Are there any natural alternatives that you would recommend

I really appreciate this question—it shows you're thinking holistically about your care, which matters. But I want to be direct with you: given where you are in your treatment right now, I can't recommend natural alternatives as replacements for your current therapy. Here's why, and what I can suggest instead.

Why This Moment Is Critical

Your situation is actually quite encouraging:

• Your tumor markers (CA 19-9 and CEA) are both normal—this is excellent
• You're on a combination that's working: gemcitabine/abraxane + avutometinib/defactinib
• You've already shown you can tolerate aggressive treatment (you completed FOLFIRINOX previously)

But your body is also signaling it needs support:

• Elevated liver enzymes (AST 57, normal ~30-40)
• Mild anemia (hematocrit 32.7%, normal 36-46%)
• Recent hepatic abscesses that required antibiotics

Adding unproven natural remedies right now could:

1. Interfere with what's working — Your current regimen is keeping your tumor markers normal
2. Stress your liver further — Most herbs are metabolized by your liver, which is already working hard
3. Interact with your medications — Gemcitabine, abraxane, avutometinib, and defactinib all have complex interactions we need to protect
4. Mask warning signs — If something goes wrong, herbal supplements could hide symptoms your team needs to see

What I DO Recommend (Evidence-Based)

Instead of natural alternatives, here are supportive approaches that won't interfere with your treatment:

1. Oncology Nutrition Support ⭐ (NCCN-Recommended)

• Work with a registered dietitian who specializes in cancer
• They can optimize your nutrition to support your immune system AND your liver
• They know which foods/supplements are safe with your specific medications
• This directly addresses your anemia and liver stress

2. Liver Function Support (Medical Monitoring)

• Your elevated AST needs attention—ask your team about:
  • More frequent liver function tests
  • Whether you need hepatic imaging to ensure the abscess is fully resolved
  • Dietary modifications that support liver health (not supplements)
  • Whether your current drug doses need adjustment

3. Anemia Management (Evidence-Based)

• Your hematocrit of 32.7% is affecting your energy and treatment tolerance
• Ask your oncologist about:
  • Iron studies (do you need iron supplementation?)
  • Whether you're a candidate for erythropoiesis-stimulating agents (ESAs) if anemia worsens
  • Dietary iron sources (spinach, lean meats, legumes)
  • B12 and folate levels (important for blood cell production)

4. Fatigue & Side Effect Management

• Acupuncture (some evidence for chemotherapy-related side effects)
• Gentle exercise/physical therapy (improves energy, doesn't stress liver)
• Sleep optimization
• Stress management (meditation, counseling)

These are supported by NCCN Guidelines for Supportive Care in Cancer and don't carry interaction risks.

5. Symptom Monitoring (Critical Right Now)

• Keep a symptom log for your team
• Report any changes in liver function (jaundice, dark urine, abdominal pain)
• Track energy levels, appetite, digestion
• This helps your team adjust your treatment if needed

Questions to Ask Your Oncology Team

At your next appointment, bring these:

1. "My liver enzymes are elevated and I had a recent infection. What's the safest way to support my liver health right now without supplements?"

2. "Can I work with an oncology dietitian to optimize my nutrition? This might help with my anemia and energy."

3. "My hematocrit is 32.7%—should we investigate why? Do I need iron studies or other blood work?"

4. "Are there any evidence-based supportive care options (acupuncture, exercise, etc.) that would help with fatigue without interfering with my treatment?"

5. "How often should we monitor my liver function given my recent abscess? Are my current medications still the right doses?"

6. "Before I try anything new—even 'natural'—who should I ask? Can I always run it by you first?"

The Bottom Line

You're in a good place with your current treatment—your tumor markers prove it's working. The best thing you can do right now is:

• Protect what's working by not adding unproven interventions
• Support your body through evidence-based nutrition and symptom management
• Monitor closely because your liver and blood counts need attention
• Partner with your team on every decision

According to NCCN Guidelines for Supportive Care in Cancer Patients, the most effective approach combines your current oncologic treatment with professional nutritional support, symptom management, and close monitoring—not herbal alternatives.

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This information is for educational purposes only. Always consult your healthcare team for personalized medical advice and decisions.