Nutritional supplements like St John’s Wort have many health benefits and are being widely used by cancer patients and those at-genetic-risk of cancer. But, is it safe to take St John’s Wort supplements for all types of cancer and without considering any ongoing treatments and other lifestyle conditions? A common belief but only a myth is that anything natural can only benefit me or do no harm. As one example, the use of grapefruit with certain medications is not recommended. Another example, the use of spinach with some blood thinning medications can cause adverse interactions and should be avoided. For cancer, nutrition which includes the food and natural supplements has been shown to influence outcomes. Hence a frequently asked question by cancer patients to dieticians and doctors is “What Should I eat and What Should I Avoid?”.
Taking nutritional St John’s Wort supplements can benefit ALK +ve Non-Small Cell Lung Cancer patients on Alectinib treatment. But avoid St John’s Wort supplements if on Cisplatin treatment for Hepatoblastoma. Similarly, taking nutritional supplement St John’s Wort can benefit healthy individuals who are at genetic risk of cancer due to mutation of gene KIT. But avoid taking nutritional supplement St John’s Wort when at genetic risk of cancer due to mutation of gene MRE11.
The takeaway being – your individual context will influence your decision if nutritional supplement St John’s Wort is safe or not. And also that this decision needs to be constantly revisited as conditions change. Conditions like cancer type, current ongoing treatments and supplements, age, gender, weight, height, lifestyle and any genetic mutations identified matter. So a legitimate question for you to ask for any recommendation of food and natural supplement is how it is related to your individual context.
Nutritional supplements – vitamins, herbs, minerals, probiotics, and other specialty categories are increasing. Supplements are high concentrations of active ingredients which are also found in different foods. The difference being foods contain more than one active ingredient at lower diffused concentrations. Remember that each of these ingredients has its own science and biological mechanism at molecular level – hence choose the right combination of supplements like St John’s Wort based on individual context and conditions.
So the question is should you take supplement St John’s Wort? Should you take it when at genetic risk of cancer for mutation of gene MRE11? Should you take it when at genetic risk of cancer for mutation of gene KIT? Should you take it when diagnosed with Hepatoblastoma? Should you take it when diagnosed with ALK +ve Non-Small Cell Lung Cancer? Should you take it when on Cisplatin treatment? Should you continue taking St John’s Wort supplement if you change your treatment from Cisplatin to Alectinib? So a general explanation like – it is natural or it increases immunity may not be acceptable and sufficient for choosing St John’s Wort.
Cancer remains an unsolved problem statement. The improved availability of personalized treatments and monitoring of cancer via blood and saliva have been significant factors to improve outcomes. The earlier the intervention – the better the influence on outcome. Genetic testing has the potential to assess cancer risk and susceptibility early. But besides regular monitoring in most cases there are no therapeutic intervention options available. After diagnosis with cancer such as Hepatoblastoma or ALK +ve Non-Small Cell Lung Cancer, the treatments get personalized to tumor genomics and factors like staging of disease, age and gender. During cancer remission (after treatment cycle is complete) – monitoring is used for assessment of any relapse and accordingly decide next steps. A large majority of cancer patients and those at-risk do take nutritional supplements like St John’s Wort.
So the question is that are all genetic mutation risks and types of cancers to be considered as one when deciding the use of St John’s Wort? Are the biochemical pathway implications of genetic risk for cancer due to mutation of gene MRE11 the same as due to mutation of gene KIT? Are the implications of Hepatoblastoma same as ALK +ve Non-Small Cell Lung Cancer? Is it one and the same if you are on treatment with Cisplatin or on Alectinib?
St John’s Wort – A Nutritional Supplement
St John’s Wort is a flowering plant native to Europe and Asia which has been used as herbal medicine for centuries for mental health problems including depression, anxiety and sleep disorders. St John’s wort is usually consumed in the form of dietary supplements or tea. However, St John’s Wort supplements are known to have adverse interactions with many common medications and cancer drugs and hence should be consumed only after consulting with your doctor.
St John’s Wort supplements contain many active ingredients including Quercetin, Kaempferol and Luteolin at different concentration levels. The molecular pathways which are regulated by St John’s Wort include Epithelial to Mesenchymal Transition, Stem Cell Signaling, Nucleotide metabolism, Oxidative Stress and RAS-RAF Signaling. These cellular pathways directly or indirectly regulate specific cancer molecular endpoints like growth, spread and death. Because of this biological regulation – for cancer nutrition, the right choice of supplements like St John’s Wort individually or in combination is an important decision to be made. When making decisions on the use of supplement St John’s Wort for cancer – do consider all these factors and explanations. Because just as true for cancer treatments – St John’s Wort use cannot be a one-size-fits-all decision for all types of cancers.
Choosing St John’s Wort Supplements for Your Cancer
The reason there is no easy way to answer the question “When should I avoid St John’s Wort for Cancer” is because “It Depends!”. Just like the same treatment does not work for every cancer patient, based on your individual context the St John’s Wort may be harmful or safe. Along with which cancer and associated genetics – the ongoing treatments, supplements, lifestyle habits, BMI and allergies are all factors deciding if St John’s Wort should be avoided or not and why.
1. Will St John’s Wort Supplements benefit Hepatoblastoma Patients undergoing Cisplatin treatment?
Hepatoblastoma is characterized and driven by specific genetic mutations like CTNNB1 and NCOA3 leading to biochemical pathway changes in Epithelial to Mesenchymal Transition, Oxidative Stress, MYC Signaling, WNT Beta-catenin Signaling and Adherens junction. A cancer treatment like Cisplatin works through a specific pathway mechanism of action. The goal is to have a good overlap between the treatment and cancer driving pathways for a personalized approach which is effective. In such a condition any food or nutritional supplement which has a contrary effect to the treatment or reduces the overlap should be avoided. As an example, St John’s Wort should be avoided for Hepatoblastoma along with treatment Cisplatin. St John’s Wort impacts pathways/processes like Epithelial to Mesenchymal Transition and Oxidative Stress which either promote drivers of the disease and/or nullify the treatment effect. Additionally, St John’s Wort supplements contain active ingredients like Quercetin, Kaempferol and Luteolin which have CYP3A4 interactions with Cisplatin treatment, and hence should be avoided by cancer patients undergoing this treatment. (Luigi Quintieri et al, Biochem Pharmacol., 2008; Fang-fang Zhang et al, Zhejiang Da Xue Xue Bao Yi Xue Ban., 2006; Pius S Fasinu et al, Front Oncol., 2019) Some of the factors which should be considered when choosing nutrition are type of cancer, treatments and supplements being taken currently (if any), age, gender, BMI, lifestyle and any genetic mutation information (if available).
2. Will St John’s Wort Supplements benefit ALK +ve Non-Small Cell Lung Cancer Patients undergoing Alectinib Treatment?
ALK +ve Non-Small Cell Lung Cancer is characterized and driven by specific genetic mutations like ALK and TP53 leading to biochemical pathway changes in Epithelial to Mesenchymal Transition, RAS-RAF Signaling, Inositol Phosphate Signaling, Small Molecule Transport and PI3K-AKT-MTOR Signaling. A cancer treatment like Alectinib works through specific pathway mechanisms. The goal is to have a good overlap between the treatment and cancer driving pathways for a personalized approach. In such a condition any food or nutritional supplement which has a compatible effect to the treatment or reduces the overlap should be considered. As an example, St John’s Wort should be considered for ALK +ve Non-Small Cell Lung Cancer along with treatment Alectinib. St John’s Wort impacts pathways/processes like Epithelial to Mesenchymal Transition and RAS-RAF Signaling which either obstruct drivers of the disease and/or improve Alectinib treatment effect.
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3. Are St John’s Wort Supplements Safe for Healthy Individuals with MRE11 Mutation Associated Genetic Risk?
Different companies offer panels of genes to be tested for assessing genetic risk to different cancers. These panels cover genes associated with cancers of the breast, ovary, uterus, prostate, and gastrointestinal system and others. Genetic testing of these genes may confirm a diagnosis and help guide treatment and management decisions. Identification of a disease-causing variant may also guide testing and diagnosis of at-risk relatives. MRE11 is one of the genes generally available in panels for cancer risk testing.
MRE11 mutation causes biochemical pathways Stem Cell Signaling, Estrogen Signaling, DNA Repair, Angiogenesis and Growth Factor Signaling to get impacted. These pathways are direct or indirect drivers of cancer molecular endpoints. St John’s Wort should be avoided when the genetic panel identifies mutation of MRE11 for Breast Cancer. St John’s Wort impacts pathways/processes like Stem Cell Signaling and Estrogen Signaling and creates adverse effects with MRE11 and related conditions.
4. Are St John’s Wort Supplements Safe for Healthy Individuals with KIT Mutation Associated Genetic Risk?
KIT is one of the genes available in panels for cancer risk testing. KIT mutation causes biochemical pathways Nucleotide metabolism, Hypoxia, Stem Cell Signaling, RAS-RAF Signaling and MAPK Signaling to get impacted. These pathways are direct or indirect drivers of cancer molecular endpoints. Consider taking St John’s Wort supplements when the genetic panel identifies mutation in KIT for Gastric Cancer and Hematological Cancer. St John’s Wort impacts pathways/processes like Nucleotide metabolism and Hypoxia and creates a supportive effect in those with KIT and related conditions.
* Other Factors are also included like BMI, Lifestyle Habits, Treatments
The two most important things to remember are that cancer treatments and nutrition are never the same for everyone. Nutrition, which includes food and nutritional supplements like St John’s Wort, is an effective tool which can be controlled by you, while facing cancer.
What food you eat and which supplements you take is a decision you make. Your decision should include consideration of the cancer gene mutations, which cancer, ongoing treatments and supplements, any allergies, lifestyle information, weight, height and habits.
The nutrition planning for cancer from addon is not based on internet searches. It automates the decision making for you based on molecular science implemented by our scientists and software engineers. Irrespective of whether you care to understand the underlying biochemical molecular pathways or not - for nutrition planning for cancer that understanding is needed.
Get started NOW with your nutrition planning by answering questions on the name of cancer, genetic mutations, ongoing treatments and supplements, any allergies, habits, lifestyle, age group and gender.
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Cancer patients often have to deal with different chemotherapy side effects which affect their quality of life and look out for alternative therapies for cancer. Taking the right nutrition and supplements based on scientific considerations (avoiding guesswork and random selection) is the best natural remedy for cancer and treatment related side-effects.