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Lifestyle and Nutrition Considerations for Breast Cancer Patients and Survivors Series, Part 1: Why You Can’t Get Consistent Answers to Your Nutrition Questions

Cathy Leman, MA, RD, CPT,  is a registered dietitian nutritionist, certified personal trainer, nutrition therapist, blogger, speaker, and the founder of dam. mad. About BREAST CANCER®. In October 2014, after being diagnosed with Stage 1 invasive ductal carcinoma breast cancer, Cathy made it her mission to serve the breast cancer community with evidence-based recommendations and guidance. She educates, informs and inspires women to eat, exercise and practice self-care/wellbeing with confidence.

By Cathy Leman, MA, RD, CPT

Two years ago, I had the sincere pleasure of attending my first oncology nutrition symposium, a biennial event hosted by the Oncology Dietetic Practice Group of the Academy of Nutrition and Dietetics. Nutrition science ruled at this event, and “voodoo nutrition” based on conjecture, personal opinion, philosophies, and miracle cures was denied a seat at the table.

Well, that’s not entirely true.

“Voodoo nutrition” shows up at EVERY dietitian event. We always discuss the latest myths and misnomers slithering through the internet and beyond, to be met unfailingly with eye-rolling, gnashing of teeth and hand gestures that scream “WTH?” Regardless, I cannot stress the following point strongly enough. The majority of the ~350 dietitians who organized, attended or presented at this symposium are IN THE TRENCHES with cancer patients 365 days/year. They work inpatient and outpatient, at cancer centers, hospitals and cancer support facilities, and are deeply committed to helping their patients gain health AND knowledge; knowledge based on evidence-based, peer-reviewed, gold standard research. Not reality TV.

During her opening session, Alice Bender, MS, RDN, (now former) Director of Nutrition Programs for the American Institute for Cancer Research (AICR) set the tone; HOW we communicate is what distinguishes the voice of dietitians from the noise and hype of sensationalized cancer nutrition messages:

  • Sensible vs sensational
  • Evidence vs belief
  • Build behavior change vs “Do this one thing…”
  • Reduce risk vs guarantee

My mission is to share nutrition and breast cancer science to help end confusion, uncertainty and frustration for the breast cancer community. I want you to feel good about the decisions you make for nutrition and healthy lifestyle choices by offering insight and answers to five of the most common questions I get.

1) Why can’t anyone agree on a consistent answer to my nutrition questions?

There is an amazing body of work produced through a global network of experts and researchers that analyzes cancer prevention and survival research linked to diet, nutrition and physical activity. This work, the Continuous Update Project (CUP), is an up-to-date database with all relevant papers from randomized controlled trials and cohort studies for 17 different cancers and breast cancer survivors. CUP serves as a trusted, authoritative scientific resource to help develop evidence-based guidelines and policy. Unfortunately, not every cancer center is familiar with CUP and its guidelines. Although members of this respected network work tirelessly to educate and inform on this reliable source, their messaging doesn’t reach everyone; clinicians can’t promote guidelines they don’t know about.               

I don’t know why that is.

If I were leading a cancer center, I’d be certain my clinicians had access to, were trained in, and promoted up-to-the-minute lifestyle guidelines and information, but until I’m in charge of all the cancer centers on the planet, it’s just not like that. Another consideration is that non-dietitian clinicians lack training in and a knowledge base of nutrition. If you receive nutritional guidance from someone in that category, you won’t get consistency and may not get accurate information.

2) Why is it so difficult (or impossible) to get a referral to a dietitian?

The greatest barrier to adequate oncology RD staffing involves lack of reimbursement. Many RD’s spoke to the challenge of getting funding for a full-time (even part-time) position at their center, even while juggling a mind-boggling patient load and often, multiple centers. One attendee told me she works two days/week for a total of 8 hours. While this was an American symposium, I assume that the sentiment exists in Canada. 

Another reason? There simply aren’t enough cancer center RD’s to meet demand. According to 2016 data, there was an average of 3.3 RD’s for every 10,000 persons. This number ranged from 2.8 RD’s in Ontario and British Columbia, to 6.2 RD’s in Eastern Canada.1 

How many of you aren’t getting the guidance you WANT, NEED and DESERVE due to limited RD access? This lack of access isn’t because dietitians are shirking the workload. On the contrary, many of the attendees I spoke with want that full-time position. But convincing the folks in charge of budgets to allocate dollars to cover their salaries, while at the same time proving to these same folks that RD’s actually add VALUE is an alarming theme I heard repeatedly.

3) What are the best nutrients I should eat?

Because we eat FOOD, not nutrients, nutrition recommendations are food-based. Whole foods deliver the nutrients your body needs, along with other health promoting compounds like antioxidants and phytochemicals. That’s not to say we won’t someday have evidence of specific nutrients reducing the risk of, or even preventing breast cancer, we’re just not there yet. Eat a VARIETY of foods (especially fruits and veggies) every day to increase the likelihood of getting all the nutrients you need.2

4) Should I take high levels of antioxidant supplements during my radiation (or other) treatment?

Recommendations are to avoid high levels of antioxidants in supplement form. However, especially for people who don’t drink or smoke, high intake through DIET (there’s that food again!) is found to help protect cells from damage caused by free radicals.3  Some of the antioxidants found in food are vitamins C and E, and carotenoids that include beta-carotene, lycopene and lutein.4

Here’s a non-exhaustive list of some of the best foods to load up on:

  • Citrus fruits
  • Bell peppers
  • Brussels sprouts
  • Berries
  • Cherries
  • Dried beans
  • Prunes
  • Apples
  • Pecans
  • Spinach
  • Sweet and white potatoes
  • Broccoli
  • Wheat germ

5) Do I have to eat a completely vegan diet to follow a plant-based eating plan?

No. In terms of benefit, there is small to no difference between a completely vs mostly plant-based diet.2 But we do know that evidence in support of eating a plant-based diet to help reduce risk of recurrence is strong, so I encourage you to work toward putting more plants on your plate during every meal and snack.

If you’re thinking about adopting a plant-based diet but aren’t sure how you’ll get enough protein, or are unfamiliar with the different types of plant-based diets, get started here.

References

1. Canada’s Health Care Providers Provincial Profiles, 2007 to 2016—Data Tables. Canadian Institute for Health Information. Population estimates. Statistics Canada. Quarterly Demographic Estimates, 2012;25(4)

2. AICR Research Updates: The Urgency of Cancer Prevention Evidence to Action. 4th Biennial Oncology Nutrition DPG Symposium, April 13, 2018. Presentation: Alice Bender, MS, RD, AICR Director of Nutrition Programs.

3. Antioxidants, Fasting and More: A Discussion of Hot Topics in Oncology Nutrition. 4th Biennial Oncology Nutrition DPG Symposium, April 15, 2018. Presentation: Suzanne Dixon, MPH, MS, RD, Senior Medical Writer, Mesothelioma Center.

Photo by Siora Photography on Unsplash