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Berberine calms GI upset from radiation therapy
Jacob Schor ND, FABNO
August 9, 2011
One of the drawbacks of radiation therapy, especially of the abdomen, is that it leaves things a mess. The tender tissue that lines the digestive track is especially sensitive to radiation. While the treatment may kill cancer cells, it unfortunately leaves havoc in its wake. There are nice euphemisms for this damage, for example, ‘radiation gastritis’ or ‘acute radiation intestinal syndrome.’ Neither term does justice to describe the resultant discomfort.
Radiation can cause long term weakening, scarring and thickening of the tissue. As it shrinks and constricts it can cause narrowing of the lumen, that is the opening stuff moves through, and you can imagine the resultant problems.
Approximately half of all patients diagnosed with pelvic or abdominal cancers will receive radiation treatment. The side effects can be severe. A paper published in 2009 by Abayomi et al that almost half the women treated with radiation therapy for cervical or endometrial cancer, end up with chronic radiation enteritis.
Thus it gets our attention when any research gets published suggesting possible ways to prevent this damage.
An especially interesting paper was published in September 2010 using an herbal extract called berberine. This chemical is found in a number of different plants.
This study was randomized placebo controlled prospective trial conducted in humans. Two subgroups of patients received the berberine, 300 mg 3 times a day, throughout the trial along with standard radiotherapy and two subgroups received placebo. A fifth subgroup received placebo for the first two weeks of the trial and then was given the active medication.
Two separate groups of patients took part in this study, 36 with seminoma or lymphoma and 42 with cervical cancer. Half of each group received placebo.
The study measured radiation induced toxicities such as fatigue, anorexia/nausea, etc. Levels of each of these complaints were graded weekly by a radiation oncologist according to the common toxicity criteria (CTC) version 2.0.
Taking berberine significantly decreased the incidence and severity of radiation induced acute intestinal syndrome in these patients compared to the patients in the control group. (P < 0.05). Berberine postponed the symptoms so that if they occurred they did so later in the course of treatment.
Although this report looked only at acute reactions to radiation there is every reason to assume that if berberine decreases these acute reactions it may also decrease long term reactions as well. We are expecting further studies by this same research group to appear in the future as data accumulate.
This is not the first report suggesting that berberine was protective against radiation damage. A paper by the same authors, Li et al, published a month earlier, in August 2010, also reported that berberine protects against radiation caused intestinal injury. This earlier study was on mice, not people. In it mice were given berberine and then subjected to high doses of radiation. Berberine reduced measurements of radiation damage and delayed mortality, that is reduced the lethality of treatment.
An earlier human clinical trial that assessed the effect of berberine on toxicities resulting from radiation treatment of non-small cell lung cancer (NSCLC) was published in 2008. Liu et al gave either berberine or placebo to 90 patients who underwent chest radiation therapy. Chest radiation causes injury in a way similar to what pelvic radiation does, though in this case it is called, ‘radiation-induced lung injury’ (RILI).
After 6 weeks, only 45.2% of those patients taking berberine had symptoms of ‘radiation-induced lung injury’ (RILI) compared to 72.1% of those taking the placebo. At six months the numbers were 35.7% and 65.1% respectively. Measurements of lung function were also significantly better in those taking berberine.
Thus berberine may reduce the radiation induced toxicity symptoms in patients caused by pelvic, abdomen and chest radiation treatments. Will it also reduce the cytotoxicity of the treatments? At this point, there are hints that at least in some cancers, berberine makes the cancer cells more sensitive to radiation treatment. Peng et al reported in 2008 that berberine has a synergistic effect with radiation against lung cancer.
Berberine without radiation certainly has a significant anti-cancer effect against a wide range of cancer types. It induces apoptosis in glioblastoma cells. Papers published in the last few months suggest berberine also acts against cervical, liver, and colon cancer. Berberine enhances the cytoxic effect of the chemotherapy drug cisplatin.
It is possible that berberine will decrease the peripheral damage and toxic side effects of radiation therapy, and improve patient outcomes by enhancing radiation action.
As a result of this paper in particular, we’ve been using far more berberine over the past year than we have in the past.
Berberine is also on our list of things which lower transforming growth factor Beta-1 (TGFB-1), a factor that may increase risk of metastasis of some cancers. Thus if test results for TGFB-1 are high, berberine is often our first choice in supplements that may lower it.
More info on TGFB-1: http://ndnr.com/web-articles/oncology/nov-09-transforming-growth-factor-beta-1/
Abayomi J, Kirwan J, Hackett A. The prevalence of chronic radiation enteritis following radiotherapy for cervical or endometrial cancer and its impact on quality of life. Eur J Oncol Nurs. Sep 2009;13(4):262-7.
Li GH, Wang DL, Hu YD, Pu P, Li DZ, Wang WD, Zhu B, et al. Berberine inhibits acute radiation intestinal syndrome in human with abdomen radiotherapy. Med Oncol. 2010 Sep;27(3):919-25.
Li GH, Zhang YP, Tang JL, Chen ZT, Hu YD, Wei H, Li DZ, Hao P, Wang DL. Effects of berberine against radiation-induced intestinal injury in mice. Int J Radiat Oncol Biol Phys. 2010 Aug 1;77(5):1536-44.
Liu Y, Yu H, Zhang C, Cheng Y, Hu L, Meng X, Zhao Y. Protective effects of berberine on radiation-induced lung injury via intercellular adhesion molecular-1 and transforming growth factor-beta-1 in patients with lung cancer. Eur J Cancer. 2008 Nov;44(16):2425-32.
Peng PL, Kuo WH, Tseng HC, Chou FP. Synergistic tumor-killing effect of radiation and berberine combined treatment in lung cancer: the contribution of autophagic cell death. Int J Radiat Oncol Biol Phys. 2008 Feb 1;70(2):529-42.
Eom KS, Kim HJ, So HS, Park R, Kim TY. Berberine-induced apoptosis in human glioblastoma T98G cells is mediated by endoplasmic reticulum stress accompanying reactive oxygen species and mitochondrial dysfunction. Biol Pharm Bull. 2010;33(10):1644-9.
Mahata S, Bharti AC, Shukla S, Tyagi A, Husain SA, Das BC.
Berberine modulates AP-1 activity to suppress HPV transcription and downstream signaling to induce growth arrest and apoptosis in cervical cancer cells. Mol Cancer. 2011 Apr 15;10(1):39.
Hou Q, Tang X, Liu H, Tang J, Yang Y, Jing X, Xiao Q, Wang W, Gou X, Wang Z.
Berberine induces cell death in human hepatoma cells in vitro by downregulating CD147. Cancer Sci. 2011 Mar 28.
Wu K, Yang J, Zhou Q. [Preventive effects of berberine on experimental colon cancer and relationship with cyclooxygenase-2 expression]. Zhongguo Zhong Yao Za Zhi. 2010 Oct;35(20):2768-73
Youn MJ, So HS, Cho HJ, Kim HJ, Kim Y, Lee JH, Sohn JS, Kim YK, Chung SY, Park R. Berberine, a natural product, combined with cisplatin enhanced apoptosis through a mitochondria/caspase-mediated pathway in HeLa cells. Biol Pharm Bull. 2008 May;31(5):789-95.