After diagnosis, cancer patients have a lot to manage. Oncology dietitian Nichole Giller works with patients to reduce the confusion around diet during and after cancer treatment. Giller said her work is rewarding because she can discuss modern research with cancer patients and survivors in hopes of giving them the confidence to eat the foods they love while optimizing treatment outcomes. We asked Giller five questions about how cancer patients should navigate the complicated relationship of diet and cancer.
Q: What unique challenges do cancer patients face when it comes to nutrition?
A: Some cancer patients are victims of misinformation from the internet, clinicians that are not experts in nutrition, or overbearing advice from friends and family. This oftentimes exacerbates disordered eating patterns post-diagnosis. Even when a cancer patient is in remission, people in their life will watch and comment on food choices of survivors. Going through cancer diagnosis and treatment is traumatic – food insecurities and confusion is part of that.
Another common challenge is that patients want to follow an anti-cancer diet soon after diagnosis. However, cancer prevention nutrition begins only once cancer treatment ends. This includes surgery, chemotherapy, and radiation. For example, red meat is recommended to be limited post treatment to 18 ounces or less per week to reduce risk for colorectal cancer. However, during treatment patients need all the protein they can get. Therefore, patients need to continue eating red meats along with other proteins as much as they can during treatment.
Q: What are misconceptions you often see when it comes to food and cancer?
A: I hear all kinds of misconceptions. One is that sugar feeds cancer. This is false. Eating sugar will not make your cancer worse and limiting it will not improve outcomes. Although research has shown that cancer cells consume more sugar (glucose) than normal cells, no studies have shown that eating sugar will make your cancer worse or that if you stop eating sugar, your cancer will shrink or disappear. However, a high-sugar diet may contribute to excess weight gain, and obesity is associated with an increased risk of developing several types of cancer.
Some people say to avoid soy in order to reduce breast cancer risk. On the contrary, soy doesn’t contain estrogen. Soy contains isoflavones which help reduce risk for breast cancer. This protective effect is less dramatic for women who eat less soy or who start eating soy later in life. Soy contains protein, isoflavones and fiber, all of which provide health benefits.
I’ve also heard that patients should choose all organic. However, there are no significant nutrient differences between organic and non-organic foods.
Q: What positive outcomes can cancer patients see from working with a dietitian?
A: Dietitians are an essential part of the cancer patient treatment. Their job is to apply medical nutrition therapy that focuses on managing symptoms, preventing weight loss and maintaining optimal nutrition status during cancer treatment. Studies demonstrate the value of nutrition interventions from working with a dietitian on functional outcomes including improved tolerance to treatment, reduced treatment breaks, decreased weight loss, confidence in food choices and quicker recovery post treatment.
Q: How does diet play into treatment?
A: During cancer treatment we focus on two main areas: maximizing protein intakes with all meals and maintaining body weight. The presence of cancer induces alterations in protein and amino acid metabolism. Some alterations in protein metabolism for cancer patients could look like increased muscle wasting, increased liver protein synthesis, negative nitrogen balance or other issues. Protein requirements are increased, up to doubling, after a cancer diagnosis and during treatment. Meeting those increased needs will fight back against negative protein metabolism alterations to maintain optimal nutrition status and avoid malnutrition.
Individuals with cancer usually have increased requirements for calories (and protein) due to periods of under-nutrition before or after diagnosis and metabolic effects from the cancer and its treatments. The main goal with cancer patients is to preserve lean body mass during treatment; we can monitor this by making sure the patients do not lose or gain weight. Certain cancers can cause higher energy expenditures. It is critical for patients to work with a dietitian on a weekly basis to see how protein and calories may need to be adjusted during treatment and support the best possible cancer treatment outcomes. Over and underfeeding both have detrimental effects.
Q: What are you a big proponent of when it comes to food and cancer?
A: Reducing food fear after a cancer diagnosis; during treatment and once treatment commences, knowing what the research says and not being fearful when eating related to another cancer diagnosis.
Working with a dietitian who specializes in oncology and understands the science related to cancer and nutrition is also important. Patients can learn the facts and not become overwhelmed with the plethora of misinformation around oncology nutrition.
Learn more about living a cancer fighting lifestyle here.