Published on July 11, 2019
Unsure of what to eat during or after treatment? Tune in to hear Julie Lanford, also known as “The Cancer Dietitian,” answer common questions on diet, nutrition and cancer from the Patient Power community.
Transcript | Cancer Dietitian Explains What to Eat During and After Treatment
Hey, everyone. This is Julie Lanford, the cancer dietitian, and I am over here on Patient Power's page again today. We've had a few technical issues, we'll just call them challenges, but we are finally live. And today's topic, we were really going to do a Q&A with myself and Andrew, but since only one of us can be on, I'm going to be on, but I have a lot of the questions that we were going to be going through, things that patients have asked me several times, kind of the most common questions that I get around nutrition and cancer.
So just to give you a little bit of a background, I've been contributing to Patient Power's content on nutrition and cancer for the last, I don't know, couple years, so you can find some of my articles on their website and their Facebook page and a couple videos on their website too.
But today we were going to do a Q&A, just general questions about nutrition and cancer, some of those common things that people have that they wonder about nutrition, not sure what's true or not or what can help during treatment or for survivorship. So the reason that I'm here is that I'm a registered dietitian by training. That means I have a four?year degree in nutrition from an accredited college.
And then to be a dietitian I have to have a supervised internship and pass an exam. I'm also a board?certified specialist in oncology nutrition, which is a specialty exam that dietitians can take every five years along with practice hours in oncology to sort of just prove that you know what you're talking about in oncology. So I say these things not just to impress you with my credentials, to make sure that you know that the information I'm giving you is coming from a science and evidence?based perspective, which I think is important.
And the other thing is if you aren't working with a dietitian and you're currently in treatment and having some side effects related to nutrition or causing challenges in eating, I always recommend that you would go to your treatment center and ask if you have a dietician available to you. What I find is that a lot of people actually have a dietitian available but it may never have been offered to them. A lot of centers have someone that's dedicated just to the cancer center, or sometimes the hospital dietitians will cover the oncology outpatient or inpatient floors, and so they might be available to you and you just don't know it.
So some of the things that I've got on my list to cover today, I will call them, you know, the top hits when it cines to nutrition and cancer. The first one is always people ask me about sugar. They say they've heard people say that sugar feeds cancer, they get worried about it. So my bottom line on that statement is that, first it of all, it's a myth. It's an overstatement to think that any one nutrient could contribute to cancer risk or development.
And so sugar is a nutrient. It's actually kind of a complicated topic, and I've talked about it many times, so if you're not aware I have a website, it's cancerdietitian.com, and you can read about my perspectives on sugar. But the bottom line is that our bodies don't pick and choose which cells get what fuel when it comes to nutrition. So we digest and absorb our food. It's into our bloodstream, and then our cells take what they need. So cancer cells don't preferentially get sugar more than any other cell in our bodies.
And glucose is the building block of carbohydrate foods, and that's what we see—or that's how carbohydrates are absorbed. Whether they come from simple sugars or complex carbohydrates, they are all broken down into these glucose or glucose?like substances, and that gives us energy. So I don't want anyone to hear that I'm saying that carbohydrates are bad. They are not bad. They are good. They're good for energy. They're good for our brains. We need carbs.
But the idea that somehow sugars would preferentially feed cancer is something that I hear a lot from my patients, but it's not the whole truth. So I would encourage people to eat those healthy versions of carbohydrates.
Yes, someone's commenting, I love my licorice jellybeans too much. So I think that's a really important point is that when it comes to added sugars, that's a different story. When it comes to natural sugars that you find in fruits and whole grains and starchy vegetables, they're good for you, and we want you to include those in a healthy diet, and they are an important part of a healthy diet.
When it comes to some of those added sugars, you know, I might call them—actually I don't call them this, Cookie Monster calls them this—a sometimes food. We all know I think what those sometimes foods are, and we need to strike a balance. What we see in the typical American is that they consume a lot of added sugars from sugar-sweetened beverages and from processed foods that have sugars added to them.
So I encourage you to buy the plain versions of food, and then you can add sugar, just as much as you need to make it taste right. And to also be sure to include those healthy forms of carbohydrates that you do find in fruits and whole grains and starchy vegetables. So that's that.
The second thing on our list today is to talk about alkaline. I have heard many people ask me, well, do acidic foods cause cancer? Should I eat alkaline? There are some celebrities and a variety of other not reputable places of information who will sometimes push an alkaline diet. There is actually no evidence behind it, and the truth is that you can't control your body's pH through food, especially a blood pH is very tightly regulated, and so I would just say that it is not true that you can affect alkalinity or acidity of your body based solely on the foods that you eat.
And there's no proof that any particular pH in the body causes cancer to either grow or shrink. We have—I think there is some data showing that the environment around a tumor is acidic, but that is because the tumor is causing it to be that way. It's not that because the environment is acidic it causes the tumor to grow. So there's a lot of confusion around that.
The next on my list, actually I think is something that I've heard recently. I've written on it on my website, but it's about intermittent fasting, and I heard someone talk about it here in one of our support groups at Cancer Services a few weeks ago. It is popular in current sort of media circles to talk about intermittent fasting. So if you haven't heard of it, just means that there are periods of time where you would intentionally fast.
You know, so there's not consistent data on this as well. It's actually really hard to study nutrition in humans, because we like to do what we want to do, and we don't want to eat only what the research study tells us we can eat. And so when you see studies that are done on rats or in laboratories or Petri dishes it's really not applicable to us in day-to-day living. So I always—when somebody sends me a study I look at it, read it, and if it was done in rodents or cell lines or in Petri dishes I pretty much tell people that's really not a conclusion that we can apply to our daily lives.
So that's how it is with a lot of this information and especially with intermittent fasting. I think there was a study done with breast cancer survivors, a very small group, and they found some benefit from 13-hour fasts, but it really wasn't conclusive. It wasn't a large enough study for us to feel like you would apply it to everybody, and we need to see that data replicated more than once because it could just be by chance that time.
But the other thing that I tell people is especially during treatment if you're struggling to get enough calories or protein to nourish your body, the last thing we want you to do is to spend long periods of time not eating. And then the other thing I point out to people is some—you know, we do go through a fast. It's typically overnight while we're hopefully getting good sleep, and so the idea that you have to be regimented about intermittent fasting, I just think it doesn't, the evidence doesn't really pan out.
However, if you're somebody who thinks that maybe it would be a benefit to you, I would encourage you to maybe look at some of the shorter fast periods. I think 13 hours might be pretty reasonable. Somebody could finish up their dinner by seven o'clock at night. You would go to bed, and then maybe eat, start eating at eight o'clock in the morning. And if you have any medications you have to take on an empty stomach, then first thing in the morning before you eat your breakfast is a great time. So for me, that would be kind of a reasonable way.
I would say a lot of people are practicing that without being that intentional about it. That's just their schedule. So I honestly don't think that that kind of regimen is necessary, but it's certainly something that I'm okay with my patients trying if it's a—if they want to.
The next on the list sort of ties back with the sugar question, where looking at should I be doing a keto diet. This is really popular right now, and I will just say right off the top that I would not recommend it. I don't think that it's a healthy eating pattern. I don't think it has a lot of strong data. If, however, you think or you read or maybe a medical provider has said maybe it would be a benefit, depending on what type of cancer you're facing.
If you do a true ketogenic diet, which is very restrictive, very low in carbohydrate, you need a lot of healthy fats to make up for the lack of carbohydrate. It needs to be done under medical supervision. So there are some oncology dieticians who do help people to follow a true ketogenic diet. If you are trying to eliminate—to increase the amount of ketones and limit the amount of glucose in your blood, which is the theory behind it, then you need to be doing it under the supervision of someone who can help make sure that you're nourishing yourself.
What I see in the popular culture, people who are following or say they are following a keto diet, they really are not following the actual ketogenic diet, and for the most part they're just kind of winging it is what I would say. If they don't have a specific amount of carbohydrates they're going for and also measuring their ketones and not you know just here and there, it's kind of something that needs to be monitored.
So the thing that I don't like about the keto diet is that it completely cuts out food groups that I think are important for nourishing your body. So. This one's not a fan, but if somebody wanted to try it, I think medical supervision and being practical and seeing the big picture and trying pick out maybe a version of healthy eating that could fit the goals that you're going for.
Next on our list is about organic food, which is another big question that I get. What I will tell you is that when it comes to organic foods there is no proof that people who eat all organic have better health outcomes. People who say that it's healthier to eat organic don't really have a lot of strong evidence around that. It's based on sort of a theory or an idea, which a lot of times is how we do make decisions as humans. So you can only take whatever evidence is available to you and try to make the best choice.
So what I tell my clients is I don't think it's necessary for you to eat organic food or to choose organic all the time. What is necessary is that you eat plenty of fruits and vegetables, whole grains, beans, nuts, seeds, lots of plant foods. If you want to include meat and dairy, that's fine in moderation, but really the bulk of your food should be coming from plants that aren't real processed. Whether those are organically grown plants or not is not my biggest concern. My biggest concern is are people actually getting it in their mouths and chewing it up and swallowing.
Because even with conventional foods the amount of pesticides that are on them is very, very small, and you would have to eat a lot of those foods in order to even get to a point where it was close to the threshold of where we think that you would be harmed by the amount of pesticide. And when I say that I mean it would not be possible for you to eat that many apples in a day to get that exposure, that high exposure to pesticides.
So but I have—I mean I had someone write me this week asking about it. She's a nurse and a cancer survivor, and she was concerned about it. And what I tell my clients as well is if it's something that's causing you sort of stress and anxiety, that decreases your quality of life, and so it is this balance between, okay, well the science and the evidence might say that it's perfectly fine to eat organic but??or to not and eat conventional, but my heart and my mind are sort of preoccupied, and I'm concerned about it.
And I say if it gives you peace of mind and you have it in your budget and you want it choose organic foods that's a perfectly fine choice. But also if you're just at the grocery store and all you want to do is just pick up some food and not worry about reading every little line on the label, you know, just buy the food you need and get going because the purpose of healthy eating and nourishing your body is that so you can go out and live. Health in itself is not an end point.
So I think that sometimes the answer of should I eat organic, it's really a personal choice. I call it a choose your own adventure, but certainly you do not have to in order to have a nutritious diet.
Does meat and dairy cause cancer? Another good question. There's some documentaries that aren't very, I guess I would say they're very sensational, and they're built a lot around fear but not necessarily around facts, but where people will come in and ask me about the dairy and the meat issue. So I call that another choose your own adventure. It has been shown that people who eat plant?based diets that include meat and dairy, so let's say like a Mediterranean diet or even if you follow the government's my plate guide where you have a small amount of meat on your plate, we see great health outcomes as long as you're eating lots of fruits and vegetables and whole grains and other plant foods.
So to me it's less about do you have meat on your plate or not, and it's more about are you eating enough plant foods. So certainly vegetarians and vegans are people who don't eat meat very often, they eat more plants. And so we do see good outcomes when people choose is eat plants for the bulk of the foods that they eat.
Let's see. Another common question that I get, usually tied in with organic is do genetically-modified foods cause cancer, and I would say our current evidence, the National Academies of Sciences reviewed over 900 well-designed trials around genetically-modified foods and found that there was not any increase in risk for adverse health effects. And we do see a lot of benefits to genetically modified or genetically engineered foods, especially in other countries where they really have a hard time meeting their nutrient needs.
So to me that's not something that I need my patients to be concerned about. I think that there's a lot of technology from agriculture that we can actually use to help reduce our exposure to pesticides and help to produce a lot more food on the same acre of land, which will help control costs and make sure that everyone is able to eat on their budget.
All right. So I feel like my time has to be running short. So what I'm going to do is answer one more question and then give you a resource that maybe would be a benefit to you.
The last question that I'm going to do is should I take supplements, because this is a really common thing. We've done surveys of cancer survivors, and a very large percentage of them are consuming nutrition supplements. And what I would say is we actually have evidence?based recommendations that suggest avoiding supplements unless there's a good reason that you need them.
So what I mean by that is you don't need to be taking a supplement just to take it. You should be taking a supplement if you're going to find that health is improved, and sometimes we see that taking supplements, usually in large amounts, so we would say super doses or high doses of supplements, they are actually harmful. So I would caution you against that. This also helps save your budget if you don't have to take those. You can use it buying fruits and vegetables.
So the last thing I'll say is that I do have a new program. I don't charge for my programs on cancerdietician.com because it's part of the nonprofit that I work for, but it is an email program that really goes through a what are the current guidelines around nutrition for cancer survivors. So if you want to get that it's an eight-week email series where you kind of get a little bit every week about what is suggested that you eat. So you can find that at cancerdietitian.com/wordpress/survivordiet. Again, there's no charge for that. It's just a way for us to try to get that evidence-based nutrition information out.
So I hope that this has been helpful, and we always look for—Patient Power is always looking for input on what kind of nutrition topics we should talk about next. You can always add questions if you're watching this after the fact. You can add questions to the comment box, and we'll try to point you to resources. And so I hope that that's been useful, and I appreciate so much Patient Power having me on here and all of you submitting questions and just sharing your information because it helps get that out there. Have a great day.