Radiation treatment (radiotherapy) can result in side effects such as fatigue, skin damage, and injury to the heart and lungs. A number of foods or their component molecules have been shown to help obtain relief from these adverse effects without lessening the cytotoxic impact of radiation on breast cancer cells.
The foods listed below are recommended during radiation treatment. The food list, which is updated continually as new research becomes available, has been developed based solely on the results of published academic studies. Clicking on any of the foods will take you to its webpage, which contains specific information concerning that food's relationship to beast cancer (including its overall ranking, for example, highly recommended or recommended in moderation), as well as links to supporting studies. Emphasizing the foods below will help maximize the treatment effects of radiotherapy while increasing well-being and reducing side effects such as fatigue.
Foods that enhance the effectiveness of radiation treatment
The following foods are good sources of compounds that have been shown to increase the anti-cancer effects of radiation treatment and/or protect normal tissues, but not tumors, from radiation:
- Arctic char
- Beans, dry
- Bell peppers
- Black cumin
- Black pepper
- Bok choy
- Brussels sprouts
- Butternut squash
- Cherries, especially sour or tart
- Currants, black
- Grapes and grape juice, red
- Green tea
- Honey, min. processed
- Hot peppers
- Lake trout
- Olives, black
- Onions, green or red
Tamoxifen has been shown to enhance the effects of radiotherapy in ER+ breast cancer. The antidiabetic drug metformin has also been reported to increase the effectiveness of radiotherapy. Research also suggests that cholesterol-lowering drugs could result in less radiation resistance among hormone receptor positive (ER+/PR+) and inflammatory breast cancer (IBC) patients who undergo radiotherapy. There is also some evidence that limiting calories to some extent could heighten the treatment effects of radiation treatment. Topical application of honey has been shown to be effective in reducing the severity of radiation-induced oral mucositis. Cigarette smoking during radiotherapy can result in increased treatment-related complications.
Supplements for patients being treated with radiotherapy
The following supplements generally have been found to be safe and beneficial for those being treated for breast cancer, including with radiation:
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 during radiation treatment
The foods listed below have been found to protect cells against radiation treatment (i.e., they are radioprotective) without having been proven not to interfere with the cytotoxic effects of radiotherapy.
Shellfish, especially raw shellfish, should also be avoided during radiotherapy since they have the potential to cause foodborne illness that could interfere with the timely completion of treatment.
Supplements that should not be used during radiation treatment
While antioxidants consumed in food as part of the diet do not appear to interfere with the effectiveness of radiotherapy (or chemotherapy), the use of antioxidant supplements during such treatment has long been a source of controversy. Radiation oncologists and others have expressed concern that antioxidants are capable of diminishing the effectiveness of radiotherapy by protecting tumor cells from radiation. This is because radiation destroys cancer cells in part by generating high levels of free radicals and antioxidants have the potential to neutralize and nullify this mechanism of action.
On the other hand, it has been argued that antioxidants do not interfere with treatment and may, in fact, increase tumor response. Furthermore, the adverse side effects of radiotherapy can be mitigated with antioxidant and other supplements, thereby enabling patients to endure the treatment. In addition, radiation itself reduces the level of antioxidants such as vitamin A, C, and E in tissues, which may need to be replenished. (However, this leaves the question of dosage for the most part unanswered.)
We do not intend to try to solve this question. However, it is clear that the chemical and other interactions that lead to tumor cell death are complex and this complexity is too profound to be explained in all cases by relatively simple theories or clear-cut narratives. High-quality academic research still reports conflicting conclusions as to whether it is safe to take certain antioxidants and other supplements in combination with radiotherapy. Since research is in disagreement, we lean on the side of caution and recommend against taking the supplements listed below, which have been studied and reported (in some, but not all or even most studies) to reduce the effectiveness of radiotherapy:
We also caution against taking micronutrients such as apigenin, lycopene, or resveratrol that have been reported to be radioprotective and/or to increase radiosensitivity. This is because of the possibility of unintended outcomes. Safe and effective dosages for these supplements during radiation treatment have not been established; it is best to obtain them through diet.
Please also see our article on how to optimize your breast cancer diet for more information on tailoring your diet according to treatment and breast cancer type and subtype.
Selected breast cancer studies
Does omega-3 PUFA-enriched oral nutritional intervention benefit cancer patients receiving chemo (radio) therapy? A systematic review and meta-analysis of randomized controlled trials
Wang Y, Liu R, Chang M, Wei W, Guo Y, Jin Q, et al. Does omega-3 PUFA-enriched oral nutritional intervention benefit cancer patients receiving chemo (radio) therapy? A systematic review and meta-analysis of randomized controlled trials. Critical Reviews in Food Science and Nutrition. Informa UK Limited; 2021;:1-16 10.1080/10408398.2021.1984199
Abstract 737: Estrogen receptor inhibition with tamoxifen mediates radiosensitization of ER+ breast cancer models
Michmerhuizen AR, Pesch AM, Schwartz R, Wilder-Romans K, Liu M, Azaria R, et al. Abstract 737: Estrogen receptor inhibition with tamoxifen mediates radiosensitization of ER+ breast cancer models. Endocrinology. American Association for Cancer Research; 2021; 10.1158/1538-7445.am2021-737
A radiosensitizer, gallotannin-rich extract from Bouea macrophylla seeds, inhibits radiation-induced epithelial-mesenchymal transition in breast cancer cells
Kantapan J, Paksee S, Duangya A, Sangthong P, Roytrakul S, Krobthong S, et al. A radiosensitizer, gallotannin-rich extract from Bouea macrophylla seeds, inhibits radiation-induced epithelial-mesenchymal transition in breast cancer cells. BMC Complementary Medicine and Therapies. Springer Science and Business Media LLC; 2021; 21 10.1186/s12906-021-03363-6
Impact of metformin on the therapeutic effect of radiotherapy
Agbele AT, Faromika OP, Awe OO, Amodu FR, Edaogbogun GO, Bello KA. Impact of metformin on the therapeutic effect of radiotherapy. Radiation Medicine and Protection. Elsevier BV; 2021; 2:17-22 10.1016/j.radmp.2020.12.002
Smoking, Radiation Therapy, and Contralateral Breast Cancer Risk in Young Women
Reiner AS, Watt GP, John EM, Lynch CF, Brooks JD, Mellemkjær L, et al. Smoking, Radiation Therapy, and Contralateral Breast Cancer Risk in Young Women. JNCI: Journal of the National Cancer Institute. Oxford University Press (OUP); 2021; 10.1093/jnci/djab047
Clinical applicability of natural products for prevention and treatment of oral mucositis: a systematic review and meta-analysis
Lima ICGdS, de Fátima Souto Maior L, Gueiros LAM, Leão JC, Higino JS, Carvalho AAT. Clinical applicability of natural products for prevention and treatment of oral mucositis: a systematic review and meta-analysis. Clinical Oral Investigations. Springer Science and Business Media LLC; 2021; 10.1007/s00784-020-03743-1
Suppression of local type I interferon by gut microbiota–derived butyrate impairs antitumor effects of ionizing radiation
Yang K, Hou Y, Zhang Y, Liang H, Sharma A, Zheng W, et al. Suppression of local type I interferon by gut microbiota–derived butyrate impairs antitumor effects of ionizing radiation. Journal of Experimental Medicine. Rockefeller University Press; 2021; 218 10.1084/jem.20201915
Simvastatin treatment varies the radiation response of human breast cells in 2D or 3D culture
Manda K, Juerß D, Fischer P, Schröder A, Koenen A, Hildebrandt G. Simvastatin treatment varies the radiation response of human breast cells in 2D or 3D culture. Investigational New Drugs. Springer Science and Business Media LLC; 2020; 10.1007/s10637-020-01046-6
The Two Sides of Dietary Antioxidants in Cancer Therapy
Adewumi Akanji M, Demilade Fatinukun H, Emmanuel Rotimi D, Lawrence Afolabi B, Stephen Adeyemi O. The Two Sides of Dietary Antioxidants in Cancer Therapy. Antioxidants [Working Title]. IntechOpen; 2020; 10.5772/intechopen.94988
Skin toxicity following radiotherapy in patients with breast carcinoma: is anthocyanin supplementation beneficial?
Bracone F, De Curtis A, Di Castelnuovo A, Pilu R, Boccardi M, Cilla S, et al. Skin toxicity following radiotherapy in patients with breast carcinoma: is anthocyanin supplementation beneficial?. Clinical Nutrition. Elsevier BV; 2020; 10.1016/j.clnu.2020.09.030
Tomato Juice Consumption Could Improve Breast Skin Adverse Effects of Radiotherapy in Breast Cancer Patients
FUKUSHI Y, MARIYA Y, YAMADA K, YOSHIDA K, SASA A, SAITO H, et al. Tomato Juice Consumption Could Improve Breast Skin Adverse Effects of Radiotherapy in Breast Cancer Patients. In Vivo. Anticancer Research USA Inc.; 2020; 34:3013-3021 10.21873/invivo.12133
Melatonin as a Radio-Sensitizer in Cancer
Alonso-González C, González A, Menéndez-Menéndez J, Martínez-Campa C, Cos S. Melatonin as a Radio-Sensitizer in Cancer. Biomedicines. MDPI AG; 2020; 8:247 10.3390/biomedicines8080247
The impact of smoking on adjuvant breast cancer radiation treatment: A systematic review
Wong G, Lam E, Karam I, Yee C, Drost L, Tam S, et al. The impact of smoking on adjuvant breast cancer radiation treatment: A systematic review. Cancer Treatment and Research Communications. Elsevier BV; 2020; 24:100185 10.1016/j.ctarc.2020.100185
Resveratrol induces apoptosis and attenuates proliferation of MCF-7 cells in combination with radiation and hyperthermia.
Amini P, Nodooshan SJ, Ashrafizadeh M, Eftekhari S, Aryafar T, Khalafi L, et al. Resveratrol induces apoptosis and attenuates proliferation of MCF-7 cells in combination with radiation and hyperthermia.. Current Molecular Medicine. Bentham Science Publishers Ltd.; 2020; 20 10.2174/1566524020666200521080953
Phenethyl Isothiocyanate Suppresses Stemness in the Chemo- and Radio-Resistant Triple-Negative Breast Cancer Cell Line MDA-MB-231/IR Via Downregulation of Metadherin
Nguyen YT, Moon JY, Ediriweera MK, Cho SK. Phenethyl Isothiocyanate Suppresses Stemness in the Chemo- and Radio-Resistant Triple-Negative Breast Cancer Cell Line MDA-MB-231/IR Via Downregulation of Metadherin. Cancers. MDPI AG; 2020; 12:268 10.3390/cancers12020268
Vitamin D and selenium blood levels and acute skin toxicity during radiotherapy for breast cancer
Männle H, Momm F, Münstedt K. Vitamin D and selenium blood levels and acute skin toxicity during radiotherapy for breast cancer. Complementary Therapies in Medicine. Elsevier BV; 2019; 49:102291 10.1016/j.ctim.2019.102291
Radiosensitizing effect of curcumin-loaded lipid nanoparticles in breast cancer cells
Minafra L, Porcino N, Bravatà V, Gaglio D, Bonanomi M, Amore E, et al. Radiosensitizing effect of curcumin-loaded lipid nanoparticles in breast cancer cells. Scientific Reports. Springer Science and Business Media LLC; 2019; 9 10.1038/s41598-019-47553-2
Selenium does not affect radiosensitivity of breast cancer cell lines
Schilling D, Herold B, Combs SE, Schmid TE. Selenium does not affect radiosensitivity of breast cancer cell lines. Radiation and Environmental Biophysics. Springer Science and Business Media LLC; 2019; 58:433-438 10.1007/s00411-019-00801-5
Antioxidant supplementation and breast cancer prognosis in postmenopausal women undergoing chemotherapy and radiation therapy
Jung AY, Cai X, Thoene K, Obi N, Jaskulski S, Behrens S, et al. Antioxidant supplementation and breast cancer prognosis in postmenopausal women undergoing chemotherapy and radiation therapy. The American Journal of Clinical Nutrition. Oxford University Press (OUP); 2019; 109:69-78 10.1093/ajcn/nqy223
Pharmacology of natural radioprotectors
Mun G, Kim S, Choi E, Kim CS, Lee Y. Pharmacology of natural radioprotectors. Archives of Pharmacal Research. Springer Science and Business Media LLC; 2018; 41:1033-1050 10.1007/s12272-018-1083-6