Dietary supplement usage continues to increase among cancer patients, with the goal of aiding in cancer remission and cure. Beetroot is of interest, because it contains betanin, a phytochemical believed to have synergistic anti-tumor activity with concurrent chemotherapy. Betalains are the red and yellow nitrogen containing pigments found in beets. Betalains are also of interest as they have been implicated in synergistically enhancing cytotoxic abilities of chemotherapy. The high nitrogen content of beetroot also may benefit patients experiencing increased protein metabolism and muscle wasting. Concurrent treatment with beetroot demonstrated an increase in cytotoxic properties in prostate and breast cancer human cells and has been shown to improve protein metabolism and nitrogen balance in cancer patients. Future clinical trials are necessary to further assess the efficacy of concurrent treatment with beetroot supplements and chemotherapy agents.
Introduction With the cancer epidemic growing, and, a 2017 incidence of 1,735,350 new cases expected to be diagnosed in 2018, many individuals affected by cancer search for any and every treatment option that may provide a survival benefit, including new medications, clinical trials, chemotherapy, radiation therapy, or combination therapies. According to a 2008 study by Velicer et al, in the Journal of Clinical Oncology, between 14% and 23% of people with cancer begin using dietary supplements after diagnosis. Red beetroot, also known as Beta vulgaris rubra, has gained attention as a potentially beneficial supplemental therapy for cancer patients . Although the interest in beetroot is primarily due to the dietary nitrates it provides, other compounds in beetroot also contribute to its beneficial effects . Beetroot is rich in ascorbic acid, carotenoids, phenolic acids, and flavonoids, and is one of the few vegetables that contain a highly bioactive group of pigments known as betalains. Betalains are a red nitrogen pigment found in foods that are absent of anthocyanin . They are a highly bioavailable antioxidant known to prevent oxidative processes and anti-inflammatory properties . Betalains have also been found to inhibit lipid peroxidation in very low concentrations . Cytotoxic properties of betalains are of interest, as these compounds are thought to work synergistically to enhance the cytotoxic activity of chemotherapy drugs . Cancer treatments have severe cytotoxic effects that cause apoptosis of cancer cells and may affect normal cells as well. Numerous side effects dependent on medication type, dosage, number of medications, and treatment types have been reported .\
Cytotoxic medicines can affect the bone marrow, which subsequently alters and depresses the immune system, and have been linked to weight and muscle loss from side effects like decreased dietary intake Studied have reported that loss of muscle and lean body mass can increase the risk and severity of dose limiting toxicities .lean tissue loss can be most severe if the patient is experiencing cancer cachexia, which is characterized by metabolic aberrations, decreased fat mass, loss of skeletal muscle mass, and changes in pro-inflammatory cytokines .Cancer cachexia affects 50% to 85% of cancer patients at some point during cancer care, and is estimated to cause up to 20% of cancer deaths
Discussion Betanin and Betalain, similar red pigments found in red beetroot, have shown significant ability alone, and in combination with chemotherapy drugs, to induce cytotoxicity in an array of cancer cell lines. The antioxidant properties of these phytochemicals, and their ability to work synergistically with cytotoxic drugs, provides a promising avenue for further research. Further, not only do beetroot, beetroot juice, and beetroot supplements provide increased nitrates, which may be beneficial for cancer patients to maintain adequate nitrate intake for appropriate lean body mass maintenance through increased ATP production, it also appears to provide further protection for those undergoing cytotoxic treatments .
Due to inadequate intake of protein/nitrates, cancer patients are more susceptible to cancer cachexia or loss of lean body mass . Beetroot juice may provide assistance in maintaining lean body mass during chemotherapy, which can aid in improving outcomes . The cell and animal studies presented demonstrate betanins or beetroot/beetroot juice improve cytotoxicity when compared to controls, and may also enhance cancer cell cytotoxic properties of chemotherapy agents. Beetroot also may reduce renal specific adverse effects of chemotherapy agents . Beetroot decreased the risk of acute renal failure associated with chemotherapy treatments in rats, while increasing the kidney’s ability to preserve protein, resulting in a decreased risk of lean body mass loss . Although these studies provide positive data to support the concurrent use of dietary beetroot or beetroot supplements/juices, during chemotherapy, there are limitations in the quantity and types of studies . The studies on human cell lines and rat models need to be validated in human trials. Other limitations include the small selection of chemotherapy agents tested compared to the array of chemotherapy agents currently in use in oncology treatment. Further studies are required to determine if beetroot also work