Hot Topics in Oncology Nutrition: Myths vs. Reality, Pt. 2

In this podcast, Lisa Jones RDN, LDN speaks with Amy Bragagnini RD, CSO, a clinical oncology dietitian at Trinity Health Lacks Cancer Center in Grand Rapids, MI, about the commons myths about diet and cancer, how patients can discern between myth and fact when it comes to cancer nutrition, the resources patients can rely on and trust, and more. This is part two of a three-part series.

Additional Resources:

Listen to part one of this three-part series here. 

Listen to part three of this three-part series here. 

TRANSCRIPTION:
 

Lisa Jones RDN, LDN: All right, well, welcome back. We are here again with Amy Bragagnini, and she will be talking about hot topics in oncology nutrition today. We're going to be discussing myth versus reality. Welcome, Amy.

Amy Bragagnini RD, CSO: Thank you for having me.

LJ: Yes, thank you for coming back from our first episode. So I just want to kind of briefly talk about if you had any key takeaways from our audience that may not have caught that episode yet, the episode that we were talking about the cutting edge of cancer fighting foods, what would be a top takeaway from that episode in our discussion?

AB: I think basically just reviewing that, getting a good balance of nutrients in your diet, not just from one specific food that is gonna basically fight or kill the cancer, but a variety and knowing some of the most potent foods against cancer, you know, broccoli, probiotic foods, omega-3 fatty acids, vitamin D, there's so many out there. And I always think it's a really good idea if you have the opportunity to meet with a registered dietitian and he or she can actually sit down with you and really help you incorporate some of those cancer fighting foods into your diet.

LJ: Yes thank you fantastic takeaway and make sure you check out that episode because Amy does break down the different foods that help, so thank you for that. I have my first question ready for you and that is what are some common myths about diet and cancer that you often encounter?

AB: This was an excellent question. In fact, I have an entire class that I teach based on this topic, so it's perfect. I do find that with technology today and with opportunities to read articles that have been written to get on the internet, there's a lot of things out there and a lot of let's say myths and maybe misunderstandings about nutrition and cancer. The first one I hear almost on a daily basis is does sugar feed cancer? And the way that I try to explain it is that carbohydrates are one of the macronutrients that we eat in addition to protein and fat. Carbohydrates, eventually when we eat them, things like bread, rice, you know, cereal, eventually break down in our bodies and form glucose, right? Our blood sugar.

Now, if we have a situation where we have high amounts of blood glucose, and I'm talking high on a consistent level, so we're saying that someone that, you know, might wake up and have a sugary cereal and drink sweetened beverages all day and eats a candy bar, and so we're talking high sugar, that isn't necessarily the best for cancer because their bodies are going to produce insulin. And insulin is a hormone that can actually cause cells to multiply and divide faster than normal. And in a cancer situation, we do not want that.

So I can't really answer, does sugar feed cancer? Yes or no? Because technically carbohydrates or blood sugar feeds every cell in our body. So yes, including cancer. However, carbohydrates are our body's preferred nutrient source, right? They're really important in our diet. So I never tell patients, they need to cut out all sugar because that's not necessarily the best for them. What I do try to do is have them focus on reducing added sugar in their diets. And I help them try to focus on getting other ways to reduce, you know, blood, blood sugar.

So eating more protein, eating more healthy fat, and eating more fiber. But the situation I get sometimes with patients, if they're getting chemo, they're not hungry anyway. And if they're malnourished and losing a lot of weight and all that sounds good as a milkshake, I don't want them to be scared of drinking the milkshake because it's got some sugar in it. Does that, does that make sense?

LJ: Oh, yes. Totally. And cause that, that was actually what I was going to say. That's the question I always hear. Yes. I'm sure it's a very popular one that people will just say, okay, I'm just going to cut out the sugar and not eat it at all. And then they cut out everything and they're essentially on some sort of like dangerously low carbohydrate diet.

AB: Yes, you're absolutely right. And in my line of work, I mean, balance is the key, you know, I feel like if, if they're taking on an approach where they're cutting out too many things, they're actually, they're going to be starving their healthy tissues and cells. And that's not what I want them to do. So another common question that I get very often is, I have breast cancer, can I eat soy foods or do I need to eliminate them? And the simple answer is you can eat them. And the explanation behind it is that, or basically how the concern got started. So if you, there are some types of cancer that are fed by estrogen, they're called estrogen receptor positive cancers. And so basically, if you look at the chemical structure of estrogen, and the chemical structure of soy or isoflavones, they're very similar. And so the concern was is if isoflavones and estrogen have a very similar chemical structure, are they going to act similar in the body? So if I have an estrogen fed cancer, I certainly don't want to eat a lot of soy, if that's that's gonna feed my cancer.

And they've done lots and lots and lots of research on this topic and they found that actually, soy is a little bit like estrogen, but it's enough different that it actually might block the estrogen from forming with the receptors. So it's actually, it might be a really good defense. And so basically there's many things we know about soy in general. It's very helpful from a protein fiber perspective. It's good to fight against osteoporosis. And we also know that from epidemiological studies, you know, people that children, especially that are raised eating a variety of soy foods have much lower incidence of cancer when they reach adulthood.

So in a roundabout way, absolutely, one of the American Cancer Society's recommendations is if you do have cancer, you don't have cancer, try to get one or two servings a day but make it whole soy foods.

LJ: Whole soy foods I'm writing. Okay.

AB: Yep I know again back to part of what we talked about before is if someone knows that oh okay so isoflavones might be good in my body I'll just take one in a pill form and so once again I just try to remind them that if they really try to need to you know to get soy from a whole soy food form. So edamame, soy milk, soy nuts, miso, that kind of thing.

LJ: Yes, whole foods. We're always reminding people about whole foods.

AB: Yes.

LJ: It was a great reminder, by the way.

AB: Yeah, it really is.

LJ: Oh, so that sounds like the top two common myths.

AB: That's right, really.

LJ: Very popular ones. And then so how with, on both sides, really, the patient and other dietitians that are practicing in this area or any area, because you can be not practicing in cancer nutrition and still get some of these questions. So how can we all discern between myth and fact when it comes to cancer nutrition?

AB: I think a lot of dietitians, and I know you know this, Lisa, if something seems too easy, then it's probably not going to be the thing that's going to work for you long term, right? So if you see a health claim or something like that that seems really sensationalized, it's not probably the thing that's going to be sustainable. So anything that's terribly sensitive, let me start that over. So anything that's too sensationalized, definitely really be cautious about following that recommendation. You know, you can always look at the source to is it someone trying to sell something, a supplement, a pill, does the present is the person trying to sell it going to have financial gains from you following this information.

Are there science-based references? That's probably the number one is when I have a friend say, "Oh, you know, you should just take this because it does this." And I'll ask, well, what research do you have or what study or what's the science behind it? Well, I don't know, but they only cost $20. So that's the first indication that I'm like, okay, let me dive into this a little bit and see what the hype is about. And again, most of the time it's just hype.

Consider consensus statements. So if somebody's making a grant that you must do this statement, is there a consensus behind them? Are there experts behind them further bolstering that statement. And then the most important thing for a lot of my patients is just be critical against anecdotes. If you're picking little quips up from here or here, or it's notorious in my cancer center that my patients will say, "Well, my best friend's brother's mailman's preacher said I should be eating fill -in -the -blank." You know, once again, know your source. And if you ever have questions, ask a registered dietitian and let us do the research for you.

LJ: Yes. And, and I really like the recommendation of science based reference because that reminded me when you were talking about like listening to your like brother's friend and my, I have a friend that's always on Instagram and she's always texting these different supplements that I should try. Like she knows I'm a registered dietitian, but she still sends them to me and I'm like, Instagram is not the

AB: My, my wife on a daily basis will say to me, Oh, you know, and these supplements will show up and I'll, I'm like, well, where did you, well, I got this from Instagram. Thanks. You don't know what I do for a living. Like, could you have asked what my opinion is? So it's, it's definitely one where I know that it's easy to see what's presented and to get not sucked in, but to get a lured from it. I almost fall for it on a daily basis. But And then you just put your critical thinking cap on it and just think, is this too simple? Or who's the science behind, what is the science behind this?

LJ: Yes, and that leads perfectly into my other question, which is resources or organizations. What can everyone trust for reliable information on cancer nutrition?

AB: Well, the first major recommendation that I always provide to people is the Academy of Nutrition and Dietetics at eatright .org. They have a really variable website that has lots of good science -based information on a number of topics, including cancer. Also, kind of akin to the Academy of Nutrition and Dietetics would be the Oncology Nutrition Diagnostic Practice Group. It's called ONDPG. I belong to this. And I love it because other oncology dieticians can be connected and discuss what hot topics are, struggles with patients, and also have really good evidence-based research on the site. I love American Cancer Society. I like their website. I like the ease of it and that always provides really good information. The National Cancer Institute is a good one. The American Institute for Cancer Research is another really good one. The World Cancer Research Fund, and the American Society of Parental and Enteral Nutrition. Those are always probably my go-tos. Out of probably the one I use the most besides on DPG would be the Memorial Kettering Sloan Cancer Center, MSKCC. They have a little section of their website called About Herbs. And so when my patients will say, well, I was told to take turkey tail supplement or whatever. And I've never heard of it before. I can actually go on this website and it will have, if it's researched it, the actual mechanism that it might be beneficial and then the contraindications, which I think for my world is the most important. I don't want patients taking something if it's gonna interfere with their treatment.

LJ: Yes, this is so important. And I thank you for sharing all those resources. They are so helpful for people, especially if they're dealing with any type of myth versus fact and the questions that they can get and where could they go because a lot of times you just don't know. So I appreciate that.

AB: Thank you. You're welcome.

LJ: And thank you for being on this episode of Hot Topics in Oncology Nutrition.

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