1. Cancer Wellness Center May 13, 2010 Anne Leavell, MS, RD, LDN, CDE Department of Neurology, Northwestern Medical Faculty Foundation Supplements For Your Nervous System

2. Supplements Disclaimer: Dietary supplementation should NOT be initiated without the supervision of a qualified physician. Check with your doctor before you begin. Dietary supplementation should NOT be initiated without the supervision of a qualified physician. Check with your doctor before you begin. Several of these supplements may have adverse effects Several of these supplements may have adverse effects

3. Vitamin E Vitamin E Powerful antioxidant that reduces levels of free radicals and oxidative stress. Powerful antioxidant that reduces levels of free radicals and oxidative stress. Protects against side effects: numbness, tingling, burning and pain Protects against side effects: numbness, tingling, burning and pain B Complex: B1(thiamine), B2(riboflavin), B3(niacin), B5(pantothenic acid), B6(pyridoxine), B7(biotin), B9(folic acid), B12(cobalamins) B Complex: B1(thiamine), B2(riboflavin), B3(niacin), B5(pantothenic acid), B6(pyridoxine), B7(biotin), B9(folic acid), B12(cobalamins) B12 deficiency results in damage to protective covering of nerves B12 deficiency results in damage to protective covering of nerves Decrease in pain (B1/B6/B12) Decrease in pain (B1/B6/B12) Folic acid (B9): maintenance of nerve cells Folic acid (B9): maintenance of nerve cellsSupplements

4. Acetyl-L-Carnitin e Acetyl-L-Carnitin e Neuroprotective properties Neuroprotective properties 2 small studies - limit chemotherapy induced neuropathy 2 small studies - limit chemotherapy induced neuropathy More studies needed, effectiveness not established More studies needed, effectiveness not established Alpha lipoic acid Alpha lipoic acid Benefit in diabetic neuropathy (less pain, burning and numbness) Benefit in diabetic neuropathy (less pain, burning and numbness) Further studies needed for safety/efficacy of ALA in prevention/treatment of chemotherapy induced neuropathy Further studies needed for safety/efficacy of ALA in prevention/treatment of chemotherapy induced neuropathySupplements

5. Glutamine Glutamine A neutral nonessential amino acid though to have neuroprotective effects (particularly with Paclitaxel) A neutral nonessential amino acid though to have neuroprotective effects (particularly with Paclitaxel) More research needed to assess efficacy of glutamine More research needed to assess efficacy of glutamine Glutathione Glutathione Tripeptide thought to prevent neurotoxicity Tripeptide thought to prevent neurotoxicity Efficacy seen in 50 advanced gastric cancer undergoing cisplatin- based chemotherapy Efficacy seen in 50 advanced gastric cancer undergoing cisplatin- based chemotherapySupplements

6. Supplements Magnesium/Calcium Magnesium/Calcium Improvements in neurotoxicity following infusion Improvements in neurotoxicity following infusion Caution: may cause diarrhea in large doses Caution: may cause diarrhea in large doses Need more research to evaluate use as prevention/treatment of chemotherapy induced neuropathy Need more research to evaluate use as prevention/treatment of chemotherapy induced neuropathy N-acetylcysteine (amino acid) N-acetylcysteine (amino acid) Powerful antioxidant Powerful antioxidant Animal studies have shown inhibition of diabetic neuropathy and protection against neuropathies caused by chemotherapy drugs Animal studies have shown inhibition of diabetic neuropathy and protection against neuropathies caused by chemotherapy drugs

7. Supplements Omega-3 fatty acids: Omega-3 fatty acids: High quantities in coldwater fish (salmon) and widely consumed for anti-inflammatory powers High quantities in coldwater fish (salmon) and widely consumed for anti-inflammatory powers Essential fatty acids and important component of cell membranes, myelin sheath that protects nerves Essential fatty acids and important component of cell membranes, myelin sheath that protects nerves Studies show ability to reduce demyelination of nerves and neuropathic pain Studies show ability to reduce demyelination of nerves and neuropathic pain