Nutrition Before During and After Cancer

Information on nutritional needs for cancer patients

All the talk about Vitamin D


Vitamin D, the sunshine vitamin, is produced in the body with mild sun exposure or can be consumed in food or supplements.

 Adequate vitamin D intake is important for the regulation of calcium and phosphorus absorption, maintenance of healthy bones and teeth, and it is supposed to have a protective effect against multiple diseases and conditions such as cancer, diabetes type 1 and multiple sclerosis.

Vitamin D is a pro-hormone and not a vitamin. This is because the body is capable of producing its own vitamin D through the action of sunlight on the skin, while vitamins are nutrients that cannot be synthesized by the body and must be acquired through the diet or supplements.


 Vitamin D has multiple roles

  1. Maintain the health of bones and teeth
  2. Support the health of the immune system, brain and nervous system
  3. Regulate insulin levels and aid diabetes management
  4. Support lung function and cardiovascular health
  5. Influence the expression of genes involved in cancer development. 

It is estimated that sun exposure on bare skin for 5-10 minutes 2-3 times per week allows the body the ability to produce sufficient vitamin D, but vitamin D has a half-life of only two weeks, meaning that stores can run low, especially in winter. Recent studies have suggested that up to 50% of adults and children worldwide are vitamin D deficient.

 Vitamin D is produced when sunlight converts cholesterol on the skin into calciol (vitamin D3). Vitamin D3 is then converted into calcidiol (25-hydroxyvitamin D3) in the liver. The kidneys then convert calcidiol into the active form of vitamin D, called calcitriol (1,25-hydroxyvitamin D3). As such, statins and other medications or supplements that inhibit cholesterol synthesis, liver function or kidney function can impair the synthesis of vitamin D.


Some Facts about Vitamin D

  • Vitamin D’s primary role is to support the development and maintenance of bones and teeth.
  • Vitamin D deficiency is common, especially in the elderly, infants, people with dark skin and people living at higher latitudes or who get little sun exposure.
  • Vitamin D deficiency has been seen in up to 80% of hip fracture patients.
  • 800IU of vitamin D per day reduces the risk of fracture by 20% in the elderly and decreases the risk of falls.
  • The metabolism of vitamin D may be affected by some medications, including barbiturates, phenobarbital, dilantin, isoniazid and statin drugs.



Supplements of Interest for Cancer Survivors

The following are some supplements of particular interest for cancer survivors:

cancer survivor

Vitamin D

Vitamin D seems to have anti proliferative effects that may be especially beneficial for decreasing cancer progression and enhancing survival, at least based on animal studies. Low circulating 25-hydroxy vitamin D [25(OH) D], the recommended biomarker of vitamin D status, is linked to an increased risk of several cancers. Observational studies tie higher 25(OH)D levels to improved outcomes among colorectal cancer survivors and possibly breast cancer survivors. But even when low circulating 25(OH) D is associated with worse outcomes in observational studies, it isn’t clear whether supplementation changes prognosis.

It’s unclear whether the Institute of Medicine’s 25(OH) D, recommendation of 600 to 800 IU daily based on bone health are adequate, for bone or overall health among cancer survivors. Some researchers propose targeting serum 25(OH)D levels of at least 30 ng/mL or 40 to 80 ng/mL in the survivor population, with an intake of 1,000 to 2,000 IU of vitamin D commonly recommended to reach those levels but still not established as optimal.

A concern among breast and prostate cancer survivors is the risk of osteoporosis secondary to surgical, chemotherapy, or hormonal therapies that decrease estrogen or testosterone levels, respectively, or following long-term corticosteroid use. While aiming for bone- and cancer-protective benefits, researchers emphasize that evidence is lacking regarding the safety of high blood levels of vitamin D.


Glutamine is an essential amino acid of interest for its potential to aid mouth sores and other symptoms of mucositis and to improve peripheral neuropathy that develops as a side effect of chemotherapy. It supports gastrointestinal cell growth and regeneration, and it may reduce the production of inflammatory cytokines. Significant side effects are uncommon with oral glutamine supplementation. More research on its use is needed, but caution is advised among patients with hepatic or renal insufficiency because, since it’s an amino acid, the liver and kidneys must metabolize glutamine. In patients with liver or renal insufficiency on protein restriction, glutamine supplementation should be avoided so as not to burden these organs.

Glutamine is used in clinical practice as a powder mixed into oral solution, generally “swished” before swallowing for mucositis benefit.


This is a hormone secreted by the pineal gland, holds dual interest for cancer survivors. For those who have difficulty falling asleep, doses of 0.5 to 3 mg at bedtime may be helpful. Emerging evidence suggests that melatonin may provide cancer-protective effects by upregulating antioxidant enzymes and suppressing factors that promote cancer development. Limited data show some improvement in mortality rates when used at higher doses as an accompaniment to conventional cancer therapy.

Since melatonin can alter estrogen levels and may interact with drugs metabolized through certain pathways, those considering use should consult their physicians.

Those Vitamins

Happy and Healthy Holidays to all!

The United States Preventive Services Task Force (USPSTF) recommends against the use of beta-carotene or vitamin E supplements for the primary prevention of cardiovascular disease or cancer, according to a recommendation statement published in Annals of Internal Medicine.


Researchers conducted a systematic review of the evidence to assess the benefits and harms of using vitamin, mineral, and multivitamin supplements for the primary prevention of cardiovascular disease and cancer. The evidence suggests that beta-carotene increases risk for lung cancer in people at risk for the disease. New evidence on the use of vitamin E proves that it lacks effectiveness in preventing cardiovascular disease or cancer

Evidence was insufficient to assess the benefits and harms of the use of multivitamins or single- or paired-nutrient supplements (with the exception of beta-carotene and vitamin E) for preventing cardiovascular disease and cancer.


About half of U.S. adults report using at least one dietary supplement and about one-third report using a multivitamin-multimineral supplement. Appropriate intake of vitamin and mineral nutrients is essential to overall health. The benefits of vitamin supplementation are uncertain, so it is recommended that Americans get most of their nutrients from foods.

Eating a nutrient-rich diet comprised of mostly fruits, vegetables, whole grains, fat-free and low-fat dairy products, and seafood should provide adequate nutrition. However, there may be specific groups of patients with well-defined conditions for whom specific nutrients will provide benefits.

 nutrient rich diet

The focus of the recommendation is healthy adults without special nutritional needs. This is an update to the USPSTF’s 2003 recommendation.

The American Institute for Cancer Research funds research into how individuals just like us can reduce our cancer risk – and prevent some cancers – through a healthy lifestyle.


AICR research shows that 1/3 of most cancers can be prevented with a healthy diet, weight management and at least 30 minutes of physical activity each day. And according to the World Health Organization, as many as 50% of cancers could be prevented when smoking and other factors are taken into account.