Chemo Brain – You've Survived Your Cancer Treatments... But Was It Worth It?
So, what is Chemo Brain? Unfortunately, it's one of the more significant side-effects you can experience after chemotherapy, causing neurotoxicity and hence nerve damage within the brain. Keep in mind that the brain is primarily a 'lump of fat', and because chemo and radiotherapy are so inherently oxidizing in their action, they literally make that fat go rancid. Not good for brain function! When a piece of iron goes rusty, this is due to oxidation. In those who have received the standard cancer treatments of chemo or radio, it's the same 'rusting', or oxidative process, which causes all the collateral damage - one example of which is chemo brain. Alas, having such oxidation occur in the brain can have serious ramifications on a person's subsequent state of wellness. For some people, the level of degeneration in life quality can occur to such an extent, that they even question the value of having survived their cancer, let alone the treatments for their cancer.
Informed Consent? You Wish!
Most chemotherapy patients are not warned of chemo brain as a possible side effect from their cancer therapy, so it can come as quite a shock to now find themselves possibly 'cured' of their cancer, but significantly scarred and disabled by the very treatment that supposedly cured them. For many, chemo brain can last from months to as much as 10 years or more. However, in a way it is good news, because it does mean that even for those left to their own healing processes, usually the body is able to repair itself – despite possibly taking a long time to do so. However, it also means that if one were to be more pro-active, and choose specific natural medicines, then this offers hope for a speedier recovery from what can be a devastating cancer treatment side-effect. Many natural remedies, such as certain medicinal herbs, nutrients or homeopathics have long been known to enhance the formation of new brain cells, or improve brain function. It's these avenues we'll be exploring in greater depth as the discussion continues.
Which Chemo Agents Cause Chemo Brain?
Research has shown that many people suffering different cancer types – from breast cancer to ovarian, to prostate cancers, as well as others, can all come down with chemo brain. (7) What this means is that the phenomenon of brainfog or chemofog is not just due to a few isolated chemotherapeutic agents, but rather, is related to a large range of these type of anti-cancer drugs. Such agents include chemo drugs like adriamycin, 5-flurouracil, cisplatin, BCNU, cytarabine and others. Research has shown that these chemotherapeutic agents can damage neural progenitor cells – those precursor cells which result in the development of new nerve and glia cells in the brain. (8) In turn, it's also known that 5-flurouracil, and agents like methotrexate can significantly reduce brain derived neurotrophic factor - a protector of existing neurons, and stimulant for new brain cell formation. Equally, these chemo drugs can cause a definite decrease in hippocampus cell proliferation, thus affecting memory. What this all means is that some of the mechanisms of how chemo brain occurs are starting to be understood by science. Although one study (12) showed that Modafinil – an agent capable of improving brain alertness – can help chemo brain in breast cancer survivors, the big problem remains that presently medicine has no real answers for preventing or reversing such brain damage. Thankfully, there are many naturopathic strategies which can help, and these will be explored shortly.
Chemo Brain Was Initially Repudiated By Medicine
Even though chemotherapy first started in the 1940's, for a long time medicine denied that this cancer treatment could cause such cognitive impairment as part of chemo side effects - much as medicine used to deny that PMS/PMT, ADHD, Autism, Chronic Fatigue Syndrome; Fibromyalgia were a reality too. Yet, once medicine finally decided to do serious research into these latter conditions, each one of them was found to be a valid medical condition, and not the neurotic imaginings of hypochondriacs.
Radiotherapy Can Be Just As Damaging As Chemotherapy
Radiation therapy can also cause what is known as 'radio brain'. During the late '70's and early '80's it was routine for leukemia patients to be given head irradiation as part of their treatment protocol. Subsequent studies showed that such radiotherapy caused chronic inflammation in the areas irradiated. Research by the University of Pennsylvania, from 1981 onwards, found that many of these irradiated leukemic patients suffered notable IQ decreases, and the research also confirmed that this was definitely one of the radiotherapy side effects. Research is also strongly suggesting that inflammation is a potent factor enhancing chemo brain. It's been found that 56 of the 132 FDA approved chemo agents are known to be strong sources of oxidative stress i.e. inflammation. (5) Furthermore, the primary inflammatory cytokine found to negatively impact on the ability of nerve cells to regenerate is IL-6. Additional studies using an anti-inflammatory like Indomethacin did result in a 35% drop in inflammation, and thus the destructive impact on brain cells, strongly suggesting an inflammatory connection to chemo brain. (6)
First Acknowledgement Of Chemo Brain Occurs in 1997
The first mention of the term chemo brain appears in the literature as late as 1997. Then in 2004 a 'US News & World Report' cover story, titled: 'Cancer: the new survivors' (1) finally admitted that cancer treatments can… 'often leave in their wake debilitating physical and emotional scars'. The article goes on to say: 'the very therapies that cured can also create a whole new set of problems – some many years later'. Research is increasingly validating that chemo does have a negative impact on brain function, despite the earlier belief that the blood-brain barrier would protect brain tissue from such chemotherapy side effects. Unfortunately, the very inflammation induced by many chemo drugs is also the factor causing the blood-brain barrier to lose some of its protective capacity. Research has further shown that the brain areas that seem most affected include the visual and semantic memory, as well as the attention and motor co-ordination areas. Despite research advances into the phenomenon of chemo brain, there's still some debate as to exactly how this syndrome occurs. However, research is at least vindicating that chemo brain is real, because it can actually be measured in those who have undergone chemo or radiation therapy. In this regard, MRI studies have shown that chemo-exposed brains can shrink significantly. (10) PET Scans have equally shown that chemo can decidedly affect the flow of blood to certain areas of the brain, especially the frontal cortex and cerebellum, affecting short-term memory tasks. (11)
Some Of The Symptoms Of This Syndrome
The medical term for this unfortunate condition is PCCI – 'post-chemotherapy cognitive impairment' – but the terms 'chemo brain'; 'chemo fog'; 'brain fog' or 'mental fog' provide a more descriptive idea of what people suffering this condition have to endure. Some of the symptoms of chemo brain include: poor concentration, problems learning new material, difficulty with visual-spatial and visual-motor activities - or motor co-ordination. (2) All such brain functions are highly dependent on a healthy hippocampus, the latter being an area of the brain particularly prone to the damaging effects of chemo. Because chemotherapy can induce such dysfunction in this and other brain areas, the degree of poor semantic memory, attention and motor co-ordination can affect a wide range of school, work and social functions. (3) This can have serious repercussions on the ability of such patients to remain viable in their previous jobs, especially where this required a degree of mental agility, which is often precisely what is negatively affected in chemo brain. (4) However, it doesn't stop there, because continuing with an education can become equally challenging, as multi-tasking, word retrieval and other neurocognitive abilities, such as the ability to follow a thread of conversation, or remembering what has just been read can all be seriously affected. Such dysfunctions can have a profoundly negative impact on how cancer/chemo survivors are now able to interact with their loved ones, let alone work colleagues and the general world.
Neuropsychological Assessment May Be Too Blunt A Test At This Stage
One thing that can occur is that many post-chemo patients complain of cognitive complaints, even though they perform within 'normal limits' of any neuropsychological task-testing. One suggested reason is that such patients need to recruit a far greater volume of neural circuitry to complete these tasks, giving them the subjective feelings of having to work harder at recalling names; do certain brain related functions, as well as motor co-ordination activities. One study done on twins does tend to indicate this to be a strong possibility.(9)
You Don't Need To "Learn To Live" With Chemo Brain
On the surface it may appear as if chemo brain is one of those unfortunate health issues you'll just need to get used to 'living with'. Not necessarily so! Enough research is proving that the brain is more 'plastic' than previously thought, and has a far greater capacity to regenerate or repair itself than was previously held as 'scientific fact'. Authors like Norman Doidge, MD, who wrote the book 'The Brain That Changes Itself' have shown that under certain circumstances there is a lot of hope for those living with brain damage. Indeed, animal studies have shown that stimulating brain function through exercises to improve memory, during and after irradiation, can result in an increased number of new, precursor neuron being developed.(13) If this can occur in animals, there is no reason why it shouldn't also be applicable within humans. To that end, there are numerous brain teaser puzzles, or various mental training games (20) that are known to help with memory problems. These can all help to improve brain memory, or mild cognitive impairment. Neurofeedback training can similarly improve your memory. Equally, brainwave training via the 'Holosync' system,(18) has a proven record of enhancing the generation of new neural pathways. Hence, a range of presently available techniques show that there is already much that can be done to help improve cognitive dysfunction. Luckily, such mental training exercises, and other techniques, can provide a way to improve your memory, and give back hope for conditions like memory loss, forgetfulness and other forms of cognitive impairment.
Co-factors Affecting Chemo Brain
Medicine is also starting to acknowledge that there may be a number of secondary factors affecting the incidence or severity of chemo brain. These could include concomitant drugs used during anesthesia, or antibiotics used to treat the many infections chemo patients are more prone to, let alone the numerous other medications used in overall cancer treatments, such as cortisone – long known to have negative impacts on brain function. Other issues will also be important predictors of a person's ability to handle the present day cancer therapies, and hence whether they might develop chemo or radio brain. Such factors include: • A patient's age when undergoing chemotherapy or radiation therapy. Obviously, a patient in their 70's or 80's is less likely to have the necessary reserves with which to handle the onslaught of these cancer treatments than someone in their 20's. • Whether chemo or radio patients also have concurrent health issues, such as cardiovascular disease or diabetes – both known to be driven by inflammatory processes. • Previous or present lifestyle factors such as smoking; chronic, excessive alcohol intake; major eaters of junk food and take-aways, etc. These can all be considered extra, unfavorable drivers towards furthering the potential development of chemo or radio brain, upon undergoing modern day cancer treatments. Hence, aside from all these above factors being able to cause their own individual lists of side effects, in conjunction with the toxic chemo drugs they may further aggravate the degree of damage done to the body, thus accentuating the propensity towards chemo brain. Hence, with further research it may well be found that the interaction of all these different factors produces a negative synergistic effect on brain function, and hence the incidence of chemo brain.
Endogenous Antioxidant Defenses May Determine A Person's Proneness To Chemo Brain
It is also known that some people have very strong endogenously derived (produced within a person) antioxidant defenses; this can actually be measured. Hence, those who are best able to resist a range of oxidizing factors (inflammation) within their system – especially from those corrosive chemo drugs, or from the oxidative effects of radiotherapy – may also be the ones who succumb least to chemo or radio brain. This would be a relatively easy avenue of further research. There is an urgent need for such investigation, simply because it would also provide for a powerful way in which to prevent or minimize the devastating effects of chemo or radio brain. Other people are known to have more robust telomere status (anti-aging ability). This too could be tested for pre and post cancer treatment. Besides, a range of complementary therapy solutions do already exist to enhance telomere health, such as resveratrol, Vit. B12, Vit. C, Vit. E, Omega-3, and more. Medicine, however, has reservations about using antioxidants in chemo or radiation therapy, precisely because they believe such agents would negate the action of their oxidizing anti-cancer treatments. However, although this is an entire topic of its own, these fears have not been vindicated by ongoing research into this possibility. (14,15,16,17)
Some Basic Suggestions To Help With Chemo Brain
What needs to be understood is that there won't be one 'magic bullet' which can somehow miraculously negate or reverse chemo brain. Nevertheless, there are a range of options which you might like to explore further, and then decide to utilize - or not. The ideal, however, would be to use a form of cancer therapy where a far lower dose of chemo is needed. This is not as unrealistic as it sounds! Two such options – which presently exist as a clinical reality in Europe - include 'Insulin Potentiating Therapy' (IPT) and Hyperthermia. To explore these treatment ideas in greater depth, you might like to read the article: A Naturopathic Perspective on Cancer. If this treatment option isn't possible, because your local oncologist doesn't know about this more sophisticated form of cancer treatment, then you might like to think about pre-loading your body with a range of the following natural therapies, before you start your chemo or radiation therapy. The other option is to either use such natural interventions during the conventional cancer therapy, or at least do a form of rescue therapy for quite some time after your orthodox cancer therapy has finished, in order to maximize your body – and brain's – ability to regenerate and repair. Remember, earlier we discussed the fact that in most people, chemo brain does resolve itself within months - or it may take as long as 10+ years. It needs to be understood that usually this is happening in people who are not actively helping the brain regenerate itself via natural therapeutics, known to be able to enhance this innate recovery process. Hence, instigating pro-active regimens using safe, natural substances, known to positively impact brain protection or brain regeneration can only enhance any inherent capacity of the brain to repair itself. To explore each natural option mentioned below would require an entire webpage of its own, so for now, see this as a list of treatments you can further research by yourself. The most important point to take home from this entire discussion on chemo and radio brain is to realize that: • firstly it's a sad but definite reality • Secondly, that there are things you can pro-actively engage in to help empower yourself in either preventing, or at least minimizing the potential of this nasty chemotherapy side effect from ruining your life.
Nutritional Issues To think Of In Treating Chemo & Radio Brain
Firstly, people undergoing chemotherapy or radiation therapy can often lose their appetite, so this is a factor that needs to be taken into consideration in order to guarantee they're still getting adequate nutrients from whatever food they're able to get down. It also highlights the need, and validity of taking extra nutritional supplements to augment what those with a loss of appetite may be missing out on, due to their lower than normal food intake. Next, it's important to look at such simple issues as making sure you're eating as healthily as possible – for example, organic produce wherever you can manage this option. Another way to optimize food intake, if your chemo or radio has affected your appetite, is to ensure you only eat small snack-like meals, but far more frequently – say, every 2 hours or so. Also make certain you have loads of fresh vegetables and fruit - again, organic if possible – or at least of the highest quality available. Ensuring you really chew your food properly – something we often don't do in our culture! - is another important factor in maximizing the nutrients you can extract from your food. Why? Because the simple act of adequately chewing your food can have a profoundly positive effect on its subsequent ability to be better digested, and hence absorbed into areas where it's needed for body – and brain! - repair.
Medicinal Herbs To Think Of
Below is a list of medicinal herbs that have already shown strong clinical value in the treatment of dementia, and other neurological or cognitive impairment issues. • Andrographis - (Andrographis paniculata) • Astragalus - (Astragalus membranaceus) • Bacopa - (Bacopa monniera) • Boswelia - (Boswelia serrata) • Bupleurum - (Bupleurum chinense) • Cats claw - (Uncaria tomentosa) • Dan shen - (Salvia miltiorrhiza) • Gingko biloba - (Gingko biloba) • Gotu kola - (Centella asiatica) • Korean ginseng - (Panax ginseng) • Mate tea - (Yerba mate) • Polygonum - (Polygonum multiflorum) • Poria - (Poria cocos) • Reishi mushroom - (Ganoderma Reishi) • Rhodiola - (Rhodiola rosea) • Sage - (Salvia frutocosa - formerly 'officinalis') • Schisandra - (Schisandra chinensis) • St. John's wort - (Hypericum perforatum) • St. Mary's thistle - (Silybum marianum) • Turmeric (Curcumin) - (Curcuma longa) • Vinca minor - (Vinca minor) • Withania - (Withania somnifera)
Remedies From Your Kitchen Cupboard
Similarly, there's a range of safe, kitchen herbs and spices which have a known, positive effect on brain function, protection and repair, often through the mechanism of reducing inflammation. These could be added to your cooking on a regular basis. They include: • Garlic • Ginger • Green tea • Oregano • Rosemary • Turmeric
Specific Nutrients For Helping Brain Function
Next, a list of nutrients known to have positive and restorative effects on brain function and repair, include: • Acetyl-L-carnitine • Adenosine • B12 • B3 • Barley grass • B-complex • Carnosine • Choline • CoQ10 • Creatine • EGCG • Fish oils (EPA/DHA) • Folate • Glutamine • Glutathione • Inositol • Lipoic acid • Lithium aspartate - low doses (this is completely different to the normal lithium carbonate used for schizophrenia) • Magnesium • Melatonin • NAC (can act as a potent precursor of Glutathione) • Phosphatidyl serine • Quercetin • Resveratrol • Schuessler Remedy – Kali phos. 6x • Selenium • Theanine • Vinpocetine • Vit. C (see ref. 19) • Vit. D (to enhance nerve growth factor) • Vit. E • Zinc Again, to thoroughly discuss each item would take pages upon pages, which is not possible here. However, what this list hopefully will do for you is to alert you to just how much there is that can be of use in chemo and radio brain.
Some Final things To Think About In Dealing With Chemo Brain
• If you have insomnia, do whatever it takes to ensure you get a good 7-8 hours of good quality sleep nightly. Chronic lack of sleep is a major stressor, which in turn is a major driver of inflammation, which is exactly a major component of chemo brain! It is critical to get a good night's rest each and every night! • Exercise is a great way of helping to 'burn up' stress hormones from your body. No need to go to gym, or run yourself ragged! Increasingly, research is proving that something as mild as a 20 minute 'huff-and-puff' walk daily provides for enormous health benefits. See if you can fit such a 20 minute walk into your daily program. If you're really feeling weak, or are very unfit, then simply start on a slow 5 minute walk daily. Just start somewhere though, and build up as you can! • If your chemo brain is seriously affecting your ability to live your daily life, or you're suffering chronic anxiety or depression, either from having to deal with something like cancer, or from the treatment for cancer, then please do speak to your doctor or natural therapist about it. Ask for help! There will be a range of strategies they can help you with through which to better manage poor memory and other cognitive problems. Such interim help is especially important for those who already have chemo brain, and haven't yet started a natural therapy intervention program to help hasten brain repair. • Another important point needing to be emphasized is to make sure you actively look for a good natural therapist who is local to you, and who has experience in managing cancer from a complementary perspective. As you can see from the above list of things that can help you with chemo brain, there is a lot to choose from, and it is vital that you also get expert advice as to how to incorporate the right combination of these options for your specific needs and situation. It would be totally foolhardy to try and take them all! Such a natural therapist should also have a good working knowledge of the crucial role that glands and organs like the thyroid, liver, gut and adrenals do play in being able to recuperate – not just from your cancer – but also from the treatment for your cancer. One easy-to-read and highly informative eBook on the subject of why a sluggish thyroid is so important in any health issue is called: 'Sluggish Thyroid Syndrome – why tests keep coming back normal, yet you continue feeling unwell'. You can access a sample from this eBook by clicking here. • Finally, do ensure you have regular checks with you medical doctor, as well as with you natural practitioner. Several blood parameters really worth testing for on a routine basis include: - Fasting homocysteine levels (elevated levels have been associated with inflammation, as well as Alzheimer's Disease, yet such levels are easily reduced in most cases via a range of B-complex vitamins, such as B12, B6, Folic Acid, Vit. C and Lysine) - h.s.-CRP (a sensitive measure of inflammation within the body) - Vitamin D levels (these should be at least in the range of 100-120 nmol/L, rather than just scraping over the lower border of 'normal' – i.e. 48 nmol/L.
In Conclusion
Hopefully, what you've gained from this article is: • Firstly, a greater awareness that chemo brain, as well as radio brain are very real and serious health consequences that can occur post chemotherapy or radiation therapy. Yet, most patients undergoing these toxic cancer treatments are rarely warned about this potential side effect. • Secondly, a better understanding of what causes this often devastating consequence from orthodox cancer treatments • Thirdly, just how much you can do to either prevent, minimize or hasten the reversal of this challenging syndrome.
REFERENCES
1) US News & World Report, 'Cancer: the new survivors', April 5, 2000 2) Raffa, R. B. & Tallarida. 2010. "Effects on the visual system might contribute to some of the cognitive deficits of cancer chemotherapy-induced 'chemo-fog'." "Journal of Clinical Pharmacy and Therapeutics", 35 (3): 249-255. 3) Nelson CJ, Nandy N, Roth AJ (September 2007). "Chemotherapy and cognitive deficits: mechanisms, findings, and potential interventions". Palliat Support Care 5 (3): 273–80. PMID 1796983 4) Nelson CJ, Nandy N, Roth AJ (September 2007). "Chemotherapy and cognitive deficits: mechanisms, findings, and potential interventions". Palliat Support Care 5 (3): 273–80. PMID 17969831 5) Myers, J. S., Pierce, J., & Pazdernik, T. 2008. "Neurotoxicology of chemotherapy in relation to cyotkine release, the blood brain barrier, and cognitive impairment." "Oncology Nursing Forum", 35 (6): 916-920. 6) Monje, Michelle L., Palmer, Theo D., and Toda, Hiroki (2003). "Inflammatory Blockade Restores Adult Hippocampal Neurogenesis." Science. 302(5651). 1760-1765. 7) Matsuda T, Takayama T, Tashiro M, Nakamura Y, Ohashi Y, Shimozuma K (2005). "Mild cognitive impairment after adjuvant chemotherapy in breast cancer patients--evaluation of appropriate research design and methodology to measure symptoms". Breast Cancer 12 (4): 279–87. doi:10.2325/jbcs.12.279. PMID 16286908 8) Dietrich, J., Ruolan, H., Yang, Y., Margot, M. P., Noble, M. 2006. "CNS progenitor cells and oligodendrocytes are targets of chemotherapeutic agents in vitro and in vivo." "Journal of Biology", 5 (7): 22. 9) Ferguson, R. J., McDonald, B. C., Saykin, A. J. & Ahles, T. A. (2007). Brain structure and function differences in monozygotic twins: possible effects of breast cancer chemotherapy. Journal of Clinical Oncology, 25: 3866-3870. 10) Inagaki M, Yoshikawa E, Matsuoka Y, et al. (2007). "Smaller regional volumes of brain gray and white matter demonstrated in breast cancer survivors exposed to adjuvant chemotherapy". Cancer 109 (1): 146–56. doi:10.1002/cncr.22368. PMID 17131349. 11) Silverman, D. H., Dy C. J., Castellon, S. A. (2007). Altered frontocortical cerebellar, and basal ganglia activity in adjuvant treated breast cancer survivors 5-10 years after chemotherapy. Breast Cancer Research and Treatment, 103 (3), 303-311. 12) Modafinil Relieves Cognitive Chemotherapy Side Effects Psychiatric News, Stephanie Whyche, August 3, 2007 Volume 42 Number 15, page 31 13) Fan, Yang, Fike, John R., Weinstein, Philip R., Liu, Jialing, and Liu, Zhengyan (2007). "Environmental Enrichment Enhances Neurogenesis and Improves Functional Outcome After Cranial Irradiation." European Journal of Neuroscience. 25. 38-46. 14) Prasad KN. Multiple Dietary Antioxidants Enhance the Efficacy of Standard and Experimental Cancer Therapies and Decrease Their Toxicity. Integrative Cancer Therapies, 3(4); 2004 pp. 310-322 15) Multiple Dietary Antioxidants Enhance the Efficacy of Standard and Experimental Cancer Therapies and Decrease Their Toxicity: (Kedar N. Prasad, PhD. Integrative Cancer Therapies, 3(4); 2004 pp. 310-322.) 16) Houston, Reagan, Vitamins, Cancer and Hope, Townsend Letter For doctors & Patients.July,2005.264.78-80 17) Moss, Ralph W., The Concurrent Use of Antioxidants and Cytotoxic Cancer Treatments, A Speech to the 7th International Symposium for Biologically Closed Electric Circuits in Biomedicine Marienlyst Conference Centre, Helsingør, Denmark, July 19-22, 2001 18) Holosync: https://www.centerpointe.com/ 19) Lyposomal Vitamin C: http://www.livonlabs.com/ 20) Lumosity Brain Training - http://www.lumosity.com/app/v4/personalization
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