Kmb50

Hi,

Anybody had knee pain. Mine is on the right side of the right knee and in the back. Beth 

While the last question from the ASCO update was very positive particularly for those in academic research, the actual clinical translation for non- met disease was almost nil.Beth

The below is a revison from Edge, for those on an AI, especially Aromasin and Femara. The inhibitors are in addition to no crucifors. I really do wonder if this has any validity. Beth   

Dear Betty:

Quick refresher: Not onion (or garlic), a potential CYP3A4 inhibitor, and celery, parsley and parsnips may also exert some CYP3A4 activity. But these should be fine:

Asparagus, carrots, cucumber, endive, fennel, Jerusalem artichoke, Japanese eggplant, jicama, lettuce, potatoes, all sea vegetables (hijiki, kumbu, wakame, etc.), spinach, all squashes, sweet potatoes and yams, Swiss chard, and tomatoes, among others.

Peppers are also not a problem but the capsicum component can aggravate hot flashes if that is relevant. Phytoestrogens as I have documented are not a clinically significant problem, and fruits other than grapefruit and seville oranges are also generally not an issue.

Hi,

My onc said fine to fish oil while on Aromasin and ER+ and D3.Beth 

BBS,

This one and I will next post another- from NOSurrender site 

CYP3A4 Warning Once Again - And My Last

Still, my advice on consumption of CYP3A4 inhibitors dietary and otherwise, remains the same: the advice of your naturopath is in error - cooking can indeed inactivate myrosinase, the enzyme which hydrolyzes glucosinolates in cruciferous and brassica vegetables into biologically active isothiocyanates (ITC), but the fallacy here is the failure to realize, well-documented, that even if myrosinase has been inactivated, intestinal microbial metabolism of glucosinolates also contributes to ITC exposure, and although this is apparently at a lower level (10% to 20%), there is absolutely no reassuring data to show that this isn't sufficient to support adverse interaction with active oncotherapy. It isn't just the range of methods used to prepare these foods and the associated degree of myrosinase inactivation that determines potential adverse interaction, but also the activity level of the consumers' dentition / chewing, as well as the consumer's colonic microbes, that all contribute to an individual's risk exposure, and indeed this is also dependent on genetic polymorphisms in biotransformation enzymes that metabolize ITC, and possibly as well receptors and transcription factors that interact with these compounds, all factors independent of cooking inactivation and contributing wide individual variation which may sustain adverse risk at clinically significant levels in any one individual.

And as Lilli Link at Columbia and John Potter at the Fred Hutchinson Cancer Research Center have noted, the average excretion of isothiocyanates in the 24-hour urine collection was still a non-trivial 20.6 µmol even in those who ate broccoli steamed for 15 minutes, confirmed also in the earlier research of Clifford Conaway's team at the American Health Foundation, and this independent of possibly further enhancement of level under variable circumstances of the additional affecting factors such as gut microflora, pH and the presence of various cofactors. Furthermore, glucosinolate hydrolysis in the gut can produce a range of breakdown products in addition to the isothiocyanates, and the yields of such different groups of metabolites, including isothiocyanates, nitriles and epithioalkane nitriles, and the factors that may affect these yields after glucosinolate ingestion, are not well understood, but the delayed release of isothiocyanates in significant quantities after cooking - which supposedly should have inactivated such production - has been decisively demonstrated recently by Gabrielle Rouzaud's team at Aberdeen, via the action of the colon microflora when dietary glucosinolates reached the colon, and such colonic hydrolysis - as opposed to and in addition to myrosinase-mediated hydrolysis - of glucosinolates may yield other active products such as nitriles in addition to isothiocyanates. Finally, it would be naive to think that all cruciferous and brassica vegetables are either consumed cooked, or raw as dry food, rather than drink - many people have health-food vegetable drinks, and it's been decisively shown by Fekadu Kassie's team in Vienna collaborating with the UK Institute of Food Research that juices of Brussels sprouts, white and green cabbage, cauliflower, kohlrabi, broccoli, turnip,and black radish all induce pro-mutagenic genotoxic activity.

We have too often been assured, always incorrectly in historical hindsight, that it would take large amounts of dietary substances to be adversely interactive with various therapies - we were told so about the large amounts of garlic that would be required to interfere with HIV/AIDS anti-retrovirals, until it was demonstrated that just one clove of garlic was sufficient to render many such agents to near placebo level; whoops! So the caution I have issued concerning potentially adverse CYP3A4-mediated interaction is in agreement with the cautions of all the leading pharmacokinetic experts - Alex Sparreboom at NCI, David Flockhart at Indiana University and innumerable others. In agreement, I can confidently say with 100% certainty that no one has died or been harmed by not consuming or supplementing with CYP3A4 inhibitors - foregoing therefore the broccoli, the cabbage etc. - during active oncotherapy; the contrary, I have considerable less confidence in. But I have realized that people will do what they will on this score indifferent to the science or risk, so that was my second and last caution on this theme, to be followed by silence hereafter.

Another shorter pos.T his is from a site-Breastcancer watch. .This applies only to ER+ women on an AI.

 Below is Edge's post.

Our knowledge base is always changing and expanding on this issue as new research completes, but right now, the major food items with some evidence of potentially adverse interaction during concommitant oncotherapy across the cytochrome p450 hepatic enzyme system are:

* brassica / cruciferous vegetables and garlic;
* the juice and fruit of grapefruit and seville oranges;
* the juices of wild grape, pomegranate, and black raspberry (and probably others not yet tested);
* extracts and teas of licorice, goldenseal and chamomile;
* evening primrose oil (EPO) and borage oil;
* the spices sage, thyme, and cloves

but this will inevitably change and refine with new data, appearing almost weekly if not daily. And yes, the potential for adverse interaction from garlic exists across all AI agents.

Eric,

This not really news. It was reported one year ago as your link notes. But it does reflect the problems of changing treatment when the NCI institutions demand very high levels of proof before rejecting what to many is tx as a result of carefully controlled double blind studies in which the new treatment is superior to the previous.This year the efficacy of taxol for ER+, Her- women was also questioned. Now the oncs have a real problem. Their arsenal is getting rather bare. Two of the AIs are similar so there may be 4- Tamox,Femara-Arimidex,Aromasin and Falsadex-sp. It took years for doctors to move to lumpectomy even when the results were in.Beth

Tender,

Did you mean that effect is demonstrated for non- diabetics. It was thought to be a meaningful intervention for glucose control in diabetics, but the most recent studies refute that. Beth 

Lil,

My onc called that a ganglion -sp-two weeks ago. He asked if I could stand it, but was not impressed. beth 

Hi,

This is a more complete list from Edge. I am wondering about non-wild grapejuice like Welch's organic concord. I use a little with seltzer. What about eating blackberries. I assume they are not black raseberries and the fruit is different. I know at times we -I- sound paranoid, but there must be some reason, hopefully no just genetic, that reduce recurrance rates.NOTE CHANGE TO ALL AIs and garlic. THYME is also new to me. Oncotherapy below means AIs and during many chemos- Taxol for sure

FROM EDGE: Our knowledge base is always changing and expanding on this issue as new research completes, but right now, the major food items with some evidence of potentially adverse interaction during concommitant oncotherapy across the cytochrome p450 hepatic enzyme system are:

* brassica / cruciferous vegetables and garlic;
* the juice and fruit of grapefruit and seville oranges;
* the juices of wild grape, pomegranate, and black raspberry (and probably others not yet tested);
* extracts and teas of licorice, goldenseal and chamomile;
* evening primrose oil (EPO) and borage oil;
* the spices sage, thyme, and cloves

but this will inevitably change and refine with new data, appearing almost weekly if not daily. And yes, the potential for adverse interaction from garlic exists across all AI agents.

He also strongly advocates calorie reduction and exercise, esp. weight work and resistence to build muscle. He states aerobic is not enough. He also includes upper leg fat as being in the same negative category as belly fat. So much for the pear advantage.He does say that both chemo and AIs reduce muscle and increase % body fat even if no weight is gained or even when lost if no muscle is built. It is time for me to post on "Bitch and Moan" Beth
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