We always talk about food being medicine and when it comes to cancer and its treatment, there is no other field where the impact of food is so powerful. If you look at the treatment of cancer, it has not changed much in the last 50 years and still we are chasing the last cell, when what we should be focused on is the very first cell. This is where nutrition comes in picture because nutrition or food is the fuel of the body. It’s essentially what your body is built of and thus it plays a major role in contributing to your holistic health. Inevitably, it has an impact on your body’s metabolism and overall health including:
- Body’s immunity against diseases
- How well it responds and corroborates with the treatment
- How fast and well does it recover from any setback
In our latest podcast, Dr. Nisha Chellam, Founder and Internist at Holistic ICON discusses the role of nutrition in cancer prevention, treatment, and cure in conversation with Allison Tierney, Outpatient Oncology Dietitian and Founder of Wholesome LLC.
If you or someone you know is undergoing cancer treatment and trying to figure out the right nourishment, then this conversation is for you. This conversation delves deep into discussing some potent questions around oncology nourishment such as:
- What nutrition does a cancer patient actually need?
- Do they need to eat before chemotherapy?
- What type of diet and nutrition will support their recovery process?
…and more. Let’s get started.
Dr. Chellam: Tell us your journey into being a registered dietitian particularly your interest in the field of oncology. What brought your interest particularly in this field and what makes you say that food has any impact on the development of cancer or even the treatment of cancer?
Allison: Yeah, absolutely. So I actually went to school to study business. I have a bachelor’s degree in business, leadership and management and it seems kind of weird to me to mention that but while I was in school I was mostly interested in nutrition from the perspective of sports performance, I was an athlete in college and I always wondered how nutrition could improve my performance. But when I was in college working towards achieving that business degree, when I was a freshman, my mom was diagnosed with breast cancer and again when I was a senior, my grandfather was diagnosed with liver cancer. Further down the line, my grandmother was diagnosed with breast cancer, my godmother was diagnosed with breast cancer and then my other grandmother actually passed away from lung cancer before I was born.
So all of these cancer diagnosis started to pop-up in my family life and just started to switch my shift of thought about nutrition as it relates to sports performance over to as it relates to chronic disease cancer because I was really interested to learn if nutrition could have altered the paths to the cancer diagnosis, could it help during the course of treatment process and could it help patients into survivorship and as you can imagine, I probably wouldn’t be speaking with you today if I didn’t find that the answer was yes, yes and yes to all those situations.
So, after I graduated with my degree in business, I actually went back to school to get a bachelors of science and dietetics, and became a registered dietician and continued on to receive my masters in nutrition and during that time when I decided to be a dietician, I told all my professors that I wanted to be an oncology dietician. It was really important for me. The reason why I wanted to share my interest with them and what I wanted to do with it was because you don’t get a lot of training in oncology during dietetics school. I can actually recall we only had one, one hour lecture in all of Dietetics School on Oncology so I asked for every opportunity possible, every shadow experience possible to learn about oncology nutrition and thankfully because of that I was able to have an outpatient oncology dietitian experience before I graduated. I also had some really great experiences with a well known cancer center and actually was hired on full time after my internship and became an outpatient oncology dietitian there.
It really stemmed from my interest about how could nutrition play a role in my family but also beyond that to everybody and you know as somebody who has such a bad family history in regards to cancer, I’ve always thought to myself that you know, nobody is invincible by cancer, it doesn’t discriminate by age, color, race , ethnicity, culture, name, it does not discriminate but my goal as an individual is if I can live with a healthy lifestyle with a healthy diet that helps reduce the risk of developing cancer someday, if I’m ever diagnosed, I can look back and say I did everything that I could, so that’s kind of where it all stems and now I’ve a private practice where I work with oncology patients to help them throughout the course of treatment as it comes to side effect management, because there are several different types of side effects and as it comes to cancer treatment that can impact nutrition status. But also one of the biggest things I’m most passionate about is the prevention of cancer in the first place or prevention of recurrence so that’s really where I focus a lot of my clientele on and how I work with clients.
Dr. Chellam: So, basically nutrition can not only prevent cancer, it can prevent its recurrence and it can also help you with the side effects of the existing treatment of cancer?
Allison: That is correct.
Dr. Chellam: And also we do know that research shows that during the course of treatment, adequate nutrition and improved nutrition can actually improve the outcomes of cancer treatment and may make chemotherapy, more effective, improve the quality of life, boost mood, I mean there are so many great benefits of proper nutrition throughout the course of treatment as well. So yes, it can help in prevention during the course of treatment and prevent recurrence. So this has been my experience, I have someone very, very close to me diagnosed with cancer and I’ve had several patients, one of the bigger challenge is and as you know well, not everybody is trained in the right kind of nutrition whether it be dietitian in the hospital setting or physicians and they usually push for a high protein diet so the patient can withstand chemo and radiation, and a high protein diet in all our heads is a lot of meat and the more protein you consume, the better is what they think. The other thing which I think what cancer patients do is that they have this craving for sugar and they tend to have pop and candy. So let’s delve a little deeper into your journey of what you were taught and how does oncology nutrition differ and what is the right way to go? Is the high protein diet really the right thing for most patients with cancer or is every cancer patient different?
Allison: Lots of great questions, there is a lot to unpack there for sure however let’s start off with the high protein. It’s so common for physicians, oncologists to tell a patient when it comes to or when they’re going through treatment, you just need to get a high protein diet and as you said that often relates to a lot of people eating high amounts of proteins like chicken or beef to help meet those needs. Well the truth of the matter is, that is it true that your protein needs are higher during the course of treatment, yes, however they’re not that significantly higher that we need to double down on animal based protein. For example, one of my patients when I was still working at the local cancer center, the physician told them that they should be eating a high protein diet so he was doubling down on the meat and so forth but this particular patient had kidney disease as well and for those who are familiar with kidney diseases know that they relate to proteins. You actually want to have a low protein diet because protein can actually damage the kidneys even further because kidneys have to filter out the extra nitrogen waste product. So here we’ve this individual who has colon cancer and kidney disease and the doctor is telling him to eat a high protein diet but not taking into account the fact that this individual has kidney disease. So unfortunately, you are right, not a lot of people are very trained in this and I have to go back to the physician and say, here these are the reason as to why we don’t want to adopt this diet for this patient, we want to adopt more plant based proteins depending on you know the types of the proteins that help reduce the strain on his kidney but also to help reduce the risk of cancer recurrence and help fight against the cancer.
So what a lot of people don’t know is that too much protein is not a good thing for our bodies, too much of anything is not a good thing. A lot of people seem to forget that too much protein is harmful for us as well. Increased protein, especially animal based protein is linked to several different types of chronic diseases, some cancers, osteoporosis, heart disease and accelerated aging diabetes. I mean the list goes on and on but if that protein intake is actually plant based protein intake, the risks are eliminated or drastically reduced. So to answer your question in short summary, yes, you do need a little bit of protein for someone who is going through cancer treatment but its not as significant as most think and therefore I do encourage people who are going through the course of treatment to make sure they have access to an oncology dietician that is board certified, knows the information and can help them by adequately informing them about how much protein they actually need because it’s just not as nearly as they think.
Dr. Chellam: Yeah, and also very important for people to understand what is the difference between plant based protein and animal based protein. Animal based protein, the way I’ve been able to simplify is always accompanied by fat , usually a saturated fat or a cholesterol based fat and a plant based protein is always accompanied by a fibre and that’s a huge difference, and sometimes it makes me wonder whether it’s the fibre that’s more important than actually the protein itself but you can speak on that. So if somebody needs to understand like I’m having radiation and chemo and I’m going to get weak if I don’t eat a little piece of chicken or a little piece of fish, how can I get it from plant based protein? How to educate them?
Allison: Yeah, so first and foremost, if somebody has a lack of energy it’s usually not because they’ve a lack of protein, it’s because they have a lack of carbohydrates and a lot of people have this negative viewpoint of carbohydrates, that carbohydrates are this very negative thing but the right type of carbohydrates that come from whole grains, legumes, fruits and vegetables are very positive carbohydrates that fuel us and give us energy. Yes, I’m not advocating for refined carbohydrates like sugar and white flours, that’s totally different but most people need complex carbohydrates to actually fuel their energy when they’re going through the course of their treatment. So, that’s something to keep in mind is that you can absolutely get the energy you need but also when it comes to protein, all whole plant based foods have a source of protein, even fruits, even though they are not significant however there is a significant amount of protein in plant based products such as legumes which are beans and lentils, tofu, tempe but even whole grain and different types of starchy vegetables. They all have protein in it. What a lot of people don’t realize is that their need is not as much as they think it is, I can give you an example of myself. I’m 140 pounds so my need of protein is about 36 to 51 gm per day and that estimation is based on the World Health Organization (WHO) to the RDA recommendation or the Recommended Dietary Allowance and if I have just to give you a little bit of peek too, half a cup of black beans contains about 8 gms of proteins, that’s pretty significant when you think about those 36 gms of proteins which is a low estimated need so it’s a lot easier to meet those needs than a lot of people think.
Dr. Chellam: So someone who has a strong family history of cancer, as we know 35% of cancers around the world are preventable and we don’t realize that mostly due to the environment. Now a family history doesn’t mean anything because people who undergo genetic testing will always say my mother had cancer, my aunt had cancer but none of us have the genes so what’s wrong and usually it comes down to the interaction of the various elements of the environment but if somebody is worried as they have a strong history of multiple cancer, if I put for instance your own family, you spoke about breast cancer, two of the members in liver cancer, how would you council them to prevent, what’s the process actually that you take them through and what is the main shift that they would need to make when it comes to nutrition?
Allison: Yeah, that’s a great point and though very small percent of cancers are actually genetically related, meaning that a specific gene mutation caused individual cancer so someone who has those high amount of family risk factors, they may consider their genes looked at and have genetic counselling to see if they do have any of those genes because it’s true for example a BRACA-1 mutation can actually increase a woman’s risk of breast cancer to about 80% so that’s a much larger risk. I’m somebody that doesn’t has that gene, but at the same time whether somebody has that gene or not or somebody who’s looking to reduce their risk of cancer, I’m to recommend the same thing which is to adapt a more whole food based diet or adopt an exclusive whole food plant based diet and the reason that this plant based diet can be so beneficial at reducing cancer risk is multi factorial and I kind of going back to what you were saying, it’s because of more of the fiber that’s in the plant based protein or it’s the fact that it’s plant based protein. I think that there are several different factors there. One of them is the fiber. Fiber helps get rid of excess toxins and extra hormones. Fiber absolutely plays a role and the other piece of the puzzle is likely that researchers have shown that the vital chemicals or the vital nutrients that are found in these plant based foods, these are plant based nutrients, only found in plants that have been identified to help reduce the risk of cancer or other chronic diseases by reducing inflammation, helping to prevent the spread of cancer cell, helping to regulate hormones, and also very important, to help reduce risk of damage and even reverse damage that has already happened in the DNA. So, the list goes on and on but when you adopt a plant based diet, you’re including all of these great cancer fighting products but the other piece of it is you are reducing the animal based products that have been linked to increasing the risk of cancer such as processed meat, red meats etc.
Dr. Chellam: And does egg play a role in this and dairy products?
Allison: Yeah absolutely, so unfortunately for a lot of people, dairy does play a big role and so do eggs. Dairy is increasingly linked to something called IGF1 i.e. Insulin Like Growth Factor and it’s just exactly what it sounds like. It’s a growth factor so as you can imagine, we have a small amount of IGF1 naturally with our body which we do want to have, we want our hair cells to turn over, our skin cells to turn over, all of the above but what we don’t want is the excess growth because cancer for example is uncontrolled cell growth so when we have high amounts of dairy and other animal proteins through meats, our IGF1 tends to increase and the other thing about dairy is that it also increases our exposure to hormones that come from animal based products so we’re getting increased sex drive hormones like estrogen and progesterone.
Dr. Chellam: Got it. As we know, more and more nutrition based approaches to cancer have been experimented with, there’s this huge body of information about Ketogenic diet for cancer, what has been your experience with ketogenic diet and in fact ketosis as a treatment for cancer? Whether it comes from starvation or nutrition, ketosis is a huge part of cancer treatment, what would you advise somebody who’s been told by a physician or by a family member that they need to do a ketosis, ketogenic diet for this specific type of cancer? What has been your experience or your knowledge on that?
Allison: Absolutely, so as you had mentioned about me before, I’m a big believer in what the evidence says is right, so we really only have scientific evidence to show that a ketogenic diet is beneficial in a certain type of brain cancer called Glioblastoma. There has been some benefit of the ketogenic diet there, also with pediatric palsy, it’s been studied in breast cancer. There’s still an ongoing study however, research does not show that a ketogenic diet is beneficial because a ketogenic diet also incorporates high amounts of fat. You often depend on how the diet is done but oftentimes by high amounts of saturated fat that comes from bacon and eggs and ground beef (dairy products) and that’s one piece of it but the other piece of it is extremely low in fiber. Fiber has so many beneficial qualities to reducing the risk of cancer and fighting against cancer. I would highly advise someone to not practice a ketogenic diet in order to fight their cancer or reduce the risk of developing cancer because there is no long term evidence or even short term evidence to show that it’s beneficial.
The research that we do have is plants based diet is extremely beneficial for reducing the risk of cancer over all. So I think these studies will continue to be done in a plant based diet but it still wins out over and over, again and again. It’s a multi factorial between fiber, vitamins and mineral etc which a ketogenic diet lacks and I will not deny that someone following a ketogenic diet will lose weight very quickly however in the long run it shouldn’t be about weight, it should be about health and chronic disease and yes weight is one piece of the data point if you want someone to achieve a healthier weight but not through ketogenic diet.
I can share a story of a client of mine, she came to me wanting to lose her weight after she had gone through cancer treatment and wanted to adopt a ketogenic diet cause she didn’t have success doing it before. Of course I highly recommended she didn’t do that and she admitted to me later that she thought she would just do it regardless of my advice. And so what happened was she ended up having a lot of pain in the pelvic region as she developed tumors on her ovaries. This was a breast cancer patient. The doctor said, this was a short term factor for doing a ketogenic diet and told her we need to get the surgery done and she said can you just give me a week or two. In such a short period of time she stopped the ketogenic diet, went to a whole fruit and plant based diet very quickly and when she went in for surgery, the doctors went in and said “Its gone! Your tumors that you developed are gone.” And of course they talk it up to miracle and nothing related to the diet switch but it’s something that I have seen. Patients have these difficulties with tumors because of adopting a ketogenic diet even for a short term. So there’s a very high amount of risk associated with adopting a ketogenic diet even in the short term.
Dr. Chellam: Got it. What about starvation like fasting? There have been studies that have shown that if they go fasting prior to chemo, the side effects are less and even after chemo if there’s a five hour fasting window, the side effects of probably radiation and chemo are less. It is very difficult to get cancer patients to fast because for some reason maybe because the cancer cells use glucose as their source of energy, they tend to crave sugar a lot or may because they’ve a poor dietary habit and insulin resistances, an overwhelming part of their health and disease process that they tend to crave sugar. Have you noticed the impact of intermittent fasting as well?
Allison: Yes, so there has been an incredible amount of research on intermittent fasting and I know you had Dr. Longo in your summit and his research is quite incredible as it relates to diabetes, cancer, multiple sclerosis, etc. but yes there definitely is benefit of adopting some sort of fasting protocol whether you are going through treatment or not as a regular healthy individual. However, when it comes to fasting prior to chemotherapy, it’s pretty fantastic results that people are experiencing. The protocols are slightly different but usually what I’ve been seeing is like a 7-8 hours fasting window with 48 hours of that being before chemo and 24 hours after it being after chemo where there are consuming very low amounts of calorie and you’re between 509 and 200 calories per day. But what they’re experiencing is that as you mentioned very low, very minimal side effects if any as it relates to chemotherapy. It has not become a wide spread protocol by any means. I know there are a lot of oncologists that are very skeptical about it and concerned about it but it’s definitely something to watch, keep an eye out for that information to possibly start making those protocols across the country because the results Dr.Longo had are pretty fantastic.
Dr. Chellam: I think this is one of the reasons we do these podcasts, because people are not aware of what all the research is going on and a lot of the doctors are not aware of a lot of the research that’s going on. Everybody is focused on what is right no matter how much you and I shout from the top of the roof that it’s about your health not about your weight. Your weight, it is a side effect of your health. People still are hooked to weight issues so the researches going on should be impacting diseases like we want to make an impact on cancer, heart disease which is a leading cause of deaths across the world and then of course diabetes which actually feeds into most of these diseases and then auto immune conditions. I mean we have a very broad range of diseases, all of them are impacted by nutrition and high fiber basically and all of them are impacted by giving that rest period and creating that ketosis with fasting. So for somebody who’s completely novice in nutrition and its impact in cancer, I think the bigger challenge for such patients would be to navigate between a dietician or a nutritionist who’s helping them with the whole food plant based or going into ketosis mode and the doctor’s belief system. How do you coach people to speak about nutrition with their doctors? What are the tools that you provide to them to have that discussion in a very science based manner?
Allison: Yeah, I think what’s the biggest thing is yeah some physicians aren’t going to ask about their nutrition, some of them are, but my standpoint is that my role is to teach someone about the research and educate them so that they can understand in a very easy to understand manner and also to they can relay that info to someone like the physician. So something to the point as someone, even if you’re at a point at a family gathering and someone says why are you adopting a plant based diet, I want them to have the tools and the knowledge to have been able to communicate why they are doing it and I think that’s very important for not having conversation with other people because what’s someone’s business is someone’s business right but in the very end point is that I want my clients to understand why they’re doing something because it motivates them to stick with it. I always tell people, I don’t need to tell you but fruits and vegetables are healthy for you but if I can tell you why broccoli is so beneficial for your treatment, you’re going to be a lot more inclined to eat broccoli inclusive of fruits and vegetables. Because it’s something you’re going through so I truly believe if I can give you the tools and the knowledge to help understand what they’re doing they can help to relay it to the family and friends and their oncologist as well. I’m always open to talking to my client’s physicians or being able to share research with their physician so they could go into their appointment and say, here look at this, this and this. My practice and I’m virtual based, I don’t have access to draw constant labs for an individual so I think there should be monitoring that needs to be done beyond my scope of practice but it’s something we can talk with the oncologist together with and those I think are very important you know.
Dr. Chellam: It’s not inappropriate but I think it’s because it’s a source of confusion for a patient who is just beginning their health journey when they get a catastrophic diagnosis and they’ve worked with somebody like me and go on a whole food plant strong diet with lots of fiber and they walk into their oncology clinic and their oncologist says make sure you’re on a high protein diet and that’s when the confusion hits them. So they need to be empowered to stand, basically understand why they’re doing what they’re doing. I think that’s where the confusion comes for the patient because the patient gets caught between a nutritional intervention and the doctors. Doctors believe “Oh, you have to be on a high protein diet because I’m giving you chemo radiation” and I think that becomes very important and I think that’s why I bring up that point. So first of having being diagnosed with cancer, changing their diet or trying to do fasting with a good diet, how more does it take for patients to see the impact of diet in your experience, I know the stage of the cancer, the stage of the patient and all of the other things but in general how do they know that they’re on the right track?
Allison: Yeah, you’re right. It does vary from patient to patient, and so many different factors however many people notice it is a matter of days or a short couple of weeks or most people experience it from the amount of energy they have, improvement in their bowel movements and though we sometimes underestimated the power of a healthy bowel movement, clarity in their mental state like brain thoughts, ability to focus on their work. You know a lot of my clients who are going through cancer treatment and still working whether it’s full time or part time, it’s really important to have that focus so often times they search to have that energy, the bowel movement, the mental energy/brain thought since if you’re going through the course of the treatment, minimal side effects like nausea, bowel changes etc are common.
Dr. Chellam: Perfect. So in terms of the questions they should be asking when they meet a cancer specialist, is there anything specific that you’ll tell because most people will ask about nutrition and invariably the doctor is going to say no you don’t need to do anything else, you can just continue to eat what you’re eating and what would you tell a patient who got a diagnosis of cancer, what are the things they need to think about because like I mentioned in the beginning of this conversation in 55 years, treatment of cancer has not changed, we’re always concerned about changing the last cancer cell when we should always have been very careful of the first cancer cell. According to one statistics from a recent study, almost 50% of the patients die from the treatment rather from the cancer itself which is very sad when you really look at it, when you’re going for a treatment which is potentially supposed to help you treat the disease but it can actually kill you and that’s like a toss of a coin when you say 50%. And that’s not very good. So for all the patients who are listening to this, if I get a diagnosis of cancer and my doctor says no you don’t need to do any changes in diet, how should they approach that?
Allison: Yeah that’s a really great question because if your physician tells you or your oncologist tells you that nutrition plays no role if the course of treatment then I would definitely not take that oncologist opinion when it comes to nutrition, not to say that they’re an expert on oncology but not necessarily nutrition and rather find a dietitian board certified in oncology nutrition that emphasizes a plant based diet. Doesn’t necessarily mean that it has to be someone who exclusively focuses because international guidelines by reputed health organizations talk about adopting a planned focused diet when it come to the prevention of cancer so someone who tells you it doesn’t matter isn’t reading the information, isn’t reading the research so find someone that knows the information hopefully because they’re going to be in a great place to help you out.
Dr. Chellam: And I think the recent guidelines from the International Cancer Society is about adding of fruits and vegetables in the patient’s diet and reducing red meat as they speak of, excluding processed meat from the diet, and meat in general so that’s a bold statement coming from such a big organization that never spoke about diet and its impact. We know a high fat diet is one of the common reasons why people develop breast cancer and alcohol is another one causing the risk of a 21% increase in breast cancer. So there’s a lot of information on why you got cancer so the treatment, the prevention or the secondary prevention of cancer can be optimized, improved and really made better. The whole experience of the treatment of cancer can be made better by shifting your nutrition. I really wanted it to be the goal of this conversation and I think you have propped that around talking about a planned focused diet. Is there a question that I should have asked you and I haven’t asked?
Allison: No, I don’t think so. I think we talked about a lot , obviously there’s so much when it comes to cancer and nutrition but the foundation is in the fibres and nutrients and reducing animal based proteins but I truly believe, it’s just kind of what you mentioned is that nutrition should be a complementary treatment to the rest of cancer treatment. You know, often times people think of my work as alternative treatment and I don’t understand how does nutrition has to be an alternative when it should be a foundation so if I believe someone’s going through chemo and radiation, specific protocol to help with their treatment is only going to aid in their results in a positive way so hopefully this would help someone make all the changes, doesn’t have to be overnight but small little changes make big strides in the end.