation exposure exhausts this essential antioxidant. Glutathione also regulates healthy microglial cell activity. Research showed that pretreatment of microglial cells with glutathione actually reduced the production of the beta amyloid protein from microglial cell over-activity in humans. The anti-inflammatory, antioxidant effects from glutathione was highly beneficial in stopping the progression of Alzheimer’s disease and dementia concerns.

Understand that glutathione and what your tissue levels are may be the difference between successful healthy aging and degeneration and disease development. It is that critical. In fact, neurobiologists recognize that glutathione support is so valuable to the function of the brain and immune system that they want to make the glutathione system a drug target. Get a lab test done to determine what your levels are. It is a readily available lab test that everyone should do periodically. The good news is, you do not need a drug to make glutathione. Nature has provided a plethora of wonderful resources to help with this process.

Nutrients such as N-acetyl cysteine (NAC), phytochemicals like curcumin, resveratrol, cinnamon, and fisetin help increase intracellular glutathione concentrations. Several other nutrients like silymarin, several B vitamins, r-alpha lipoic acid, and whey protein also help with the manufacture, protection, and recycling of glutathione. Cruciferous vegetables help reduce the IL-6 and IL-beta cytokines. Many of these same nutrients help reduce high levels of excitotoxic compounds like glutamate and aspartate that create the ping-pong damage of excitoxicity. Quercetin and curcumin naturally support serotonin production, reduce inflammation, and protect brain mitochondria.

Carnosine and Tocotrienols


Carnosine has been shown to be protective against radiation exposure in other areas of the body. It has the powerful ability to quench reactive oxygen species (ROS) and helps support SOD activity.

Tocotrienols have earned a place of respect within neurodegenerative concerns. Human studies showed that the natural family of mixed tocotrienols stopped the progression of neurodegeneration and tissue damage. This two-year study was done within the context of blood vessel damage and stroke that caused scar tissue and death of brain cells. Patients who did not receive treatment experienced further deterioration and had an increase in brain scar tissue. The patients who received 200 mg of tocotrienols per day stabilized and improved.

Methylation Defects


Individuals who have methylation defect concerns have added risk for chemo brain consequences and increased dementia difficulties. Methylation defects relate to how the body uses B6, B12, and folate. It affects DNA and gene expression, myelination, cancer and many hundreds of other processes in the body. Many chemo drugs severely interfere with these nutrients and the process of methylation. It can make drug toxicity problems far worse. Faulty methylation function is intimately related with many neurodegenerative problems, especially Alzheimer’s disease and other types of dementia. It is critical for keeping brain synapses healthy and engaged in neuroplasticity. This topic of methylation is an immense developing subject since it’s discovery with the Human Genome Project in 2003. Testing for methylation defects is done with blood tests or genetic screening profiles found commercially. It is critical to determine if this problem is present for anyone with chemo brain, neurodegeneration or other disorders. It is also helpful information for anyone who wants to prevent disease expression from hundreds of known disorders. Methylation activity requires the right type of activated B6, B12, folate and several other nutrients. If one takes the synthetic B6 (pyridoxine HCl), B12 (cyanocobalamin), and folic acid (folate is the active, methylated form), further damage actually occurs with worsening health.

AMPK and Other Factors


Cancer research is exploding on the subject of AMPK activation and how to use it as part of cancer treatment. Supporting healthy AMPK activity helps the birth and function of mitochondria, energy production, pain, oxidative stress, and brain clean-up. This is integral to brain health and function. Consider incorporating this information into your protection and recovery regime.

There are many factors beyond chemo brain that determine brain health. It is vital to understand how a healthy brain works to overcome such longstanding toxic reaction to drugs. Anesthesia long-term effects, nutrient deficits induced by the drugs and radiation, the physical, mental, and emotional drain that occurs with stress of illness and life disruption, sleep deprivation, lack of physical activity and lack of learning new things, and so many more are significant. The goal is to find and use focused levels of support that help restore healthy antioxidant systems and quench the inflammatory fire that drives chemo brain. Support healthy BDNF production along with these tools mentioned in this article. Chemo brain is nothing to ignore. You survived the cancer, now use these tools to survive, thrive, and enjoy our most precious gift - the gift of life.

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