Steroids are biological compounds found in plants, animals, and fungi. Steroids that are formed in the endocrine glands of the human body are called steroid hormones. One particular kind of steroid hormone, called glucocorticoids, has been proven to be effective in the treatment of certain cancers.

Leukemia is a condition in which the white blood cells are reproducing at an abnormal and dangerously rapid rate, forming white blood cell clumps called “blasts.” Allowed to reproduce unchecked, they take over the body, resulting in death. Per a study, the steroid hormone glucocorticoids, (sometimes referred to as “corticosteroid”) is capable of impacting white blood cells, causing cellular death of cancer cells, and are very important for attaining remission in certain cancers. There are two synthetic glucocorticoid products manufactured for this purpose: Dexamethasone and Prednisone. [1]

Unfortunately, there can also be adverse side effects with long-term use. A study was completed in 1975 to see the effects from long-term use of corticosteroids. It was found that they markedly increased the chance of getting dangerous, lethal infections, which increase the risk of mortality and further suppress the immune system. The most common side effect is osteoporosis, i.e., the bones becoming brittle. [2]

In treating cancer, some side effects can be mitigated by using a procedure called “pulsing,” or using them for a certain number of days on, then off. Even so, side effects do occur. Here are some of the more common ones:

Side Effects: redistribution of fat (moon face, weight gain), sore spots on the body that are tender to the touch, (also, mouth sores,) electrolyte imbalance, muscle weakness (loss,) insomnia, elevated blood sugar levels (predisposition to diabetes,) osteoporosis (risk of bone fractures,) Osteonecrosis (rare,) [3] increased appetite, increased or decreased energy, mania, psychosis, emotional highs or lows (depression,) irritation of the stomach lining (predisposition to peptic ulcer,) stunted growth, swollen abdomen, and thin arms & legs, headaches, salt craving, shakes, increased risk of glaucoma and cataracts, peptic ulceration (Note: See “Mitigating the Side Effects” below)

For full information go to the Mayo Clinic website at www.mayoclinic.com/health/steroids/HQ01431

Mania or Psychosis

Mania is characterized by intense rages. Psychosis is characterized by hallucinations or delusions. When a patient exhibits mania or psychosis, call the treating physician immediately. Another parent told me that her son was bouncing off the walls from steroids. When she brought her son to the doctor he told her that it was steroid induced psychosis. The doctor reduced the dose by 50 percent and the weird behavior disappeared.

Get on a Basic Healthy Diet and Eliminate Processed Foods

When fighting cancer, every action possible should be taken to improve overall health. Most fast foods lack nutrients because of the way the food is processed. Even if you eat a really good diet of vegetables, salads, fruits and proteins, it is likely that you will be deficient in some essential nutrients anyway! If regular, unprocessed food such as vegetables and fruit are not providing the nutrients that we need, what are we getting when we eat “processed foods,” such as powdered potatoes, instant rice, and most fast foods? The only way to correct this is to eat a good diet and add daily supplementation so that you are allowing your body to get the nutrients that it needs.

Dr. Donald Davis, at the University of Texas, completed a study regarding the nutrients of 43 garden crops, showing that the crops nutritive values have declined in recent decades. When he looked at the whole group of foods he found that six out of 13 nutrients had declined between 1950 and 1999. These nutrients included protein, calcium, phosphorus (a mineral), iron, riboflavin and ascorbic acid (vitamin C). These declines ranged from 6 percent for protein and to 38 percent for riboflavin. This raised serious questions about modern farming methods and how these are affecting food crops. [4]

This is a good website giving information about nutrition and processed foods. The United States Department of Agriculture has quite a bit of information regarding food, here is the link.

Lean proteins such as turkey, skinless chicken breasts, wild salmon, lean pork etc., are best. Too large a portion of meat is very hard to digest. This is a known fact for healthy people who do not have a serious medical condition. When you add cancer and steroids to the mix, and do not eat well, you’re setting yourself up for more problems. Our Neurologist recommended vegetable stews with meat. He said that these are much easier to digest.

For more diet suggestions for cancer patients: www.cancer.gov/cancertopics/eatinghints/page3

Mitigating the Side Effects

Redistribution of Fats Steroids cause a redistribution of body fats, which result in a distended abdomen and the so-called “moon face”. Adding more fats to the diet, when on steroids is foolhardy. Lots of salads, green vegetables, fruits and lean meats, are the ideal diet for cancer. 

Mouth Sores

Steroids can cause a deficiency in riboflavin. Riboflavin is a B vitamin that is water-soluble. It is a vitamin that you need to replace every day. Riboflavin is important for growth and red blood cell production and helps in releasing energy from carbohydrates. A deficiency in Riboflavin results in mouth sores, anemia, sore throat, swelling of mucous membranes and skin disorders. Because riboflavin is a water-soluble vitamin, leftover amounts leave the body through the urine. There is no known poisoning from riboflavin. [5]

Electrolyte Imbalance

When I found out that steroids cause electrolyte imbalances and questioned our doctors about this, they recommended products like Gatorade and PowerAde. There is a problem with these types of products because they have a high sugar content. High amounts of sugar are a bad idea when on steroids, as another side effect from steroids, is sugar imbalances that can lead to diabetes. An imbalance of electrolytes can cause the shakes, fatigue, anxiety and a multitude of other symptoms. A company by the name of Alacer, produces a product called Electro-mix. It does not contain sugar, is reasonably priced, and Kayla’s doctors approved the use of this product. Each box has 36 packets. You put one packet of powder into a 32ounce container of water. Drink throughout the day. Price $11.99 

Muscle Loss

To avoid muscle loss, my first thought was to improve protein consumption through the use of protein powder. We tried many protein powders and Kayla really likes Jay Robb at www.jayrobb.com. These protein powders taste fantastic and blend very smoothly. They also do not have a lot of added ingredients, which can be crucial when dealing with cancer. Jay Robb has also formulated an excellent egg white protein powder that is delicious and can be used to make a milk-free shake. 

I spoke to the staff at Jay Robb’s company and they said that if you call their customer service number at Toll Free:1.877.JAY.ROBB they will ship you samples of their products free of charge. This way you can try their products to see if you like them. 

Protein Shake Recipe 

¼ cup Coconut Milk (big hit) or organic rice milk, almond milk, or juice. We use the lite coconut milk because the regular is too thick and I also add a bit of water. 

½ scoop of  organic (egg white, soy, hemp, brown rice,) protein powder

Blend well and serve. (Full scoop of protein powder for adults.) 

Below are additional nutritional ingredients I add for Kayla. In particular, the taste of oils really repulsed Kayla. But when mixed into the shake, the oil taste is camouflaged. I was able to add Omega oils. I also add Glucosamine/Condrointin, since Kayla has had broken bones. Acidophilus liquid for her digestion. The fresh fruit or juice is nutritious and helps to hide any remaining taste of the supplements.

Udo’s Oil (Omega 3,6,9 oil) ½ teaspoon (for skin and chemo brain)

Glucosamine/Condrointin ½ tablespoon (for joints)

Coconut Oil ½ teaspoon (prevent fungus)

2 crushed tablets of Bone Care Vitamin

Zeolite mineral ½ teaspoon (prevent fungus)

½ teaspoon of acidophilus probiotic liquid (see page on fungus)

1 teaspoon of xylitol sweetener (safe for blood sugar)

5 ripe strawberries (washed thoroughly,) bananas, or any fruit to taste.

Insomnia

Kayla had trouble sleeping. In the Comprehensive Cancer Care book the author states “Melatonin levels are commonly abnormal in cancer patients”. The nighttime rise in melatonin has been found to be suppressed in some women with breast cancer and to be absent or depressed in men with prostate cancer. One study tested the relationship between immune response and melatonin production, finding that administering the immune factor interleuken-2 to patients restored normal melatonin levels.” Obviously, if you have no trouble with sleep then this is not an issue for you. Per Doctor Denk, too much melatonin can make you feeling groggy the next day. For Kayla the tablet was cut in quarters making her dose .75 mgs, which her doctors approved. For more information, read the pages on melatonin in the book, Comprehensive Cancer Care. Chamomile tea is good for relaxing and falling asleep. We have also used Magnesium powder made by Peter Gillham. Here is the link http://www.petergillham.com/pdfs/Calm-Organic.pdf

Elevated Blood Sugar

When Kayla was first put on steroids all she wanted to do was eat sugar. At first I let her go nuts on it, but gradually tapered her off sugar. Fruits of many kinds helped alleviate the cravings for sugar. Blueberries are an excellent fruit for sweetness without too much sugar. At the health food store, I found lollipops that were made with rice syrup, a good alternative to regular cane sugar. It probably sounds funny that a healthy lollypop could actually taste good, but they do. There are also bakery products at most grocery stores for diabetics and these are better than regular baked goods. It takes a bit of work, but you can do without added sugar. It is a known fact that sugar makes a person tired. It is composed of nothing but empty calories, giving a false short-lived energy rush, followed by a physical crash. This type of added physical stress is not good for anyone that is physically ill. I have to say, that I am really saddened when I see children at the oncology clinic drinking 32ounce sodas. These are children with cancer and other major diseases and they are literally adding liquids to their body that are highly acidic and contain many teaspoons of sugar, just adding to the physical stress they are already in. 

“A 12-ounce can of Coca-Cola, for example, has almost 10 teaspoons of sugar. A 24-ounce bottle of Pepsi-Cola has 21. Popular sports drink PowerAde packs 15 teaspoons of sugar in a 32-ounce bottle.” Charles P. Brenner, DDS, PA. Taken from the website www.dentistryforyoungpeople.com

Osteoporosis/Osteonecrosis: Bone Loss

Our daughter, Kayla was prescribed the steroid hormone, Dexamethasone. Kayla has osteoporosis, which is when the bones become brittle and porous. Unfortunately, she has also exhibited signs of Osteonecrosis, which were pain in her bones, loss of motion, stiffness and muscle spasms. Osteonecrosis is when the steroids, over time, cut off the blood supply to the bones causing bone death. Although Kayla’s has had symptoms of Osteonecrosis, it has not been proven by any scans.

Osteonecrosis as determined by MRI was found to be a common complication in children and adolescents after treatment with the Nordic Acute Lymphoblastic Leukemia protocols. Revision of the protocols by shortening the single exposure to Dexamethasone has diminished the risk for Osteonecrosis remarkably. High body mass index (a fancy way of saying overweight) was identified as a new significant risk factor for Osteonecrosis. [6]

Unfortunately for Kayla her reactions to the steroids has been more severe than other children. One of the staff at our oncology clinic was trying to get answers, as to what could be done to help Kayla’s bones. She sent out an email to many doctors trying to solicit answers. The following is one reply that came back. When I was given a copy of this email all names were blackened out.

Re: Endocrine late effects of cancer therapy

This is certainly an unusual presentation, although the infiltrative disease itself can cause osteopenia, and the methotrexate (chemo) and steroids are going to exacerbate it. When you say you did a scan, was that x-ray or DXA? If a DXA was not done, she should have one in a center that can compare it to her bone age (which should be done at the same time, if not done in the prior six months) and has appropriate age-matched controls.

Given the unusual fracture presentation, I would check calcium, phosphate, magnesium, albumin, alkaline phophatase, PTH, 25-hydroxyvitamin D, and 1,25-dihydroxyvitamin D levels; as well as a urine calcium: creatine.

Calcium and vitamin D should be maximized for everyone. At her age, she should be getting at least 800mg elemental calcium daily (in divided doses). Previous recommendations about vitamin D intake (400iu) are probably too low, and she should get more like 800 – 1000 IU.

If she has osteoporosis and has had three fractures, there would need to be consideration of the use of bisphosphonates, but I don’t know about use concomitantly during leukemia treatment.

I have cc’d the Director of our Bone Program for additional insight, as well as whether she knows who is an expert in pediatric bone disease closer to you in St. Petersburg.

You can see from the email above, what a doctor has determined nutritionally for bone disease. Based upon this doctor’s information, the (below) following supplementation program was implemented after receiving additional approval from Kayla’s oncologist and endocrinologist.

Kayla’s Daily Supplements for bone loss

Bone Care available through Vitamin World has 800 IU of vitamin D, Vitamin K 100 mcg, Calcium 1200 mg, Magnesium 300 mgs. Sold for around $10.00

Glucosamine/Condrointin for her joints because both legs were broken at the knees. This product is sold at WalMart for under $10.00

Lots of green vegetables such as broccoli, green beans and salads.

Besides the above diet, resistance exercise, using weights or rubber bands, etc., is key for building up bone density. The University of Arizona has an excellent page regarding bone density and exercises that increase the density of bones. http://ag.arizona.edu/maricopa/fcs/bb/exercise.html

Kayla’s doctor suggested changing the steroid from Dexathemasone to Prednisone, which is a great idea because Dexamethasone is many times more powerful than Prednisone. Hopefully with this change in steroid, Kayla will no longer have the severe reactions she has had.

In Conclusion

Kayla is a testament that much can be done to help a person who is going through intense chemotherapy and steroid treatment. Anyone can be made nutritionally healthier and emotionally happier. Much of Kayla’s success is due to my careful observations and painstaking research. With cancer patients, chemotherapy reactions and supplement reactions must be carefully monitored, and must be approved by a doctor.

Once approved, play it safe even further by trying the nutritional supplement with a reduced amount to ensure there is no allergic reaction. If the label says the serving size is two tablespoons, test it out by taking 1 teaspoon. Wait and see if there is any reaction. This is how I have always tested things with Kayla. I have never given her large doses of anything without trying a smaller amount first.

Mega doses of any supplements is foolhardy and completely reckless for someone going through the rigors of chemotherapy. The recommended dosages are there for a reason. Do not exceed label dosage recommendations and NEVER self treat!

May your health and well being be improved! 

~

References

1. The American Heritage® Dictionary of the English Language, Fourth Edition copyright ©2000 by Houghton Mifflin Company.

2. Experimental disseminated candidiasis. II. Administration of glucocorticosteroids, susceptibility to infection, and immunity. J Infect Dis. 1975 Oct ;132 (4):393-8 1185009 (P,S,E,B) Cited:2 D L Hurley, J E Balow, A S Fauci

3. Pediatrics. 2008 Jul;122(1):e53-61. Effect of long-term corticosteroid use on bone mineral density in children: a prospective longitudinal assessment in the childhood Asthma Management Program (CAMP) study. Kelly HW, Van Natta ML, Covar RA, Tonascia J, Green RP, Strunk RC; CAMP Research Group. Department of Pediatrics, University of New Mexico Health Sciences Center, Albuquerque, New Mexico 87131-0001, USA.

4. University of Texas at Austin, News December 1st 2004

5. Medline Plus, National Library of Medicine and National Institute of Health.

6. 1:J clin Oncol. 2007 Apr 20;25(12):1498-504 High Body Mass Index increases the risk for osteonecrosis in children with acute lymphoblastic leukemia. Niinimaki RA, Harila-Saari AH, Jartti AE, Seuri RM, Riikonen PV, Paakko EL, Mottonen MI, Lanning M.

7. Pediatr Blood Cancer. 2008 Apr;50(4):833-7 Decrease in peripheral muscle strength and ankle dorsiflexion as long-term side effects of treatment for childhood cancer. Hartman A, van den Bos C, Stijen T, Pieters R.

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