Our bodies host trillions of microorganisms, primarily in our gut. In fact, they outnumber our own body’s cells! These guests make up what is called our “Microbiome”. When these microorganisms are in a healthy balance, they support many of our body’s functions such as intestinal wall integrity, metabolism, optimal immunity, inflammation control, brain and nervous system health and mood function. 

Chemotherapy can disrupt the gut microbiome, which can affect treatment outcomes 1Chrysostomou, D., Roberts, L. A., Marchesi, J. R., & Kinross, J. M. (2023). Gut Microbiota Modulation of Efficacy and Toxicity of Cancer Chemotherapy and Immunotherapy. Gastroenterology, 164(2), 198–213.; Montassier, E., Gastinne, T., Vangay, P., Al-Ghalith, G. A., Bruley des Varannes, S., Massart, S., Moreau, P., Potel, G., de La Cochetière, M. F., Batard, E., & Knights, D. (2015). Chemotherapy-driven dysbiosis in the intestinal microbiome. Alimentary pharmacology & therapeutics, 42(5), 515–528.. Radiation to the abdominal or pelvic area can damage the lining of the gut and alter the microbiome 2Hauer-Jensen, M., Wang, J., & Boerma, M. (2014). Radiation-induced gastrointestinal toxicity: Mechanisms and clinical implications. Radiotherapy and Oncology, 112(1), 11–17.; Oh B, Eade T, Lamoury G, Carroll S, Morgia M, Kneebone A, Hruby G, Stevens M, Boyle F, Clarke S, Corless B, Molloy M, Rosenthal D, Back M. The Gut Microbiome and Gastrointestinal Toxicities in Pelvic Radiation Therapy: A Clinical Review. Cancers (Basel). 2021 May 13;13(10):2353. A growing body of evidence suggests that the microbiome influences the effectiveness of immunotherapy treatments. Certain microbes are associated with improved responses, though the research is complex, making it difficult to make general recommendations. 3Fuller-Shavel N, Krell J. Integrative Oncology Approaches to Supporting Immune Checkpoint Inhibitor Treatment of Solid Tumours. Curr Oncol Rep. 2024;26(2):164-174. doi:10.1007/s11912-023-01492-4; Routy, B., Le Chatelier, E., Derosa, L., Duong, C. P. M., Alou, M. T., Daillère, R., Fluckiger, A., Messaoudene, M., Rauber, C., Roberti, M. P., Fidelle, M., Flament, C., Poirier-Colame, V., Opolon, P., Klein, C., Iribarren, K., Mondragón, L., Jacquelot, N., Qu, B., Ferrere, G., … Zitvogel, L. (2018). Gut microbiome influences efficacy of PD-1-based immunotherapy against epithelial tumors. Science (New York, N.Y.), 359(6371), 91–97.; Gopalakrishnan, V., Spencer, C. N., Nezi, L., Reuben, A., Andrews, M. C., Karpinets, T. V., Prieto, P. A., Vicente, D., Hoffman, K., Wei, S. C., Cogdill, A. P., Zhao, L., Hudgens, C. W., Hutchinson, D. S., Manzo, T., Petaccia de Macedo, M., Cotechini, T., Kumar, T., Chen, W. S., Reddy, S. M., … Wargo, J. A. (2018). Gut microbiome modulates response to anti-PD-1 immunotherapy in melanoma patients. Science (New York, N.Y.), 359(6371), 97–103.  

One of the main ways we can support our microbiome is through our diet.

Strategies to support your microbiome during treatment

  1. High fiber diet 
    Consuming whole grains, leafy greens, fruits, vegetables, legumes, and nuts support a diverse microbiome, and feed beneficial gut bacteria.
    • Microorganisms in your gut ferment the fiber you feed them and make a helpful substance called butyrateButyrate is produced when “good” bacteria in your gut help your body break down dietary fiber in your large intestine (colon). It’s one of several short-chain fatty acids, which are named for their chemical structure., which becomes their key energy source. Butyrate also improves the health of the GI tract by decreasing inflammation, protecting the barrier lining of the intestines, promoting a healthy microbiome and protecting against cancers such as colon cancer, and more. 4Hodgkinson, K., El Abbar, F., Dobranowski, P., Manoogian, J., Butcher, J., Figeys, D., Mack, D., & Stintzi, A. (2023). Butyrate’s role in human health and the current progress towards its clinical application to treat gastrointestinal disease. Clinical nutrition (Edinburgh, Scotland), 42(2), 61–75. 
    • Specific foods to help with butyrate production include,
      • Whole grains: oatmeal, brown rice, quinoa,  whole wheat
      • Legumes: beans, lentils, chickpeas
      • Fruits: high-pectin fruits such as apples, berries
      • Vegetables: garlic, onions, carrots, leafy greens, cruciferous vegetables such as broccoli, and cooked and cooled potatoes (high in resistant starcha type of carbohydrate that is not digested in the small intestine but instead ferments in the large intestine.)
      • Nuts and seeds: flax and chia seeds, almonds, walnuts, peanuts
      • Full-fat dairy products in moderation: yogurt, butter, cheese, ghee and milk 
  2. Fermented foods 
    Deliver probiotics safely to the gut, creating a healthy and diverse microbiome. Fermentation also enhances digestibility and generates additional nutrients, such as vitamins and antioxidants. Other health benefits include a reduced risk of cardiovascular disease, diabetes, and obesity. 5Leeuwendaal, N. K., Stanton, C., O’Toole, P. W., & Beresford, T. P. (2022). Fermented Foods, Health and the Gut Microbiome. Nutrients, 14(7), 1527.
    • Examples of fermented foodsFood fermentation is the process of creating food or changing the properties of food using microbes.:
      • Yogurt 
      • Tempeh
      • Miso
      • Pickled vegetables, kimchi, sauerkraut (naturally fermented) 
      • Kefir 
      • Kombucha 
      • Sour cream 
      • Apple Cider Vinegar
    • Note, if you have a weakened immune system, avoid:
      • Cheeses and yogurts made with raw/unpasteurized dairy products
      • Unpasteurized drinks such as unpasteurized kombucha or raw milk;  
      • Check with your oncologist or oncology dietician to see if unpasteurized foods or beverages are safe for you.
  3. Prebiotics
    Stimulate the growth of beneficial bacteria and promote the production of short-chain fatty acids (SCFAs) like butyrate, which have evidence for supporting beneficial bacteria.It has become common for the food industry to add prebiotic supplements like Inulin, to prepared beverages or snacks. However, the best (and tastiest) source of prebiotics comes from real food:
    • Garlic
    • Onions
    • Bananas
    • Whole oats
    • Apples
    • Dandelion greens.  
  4. Probiotics 
    Probiotic supplements introduce beneficial bacteria to the gut, but choosing the right probiotic can be complex. The strain of the microbe matters. Whether and which probiotic to use is best guided by your physician, as conditions like low immunity may increase the risk for complications.

    Find an integrative practitioner to explore a personal probiotic regimen 

Read our side effect guides if you are experiencing digestive symptoms

Author

Christine Mineart, MPH

CancerChoices Program Director
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Christine has a dynamic background in the life sciences, public health, and program operations. Her career began at the lab bench with a Gates Foundation-funded HIV Vaccine research group, which led her to graduate studies in public health epidemiology at UC Berkeley. Her research experience spans clinical epidemiology research to evaluating the impacts of community nutrition programs in Los Angeles, the Central Valley, and Oakland. Most recently she has worked in executive operations for a seed-stage venture capital firm based in San Francisco. Personally, Christine is passionate about holistic health and wellness. She is a clinical herbalist and Reiki master, and she has been practicing yoga for 15+ years. She brings a breadth of experiences to her work leading the CancerChoices program.

Christine Mineart, MPH CancerChoices Program Director

Laura Pole, MSN, RN, OCNS

Senior Clinical Consultant
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Laura Pole is senior clinical consultant for CancerChoices. Laura is an oncology clinical nurse specialist who has been providing integrative oncology clinical care, navigation, consultation, and education services for over 40 years. She is the co-creator and co-coordinator of the Integrative Oncology Navigation Training at Smith Center for Healing and the Arts in Washington, DC. Laura also manages the “Media Watch Cancer News That You Can Use” listserv for Smith Center/Commonweal. In her role as a palliative care educator and consultant, Laura has served as statewide Respecting Choices Faculty for the Virginia POST (Physician Orders for Scope of Treatment) Collaborative as well as provided statewide professional education on palliative and end-of-life care for the Virginia Association for Hospices and Palliative Care.

For CancerChoices, Laura curates content and research, networks with clinical and organizational partners, brings awareness and education of integrative oncology at professional and patient conferences and programs, and translates research into information relevant to the patient experience as well as clinical practice.

Laura sees her work with CancerChoices as a perfect alignment of all her passions, knowledge and skills in integrative oncology care. She is honored to serve you.

Laura Pole, MSN, RN, OCNS Senior Clinical Consultant

Reviewer

Miki Scheidel

Co-Founder and Creative Director
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Miki Scheidel is Co-founder and creative director of CancerChoices. Miki and her family were deeply affected by her father’s transformative experience with integrative approaches to metastatic kidney cancer. That experience inspires her work as president of the Scheidel Foundation, which includes the integrative cancer care portfolio, and as volunteer staff at CancerChoices. She previously worked with the US Agency for International Development and Family Health International among other roles. She received her graduate degree in international development from Georgetown University and a graduate certificate in nonprofit management from George Mason University.

Miki Scheidel Co-Founder and Creative Director

CancerChoices provides information about integrative in cancer care, a patient-centered approach combining the best of conventional care, self care and evidence-informed complementary care in an integrated plan cancer care. We review complementaryin cancer care, complementary care involves the use of therapies intended to enhance or add to standard conventional treatments; examples include supplements, mind-body approaches such as yoga or psychosocial therapy, and acupuncture therapies and self-care lifestyle actions and behaviors that may impact cancer outcomes; examples include eating health-promoting foods, limiting alcohol, increasing physical activity, and managing stress practices to help patients and professionals explore and integrate the best combination of conventionalthe cancer care offered by conventionally trained physicians and most hospitals; examples are chemotherapy, surgery, and radiotherapy and complementary therapies and practices for each person.

Our staff have no financial conflicts of interest to declare. We receive no funds from any manufacturers or retailers gaining financial profit by promoting or discouraging therapies mentioned on this site.

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