Naturally Manage Chemotherapy Induced Mucositis
Managing Common Side Effects of Conventional Cancer Treatment: Mucositis
Dealing with the side effects of conventional cancer treatment can be one of the most challenging aspects of battling the disease. Below are some ideas on integrative interventions that may be helpful in addressing mucositis, which is one of the more common side effects of conventional therapy. As always, please make sure to discuss with your physician. Adding a trained naturopathic oncologist and cancer coach to your team can also be invaluable.
What is Mucositis?
Mucositis is one of the more common side effects of chemotherapy and radiation treatment for cancer. It is the painful inflammation and ulceration of the mucous membranes lining the digestive tract. It can occur anywhere along the gastrointestinal (GI) tract, but oral mucositis refers to the particular inflammation and painful ulceration that occurs in the mouth.
Mucositis / Gastrointestinal Toxicity
Glutamine is the most abundant free amino acid in the body.
Amino acids are the building blocks of protein. Glutamine is the major fuel source of enterocytes and is therefore essential for the maintenance of intestinal mucosal integrity and function. It also maintains immune function by serving as the principle metabolic fuel for lymphocytes and macrophages. Several studies have shown glutamine [1, 2, 3, 4, 5, 6, 7, 8, 9] to be effective in mitigating chemotherapy induced mucositis (as well as mitigating neuropathy and improving recovery after surgery – see below for more details).
How Does Glutamine Manage Mucositis and Esophagitis?
Glutamine has been shown to reduce the degree of mucositis through anti-inflammatory mechanisms (inhibition of one of the main switches that turn on inflammation, NF-kappaB, inhibition of bacterial toxins and increased tissue healing (increased fibroblast and collagen synthesis.)
Is Glutamine Safe To Give To Patients With Cancer?
There is some debate here  as it is well-known that under certain circumstances cancer cells use glutamine for energy.
In our n=1 (one person experiment), we noticed that when we used glutamine it helped alleviate many of the side effects from chemotherapy, improved quality of life, with no discernible negative impact to treatment effectiveness.
In fact, there is some evidence that glutamine can make chemotherapy more effective .
Our oncologist referred to glutamine as “bait”.
However, because glutamine could make cancer cells more metabolically active, it is not something that you would want to use in remission or when on a chemo break.
In fact, there are some finer details around timing and dosages near chemo that you would want to discuss with a trained naturopathic oncologist.
Do not use glutamine if you :
- Have kidney failure, kidney dysfunction, or if your kidney function is impaired or abnormal.
- Have liver failure, liver dysfunction, or if your liver function is impaired or abnormal.
- Have ever been diagnosed with or had a period of hepatic encephalopathy (liver function that affects your mental, emotional, or cognitive state).
- Have a history of mental illness, especially bipolar depression (manic depression), mania, or hypomania.
- Have a history of seizure disorders, such as epilepsy or are taking medications to control a seizure disorder.
- Have a history of allergic reaction to monosodium glutamate (MSG), a flavoring agent sometimes used in the preparation of Chinese food in restaurants.
- Are taking or have been prescribed to take a medication called lactulose.
Always check with your physician before starting any supplement.
Other Supplements/Compounds That May Be Helpful
Aloe Vera [13, 14] and Vitamin E [15, 16]
While not technically a vitamin, ‘vitamin U’ is the anti-ulcer substance found in cabbage leaves and other green vegetables.
It has been used for its reputed protective effect on the liver and gastro-intestinal mucosa and thus used in the treatment of gastric disorders.
A research study conducted by Yeung et al. found that the daily oral administration of a probiotic suspension of Lactobacillus casei variety rhamnosus (Lcr35) or Lactobacillus acidophilus and Bifidobacterium bifidum (LaBi) resulted in the attenuation of diarrhea, proinflammatory cytokines, and jejunal villi damages in 5-FU(fluorouracil) -induced intestinal mucositis.
Furthermore, a prospective open-labeled randomized trial in Sweden documented that Lactobacillus rhamnosus administration twice daily for 24 weeks reduced grade 3 or 4 diarrhea in patients and minimized the hospitalization due to bowel toxicity. 
Honey  has been shown to be effective as topical prophylaxis against radiochemotherapy-induced mucositis in head and neck cancer.
However, ingesting honey may not be the best idea in patients seeking to adhere to a low sugar and/or ketogenic diet.
Another study by Ortiz et al, found that a melatonin gel protects against radiation-induced oral mucositis. 
If you have found some of these or other integrative remedies to be helpful in dealing with side effects from conventional therapy, please feel free to share in the comments!
This article is part of a series of natural remedies for managing chemotherapy induced side effects. For managing chemotherapy (vincristine) induced neuropathy go here.
You may also be interested in:
Written by Scott Chaverri (father of Matthew, dx with Stage 3 Embryonal Rhabdomyosarcoma of the bile duct and liver in May of 2016 two weeks after his second birthday)
- Clinical trial: prophylactic intravenous alanyl-glutamine reduces the severity of gastrointestinal toxicity induced by chemotherapy–a randomized crossover study.
- The effect of oral glutamine on 5-fluorouracil/leucovorin-induced mucositis/stomatitis assessed by intestinal permeability test.
- A double-blind randomized placebo-controlled study of oral glutamine in the prevention of mucositis in children undergoing hematopoietic stem cell transplantation: a pediatric blood and marrow transplant consortium study.
- Glutamine in Alleviation of Radiation-Induced Severe Oral Mucositis: A Meta-Analysis.
- Glutamine and the preservation of gut integrity.
- Effectiveness of Parenteral Glutamine on Methotrexate-induced Oral Mucositis in Children with Acute Lymphoblastic Leukemia.
- Oral Glutamine in Preventing Treatment-Related Mucositis in Adult Patients With Cancer: A Systematic Review.
- Elemental diet plus glutamine for the prevention of mucositis in esophageal cancer patients receiving chemotherapy: a feasibility study.
- Glutamine as indispensable nutrient in oncology: experimental and clinical evidence.
- Q’s next: The diverse functions of glutamine in metabolism, cell biology and cancer
- Effect of glutamine on methotrexate efficacy and toxicity.
- Use Glutamine To Reduce The Severity Of Mucositis And Neuropathy (During Chemotherapy Or Radiation Therapy)
- Comparative Efficacy of Aloe vera and Benzydamine Mouthwashes on Radiation-induced Oral Mucositis: A Triple-blind, Randomised, Controlled Clinical Trial.
- Interventions for preventing oral mucositis for patients with cancer receiving treatment.
- Efficacy of Topical and Systemic Vitamin E in Preventing Chemotherapy-Induced Oral Mucositis
- The effectiveness of vitamin “E” in the treatment of oral mucositis in children receiving chemotherapy.
- Review on Biochemical Importance of Vitamin-U
- Oral Mucositis: Melatonin Gel an Effective New Treatment
- Honey as topical prophylaxis against radiochemotherapy-induced mucositis in head and neck cancer.
- Melatonin blunts the mitochondrial/NLRP3 connection and protects against radiation-induced oral mucositis.