How to Increase White Blood Cells

What are Blood Cells?

The blood contains red blood cells, white blood cells, platelets and plasma.

What is Plasma?

Plasma is the fluid that carries the blood cells and represents over half the volume of blood.

What are Platelets?

The smallest of our blood cells, that are responsible for binding together to stop bleeding. Too many and you could have a blood clot and too few and you bleed too much.

What are Red Blood Cells?

Red blood cells make up about 80% of your body’s cells by number.  They are filled with iron molecules that transport oxygen.

What Are White Blood Cells?

White blood cells are cells of the immune system and includes many different types of cells. White blood cells are continuously being made in the bone marrow and are stored in the blood and lymph tissue. Types of white blood cells include monocytes, lymphocytes, neutrophils, basophils and eosinophils.

What are Blood Stem Cells?

These are cells that are in the bone marrow that make new blood cells. Because these are rapidly multiplying cells, they are often damaged as a side-effect of chemotherapy. This will leave the patient with low white blood cells, and a weakened immune system.

What is Chemotherapy Induced Anemia?

A reduction in the hemoglobin concentration which falls below 20 g/dl (12 mmol/L) due to chemotherapy. This can be treated with epoetin or blood transfusion.

What is Febrile Neutropenia?

A fever due to low neutrophils. This is considered a medical emergency and you should seek medical attention immediately if you have a fever after receiving chemotherapy.

What is Myelotoxicity?

Bone marrow suppression, also known as myelosuppression, and it is a serious complication of chemotherapy.

What is Cytopenia?

A low level of one or more types of blood cells; either white blood cells, red blood cells and/or platelets

What is Neutropenia?

A reduced level of neutrophils. It can lead to life-threatening infections and the dose of the chemotherapy or cut the treatments short when serious neutropenia is present which can reduce the effectiveness of the chemotherapy (Chen, 2016).

What is Leukopenia?

Reduced levels of white blood cells, indicating that a person is immunocompromised.

What is Thrombocytopenia?

A deficiency of platelets.

How to Increase White Blood Cells?

It has typically been thought that there is no diet to treat a low white blood cell count, but I have found a few small studies that offer some potential for those with low white blood cell counts. Be sure to discuss any of these with your oncologist, your oncology nurse, dietitian or pharmacist. I will detail them in alphabetical order by herb, then chronological order by study;

Astragalus

Astragalus is a plant and one of the most popular herbs in Traditional Chinese Medicine (TCM) (Cao, 2019).

Astragalus and Chemotherapy Study #1 – Lung Cancer

In a review and meta-analysis, published in 2019, researchers analyzed 19 randomized controlled trials including 1,635 patients in research that was published in Chinese and therefore previously inaccessible.

The dosage of astragalus used was 20 to 60 ml per day for 2 to 5 cycles of chemotherapy. This trial included only non-small cell lung cancer patients receiving platinum-based chemotherapy (for example cisplatin and carboplatin).

Of the various outcomes being examined, 11 trials including 877 patients studied white blood cell toxicity during chemotherapy.

The results of this analysis reveal that patients who receive a combined treatment of Astragalus injection along with chemotherapy had a lower incidence of bone marrow suppression than the patients who were treated with chemotherapy without astragalus (Cao, 2019).

In addition to this, it reported the very optimistic finding that astragalus + chemotherapy group had greater one-year survival compared to the control group.

But, discouraging to read the final results which were that the authors concluded that most of the studies in the analysis were of low quality and therefore it is not possible to make recommendations (Cao, 2019).

Thankfully, there are several trials currently recruiting or underway that are testing astragalus and cancer (clinicaltrials.gov).

Astragalus and Chemotherapy Study #2 – Colorectal Cancer

Researchers from Australia also conducted a review and meta-analysis, including studies of colorectal cancer being treated with oxaliplatin (a platinum-based chemotherapy) with and without astragalus and other traditional medicines (Chen, 2016).

Thirty two studies were included in the analysis which showed that traditional medicines, including astragalus either on its own or in combination reduced all grades of chemotherapy related neuropathy by 24% (Chen, 2016).

It’s important to note though, that the studies were small – average 34 participants and 33 controls and including mostly 2 to 4 chemotherapy cycles, which is fewer than typical cancer treatment.

Some of these trials used astragalus in combination with other traditional medicines. including Atractylodes, Coix, Codonopsis and Poria which makes finding the right dosage and combination challenging.

Astragalus and Chemotherapy Study #3 – Meta Analysis

In this meta-analysis, they refer to Huangqi Injection, but huangqi is another name for astragalus, which is also known as astragali and huang qi. It is derived from the Radix Astragali Mongolici root.

A meta-analysis of 13 studies involving 841 patients showed that those that received huanqpi compared to other treatments had overall higher effectiveness rates.

But like many natural health products, the quality of the of the studies themselves was lacking. The authors recommend rigorous well-designed future trials (Zhang, 2013).

Astragalus and Hormone Sensitive Cancers

Memorial Sloan Kettering Cancer Centers notes on their site that astragalus has estrogenic effects and may interfere with hormonal therapies (mskcc.org, 2022). As with any of these supplements, speak with your oncology pharmacist and/or oncologist before adding these to your regimen.

Beta Glucan

There is a type of fibre in mushrooms called beta glucan. It has a positive reputation for its ability to boost the immune response.

Because of this, they are known as biological response modifiers or BRMs. Their strength is to restore or enhance the immune response (Natural Medicines Database, 2020).

Beta Glucan and Cancer Study #1 – Meta Analysis

Researchers from Brazil conducted a systemic review and meta-analysis of research of beta glucans during cancer treatment (Steimbach, 2020).

They analyzed 16 different clinical trials involved 1650 patients with 9 different types of cancer who received beta glucans from yeast, mushrooms or other fungi.

They concluded that;

• Beta-glucans was safe and well tolerated
• Taking the beta-glucans at the same time as chemotherapy lessened the immune reduction that typically comes with these treatments in some studies, with no significant change in others (Steimbach, 2020).

Specifically, the results of the review were;

• 4 studies examined quality of life, overall survival, overall response rate and time-to-treatment failure
• 12 studies examined beta-glucans with chemotherapy or radiation induced immune suppression or the ability of white blood cells to recover after treatment
  • Two found results were inconclusive
  • One found that beta-glucan helped to recover from chemo induced immune suppression (not statistically significant)
  • There was a tendency for more nausea on the beta-glucan supplement

Overall, it’s difficult to recommend beta-glucan supplements for cancer patients based on the current collection of clinical trials and which specific beta-glucan or method of preparation is best.

It’s also not clear whether oral, IV or intramuscular injection is the best route of delivery. However these authors suggest that oral or IV are likely preferred as the beta-glucans can be directly absorbed via the intestinal epithelial cells.  After this, they can migrate to the bone marrow or lymph nodes to activate the neutrophils and lymphocytes (Steinbach, 2020).

The other question that remains unanswered is the ideal dose of beta-glucans. These studies used 2 mg to 1800 mg per week and intervention lasted between 1 week up to 24 months. Clearly, this needs to be narrowed down as does how long to take the beta-glucans.

To read more about mushrooms including the levels of beta-glucans in various mushrooms, read. my blog Are Mushrooms and Vegetable?…and Other Facts About Mushrooms

Fasting

Short-term fasting, also called intermittent fasting has had a few small studies in both chemotherapy and radiation.

How does fasting work during cancer treatment?

Short term fasting reduces the anabolic hormones insulin and insulin-like growth factor (IGF-1) and up-regulates  several stress resistance proteins. Normal healthy cells become more resistance to oxidative stress and switch into protection mode called “differential stress resistance” and the usual cell life cycle is stopped.

Cancer cells, lack the ability to stop their cell life cycle and are therefore vulnerable to the chemotherapy and are vulnerable to the treatment and this is called “differential stress sensitization”

Fasting and Chemotherapy Study #1 – Multiple Cancer Types

Seven women and three men with a variety of cancers (breast, prostate, ovarian, uterine, non-small cell lung and esophageal) served as case studies for fasting before chemotherapy (Safdie, 2009).

Of the ten cases

• Four cases did not report WBC levels
• One case experienced no change in WBC’s with fasting
• Two cases experienced less WBC suppression with fasting
• One case experienced a faster recovery of WBC’s after chemo
• Two case experienced WBC’s remaining in the normal range through treatment

Fasting and Chemotherapy Study #2 – Breast Cancer

A study from 2015 tested 48 hours of short term fasting before chemotherapy in a group of 13 women with stage II or III breast cancer. The women received TAC (docetaxel + doxorubicin +cyclophosphamide) (DeGroot, 2015)

Seven of the women fasting for 24 hours before and after the chemotherapy, then blood levels were compared with the other 6 women who did not fast.

Results were;

• No significant difference in side effects
• Significantly higher erythrocyte counts in the fasting group on day 7 and 21
• Significantly higher thrombocyte counts in the fasting group on day 7
• No significant difference in leukocytes or neutrophils
• Two patients had to stop fasting as they developed heartburn and febrile neutropenia (but these side-effects continued even when they stopped fasting, so the researchers concluded they were not due to the fasting)

Despite what seems to me like less than enthusiastic findings, the authors concluded that “this study provides evidence that short-term fasting attenuates bone marrow toxicity in these patients and reduces chemotherapy-induced DNA damage in peripheral blood mononuclear cells and/or accelerates its recovery.”

Fasting and Chemotherapy Study #3 – Multiple Cancer Types

In this study, 20 men and women with either breast, non-small cell lung cancer, ovarian or urethral cancer fasting progressively longer before and after chemotherapy. They experienced a non-significant trend towards less grade 3 and 4 neutropenia when fasting for 48 hours and 72 hours compared to 24 hours (Dorff, 2016).

Fasting and Radiation Study #1

In this meta-analysis, four studies that tested short-term fasting during radiation were included, but none of the studies included humans, it was all pre-clinical trials involving either mice or cancer cells. But none reported on white blood cells (Icard, 2020).

If you want to read more about intermittent fasting, then check out my book Complete Intermittent Fasting.

Glutamine

Glutamine is the most abundant amino acid in the body, it is a building block for protein.

The only studies on glutamine and white blood cells during radiation (van Zaanen, 1994) and chemotherapy (Yoshida, 1998) showed protection of lymphocytes, and no effect, respectively.

But,these studies are over 20 years old and in that time chemotherapy and radiation therapy dosages and protocols have changed enough to make it difficult to consider these still relevant.

Inositol and IP6

Inositol hexaphosphate (IP-6) is a carbohydrate found in high amounts in plant foods including cereals, legumes, seeds and nuts. It is one of the strongest anti-oxidants found in nature (Proietti, 2017). It is also present in the body, with high concentration in the brain. It is made in the kidney and other tissues from glucose.

Inositol and Cancer Study #1 – Breast Cancer

Researchers in Croatia used a combination of Inositol and inositol hexaphosphate (IP6) in 14 women with invasive ductal breast cancer and treated with six cycles of FEC chemotherapy (5 fluorouracil, epirubicin and cyclophosphamide) (Bačić, 2010).

Seven patients received IP6 + Inositol powder (made by IP6 International Inc, Melbourne, FL, USA) by mouth 6 grams per day divided in two doses. The supplementation began after surgery and continued for six months, until the end of treatment. The control group received vitamin C as a placebo.

After six months the number of white blood cells had increased in the IP6 + Inositol powder group (average increase 0.25 x 10⁹/L) while the vitamin C group reduced white blood cells by an average of 3.17 x 10⁹/L.

Similarly, the platletes also increased in the IP6+ inositol group (average 2.29×109/L) while they reduced in the Vitamin C group (average 68 x 10⁹ /L). Same for red blood cells – which increased in the treatment group and decreased in the control group.

These are certainly encouraging results, which is why the authors of this study are recommending more research on this area.

Inositol and Cancer Study #2 – Breast Cancer

Researchers in Italy, divided with 20 ductal breast cancer patients into two groups. All the women were receiving CMF chemotherapy (cyclophosphamide, methotrexate and 5-fluorouracil) for six cycles, but half the group applied 4 grams of 4% topical Inositol and the control group applied 5 grams hyaluronic acid gel to the breast once a day for six months (Proietti, 2017).

After six months, results showed that

• The number of white blood cells remained within normal limits in the Inositol group while they decreased in the control group
• The number of postponed cycles of chemotherapy were three times lower in the Inositol group compared to the control group (12.5% vs. 37.5%)

Inositol and Chemotherapy Study #3 – Breast Cancer

Thankfully, research on this promising supplement continues and this study, published in 2021 continues the tradition, with its focus on breast cancer (Amabile, 2021).

In this study, 36 women with breast cancer were given a combination of oral myo-inositol plus IP6 topical for the entire time they received after their breast cancer surgery. Chemotherapy treatments included epirubicin and cyclophosphamide or paclitaxel and/or trastuzumab depending on the breast cancer cell type.

The treatment they received was 5grams topical gel containing 4% IP6 plus 390 mg of myo-inositol (made by Lo.Li. Pharma Srl, Italy).

The gel was applied to the entire breast which had the surgery (either lumpectomy or mastectomy) twice day and the capsules were taken thirty minutes before each of two meals per day. This was done for the entire duration of the chemo and for two weeks afterwards.

When analyzing the results, researchers observed a significant reduction in white blood cells in the control group only, but not in the inositol group.

Wheat Grass

Two studies have been done on wheat grass during chemotherapy and found statistically significant improvement in white blood cells during chemotherapy.

These studies were both very small – one with sixty people, and one with fifty, so this is early days in the research.

One thing to keep in mind, is that raw wheat grass juice could be dangerous for someone with a lowered immune system as it has a potential for bacterial contamination. Alternatives such as frozen or dried wheat grass would be better options.

Wheat Grass Juice for Cancer Study #1 – Breast Cancer

In this 2007 study, sixty women with invasive breast cancer, median age 50 were divided into two groups of thirty each (Bar-Sela, 2007).

One group was given 60 ml (2 oz) of wheatgrass juice to drink daily for the first three cycles of FAC (5-fluorouracil, doxorubicin, and cyclophosphamide) chemotherapy, and the control group did not.

They were allowed to take a break from the juice for three days if they felt nauseous following their chemo.

Of the 30 women that did NOT drink the frozen wheat grass juice, 11 of them experienced a blood related issue, specifically;

• 5 with neutropenic fever
• 3 with leucopenia
• 3 with prolonged neutropenia

Of the 30 women that did drink the frozen wheat grass juice, 5 had blood related issues, specifically;

• 3 with neutropenic fever
• 2 with prolonged neutropenia

This difference between the control group and the wheat grass juice (11 vs. 5) was a statistically significant finding. Two patients in each group developed chemotherapy induced anemia.

When asked about drinking the previously frozen wheat grass juice 22 out of the 30 women (73%)  said they had difficulty drinking the wheat grass juice as it tasted like…well…grass. Six of them couldn’t take it for the full ten weeks as they said it made them nauseous.

Wheat Grass Juice for Cancer Study #2 – Colon Cancer

In a 2020 study with 50 colon cancer patients in Israel, most of the patients had stage II or III colon cancer and were receiving the chemotherapy drugs capecitabine and oxaliplatin (Avisar, 2020).

Half of the patients were given 60 ml (2 oz) of wheatgrass juice (from frozen), every morning on an empty stomach while receiving chemotherapy, which lasted between five and six months.

Blood samples were taken at the beginning of the study and when chemotherapy was finished five to six months later.

Results

There was no difference in clinical outcomes but there was a slightly better survival in the wheat grass group.

• The level of IL-10 an anti-inflammatory cytokine was higher in those taking the wheatgrass juice
• White blood cell counts decreased in both groups, but they decreased to a lesser extent in the patients drinking wheat grass juice

The authors of this study noted that there were more stage III patients in the control group which could have impacted their results, but despite this, the authors concluded that this is preliminary evidence of the benefits of wheatgrass juice on immune health. They also reported that there were no adverse side effects from drinking the wheat grass juice (Avisar, 2020).

Bottom Line on How to Increase White Blood Cells

Maintaining a healthy level of white blood cells is critical during cancer treatment. To date, the main nutrition message has been to eat a healthy diet and get plenty of rest. But, I think we can do better.

I’ve presented several research on several strategies today; astragalus, beta glucan, fasting, glutamine, IP6, Inositol and frozen wheat grass juice. I think the one with the most evidence in favour are IP6 and inositol with astragalus, short term fasting, and frozen wheat grass juice next.

While I’m excited about the idea of beta-glucans, the research is too weak. It’s time to start funding research in larger, well designed trials to look at nutritional interventions that could be helpful and get large trials done. I’m really tired of nutrition interventions getting a back seat to the current research model in which striving for a patent has become the main objective in cancer research (I’ll get off my soap box now).

Speak with your oncology dietitian, oncologist pharmacist or oncologist about your options.

Want More?

To read more about wheat grass juice, or fermented wheat grass read my blog Wheat Grass Juicing and Cancer.

If you like to read fully referenced blogs on topics of cancer and lymphedema, then be sure to sign-up to receive my newest blog every month. Looking for something else to read? You may like these topics;

Herbs for Lymphedema

Immune Health Basics

Fasting Mimicking Diets

References for How To Increase White Blood Cells

Amabile MI, De Luca A, Tripodi D, D’Alberti E, Melcarne R, Imbimbo G, Picconi O, D’Andrea V, Vergine M, Sorrenti S, Molfino A. Effects of Inositol Hexaphosphate and Myo-Inositol Administration in Breast Cancer Patients during Adjuvant Chemotherapy. J Pers Med. 2021 Jul 30;11(8):756. doi: 10.3390/jpm11080756. PMID: 34442400; PMCID: PMC8400775.

Avisar A, Cohen M, Katz R, Shentzer Kutiel T, Aharon A, Bar-Sela G. Wheatgrass Juice Administration and Immune Measures during Adjuvant Chemotherapy in Colon Cancer Patients: Preliminary Results. Pharmaceuticals (Basel). 2020 Jun 23;13(6):129. doi: 10.3390/ph13060129. PMID: 32585974; PMCID: PMC7345549.

Bacić I, Druzijanić N, Karlo R, Skifić I, Jagić S. Efficacy of IP6 + inositol in the treatment of breast cancer patients receiving chemotherapy: prospective, randomized, pilot clinical study. J Exp Clin Cancer Res. 2010;29(1):12. Published 2010 Feb 12. doi:10.1186/1756-9966-29-12

Bar-Sela G, Tsalic M, Fried G, Goldberg H. Wheat grass juice may improve hematological toxicity related to chemotherapy in breast cancer patients: a pilot study. Nutr Cancer. 2007;58(1):43-8. doi: 10.1080/01635580701308083. PMID: 17571966.

Cao A, He H, Wang Q, Li L, An Y, Zhou X. Evidence of Astragalus injection combined platinum-based chemotherapy in advanced nonsmall cell lung cancer patients: A systematic review and meta-analysis. Medicine (Baltimore). 2019 Mar;98(11):e14798. doi: 10.1097/MD.0000000000014798. PMID: 30882655; PMCID: PMC6426520.

clinicalTrials.gov Chemotherapy + Astragalus

Chen M, May BH, Zhou IW, Sze DM, Xue CC, Zhang AL. Oxaliplatin-based chemotherapy combined with traditional medicines for neutropenia in colorectal cancer: A meta-analysis of the contributions of specific plants. Crit Rev Oncol Hematol. 2016 Sep;105:18-34. doi: 10.1016/j.critrevonc.2016.07.002. Epub 2016 Jul 7. PMID: 27497028.

de Groot S, Vreeswijk MP, Welters MJ, et al. The effects of short-term fasting on tolerance to (neo) adjuvant chemotherapy in HER2-negative breast cancer patients: a randomized pilot study. BMC Cancer. 2015;15:652. Published 2015 Oct 5. doi:10.1186/s12885-015-1663-5

Dorff TB, Groshen S, Garcia A, et al. Safety and feasibility of fasting in combination with platinum-based chemotherapy. BMC Cancer. 2016;16:360. Published 2016 Jun 10. doi:10.1186/s12885-016-2370-6

Icard P, Ollivier L, Forgez P, et al. Perspective: Do Fasting, Caloric Restriction, and Diets Increase Sensitivity to Radiotherapy? A Literature Review [published online ahead of print, 2020 Jun 3]. Adv Nutr. 2020;nmaa062. doi:10.1093/advances/nmaa062

MSKCC.org. About Herbs. Astragalus. Last updated April 19, 2022. Accessed April 26, 2022.

Natural Medicines Database

Proietti S, Pasta V, Cucina A, Aragona C, Palombi E, Vucenik I, Bizzarri M. Inositol hexaphosphate (InsP6) as an effective topical treatment for patients receiving adjuvant chemotherapy after breast surgery. Eur Rev Med Pharmacol Sci. 2017 Jun;21(2 Suppl):43-50. PMID: 28724186.

https://pubmed.ncbi.nlm.nih.gov/27497028/

van Zaanen HC, van der Lelie H, Timmer JG, Fürst P, Sauerwein HP. Parenteral glutamine dipeptide supplementation does not ameliorate chemotherapy-induced toxicity. Cancer. 1994 Nov 15;74(10):2879-84. doi: 10.1002/1097-0142(19941115)74:10<2879::aid-cncr2820741022>3.0.co;2-h. PMID: 7954251.

Yoshida S, Matsui M, Shirouzu Y, Fujita H, Yamana H, Shirouzu K. Effects of glutamine supplements and radiochemotherapy on systemic immune and gut barrier function in patients with advanced esophageal cancer. Ann Surg. 1998 Apr;227(4):485-91. doi: 10.1097/00000658-199804000-00006. PMID: 9563534; PMCID: PMC1191301.

Zhang C, Zhu C, Ling Y, Zhou X, Dong C, Luo J, Liu Y. The clinical value of Huangqi injection in the treatment of leucopenia: a meta-analysis of clinical controlled trials. PLoS One. 2013 Dec 12;8(12):e83123. doi: 10.1371/journal.pone.0083123. PMID: 24349444; PMCID: PMC3861487.