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Eat the Rainbow: CLL Nutrition Tips

Eat the Rainbow: CLL Nutrition Tips
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Published on April 16, 2021

Nutrition Tips for People Who Have CLL

Mom’s simple advice to “eat the rainbow” still holds true. When diagnosed with a disease like chronic lymphocytic leukemia (CLL), one may be tempted to slash calories or try a fad diet. But this is not the time to make sweeping changes. Patients need professional advice provided by a registered dietitian or nutritionist, whose goal is ensuring that patients with cancer receive adequate nutrition both before and during treatment. Here are three perspectives on CLL and nutrition.

The Hematologist/Oncologist

Dr. Farrukh Awan, MD, director of the Lymphoid Malignancies Program in the Harold C. Simmons Comprehensive Cancer Center at the University of Texas Southwestern Medical Center, looks for two things when his patients are diagnosed with CLL: low red blood cell counts due to iron deficiency and vitamin D deficiency. Low red blood cell counts can be due to an iron deficiency or stomach or colon bleeding and can result in fatigue, which can be difficult to distinguish from CLL-related fatigue.

Vitamin D deficiency is associated with worse outcomes in patients living with various lymphomas and leukemias, including CLL. This could be due to the survival signals that the vitamin D metabolism pathway provides to cancer cells. However, it is unclear if blood cancers cause a vitamin D deficiency or vice versa.

In either case, Dr. Awan recommends supplementation with vitamin D for a deficiency. The sunshine vitamin is good for overall health and, when taken with calcium, for maintaining bone strength, offsetting osteoporosis and improving muscle and nerve function. Similarly, evaluating the serum iron deficiency state and performing endoscopies to rule out gastrointestinal bleeding can help address the cause of this deficiency — and supplementation can be done accordingly.

Foods with Vitamin D
  • Fatty fish (salmon)
  • Egg yolks
  • Shiitake mushrooms
  • Fortified foods like cereal
  • Fortified drinks like cow’s milk, soy milk and orange juice
  • Dairy products

Anti-Cancer Properties of Tea and Curcumin

Research shows that both tea and the spice curcumin (turmeric) have anti-cancer properties, but not enough to warrant a definitive prescription for them yet, according to Dr. Awan. 

“Turmeric has active ingredients that have anti-cancer properties. There is work being done to see if it can be purified,” Dr. Awan said, cautioning that there’s more work to be done to figure out the right dose, formulation and schedules.

“That might be an option for some of our patients down the road,” he added.

Theaflavins, components present in black tea, have anti-cancer potential in cell cultures and animal studies.1 Small studies of high doses of the green tea extract EGCG showed some benefit, but “you’d have to drink tens of gallons or take numerous pills a day to get adequate blood levels, at which point it can have significant side effects like nausea and vomiting,” Dr. Awan said. Moreover, recent studies showed that drinking green tea in excess can lead to anemia, which people with CLL are already at risk of developing.2

Another interesting study showed some benefits of taking green tea extract to target markers of obesity, including fat synthesis, body weight and fat deposits.3 While many patients diagnosed with CLL are obese, weight loss is not a usual reason to treat, according to Dr. Awan. Future studies of tea, curcumin and other foods with anti-inflammatory properties may lead to advances in weight loss and anti-cancer effects.

When patients are diagnosed with CLL, Dr. Awan recommends seeing a registered nutritionist who can help ensure the patient eats a healthy, well-balanced diet and avoid malnutrition.

The Nutritionist

Registered and board-certified cancer dietitian Julie Lanford, MPH, RD, CSO, LDN, steers patients toward common-sense eating. She also tries to alleviate fears and do some myth-busting to avoid disordered eating.

“Some patients think that sugar causes or feeds cancer, which isn’t true,” Julie said. She doesn’t recommend eating all organic foods either. Fasting, cutting back too many calories or having a restrictive diet can lead to malnutrition.

“If people are too overly focused on what they perceive as healthy eating, they lose sight of the fact that their body needs adequate nourishment,” Julie said. This nourishment is critical while undergoing cancer treatment.

“If people don’t eat enough, that will negatively impact their outcome,” Julie added. She provides many helpful ideas on her website, including evidence-based recommendations, recipes and messages of hope. Read the “Eat the Rainbow Challenge” on her site, which gives ideas for what people can eat rather than what they can’t or shouldn’t.

For patients having side effects from cancer or the treatment itself, Julie offers customized recommendations, because every patient has unique needs. For people undergoing therapies that cause nausea and a loss of appetite, she recommends nutritional drinks and homemade smoothies to sip on when food temporarily loses some of its appeal and certain smells can be off-putting.

Comfort foods are okay, too. Cancer treatment is not the time to give up one’s favorite foods.

Julie says that patients have a general sense of healthy eating and should continue to add fresh fruits and veggies to what they already enjoy eating — even the occasional dessert!

Another important takeaway from Julie is related to food safety. Washing hands, fruits and veggies very carefully is important to avoid infections.

A Patient’s Perspective

Patient advocate Michele Nadeem-Baker wasn’t able to connect with a dietitian who specialized in her form of leukemia but found solace in intuitive eating and reading labels at the grocery store.

“I listened to my body, which has always felt best when eating vegetables, low-sugar fruits such as berries, and also nuts and proteins,” Michele said.

“In addition, I started reading every label on grocery items and was shocked to see many everyday kitchen staples — such as certain olive oil sprays, mustards, hummus, nut butters, club soda — can contain non-apparent ingredients like corn syrup, wheat, milk, soy and a plethora of other additives,” she said. Michele also avoided dairy because she is lactose intolerant.

“Without being able to find a blood cancer or CLL nutritionist, I needed to take best practices from those I met and what I read. One benefit of being a battle-tested diet warrior was in knowing what foods are highest in sugar and unhealthy fats and carbs,” Michele said.

Michele still enjoys her comfort treats, too, including dark chocolate and the occasional chewy brownie.

Eating a nutritionally balanced diet might be challenging at first, but with practice, it can become second nature. Keep an eye out for the colors of the rainbow in the produce aisle of your grocery store to stay on the healthy nutrition track.

~Lauren Evoy Davis

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1O'Neill EJ, Termini D, Albano A, et al. Anti-Cancer Properties of Theaflavins. Molecules. 2021 Feb 13; 26(4):987.

2Van Wissen, Kim, Blanchard, DP. Green Tea for Cancer Prevention. Am J Nurs. 2021 Apr 1;121(4):25.

3Ohishi T, Fukutomi R, Shoji Y, et al. The Beneficial Effects of Principal Polyphenols from Green Tea, Coffee, Wine, and Curry on Obesity. Molecules. 2021 Jan; 26(2): 453.

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