Heart Toxicity: Survivorship/Survivorsh!t

Join Dr. Tina Kaczor and Dr. Leah Sherman as they delve into the complexities of heart toxicity in cancer care. This enlightening episode sheds light on the heart’s resilience and the specific challenges posed by cancer treatments known for their toxic effects on the heart muscle. Through engaging dialogue, the hosts explore topics such as risk factors, treatments associated with the highest risk of heart damage, and integrative medicine approaches to prevention and repair.

They share personal experiences, the latest research, and practical tips for patients and healthcare practitioners aiming to mitigate the side effects of cancer treatment on the heart. Whether you’re a patient, a healthcare provider, or someone interested in the intersection of oncology and cardiology, this episode offers valuable insights into keeping the heart healthy before, during, and after cancer treatment.

Leah’s favorite sardine salad recipe (from Martha Stewart!) https://www.marthastewart.com/1050733/lemon-herb-sardine-salad

Prior episodes we mention:
The Movement Mentor: Sarah Court, PT, DPT, e-RYT https://www.thecancerpod.com/the-movement-mentor-sarah-court-pt-dpt-e-ryt/
Magnesium: The Goldilocks Nutrient? https://www.thecancerpod.com/magnesium-the-goldilocks-nutrient/
Omega 3s: Supplements 101 https://www.thecancerpod.com/listen-7/

Heart Sparing Radiotherapy Techniques in Breast Cancer: A Focus on Deep Inspiration Breath Hold https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9309321/

CoQ10 Study on Antioxidant Dietary Supplement Use During Chemotherapy https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7062457/

Impact of Hormonal Therapies for Treatment of Hormone-Dependent Cancers (Breast and Prostate) on the Cardiovascular System: Effects and Modifications: A Scientific Statement From the American Heart Association  https://www.ahajournals.org/doi/10.1161/HCG.0000000000000082

Adverse Cardiovascular Events Associated With Cyclin‐Dependent Kinase 4/6 Inhibitors in Patients With Metastatic Breast Cancer https://www.ahajournals.org/doi/10.1161/JAHA.123.029361

Cardiotoxicity of Anthracyclines doi: 10.3389/fcvm.2020.00026 

Transcript

Tina: 0:00

So the heart is a muscle all by itself, pumping 24 hours a day, seven days a week throughout our entire lifespan. And there are certain treatments that specifically are toxic to the heart muscle itself. And Leah, I think you had one of them.

Leah: 0:16

Yes.

Tina: 0:17

What did you have?

Leah: 0:18

Well, two of them, right? At AC.

Tina: 0:21

So, adriamycin and cyclophosphamide.

Leah: 0:24

Mm hmm.

Tina: 0:24

And adriamycin is also known as the red devil. And so adriamycin causes not just heart disease, Immediate effects, when someone's getting it, delayed effects, and does that concern you at all?

Leah: 0:37

Oh, absolutely. Oh, oh my god. Oh my god. Absolutely. All the time, I think about it. Because I also have a family history of heart disease. So, you know, cancer treatment is the gift that keeps on giving. You know, it's like for all of the good that it does, there's this kind of like threat

Tina: 0:53

Sequelae.

Leah: 0:54

sequelae, delayed side effects.

Tina: 0:56

We call them sequelae in medicine, but yes, most people just call it a delayed side effect. And specifically for cardiotoxicity or heart toxicity, some of these drugs don't really manifest any symptoms until seven years, ten years, down the line, where people have fatigue. I mean, that's usually the first symptom. When the heart is not pumping well, people are tired.

Leah: 1:16

Yeah. So I had some weird heart symptoms that were happening, I think back in like 2020, 2021. And I underwent a stress test because that was my concern. Right. and yeah, they did the stress test and they're like, you're great.

Tina: 1:28

Well, that's good.

Leah: 1:29

like, have you ever done a heart stress test? They're stressful.

Tina: 1:33

By design.

Leah: 1:34

I thought for sure I failed. I thought for sure I failed. Cause I was on that treadmill and I was like. Wheezing practically, and they're like, Oh, wow, you're healthy. I'm like, yes,

Tina: 1:43

All right, well, we will talk about what keeps the heart healthy and how to make sure some of these side effects that happen over time don't happen to our listeners. I'm Dr Tina Kaczor and as Leah likes to say I'm the science-y one

Leah: 1:55

and I'm Dr Leah Sherman and on the cancer inside

Tina: 1:59

And we're two naturopathic doctors who practice integrative cancer care

Leah: 2:03

But we're not your doctors

Tina: 2:05

This is for education entertainment and informational purposes only

Leah: 2:09

do not apply any of this information without first speaking to your doctor

Tina: 2:14

The views and opinions expressed on this podcast by the hosts and their guests are solely their own

Leah: 2:20

Welcome to the cancer pod

Tina: 2:38

Hi, Leah.

Leah: 2:39

hi, Tina,

Tina: 2:39

So in this episode, we're going to talk about cardiotoxicity.

Leah: 2:43

heart toxicity.

Tina: 2:44

Specifically, we're going to talk about risk factors, you know, what makes someone more vulnerable to toxicity of these treatments. And What treatments specifically are associated with the highest risk of damage to the heart muscle itself and how to lower one's risk. So actively, what can people do in their self care and day to day integrative medicine approach? And we're going to talk about supplements and herbs, things that we know work.

Leah: 3:08

we're also going to talk about things you can do during treatment to decrease your risk.

Tina: 3:12

Yes. Yep. A little more controversial just because some cancer centers don't allow people to do things during treatment, but there are some well evidenced approaches during treatment that actually lower your risk.

Leah: 3:24

Yeah. So let's start with, um, some of the risk factors and I guess the biggest risk factor, To some might kind of be obvious, it's your risk factor for having cardiovascular disease in the first place. So like a history of smoking, high blood pressure, diabetes, obesity, or just like I said, like having a history of heart problems is going to make you more likely to have heart problems. From your treatment. Um, Age. So, being over 60, it also can affect really young children, And then, being female.

Tina: 3:55

Yes.

Leah: 3:56

of the, one of the joys of being female.

Tina: 3:59

it to the list.

Leah: 4:00

Yeah, yeah, you know, it's a special perk. and like you mentioned, like there are certain drugs that people receive. So the one that I received, the, Adriamycin or doxorubicin, same thing, getting high doses of that. And that drug actually has a lifetime limit of how much you can receive because of the potential for heart issues.

Tina: 4:19

In that class of drugs, anthracycline is dose dependent. So the more you got for treatment or the more you're getting, the higher the risk of heart toxicity. Okay.

Leah: 4:28

Right. And then combining those anthracyclines with radiation therapy further amplifies it.

Tina: 4:33

Yes, and coupling it with another treatment that happens to have some heart toxicity as well. So when you're doubling down, you're getting two agents for your cancer. They're anti cancer agents, but they're also both toxic to the heart. And one that stands out in that arena is Herceptin.

Leah: 4:50

Right. So if you, which I don't really think it happens so much anymore, but if you get Adriamycin, Red Devil, you get the Red Devil and then you follow that up with Herceptin. Yeah. But they don't really do that.

Tina: 5:02

No, not so much anymore because of that cardio toxicity, but there could be listeners that have gotten that in the past.

Leah: 5:08

Absolutely. Yeah. Yeah. And as you mentioned, like some of these side effects might not occur until much later, but some of them happen actually as people are getting treatments. And The one that I think of most often that, that happens with is Herceptin. And part of that is because, I mean, people get Herceptin for long periods of time.

Tina: 5:27

Mm hmm.

Leah: 5:27

They'll get it over the course of a year, typically with breast cancer treatment, but some people are on it for life.

Tina: 5:33

Yeah. And, um, when we say Herceptin, we're using that drug as a generic in that class. So anything that's Herceptin like, so Progetta is a newer version of Herceptin.

Leah: 5:43

Yeah. And you're giving, you're giving the brand

Tina: 5:45

I am, because that's what people usually know. I don't want to,

Leah: 5:47

Trastuzumab.

Tina: 5:49

yeah, if we want to say Terastuzumab, we can, but I think it might be a little bit of a tongue twister. First of all,

Leah: 5:57

Yeah. For us.

Tina: 5:58

first of all, this is a podcast, so I don't really want a tongue twist, but

Leah: 6:01

Yeah. and the, the, the cardiotoxicity is it's varied. It's everything from having high blood pressure, which also happens with Herceptin. I had to stop myself from saying Trastuzumab, um, it also happens with Herceptin and other drugs too, right? I mean, drugs that affect your kidney are going to increase your blood pressure.

Tina: 6:22

Yeah. Right. So when you're talking about the heart muscle, you've got direct toxicities like these anthracyclines, but you also have, it's a system, you know, so anything that raises your blood pressure puts pressure on the heart because the reason that happens is when you have high blood pressure with each pump of the heart, you have to pump the blood out against a larger pressure and that can result in a cardiomyopathy, which is just a fancy word for heart damage. So that can be direct or it can be indirect through hypertension. So it'd be direct literally that it's toxic to the cells, they are damaged, and they may or may not revive from the damage. So What we're talking about today is, you know, it's a muscle. The, the beauty of this is it is a muscle and it has a lot of healing potential. I always think of different organs in the body as having different healing potentials. When you have the heart muscle you're talking about, it's got a lot of inherent ability to repair damage. So as long as you get it early enough and it's not completely dead cells and they have potential to heal.

Leah: 7:23

So one of the most commonly thought of chemotherapies that damage the kidneys and can lead to heart problems is cisplatin And that's commonly, used in patients who have lung cancer paired with radiation.

Tina: 7:37

Yeah, yeah, it's also commonly used for ovarian cancer. It's a, it's a really commonly used chemo in general. I mean, for the last, I don't know how many decades. I mean, cisplatin has been around a very long time.

Leah: 7:48

Yeah. And at the time of this recording, um, there is a shortage of it as well.

Tina: 7:53

Yeah, that's a whole nother, gosh, that'll be an interesting kind of, I don't want to call it an expose, but at least talk to people in the know, um, when there are drug shortages, how that is handled behind the scenes. Because I think that there's a lot of, um, yeah, there's a lot of unfortunate things that happen when they have to figure out who gets it and who doesn't get the drugs.

Leah: 8:12

Right. Um, okay. So moving along the other things that can happen, uh, high cholesterol. I'm kind of starting at like the lower end and then we're going to work our way up. Okay.

Tina: 8:22

I see. Yeah.

Leah: 8:24

See, I'm not going to start with like the big, you know, the big issues. We're going to say high cholesterol, which is something also that people don't think about, especially the hormonal agents, or I should say the anti hormonal agents. Cause once you start messing with the hormones, you're messing with the cholesterol and yeah,

Tina: 8:39

True that. Yes. Yeah. Yeah. Yeah. So some of the drugs like tamoxifen. can cause cholesterol to go high and cause triglycerides to deposit in the liver and actually cause dysfunction of the liver over time. So this, these things have to be weighed when people are taking this drug for five years. We know that it's, the benefits outweigh the risks for most people, um, but over longer periods of time, because they're looking at 10 years and even longer now, you have to weigh the. risk for each individual for high cholesterol, liver deposition of triglycerides, and blood clots because it does increase blood clot risk in some people.

Leah: 9:18

right. And cancer treatment itself puts a person at higher risk for blood clots.

Tina: 9:23

Yeah. As does the cancerous process. So cancer, sometimes we know in certain cancers, especially if it's extensive, if someone has stage three and certainly stage four, we have to be on the lookout for high clotting risk. So people are more likely to have a blood clot. form, um, whether, you know, it forms in their lungs or legs or, um, a stroke even, or a heart attack. We have to be very mindful that that event can occur, not to be a major downer, but it's just one of those things we need to know, right? You need to have it higher on your list of possibilities.

Leah: 9:55

Arrhythmias or like. You know, when your heart rhythm isn't what it's supposed to be. it's when your heart is beating irregularly. and that is why with certain treatments, you're getting EKGs beforehand, um, echocardiograms are another way of seeing how your heart is functioning. Um, so what I find interesting with the arrhythmias, there are medication warnings saying like, this may increase risk of long QT syndrome. And you're like, what does that mean? And that's seen on an EKG. Um, so a lot of medications can cause that from medications you're taking to decrease side effects to actual. Cancer treatments. And so, and then patients come in taking medications themselves that may have that as a potential side effect. And so that's kind of compounds, um, the risk.

Tina: 10:46

Yeah. And this is something, I know that our fellow colleagues know this very well, but I, just for the. People who are not medically trained out there, and EKG is looking at the electrical impulses through the heart and can see arrhythmias through the electrical impulse Now, this is independent of your entire nervous system. It is connected, but not directly, right? So we have something called heart rate variability, but that's a whole nother conversation. And when you're getting an echocardiogram, that's actually looking at the plumbing. So EKG is the electrician looking at it, measuring it, seeing what it looks like with electrical flow and an echo or echocardiogram is the plumbing, how much volume of blood is coming out with each pump. What does the blood look like as it goes from one part of the heart to another part of the heart, right? And so I just like to like prove that to people so that they kind of understand what they're getting tested or what it might be. The echocardiogram is something that I think people probably should get just to check if they're having any kind of symptoms, if they're 5 and 10 or even 15 years out from a drug that was toxic to their heart. It's one, it's higher on the list, like get an echocardiogram, make sure your heart is pumping properly and that the blood flow is reaching your, your organs and your, your limbs.

Leah: 12:03

And it, it's cool. It's, it's an ultrasound of your heart. Like it's really kind of a cool thing to, to see.

Tina: 12:09

It's also like a measure of the strength of each pump, right? So the ejection fraction. That's what it's called. How much blood comes out with each pump of the left ventricle of your heart, that ejection fraction has to be a certain number, a percentage. Because it doesn't pump everything that's in there, it doesn't squeeze it completely. completely clear. So a healthy ejection fraction is 55%, for example. And then if you get a treatment that's toxic to the heart and that your 55 becomes 45 or 40 or 35, don't despair because it's a muscle. You can build it back. You can do things to improve that function. And this is routine for us in naturopathic medicine and other integrative practitioners out there. Building back the heart muscle with proper diet, exercise, and nutrients and supplements is very, very doable. That's why I call it more resilient than a lot of other organs. You can see it measurably get better.

Leah: 13:04

And for people who have received Herceptin, that is something that is checked regularly. And so they're familiar with going in and getting their echoes to, to check that out. So, um, you kind of touched on cardiomyopathy, which is damage to the actual heart muscle, and that can lead to congestive heart failure.

Tina: 13:26

Yeah, there's different types of cardiomyopathy. I won't go into those kind of details, but the real danger with cardiomyopathy is congestive heart failure, which is When your heart is no longer capable of pumping enough blood for your function, right? It's also an enlargement of the heart. Sometimes this can be picked up on a routine x ray. You go in because you have a cough that won't go away. You get a chest x ray and they can see the heart shadow. It looks a little enlarged and you go on to get a further workup from there. So congestive heart failure is something that happens usually in the aging process or when the heart has a hard time pumping against the wall. So if someone has blood pressure that's high and untreated, eventually you get cardiomyopathy and that cardiomyopathy can eventually evolve into congestive heart failure. So this is why you do want to treat a high blood pressure. You don't want that to be, you know, too high. It's too stressful on the heart muscle.

Leah: 14:23

So two other issues that can come up are myocarditis and pericarditis. Itis is never a good thing.

Tina: 14:30

Well, it is true. Itis means inflamed, right? It's inflammation. So myocarditis is inflammation of the actual heart. Cardiomyocytes, which are the cells that make up the muscle of the heart, and pericarditis is inflammation of the membrane that's around the heart. So there's a nice kind of sack around the heart and pericarditis can happen as a side effect of some of these treatments. One that I was reminded of, and I had forgotten actually, is aromatase inhibitors can cause pericarditis. And I have only seen that once, it can't be very common. But I did see it once and I remember it being in a woman who had pretty severe side effects otherwise from the aromatase inhibitor. Like most people would have quit it by then because it was, it was incapacitating joint pain that she had and she stayed on it. And so when she came to see me in that first visit, she already had really bad joints and pericarditis. And so she finally had gotten off the drug and wanted to know what else she could do because she had to get off the drug. But only once. So I, when I came across it in my reading, I was like, Oh yeah, that's a. Rare, but real side effect for a few folks out there. I call them rare, but real because, you know, it doesn't help someone who's suffering from a rare side effect to hear that it's rare.

Leah: 15:41

Well, somebody's gotta be that one percent. I mean, I had so many weird stuff happen to me during my treatment, and they're like, oh, this really doesn't happen. This is really, really rare. I'm like, what's gotta happen to somebody? Somebody's gotta be that one percent.

Tina: 15:52

Yeah. And then you, and then you kind of convince yourself that when you hear rare, it means nothing to you now. Right?

Leah: 15:57

Oh, absolutely.

Tina: 15:58

Yeah. Yeah. Cause that's, that's generally what happens. People are like, I don't care about the percentages. So, you know, cause I'm always that 1%.

Leah: 16:04

Yeah, but if you have, like, hundreds of thousands of people, it's And so I mean, 1 percent is kind of a big number. So anywho, um, there were some drugs that we did not mention that also can affect heart function. So the tyrosine kinase inhibitors. So those are like the ones that end with I. B. and I. B. the nibs tie curb is like. One of the ones that is used in breast cancer. Um, and then you have the other targeted therapies as well. so some of these newer drugs are great, have fewer side effects for some people, but then they can also have, cardiovascular side effects.

Tina: 16:40

Yeah. That whole, especially in the tyrosine kinase inhibitors, there's a class of them that Right. Act on VEGF, the vascular endothelial growth factors, inhibitors. Um, that class in particular is likely to have hypertension and other cardiovascular risk factors. So, the big one we saw in clinic was Avastin or Bevacizumab is its generic

Leah: 17:06

Right,

Tina: 17:07

Since you want me to say generics, I'll say them. So, I, I,

Leah: 17:17

I was trained to say generics and I'm making this funny voice because Tina was one of the people who trained me.

Tina: 17:26

I doubt I was a stickler for that though.

Leah: 17:28

Yeah. You brought you, that wasn't your thing. I just think it's funny that

Tina: 17:32

Um, and then the other class of drugs, I think, I don't know if you mentioned this or, and I just wasn't paying attention to you, which is

Leah: 17:38

you're listening to

Tina: 17:40

it's possible. I was very busy for that 30 seconds. Um, the checkpoint inhibitor drugs.

Leah: 17:50

Oh no, I did not say that. I was actually looking that up to see like, wait a minute. I thought there was something else. That caused it. And that's exactly what it was. So

Tina: 17:59

So this is the PD 4 inhibitors, the whole checkpoint inhibitor class. They're all immune agents that are being used to great success in, depending on the cancer, 20 to 40 percent of the people getting it. I shouldn't call it drugs. They're really antibodies.

Leah: 18:17

yeah, I just kind of call everything drugs. It's getting too complicated. Um, and so I guess, I don't think we mentioned, do we, we've talked briefly saying the word radiation, but radiation is another cause and it's radiation to the chest, to any, Where close to the heart, um, so there is a technique I know for patients who are getting radiation for breast cancer If the radiation is going to go near the heart, there are breath holding techniques that kind of displaces the heart Move it aside to reduce that injury. So, you know, if you have like left sided breast cancer and getting radiation there are often techniques used to of reduce that risk.

Tina: 18:57

Yeah. And I'm sure they're not everywhere yet, but there are fancier radiation machines that follow the breath so that there's less toxicity to the, to the heart,

Leah: 19:07

Okay, so let's take a break. And when we come back, we're going to talk about supportive treatments, both while getting treatment as well as afterwards. And we'll mention a few cautions and see where it goes.

Tina: 19:19

all right, let's do it. All right, so we mentioned that some of the risk reduction happens during treatment. We mentioned some of it can be done after treatment for repair of any damage to the heart. Should we just talk about it all in one fell swoop?

Leah: 19:39

Yeah, we'll kind of say like if something is used during and or after. Um, yeah. So what are things that you have used with, with your patients?

Tina: 19:48

So movement is good because it's a muscle, right? So not using it means that it's not going to get challenged and you're not going to get repair. Okay.

Leah: 19:55

So you're talking exercise.

Tina: 19:56

exercise. Well, sometimes people don't like to hear the word exercise. I'm fine with people just keep, just keep swimming, you know, just keep swimming, just keep, just keep walking, just keep moving.

Leah: 20:06

Walking, right? And that helps with reducing your risk of blood clots too, because being sedentary increases your risk of blood clots as, you know, not being hydrated. So make sure you're hydrating, especially if you're moving and exercising.

Tina: 20:20

And at this point, look to see if the center you're at has an actual exercise during treatment program. A lot of them do now, especially the larger centers, but kind of, I'm surprised some of the smaller centers are getting this in their departments too. They're kind of like, there's cardiac, you know, the cardiac department has their own exercise. exercise team. A lot of the oncology centers are now getting an exercise team together. So there's that. Put that in place.

Leah: 20:44

and I, I am making these funny faces at you, um, because, um. That is something that I helped set up at the Cancer Center in Northern Indiana. Along with cardiopulmonary, we set that up for patients to be referred to exercise programs to target fatigue or whatever it was, and that's really, really important. Just don't go to like your local gym and talk to a trainer and tell them what, because they're They don't know specific needs of cancer patients. Um, maybe they are a cancer survivor. They still don't know unless they've had specific training. And so there are physical therapists, cardiopulmonary therapists who have received training on the specific needs of cancer patients. And yeah, so where I was working. Before I came back to Oregon was a small cancer center. It was not that big and they had the program. So definitely check. And if they don't have the program, talk about it a lot until they start one.

Tina: 21:38

Exactly. Yes. A little grassroots movement. And you and I talked to Sarah Court, the physical therapist who has her own exercise during treatment program that's free online and people can go back and we'll link to that episode so people can find that discussion if they're interested in exercise specifics. And then diet. I mean, the base is always a lot of plants in the diet. I would specifically say olive oil for this reason, the heart muscle. is unique in that it uses, preferentially uses, fatty acids for its fuel source. So, unlike so many cells in your body, it's not really using glucose preferentially, it's using a lot of fatty acids. And the fatty acid, one of them that it prefers is the oleic acid from olive oil. So all these Mediterranean diets that are linked with lower cardiovascular disease risk, it may be as simple as you're feeding the heart a preferred fuel. every day of your life if you eat a Mediterranean diet because it's so high in olive oil. So I would put olive oil high on the list no matter what someone's background is or their ancestry is or what, you know, their ancestors ate as far as fats. Usually I use that as a guide for fats and intake. Um, in this case, when we're talking about heart muscle, I think the heart really wants to take in the fatty acids.

Leah: 22:56

So just a kind of a little tip, which I learned from a chef about olive oil, because you don't really want to heat olive oil too high. if you cook something with a higher temperature oil, um, you can go back and drizzle the olive oil on top of it. And so you're getting the flavor of the olive oil and you're not destroying all the, all of the beneficial bits of it. So that's just a little hot tip.

Tina: 23:17

Yeah, that's a, that's a good point just to get the other nutrients that are in there.

Leah: 23:21

Speaking of nutrients, other nutrients that help to support your heart that you can get through food, not necessarily through supplements, but you can also get through supplements.

Tina: 23:29

Um, The amino acid L carnitine is a complement to the fatty acids that the heart uses. So the carnitine is what the fats used to bring that fatty acid into the mitochondria. It needs that amino acid carnitine. It's also an amino acid you and I have talked about when it comes to fatigue. Fatigue during treatment and L carnitine is, is in foods, yes, but you can also take it as a supplement, um, in a pretty good dose. Whenever I dose amino acids, whether it's carnitine or another one, and I want, uh, to affect someone's physiology, the lowest dose I use is like 1. 5 grams, but I, and I go up to three grams per day. Actually in carnitine, I go up to four grams because there were studies on four grams, but generally speaking,

Leah: 24:14

So yeah, what I was thinking for in terms of nutrition that you would try to increase more of the foods is magnesium.

Tina: 24:20

Mm hmm.

Leah: 24:21

So magnesium is great. Sometimes it's supplementing with magnesium during treatment can be a little precarious because people might have looser stools, diarrhea, and magnesium isn't. So great for that because it will just exacerbate it. But, um, eating magnesium rich foods, nuts, seeds, dark leafy greens, blending them if you don't like them, throwing in some blueberries, you know, to kind of mask the flavor. But eating those magnesium rich foods is another good way of supplementing your, your heart healthy diet.

Tina: 24:54

Yeah, I totally agree. Yeah, magnesium is, is really, it's one of those that's commonly deficient too. And so, the heart uses a lot of calcium and magnesium, and of the two, magnesium is more likely to be deficient. Mostly because we have a giant calcium storage. And we have a skeleton, if we really need it, we'll just pull it out of, pull it out of our bone.

Leah: 25:14

And, and we tend to eat calcium rich foods.

Tina: 25:17

after that, I use a lot of taurine. Yeah. taurine is another amino acid. It's not an essential amino acid. Um, but it is considered conditionally essential by some people. And taurine is, is, it's a multi purpose amino acid. It does so many things. It's calming to the brain. It's good for the heart. It's good for your gallbladder and your, um, digestive processes and your bile production. Um, it also, when it syncs up with magnesium in your system, it helps create the proper amount of osmotic pressure in your bloodstream. So that's a nice thing to have, especially if you're low protein. What else does it do, Leah?

Leah: 25:56

It's anti inflammatory. People might have heard of taurine. This is so random, um, because dogs that are on, um, like the no grain diets. tend to get a lot of foods that have legumes. And so for some reason that seems to displace the protein that's in the meat of these, like, no grain diets. That's what's one of the things that they think is happening with dogs. Um, and so, yeah, it's affecting the taurine. So if you have dogs and they're fed, grain free diets, your vet may have talked to you about the risks of your pet not getting enough taurine. But that's a complete aside and we don't treat animals. Um.

Tina: 26:34

Well, only our own.

Leah: 26:36

Only our own. Yes. but yeah, so another nutrient that I like give patients because it is something that's frequently used in the chronic fatigue world is D ribose.

Tina: 26:49

Um, I've never gotten into D ribose. Isn't that a funny thing? I've never really used much of it.

Leah: 26:55

That is funny, Tina.

Tina: 26:57

it's, been around a long

Leah: 26:59

if I had patients that were receiving Avastin. They were fatigued because you're on that for a long time. It can cause fatigue and then you're just trying to protect the heart in general. I, that's when I would recommend it. So it wasn't really necessarily to address a cardiac issue after it happened.

Tina: 27:16

Okay.

Leah: 27:16

It was more just like, you're really tired, you're receiving a cardiotoxic drug. Let's try some D ribose

Tina: 27:22

Yeah. And after, after, well, there's probably a couple other nutrients I might think about, you know, obviously, and I haven't said it yet, so maybe it's not obvious, but, Um, omega 3 fatty acids. So we have to make sure that there's some, there's adequate. I wouldn't give it in large amounts. I think that, you know, adequate amounts, make sure people aren't deficient. I'm not a mega doser of these omega 3 fatty acids or fish oils.

Leah: 27:47

Eat your, eat your fatty fish if you like sardines. Eat your sardines if you can tolerate them during treatment. I loved my sardine salad during treatment Um, yeah, so any sort of like, fatty cold water fish, right? We've talked about this before, we have our whole omega three episode, but yeah, any cold water fish for those fisher people out there, you know, have it once a week if you can tolerate it.

Tina: 28:09

Yeah. And if you take a supplement, you don't have to take a mega dose. Um, you know, 500 milligrams. You know, is, is it will keep you from being deficient.

Leah: 28:17

there are a few more that we were going to mention. Um, one is coenzyme Q10, which I think a lot of people think of for the heart in general. Um, it is kind of a more popular one. I've had patients coming in, taking it. Because maybe their doctor said, Oh, you're taking a statin. You could take the coenzyme Q10 along with it. so yeah, CoQ10, coenzyme Q10, that is what powers the mitochondria in your cells. So it's kind of fueling the powerhouse of your cells. And like Tina mentioned, your heart is a muscle. There's a lot of mitochondria in muscle and there's a ton in heart muscle.

Tina: 28:56

Yeah. You know, because 24 hours a day, seven days a week, contract, relax, contract,

Leah: 29:00

It never takes a break. It does not. No.

Tina: 29:04

right? It never takes a break. It needs a lot of energy.

Leah: 29:08

there are some potential cautions with using CoQ10. there's some question as to whether or not it can interact with blood thinners. Um, if someone is taking a medication for asthma, Theophylline, which is not used so much anymore, but there are probably people out there who may still be taking it. that is another contraindication. There was a study that came out in 2020 saying that the use of CoQ10 and other antioxidants along, oh no, it was the use before and during treatment for breast cancer may have adverse outcomes. But for patients that were taking antioxidants and CoQ10 during treatment without having taken it before, there were no adverse outcomes. So I don't know about this study.

Tina: 29:54

That was, that's the one you mentioned to me before we hit the record button and I looked at it and, uh, yeah, it's an observational study with a lot of problems.

Leah: 30:03

Not that many people were looked at and my favorite part was reading the affiliations of all of the people who participated in the study. So, anyways, we'll put a link to that. Y'all can look at it

Tina: 30:14

No, and you know, when people are getting treatment, you stick to a few things that you know are going to be safe. If there's even speculation about something being harmful, we just avoid it. And again, the heart being as resilient as it is after treatment is over, then we can do things like CoQ10.

Leah: 30:30

but there are alternatives to CoQ10 if you are told you cannot take it. Um, and that we have used with our patients. And I would also say super high doses aren't necessarily Good for any of these supplements, except, well, you're saying with the L carnitine, you use higher doses, but that's what's what was used in the study. But, I mean, I've had patients taking it very high doses of CoQ10, and it's not necessary. They don't have congestive heart failure. They're trying to use it to prevent something. I don't know. I think just caution with, with dosing is also, indicated.

Tina: 31:04

Yeah. Yeah. And we didn't even talk about the complexities of cancer cell metabolism. And so that goes into my thinking when I'm seeing a patient is what kind of cancer do they have? Are we concerned at all that that cancer also uses a pathway that maybe we don't want to give 600 milligrams of CoQ10 to that particular patient because we don't want the path of respiration to be jacked up and supported. So there's, there's other considerations that you'd have to be seeing a practitioner who knows metabolism really well to know whether that's, you know, contraindicative in that level.

Leah: 31:36

something else that I used with patients more during my residency than when I was at, Cancer treatment centers. It's Hawthorne. Hoth Your face just lit up! But yeah, we would use the Hawthorne extract that like, was it Wise Woman?

Tina: 31:49

Yes, wise woman had a solid extract.

Leah: 31:51

Yeah, and it tastes a little bit like prune paste.

Tina: 31:55

It's delicious! Don't

Leah: 31:57

bad, it's not bad. Um, because it's

Tina: 32:00

it sound bad, it's delicious!

Leah: 32:04

because I'm just trying to remember we have some in the fridge, I'm sure. but yes. Hawthorne extract. And I know, yeah, I don't know if this is the last thing we're going to talk about, but I know this is Tina's favorite thing to talk about.

Tina: 32:15

Well, cause I, I love tonic. You know, these plants that are literally tonifying an organ or system is like the most beautiful thing in plant medicine. Hawthorne berries and Hawthorne leaves literally strengthen the muscle of the heart. So to the point where you can see studies where people can have improvements on their cardiovascular output. So it's always in my mix. I would say Hawthorne is always in my mix, and taurine is always in my mix when people have cardiomyopathy. Magnesium is always in the mix. There's certain ones that I'm just like, those are definitely going, you know, going to be on the plan here because it's just supporting the muscle of the heart in total.

Leah: 32:56

So there are contraindications to Hawthorne, so talk with your pharmacist and see if there's a medication you're taking that, if you are considering taking Hawthorne, because we're not recommending it for you, but um, the one that I remember learning that was the biggest contraindication is if somebody is taking digoxin. So it can increase the effects of the digoxin.

Tina: 33:17

Yes. What's interesting is it's really not a drug interaction, it's strengthening the heart so you need less right? So,

Leah: 33:25

but that's what a lot of these, these interactions, if you look them up, it says it increases the effect of the, whatever drug it is. So, but it is a, it is an interaction according to your doctor. So,

Tina: 33:37

So in an ideal world, you get to take less of the, if you're working with your doctor and you're watching your medication, you can lower the medication because the actual system is stronger and healthier.

Leah: 33:49

but don't do it on your own and don't tell anyone we told you to do it because we didn't.

Tina: 33:54

I didn't tell you to do anything.

Leah: 33:56

No, and we're not making recommendations for you. We're talking about what we do with our patients. Okay.

Tina: 34:00

and this was true of people on, um, high blood pressure drugs too. I really was very diligent about having people take their blood pressure at home and having it checked in my office. And there were times where we'd lowered their blood pressure medication over time because their system got better and better. They might've gotten more in shape and maybe they lost weight, all sorts of reasons your blood pressure can go down when you're healthier and healthier. So, um, it's important to realize that when you're on medications and you're Those medications need to be checked because if you are getting healthier, if you're eating better and now you're exercising and you're taking things that improve systems that were not as efficient before, you may have to adjust your medications accordingly. So you do need to work with someone or the prescribing doctor, um, go back to that person and say, you know, do we need to make any adjustments? They'd be happy if you, if you improve your blood pressure by yourself and they could lower your medication. They will be amazed because it doesn't happen very often. Right? Amaze your doctor.

Leah: 34:57

Anything else you wanted to add in?

Tina: 34:59

Um, just, I always talk about colors in general. Anthocyanins, anthocyanidins. So tomatoes, berries, anything that's very colorful is good. And there's a few plants like hibiscus that are particularly good for the heart.

Leah: 35:13

yeah, hibiscus is really nice and it also has a diuretic

Tina: 35:16

Mm hmm. Right. So if someone It needs a diuretic effect, then that's there. And the other very colorful, plant food is beets. Beets improve circulation. They, they cause the blood vessels to relax a little bit, and you get better perfusion of tissues, including the heart muscle. And beets are supportive for the liver as well. So if you like beets, um, I think adding them to the diet is a good idea too. I think the only thing we didn't mention that it can be done in the diet is garlic.

Leah: 35:44

Hmm.

Tina: 35:45

Garlic is very good for your whole cardiovascular system and it's, has an, an effect that prevents clots from happening. So it's, uh, if your fibrinogen, fibrinogen can be measured in your, in your labs. If that's high, then garlic is more likely to be something that's useful for that person.

Leah: 36:03

Yeah. So again, if somebody is in treatment, just, you know, if you can tolerate it, you know, Add it to sauces, you know, different foods and then out of treatment. If you like garlic, then go for it.

Tina: 36:16

Yeah. I think we touched on pretty much everything. I mean, I'm always. I mean, you can name every nutrient and say, Oh, that's involved in that's about like assuming that someone doesn't have any nutrient deficiency. So they've got enough of the B vitamins and vitamin D, et cetera. So I think I,

Leah: 36:29

Oh yeah, vitamin D is, you know, always important. And, um, uh, another kind of herbal food is, you know, green tea. Very supportive to the heart health.

Tina: 36:41

yeah,

Leah: 36:41

We could go on forever.

Tina: 36:43

was going to say, there's so many weights because it is a muscle and we're, we're, we're supporting it's, it's physiology and it's, it's strength and it with each pump of the heart. I don't know if people realize this. I know every doctor does and every nurse does, but you know. Talking to non medical folks, I would say one of the cool things is when you hear a heartbeat and you hear the lub dub, lub dub, lub dub, assuming it's normal, what you're hearing is the, the closing of the valves. They're snapping closed. Lub dub, lub dub. So it's, it's kind of a neat thought that what you're hearing is the little valves closing up each time.

Leah: 37:16

I find that sound to be so soothing. Like I probably need one of those little baby things. like sound monitor type things that play the human heart. I, I could listen to a heart forever. I just, it's to me one of the most soothing sounds, listening to that, that regular heartbeat.

Tina: 37:33

So we went through risk factors for heart toxicity. And then we covered the types of heart toxicity, so things like arrhythmia, congestive heart failure, and the treatments that can cause it. And then we went through some supportive therapies, pretty briefly, and maybe not exhaustively, but we covered the high points.

Leah: 37:53

I think so.

Tina: 37:54

And I think the last thing, if people are listening this long, thank you for sticking with us. Ha ha

Leah: 38:01

Here's the true one and only thing that's going to work.

Tina: 38:06

No, what I want to remind people of is if you have had a treatment that you know, and you can look it up always, is, was toxic to your heart, even if it was 10 years ago or longer and you have symptoms that could be related, like fatigue. exercise intolerance where the, like, you can't exercise as well as you used to be able to, that kind of thing. You know, tell your primary care physician, inform them, because your health care practitioner may not have it top of mind. They don't know exactly what you got 10 years ago, always. And so I just want to say that for self advocacy, you know, you may have to be the one remembering what happened to you a decade ago or longer.

Leah: 38:45

Yeah. If you're having really odd swelling in your lower, you know, in your feet and your ankles, I mean, that's another sign. So yeah, definitely advocate for yourself. I think that's one of the main things that we like to tell our patients, as always, you want to follow us on social media, where the cancer pod on most social media platforms, Wherever you are listening to us, leave us a rating, leave us a review. Let us know what you liked about this episode. Let us know what you didn't like. But be kind, please.

Tina: 39:20

Yeah, and Spotify lets us do little polls. So if you see a poll on there, go ahead, vote. We're, we're checking it out, you know, and it's fairly new to the whole Spotify system, but there'll always be a little question on there. Sometimes we make it up. Sometimes Spotify does.

Leah: 39:36

And another way to support the podcast is we have a Buy Me a Coffee. It helps us to keep this wonderful, podcast going, um, and it helps us to pay our bills, not our electric bill at home, but more just the things that we need to keep cranking these out.

Tina: 39:55

Yep. This fancy ring light that makes me look 20 years younger.

Leah: 40:01

Paid top dollar for that.

Tina: 40:03

That's right.

Leah: 40:06

On that note, I'm Dr. Leah Sherman,

Tina: 40:09

And I'm Dr. Tina Kazer.

Leah: 40:11

and this is the Cancer Pod.

Tina: 40:12

Until next time.

40:13

Thanks for listening to the cancer pod. Remember to subscribe, review and rate us wherever you get your podcasts. Follow us on social media for updates, and as always, this is not medical advice. These are our opinions. Talk to your doctor before changing anything related to your treatment plan. The cancer pod is hosted by me, Dr. Lea Sherman. And by Dr. Tina Caer music is by Kevin McLeod. See you next time.