Nutrition and Breast Cancer: Eating Well After Diagnosis

Insight Articles
September 28, 2018
Susan FitzGerald, for LBBC

When Brenda Levin of Philadelphia was diagnosed with metastaticinfo-icon (stageinfo-icon IV) breast cancer in 2017 at age 40, she read every article she could find about the effect of diet on cancer.

She wanted to make sense of how she, someone who followed a healthy diet and lifestyle, could end up with breast cancer. More important, she wanted to know what diet she should follow to keep the breast cancer from growing more.

As a trained practitionerinfo-icon of acupuncture, Chinese herbal medicineinfo-icon, integrative nutritioninfo-icon, and shiatsu massage, Brenda thought she was prepared for whatever life threw at her. But her diagnosisinfo-icon made her rethink what she learned, particularly about food. Should she swear off sugar? Avoid alcohol and caffeine? Never eat her favorite treats again?

 “I was at a healthy weight with a healthy diet,” says Brenda. “I have always exercised. … Plus, I have always focused on getting ample amounts of vegetables, proteininfo-icon, a good balance of carbohydrates, some fruits and healthy fats into my daily food regimeninfo-icon.”

Brenda’s research showed her two important things. First, she had done nothing wrong to get cancer. Second, there were no magical foods that make cancer disappear. Since then, she has focused on eating a variety of fresh foods, cooking with healthy oils and allowing herself an occasional glass of wine or ice cream.

“I tell myself not to overthink or stressinfo-icon about anything,” she says. “If I am going to eat a chocolate croissant, I am going to enjoy every morsel of it, stress-free.”

The Truth About Food

Some people might find it reassuring to be handed a special cancer diet, a firm list of what foods to eat and not eat after a cancer
diagnosis. But nutritionists say there is no such thing as a fool-proof, cancer-busting diet, despite many popular claims that people with cancer should absolutely avoid refined sugar and alcohol and other “forbidden foods” that frequently pop up in a Google search.

Instead, nutritionists advocate for a well-balanced diet rich in vegetables and fruits that satisfy the senses and serve up healthy nutrients. That approach can also help avoid excessive weight gain, which research has linked to certain kinds of cancer.

“While there are absolutely so many things you can do with your everyday diet to … help support your immune systeminfo-icon and help support your body … we want to get away from the mindset that there is one prescriptive diet that everyone should follow,” says Stacy Kennedy, MPH, RD, CSO, LDN, a senior nutritionistinfo-icon at Dana-Farber Cancer Institute in Boston.

For example, Ms. Kennedy likes the dietary recommendations for cancer preventioninfo-icon and survivorship outlined in a new report by the American Institute for Cancer Research, which call for “a diet rich in whole grains, vegetables, fruits and beans.” She generally advises people to follow a Mediterranean-style diet, which features a lot of plant-based foods (fruits and vegetables), whole grains (such as whole wheat, quinoa and oatmeal), legumes (like peas, beans, lentils and chickpeas) and nuts.

What About Soy?

 The question of soy often comes up in relation to breast cancer. Some people worry because soy contains substances that make it similar to the hormoneinfo-icon estrogeninfo-icon, and estrogen encourages some breast cancers to grow. But there are research findings that suggest soy may be protective for the body.

 “According to research, eating natural foods that have soy is perfectly healthy and does not carry a risk,” Ms. Kennedy says. Tofu is one example. Others are soybeans or soy nuts, soy milk, and edamame (immature soybeans). Until more research is conducted, she advises against eating or drinking products with concentrated soy or soy protein isolates (heavily processed soy) which can be found in protein powders and some protein bars or meat-free products like meatless burgers, vegetarian chicken or “meat alternative.” Read ingredient lists carefully on products to see if they contain soy protein isolate, Ms. Kennedy says.

Learning to Balance Your Plate

People with cancer are often motivated to make dietary changes, but Ms. Kennedy says it’s important to stay balanced.

“You don’t always have to eat salads and grilled fish,” she says. “In real life, you are going to a barbecue or a graduation party or the beach and at times you’re going to eat foods that appear to be ‘off plan.’ In reality, that’s what healthy eating and balance is all about, trying to keep nutrition in the big picture of your overall wellness.”

Gwen Ryan, 58, of Gloucester, Massachusetts, was first diagnosed with early-stage breast cancerinfo-icon in 2014 and now has metastatic breast cancer.

 “Like most people, I was bombarded with information from well-meaning friends and I also surfed the internet on what to eat and what not to eat,” Gwen says. “I remember one day thinking, ‘I can’t eat anything.’”

She was grateful when a social workerinfo-icon at Dana-Farber, where she gets her medical care, told her about a new program designed to promote weight loss and healthier eating. At the first session, the instructor made it clear that “there is no ‘No List’.”

“I learned what a healthy plate should look like. One half should be colorful vegetables; the other half was split between a deck of cards worth of protein, healthy grains and carbs and a little fat,” she says.

She said the program, which included using a Fitbit activity tracker and a food tracking app, dispelled the myth that sugar equals cancer. It instead urged moderation and mindfulness in choosing and eating food. She learned to stop eating when she felt full.

“I learned that if you are going to have the ice cream, make sure you really enjoy it. Check in with yourself after a few bites to be sure you still enjoy it. If not, put it down or share,” Gwen says. Since starting the program she has lost 40 pounds. She’s not sure that losing weight and improving her diet will change the course of her breast cancer, but she feels more upbeat and has energy to go to the gym.

“Now I’m not living scaninfo-icon to scan, but I’m living between scans,” she says.

Research on diet and cancer can be hard to interpret because of the way studies are designed. Often they are observational, which means they look at health outcomes in large populations as they take place. This is different than studies of new medicines, which are carefully controlled and compare one treatment to another. The end result is that researchers can’t establish a direct cause and effect with cancer and diet, but they can see patterns, called associations. Associations that emerge from research can make a convincing case for following some key principles.

Abby Wetzel, MS, RD, LDN, a dietitianinfo-icon at Abramson Cancer Center in Philadelphia, says she urges people with breast cancer to make food choices that mirror the Mediterranean diet because research suggests it can help “reduce your risk of cancer occurrence or recurrenceinfo-icon.”

Ms. Wetzel counsels people to include protein with every meal, whether fish, chicken, nut butters, beans or legumes. She steers them away from white starches, including sugary box cakes, cookies, white pasta and white bread. Cutting back on processed sugar can help prevent insulin swings and may limit inflammationinfo-icon in the body, which research has linked to cancer.

“A lot of research shows that it is sugar’s relationship to higher insulin levels and related growth factors that may influence cancer cellinfo-icon growth the most,” Ms. Wetzel says. “Many types of cancer cells have plenty of insulin receptors, making them respond more than normal cells to insulin’s ability to promote growth.”

A rule of thumb is to make your plate as colorful as possible. The more color and less white foods, the less sugar you’re likely to eat.

“It is important to choose the correct carbohydrate foods, such as vegetables and fruit, to add more nutritional value to your overall diet,” Ms. Wetzel says. “The more color you add to your meals, the better you are going to feel.”

Eat Better to Feel Better

Lynne Richmond, 55, a public relations professional in Washington, D.C., met with a nutritional counselor after she was diagnosed with stage III breast cancerinfo-icon 2 years ago. At first they focused on strategies to help with chemotherapyinfo-icon side effects, but now that she is in what she calls “survivor mode,” her focus is on eating healthy for life.

“I didn’t think there was a magic fix. But I thought eating better could give me a better chance of survival than if I didn’t do anything,” Lynne says. The plan includes staying away from packaged foods, carbs and sugary desserts as much as possible, and she tries to skip the alcohol, too. She likes leafy greens such as spinach and kale, and blueberries and other fruits that are high in antioxidants.

For Sheryl Greene, 51, of Roanoke, Virginia, a cancer diagnosis led to a change in shopping habits. After being diagnosed with stage II breast cancerinfo-icon in 2012, she reflected on what she ate, helped by nutritional counselinginfo-icon she received as part of her cancer care. She came to realize that she ate a lot of canned foods and not enough foods she prepared herself. High-fructose corn syrup, a refined sugar, was in many of her packaged food choices.

Now Sheryl shops almost entirely on the perimeter of the grocery store, where fresh foods are, and avoids the middle aisles. She also likes farmers markets and looks for food marked organic.

 “There is always some study that will contradict the previous study,” says Sheryl, who works in sales. “At some point you have to just decide, ‘What is it that I am going to stick with?’”

Sheryl hasn’t gotten used to the unwanted food advice from people who know her history. They’ll order, and then make a comment like “Oh, you can’t have that.”

She prefers to view her food choices in a positive light. “I can have it, but I choose not to,” she says. 

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