Foods to eat and avoid during Adriamycin chemotherapy
Foods to eat & avoid during Adriamycin chemotherapy
Adriamycin (doxorubicin) chemotherapy is effective in improving breast cancer survivorship: numerous studies have found that it protects against breast cancer recurrence and metastases. Adriamycin can result in side effects such as hair loss, bone marrow suppression, nausea, fatigue, hand-foot syndrome, cognitive impairment (chemo brain) and serious infections.
The most serious potential side effect is heart damage (cardiomyopathy), which can lead to heart failure. Patients with BRCA mutations appear to be particularly susceptible to Adriamycin-induced cardiomyopathy.
It is important for breast cancer patients to avoid consuming foods or taking supplements that will lessen the cytotoxic impact of Adriamycin on cancer cells. Compounds that provide relief from chemotherapy side effects may also provide some protection to breast cancer cells. In fact, while various micronutrients found in fruits, vegetables and other foods have been shown to help protect against breast cancer development and metastasis, some micronutrients might enable breast cancer cells to survive chemotherapy.
The goal should be to eat a healthy diet that meets nutritional needs while avoiding harmful foods that can promote breast cancer. It is more important to avoid unhealthy foods (fast food, junk food, meals consisting mostly of highly refined carbohydrates, unhealthy fats (including most vegetable oils), red meat, fried food) than to consume cancer-fighting foods. The purpose of food during chemotherapy is to enable patients to feel well enough to continue treatment, not to eliminate side effects that may in fact be associated with successful treatment.
One 2019 study reported that the presence of fat cells promoted resistance to Adriamycin chemotherapy in a wide variety of human and mouse breast cancer cells. Clearly, weight gain, which is common among breast cancer patients undergoing chemotherapy, should be avoided. However, weight loss is also associated with unfavorable prognosis in women undergoing anthracycline chemotherapy and should not be a goal during treatment.
There are a few foods that have been shown to act synergistically with Adriamycin to enhance its effectiveness against breast cancer or to protect against heart damage without interfering with the treatment. The strategy we recommend during chemotherapy and for the following month is to consume the foods that enhance the effectiveness of Adriamycin, as well as those on the neutral food list (listed later in this article), while limiting or avoiding the foods that should not be consumed while on Adriamycin, as well as those on our general avoid list. Please see our webpage on factors influencing Adriamycin effectiveness for non-food influences on Adriamycin treatment.
Foods that enhance effectiveness of Adriamycin or safely reduce side effects
The following foods are very good sources of compounds that have been shown to increase the anti-cancer effects of Adriamycin or reduce its side effects without interfering with treatment:
- Arctic char
- Bell peppers
- Black cumin
- Black pepper
- Bok choy, or Chinese cabbage
- Brazil nuts
- Brussels sprouts
- Butternut squash
- Celery & celery hearts
- Cherries, both regular & sour
- Cranberries & lingonberries
- Currants, black
- Flaxseed & flaxseed oil
- Grape seed oil
- Grapes, red & grape juice
- Horseradish & wasabi
- Hot peppers
- Lettuce, romaine
- Mushrooms, excluding reishi mushroom
- Olive oil, extra-virgin
- Olives, black & green
- Onions, all types
- Pomegranates & pomegranate juice
- Rice, brown, black or red
- Salmon, wild
- Squash, winter
- Turnips & turnip greens
- Walnut oil
- Watercress & garden cress
Fruits and vegetables should be washed thoroughly before cooking or consuming. This includes the exterior of fruits such as watermelon since cutting through the rind can transfer bacteria such as salmonella to the flesh.
Brazil nut consumption should be limited to no more than one nut per day, on average, to avoid consuming excess selenium.
Topical application of honey has been shown to be effective in reducing the severity of chemotherapy-induced oral mucositis.
Many women develop abnormally low iron levels during chemotherapy which must be treated. However, excess iron is also to be avoided since it has been shown to reduce the effectiveness of Adriamycin. Curcumin (found in turmeric) has been shown to be an iron chelator (a compound that removes iron from the body) as well as a copper chelator. Turmeric might also protect the brain from chemotherapy, thereby reducing chemo brain. In addition, curcumin has been shown to reduce cardiomyopathy in a mouse model of Adriamycin treatment.
Supplements for patients being treated with Adriamycin
There is no supplement or combination of supplements that has been proven to reliably reduce the risk of breast cancer recurrence in women. Attempting to take advantage of the apparent treatment effects of micronutrients and other dietary components by using supplements carries the risk of adverse and paradoxical effects, including promoting breast cancer growth and metastasis.
What is known is that when a beneficial micronutrient is administered at low doses by consuming food, it is likely to have subtle chemopreventive effects, whereas when the same micronutrient is administered at high doses, it is more likely to have pharmacological effects, with mostly unknown results. Therefore, it is best to obtain beneficial compounds by consuming food, if possible. Supplements should be used if medically necessary or to make up for deficiencies that are difficult to correct through diet.
The following supplements generally have been found to be safe and beneficial for those being treated with Adriamycin:
Avoid taking supplements during the two days before, the day of, and the day after each chemotherapy treatment. Please consult your oncology team for advice concerning your situation and dosages. It might make sense to be tested for deficiency in vitamin D and plan for follow up to determine if your reading has reached a desirable level.
Foods that should be limited or avoided while on Adriamycin
The following foods have been found to interfere with the effectiveness of treatment with Adriamycin:
Supplements & other products that should not be used on Adriamycin
The following vitamins, supplements and other products have been found to interfere with the effectiveness of Adriamycin. That is not to say that most other supplements are safe to take; there are no relevant scientific studies concerning the interactions between most supplements and Adriamycin.
Nicotine has been shown to reduce the effectiveness of Adriamycin in ER+/PR+ breast cancer cells, increasing the proportion of breast cancer stem cells. This suggests that smoking and other nicotine delivery mechanisms such as vaping should be avoided.
- Apigenin supplements
- Artichoke supplements
- Caffeine, any source
- Genistein, daidzein or equol supplements
- Goldenseal supplements
- Green tea and EGCG supplements
- Iron supplements (unless medically necessary)
- Licorice root supplements
- CBD supplements
- Milk thistle, silybin or silymarin supplements
- Quercetin supplements
- Reishi mushroom products
- Rhein supplements
- Sage supplements & sage essential oil
- Vitamin A supplements
- Vitamin B12 supplements
- Vitamin C supplements
- Vitamin E supplements
Hesperidin and saffron could reduce effectiveness of cyclophosphamide
Hesperidin, a flavonoid found in oranges, tangerines, kumquats, lemons, limes and grapefruit, has the potential to interfere with chemotherapy regimens containing cyclophosphamide, such as TAC (Taxotere, Adriamycin and cyclophosphamide). Cyclophosphamide is an alkylating agent frequently used in combination with anthracyclines (Adriamycin, epirubicin) and/or taxanes (Taxol, Taxotere). Hesperidin is found most abundantly in the peel, pith and membranous parts of oranges and other citrus fruits. Prepared food sources include orange tea, commercial orange juice, orange marmalade, and dishes that incorporate citrus peel such as Szechuan Orange Chicken. See oranges for more information.
Saffron, vitamin A, vitamin B12, vitamin C and vitamin E supplements also have the potential to interfere with the treatment effects of cyclophosphamide.
Neutral foods for use during Adriamycin chemotherapy
We have provided the list below in order to increase the number of foods that can be consumed while on Adriamycin. It includes some foods for which we do not have enough information to put on our recommended list, but that do not appear to promote breast cancer or interfere with Adriamycin treatment (when consumed in moderation). It is important not to drive up blood sugar and insulin levels with high carbohydrate/low fiber meals. Consume the foods below in moderation, but concentrate on the foods recommended above.
Food should not be deep fried, barbequed, pan fried at high heat, roasted or smoked. The best cooking methods for starchy foods are steaming, boiling and baking. Very little salt should be used in preparing food.
BPA and BBP can interfere with effectiveness of Adriamycin chemotherapy
Bisphenol A (BPA), an endocrine disruptor, is suspected of increasing the risk of breast cancer. BPA at low concentrations has been shown to reduce the efficacy of Adriamycin in both estrogen receptor positive (ER+) and triple negative (ER-/PR-/HER2-) breast cancer cells. BPA exposure can be limited by avoiding canned foods, canned sodas, and polycarbonate plastic bottles and food containers, which may be marked with a 7 or 3 recycling number in a triangle-shaped icon (normally found on the base).
The phthalate BBP (benzyl butyl phthalate) has been shown to increase resistance to Adriamycin (doxorubicin) plus cyclophosphamide chemotherapy regimens. BBP is used in making vinyl floor tiles, carpet backing, car trims and dashboards, as well as artificial leather. It is also added to some adhesives, perfumes, and hair sprays.
Weight loss and weight gain during chemotherapy
Recent studies suggest that fasting around chemotherapy treatments could protect normal cells from the toxic effects of chemotherapy while sensitizing cancer cells to the treatment. However, a study in which rats were deprived of protein during anthracycline chemotherapy found that protein malnutrition reduced the elimination of both Adriamycin and epirubicin, prolonging the exposure of the heart to the drugs and increasing the anthracycline-associated heart damage. More studies and human trials are required before it can be determined whether fasting during chemotherapy is safe and effective.
On the other hand, weight gain, which is common during chemotherapy, is known to be associated with less favorable prognosis and should be avoided.
Exercise during chemotherapy
Regular exercise has been shown to reduce fatigue in cancer patients undergoing chemotherapy. However, one study suggested that intense or prolonged physical activity a couple of days before the start of radiotherapy or chemotherapy has significant potential to reduce the benefits of the treatments. Based on the available evidence, light to moderate aerobic exercise appears to be safe during treatment with Adriamycin and could help preserve heart health and reduce fatigue.
Please see our article on how to optimize your breast cancer diet for information on what to eat during all stages of treatment and recovery. Below are links to recent studies on Adriamycin and breast cancer. For a more complete list of studies, please click on the tag Adriamycin.
Selected breast cancer studies
Anticancer effect and safety of doxorubicin and nutraceutical sulforaphane liposomal formulation in triple-negative breast cancer (TNBC) animal model
Pogorzelska A, Mazur M, Świtalska M, Wietrzyk J, Sigorski D, Fronczyk K, et al. Anticancer effect and safety of doxorubicin and nutraceutical sulforaphane liposomal formulation in triple-negative breast cancer (TNBC) animal model. Biomedicine & Pharmacotherapy. Elsevier BV; 2023; 161:114490 10.1016/j.biopha.2023.114490
Short term starvation potentiates the efficacy of chemotherapy in triple negative breast cancer via metabolic reprogramming
Pateras IS, Williams C, Gianniou DD, Margetis AT, Avgeris M, Rousakis P, et al. Short term starvation potentiates the efficacy of chemotherapy in triple negative breast cancer via metabolic reprogramming. Journal of Translational Medicine. Springer Science and Business Media LLC; 2023; 21 10.1186/s12967-023-03935-9
Metabolomics Analysis Reveals Novel Targets of Chemosensitizing Polyphenols and Omega-3 Polyunsaturated Fatty Acids in Triple Negative Breast Cancer Cells
Rushing BR, Wiggs A, Molina S, Schroder M, Sumner S. Metabolomics Analysis Reveals Novel Targets of Chemosensitizing Polyphenols and Omega-3 Polyunsaturated Fatty Acids in Triple Negative Breast Cancer Cells. International Journal of Molecular Sciences. MDPI AG; 2023; 24:4406 10.3390/ijms24054406
Mechanism of Saffron Extract against Cardiotoxicity Induced by Doxorubicin: 4D Label-Free Quantitative proteomics Analysis and Bioinformatic Study
Sa R, Lin Z, Huang J, Wang Y, Lv J, Zhang X, et al. Mechanism of Saffron Extract against Cardiotoxicity Induced by Doxorubicin: 4D Label-Free Quantitative proteomics Analysis and Bioinformatic Study. Research Square Platform LLC; 2023; 10.21203/rs.3.rs-2580481/v1
Association of Anthracycline With Heart Failure in Patients Treated for Breast Cancer or Lymphoma, 1985-2010
Larsen CM, Garcia Arango M, Dasari H, Arciniegas Calle M, Adjei E, Rico Mesa J, et al. Association of Anthracycline With Heart Failure in Patients Treated for Breast Cancer or Lymphoma, 1985-2010. JAMA Network Open. American Medical Association (AMA); 2023; 6:e2254669 10.1001/jamanetworkopen.2022.54669
Quercetin Effects on Cell Cycle Arrest and Apoptosis and Doxorubicin Activity in T47D Cancer Stem Cells
Azizi E, Fouladdel S, Komeili Movahhed T, Modaresi F, Barzegar E, Ghahremani MH, et al. Quercetin Effects on Cell Cycle Arrest and Apoptosis and Doxorubicin Activity in T47D Cancer Stem Cells. Asian Pacific Journal of Cancer Prevention. EpiSmart Science Vector Ltd; 2022; 23:4145-4154 10.31557/apjcp.2022.23.12.4145
The anti-proliferative effect of β-carotene against a triple-negative breast cancer cell line is cancer cell-specific and JNK-dependent
Antunes A, Carmo F, Pinto S, Andrade N, Martel F. The anti-proliferative effect of β-carotene against a triple-negative breast cancer cell line is cancer cell-specific and JNK-dependent. PharmaNutrition. Elsevier BV; 2022; 22:100320 10.1016/j.phanu.2022.100320
An Olive Oil Mill Wastewater Extract Improves Chemotherapeutic Activity Against Breast Cancer Cells While Protecting From Cardiotoxicity
Benedetto N, Calabrone L, Gutmańska K, Macrì N, Cerrito MG, Ricotta R, et al. An Olive Oil Mill Wastewater Extract Improves Chemotherapeutic Activity Against Breast Cancer Cells While Protecting From Cardiotoxicity. Frontiers in Cardiovascular Medicine. Frontiers Media SA; 2022; 9 10.3389/fcvm.2022.867867
The Self-Administered Use of Complementary and Alternative Medicine (CAM) Supplements and Antioxidants in Cancer Therapy and the Critical Role of Nrf-2—A Systematic Review
Krejbich P, Birringer M. The Self-Administered Use of Complementary and Alternative Medicine (CAM) Supplements and Antioxidants in Cancer Therapy and the Critical Role of Nrf-2—A Systematic Review. Antioxidants. MDPI AG; 2022; 11:2149 10.3390/antiox11112149
pH-responsive co-delivery of Doxorubicin and Saffron via Cross-linked Chitosan/Laponite RD Nanoparticles for Enhanced-Chemotherapy
Heragh BK, Taherinezhad H, Mahdavinia GR, Javanshir S, Labib P, Ghasemsolb S. pH-responsive co-delivery of Doxorubicin and Saffron via Cross-linked Chitosan/Laponite RD Nanoparticles for Enhanced-Chemotherapy. Materials Today Communications. Elsevier BV; 2022;:104956 10.1016/j.mtcomm.2022.104956
Glucose deprivation reduces proliferation and motility, and enhances the anti-proliferative effects of paclitaxel and doxorubicin in breast cell lines in vitro
Khajah MA, Khushaish S, Luqmani YA. Glucose deprivation reduces proliferation and motility, and enhances the anti-proliferative effects of paclitaxel and doxorubicin in breast cell lines in vitro. PLOS ONE. Public Library of Science (PLoS); 2022; 17:e0272449 10.1371/journal.pone.0272449
Apigenin alleviates resistance to doxorubicin in breast cancer cells by acting on the JAK/STAT signaling pathway
Maashi MS, Al-Mualm M, Al-Awsi GRL, Opulencia MJC, Al-Gazally ME, Abdullaev B, et al. Apigenin alleviates resistance to doxorubicin in breast cancer cells by acting on the JAK/STAT signaling pathway. Molecular Biology Reports. Springer Science and Business Media LLC; 2022; 10.1007/s11033-022-07727-0
In Vivo Antitumoral Effects of Linseed Oil and Its Combination With Doxorubicin
Shadyro O, Sosnovskaya A, Edimecheva I, Ihnatovich L, Dubovik B, Krasny S, et al. In Vivo Antitumoral Effects of Linseed Oil and Its Combination With Doxorubicin. Frontiers in Pharmacology. Frontiers Media SA; 2022; 13 10.3389/fphar.2022.882197
Isoorientin attenuates doxorubicin-induced cardiac injury via the activation of MAPK, Akt, and Caspase-dependent signaling pathways
Li S, Liu H, Lin Z, Li Z, Chen Y, Chen B, et al. Isoorientin attenuates doxorubicin-induced cardiac injury via the activation of MAPK, Akt, and Caspase-dependent signaling pathways. Phytomedicine. Elsevier BV; 2022; 101:154105 10.1016/j.phymed.2022.154105
Comparing Flaxseed and Perindopril in the Prevention of Doxorubicin and Trastuzumab-Induced Cardiotoxicity in C57Bl/6 Mice
Eekhoudt CR, Bortoluzzi T, Varghese SS, Cheung DYC, Christie S, Eastman S, et al. Comparing Flaxseed and Perindopril in the Prevention of Doxorubicin and Trastuzumab-Induced Cardiotoxicity in C57Bl/6 Mice. Current Oncology. MDPI AG; 2022; 29:2941-2953 10.3390/curroncol29050241
Diet impacts triple‐negative breast cancer growth, metastatic potential, chemotherapy responsiveness, and doxorubicin‐mediated cardiac dysfunction
Ramirez MU, Clear KYJ, Cornelius Z, Bawaneh A, Feliz‐Mosquea YR, Wilson AS, et al. Diet impacts triple‐negative breast cancer growth, metastatic potential, chemotherapy responsiveness, and doxorubicin‐mediated cardiac dysfunction. Physiological Reports. Wiley; 2022; 10 10.14814/phy2.15192
Trends in heart disease mortality among breast cancer survivors in the US, 1975–2017
Vo JB, Ramin C, Barac A, Berrington de Gonzalez A, Veiga L. Trends in heart disease mortality among breast cancer survivors in the US, 1975–2017. Breast Cancer Research and Treatment. Springer Science and Business Media LLC; 2022; 10.1007/s10549-022-06515-5
DEHP mediates drug resistance by directly targeting AhR in human breast cancer
Hsieh T, Hsu C, Yang P, Chiu C, Liang S, Ou-Yang F, et al. DEHP mediates drug resistance by directly targeting AhR in human breast cancer. Biomedicine & Pharmacotherapy. Elsevier BV; 2022; 145:112400 10.1016/j.biopha.2021.112400
Prevention of doxorubicin-induced experimental cardiotoxicity by Nigella sativa in rats
Adıyaman MŞ, Adıyaman ÖA, Dağlı AF, Karahan MZ, Dağlı MN. Prevention of doxorubicin-induced experimental cardiotoxicity by Nigella sativa in rats. Revista Portuguesa de Cardiologia. Elsevier BV; 2022; 10.1016/j.repc.2020.12.015
Melatonin and doxorubicin synergistically enhance apoptosis via autophagy-dependent reduction of AMPKα1 transcription in human breast cancer cells
Tran QH, Hoang DH, Song M, Choe W, Kang I, Kim SS, et al. Melatonin and doxorubicin synergistically enhance apoptosis via autophagy-dependent reduction of AMPKα1 transcription in human breast cancer cells. Experimental & Molecular Medicine. Springer Science and Business Media LLC; 2021; 10.1038/s12276-021-00675-y