“What We Can Learn About Breast Cancer & Diet From the Women’s Health Initiative”

* Photos originally accompanying the initial publishing of this post have been removed to honor the request of the presenters of this session. *

You would be forgiven if you think the Women’s Health Initiative (WHI) is a vehicle for women to initiate action and take good care of themselves. You would also be forgiven if you’ve never even heard of the Women’s Health Initiative.

Sitting down with a friend over a steaming cup of coffee to discuss the outcomes and nuances of WHI is not an everyday occurrence for the lay public, but it’s exactly the lay public, specifically the FEMALE portion, that the WHI works to impact.

The Women’s Health Initiative is a multi-million dollar, 20+ year national health study focusing on the prevention of heart disease, breast and colorectal cancer, and osteoporotic fractures in postmenopausal women. In older women, regardless of race and socioeconomic background, these chronic diseases are the major causes of death, disability and frailty. (1)

This robust study was one of the most definitive, far-reaching clinical trials of postmenopausal women’s health ever undertaken in the U.S., and will continue into the future to provide practical information to inform women and their physicians.

The Observational Study portion continues to examine the relationship between lifestyle, health and risk factors and specific disease outcomes, and involves tracking the medical history and health habits of 93,676 women. 

Every aspect of the study yields fascinating outcomes for improving health, yet as you may have guessed, I’m most interested in the Dietary Modification component, an evaluation of the effect of diet, specifically a low-fat, high fruit, vegetable and grain diet, on the prevention of breast and colorectal cancers and coronary heart disease.

I recently attended the Academy of Nutrition and Dietetics annual Food & Nutrition Conference (FNCE) where three dietitians knee-deep in the WHI research presented on this topic; Dr. Marian Neuhouser and Dr. Lesley Tinker from Fred Hutchinson Cancer Cancer Research Center in Seattle, WA (the WHI Clinical Coordinating Center for data collection, management, and analysis), and Dr. Linda Van Horn from Northwestern University Feinberg School of Medicine in Chicago, IL.

Because this research continues to evolve and yield new findings, it was no small undertaking to distill volumes of information into an insightful overview and actionable directives we can use NOW , but these esteemed speakers did not disappoint. Below, I share the main take-home messages:

Insight Into Why Specific Diet Protocols Don’t Yet Exist

 

Cancer cells are wily; able to successfully evade our immune system’s efforts to destroy them, replicate themselves many times over, invade and metastasize to other areas of the body, build new blood supply’s, and resist cell death. Determining the EXACT way that food, dietary patterns and nutrition can outsmart and confer protection against a cancer cell’s innate arsenal remains elusive – yet researchers are making progress.

Nutrition, Diet and Its Impact on Cancer Initiation

 

We aren’t there yet – true prevention, that is. While I dream of a world where prevention rules, until that time comes I use the term “risk reduction.” Still, findings exist that link diet and nutrition to a positive impact on the cancer disease process at several points, specifically: DNA repair, cellular proliferation, differentiation, the cell cycle and apoptosis (cell death). How does diet do that, you ask?

Per Dr. Neuhouser, who graciously responded to my email request for answers to that question (my notes were sketchy!), “These mechanisms are influenced by nutrients – primarily micronutrients – that act as co-factors of enzymes that up-regulate or down-regulate these pathways. Energy intake also plays a role, because macronutrient intake leads to insulin secretion, and hyper insulin secretion up-regulates the cell proliferation pathways.”

Here’s a translation:

Micronutrients are nutrients in food that the body needs in small amounts; vitamins and minerals, whereas macronutrients are foods required in large amounts; carbohydrate, protein, fat (and water and fiber.) Micronutrients (i.e. vitamins E, C, D, A and minerals like calcium, potassium and phosphorus) act like “helpers” (co-factors) to make other processes happen in the body, and macronutrients supply calories (making up our “energy intake”) to fuel the body. It’s the action of these micro and macronutrients – too much or too little micronutrients and/or calorie intake – in “regulating” certain pathways that help tame or spur on cancer cells in their proliferation or differentiation, support cells in their repair efforts, or encourage cell death.

Having the ability to one day share with patients/clients specific foods that turn cancer cells on or off, knowing how much to eat for targeted results, providing meal timing guidelines, and micro and macronutrient distribution for each individual’s specific breast cancer would be a game changer. Personalized nutrition protocols such as this would make a significant difference in healing, treatment outcomes, risk reduction, and dare I say, even PREVENTION!

What We DO Know

  • Being overweight or obese is linked to nearly every common cancer in both men AND women.
  • Lifestyle factors, exercise AND diet are responsible for ~30% of all cancers.
  • A better diet is associated with lower risk of cancer deaths, which held true for all women in this study EXCEPT for those who started with a body mass index (BMI)  >30.
  • There appears to be an interrelationship between pre-diabetes and diabetes as risk factors for breast cancer, with obesity a contender as the link.
  • We may see some differences in outcomes between the different types of breast cancer (there are many) and diet.
  • Women who ate a high-fat diet at the start of the study (which was reduced during the study through intervention) showed greater reduction in breast cancer risk (possibly connected to weight loss.)
  • Over the long term, postmenopausal women who followed a diet consistent with the American Cancer Society guidelines on nutrition and other healthy diet indicators (i.e. American Institute for Cancer Research) had significantly lower breast cancer risk and mortality.
  • Breast cancer takes years to develop; a healthy diet should be maintained long-term for the maximum health benefit.

_________________________________

Putting It Into PRACTICE

As I see it, the challenge for most women in effectively and consistently using the ACS nutrition guidelines lies in only being told WHAT to do, but not HOW to do it. Below are the “whats”, and I’ve added a few “how-tos” to help make this work for you:

6 American Cancer Society Guidelines on Nutrition

  • Eat a healthy diet, with an emphasis on plant foods. 
      • ⅔ of plate filled with vegetables.
      • Eat a vegetable and/or fruit with each meal/snack.
  • Choose foods and drinks in amounts that help you get to and maintain a healthy weight.
      • Serve meals at home on 9 inch plates; have seconds if you’re still hungry (are you REALLY?), yet refill plate only 50%.
      • Take ⅔ of restaurant meals home as leftovers.
      • Order smallest size available for beverages containing calories.
  • Limit how much processed meat and red meat you eat.
      • ≤ 18 ounces/week.
  • Eat at least 2 1/2 cups of vegetables and fruits each day.
      • Not sure how much that is? Use measuring cups to train your eye, or visualize 2 ½ fists full.
  • Choose whole grains instead of refined grain products.
      • Whole wheat pasta and flour.
      • Brown rice.
      • Quinoa, amaranth, whole grain (vs. pearled) barley, millet.
  • If you drink alcohol, limit your intake.
    • No more than 1 standard drink (defined below) per day for women or 2 per day for men:
      • 12 ounces of regular beer
      • 5 ounces of wine
      • 1.5 ounces of distilled spirits
    • A standard drink contains 14 grams of PURE alcohol (the true culprit behind the cancer connection, which has nothing to do with the VOLUME in your glass.) (2)
    • For breast cancer, there is NO safe limit for alcohol.

If you want more nutrition and breast cancer information and updates on programs and services, shoot me an email at cathy@cathyleman.com.

I’ll subscribe you to my weekly newsletter, and as a thank you, send along my “25 Ways To Strike Back At Breast Cancer.”

You can follow me here. . .

Twitter: @cathylemanrd

Facebook: https://www.facebook.com/eatwellgetstrong/

Easy. Peasy. 

Sources

  1.  “The Women’s Health Initiative” 
  2. “The National Institutes of Health | The National Institute on Alcohol Abuse and Alcoholism”

 

“Travel Well Portland: 5 Bold Restaurants & 12 Random Experiences That Will Leave You Wanting MORE!”

Upon returning from my travels, my practice is to do a write-up highlighting information to help you stay “health-focused” should you one day find yourself visiting the same locale.

I’ve said it once and I’ll say it again (forever), packing healthy habits alongside your jammies is the best way to keep breast cancer risk reduction top of mind when you (temporarily) leave your regular life/routine behind!

Having just returned from a wonderful week in the Pacific Northwest – specifically, Portland, Oregon – I’m excited to share some of my health-supportive/focused finds, from restaurants offering plant-based options (NOT a challenge in Portland!), to spots for fresh air and exercise that doesn’t feel like exercise, to interestingly unique-to-Portland shops, ideas and concepts that nourish mind, body and soul.

Let me start with this: I WANT TO GO BACK!

A return trip to this part of the U.S. is definitely on the agenda, although the plan is to start in Vancouver, BC and work our way back to Portland through Washington state (Seattle Space Needle and Pike Place Fish Market, here we come!). Although we hit the ground running immediately after dumping our bags at our VRBO condo, Portland (and the surrounding area) boasts so much to see and do, it felt like we barely scratched the surface.

Portland is gorgeous, quirky, urban, friendly, and something I didn’t realize, crazy in love with dogs. My husband is the dog lover in the family, I’m the dog tolerator, but I will admit it was awfully entertaining to watch all the doggies and their owners frolicking in the park right outside our condo at all hours of the day (they were especially frolickocious in the frosty before-work and dusky after-work hours; LOTS of fetching going on.)

To kick this off, here are a handful of shots I took that capture the pure essence of Portland:

Perfect.
LOTS of smokers 🙁 in PDX. Nice vape reference – that’s nasty too.
Great poster of my fav at an actual vinyl record shop.

Eat.

If your goal is maintaining a plant-based diet (vegan, vegetarian, flexitarian or anywhere in between) while visiting the Pac-Northwest, Portland is THE place to do it.

Every single restaurant was extremely accommodating to our requests for meatless meals, although meatless meals were found on the menu at every, single restaurant we visited (obviously, it’s one of our criteria for choosing a restaurant.)

Sometimes it was simply a matter of clarifying ingredients or asking for minor substitutions, but these conversations and requests were never a big deal, in fact, it was almost expected – so refreshing! The biggest challenge in finding a meatless meal was during our trip to Cannon Beach; off-season, many restaurants closed the day we visited, but even there we ferreted out the ubiquitous hummus wrap and tomato soup (gotta love how America has discovered hummus.)

A commitment to sustainable and environmentally friendly agricultural practices, fresh, local produce, and no additives, preservatives or dyes was another thing I admired, respected and patronized several of our Portland restaurant choices for. It was another nod to health and the environment that I greatly appreciated.

Below is a collection of dining spots we hit – and loved!

  1. Boxer Ramen

The richest, most delicious bowl of ramen I’ve ever eaten. This vegan curry bowl was brimming with corn (common in traditional ramen), broccoli rabe, marinated shiitake mushrooms (great cancer risk-reducers), and scallions. I ordered extra vegetables, always a good practice when dining out, since even vegetable-heavy dishes like this tend to be light on the veggies. The precursor to the ramen was a “greens + sesame” salad (yes, MORE veggies!) of swiss chard, shiitakes, pickled cabbage and soy toasted walnuts. The gorgeous black drizzle you see on the ramen is called “mayu”, black garlic oil, the recipe for which I promptly asked the chef, and share here “Mayu” with you.  

Vegan curry ramen bowl.
Boxer Ramen!

“Boxer Ramen”

__________________________

2. Hot Lips Pizza

Any restaurant where the young guys behind the counter feverishly write down ingredients and exclaim “I can’t wait to try this!” as I share my recipe for broccoli salad, is a restaurant I will visit time and time again. 

I loved this restaurant’s commitment to using fresh ingredients from local farms, and that an entire SECTION of their menu was devoted to Vegan Pizza Pies – including the one we ordered – “Falawesome Ball Pie” (it truly was awesome.) This pie featured a delectable squash (as in the vegetable) sauce base, topped with roasted red pepper, spinach, onions, and sliced falafel chickpea balls. Precursor was a kale slaw with carrots, raisins and hazelnuts – a discussion of which kicked off the sharing of the broccoli salad recipe.

Kale slaw.
“Falawesome Ball Pie”

www.hotlipspizza.com (sorry, trouble imbedding the URL; type this into Google and you’ll get there!)

_______________________

3. Mediterranean Exploration Company

After dinner at this tapas-style restaurant, where my tastebuds were happily in overdrive and my belly was (unhappily) too full, we went an entire 24-hours eating only a bit of oatmeal and fruit – yes, we were THAT stuffed.

This place serves GORGEOUS food with exquisite and sophisticated flavor profiles, and we wanted to try EVERY plant-based item (but didn’t) on the menu. Even with limiting our choices, we still “over-ordered” and couldn’t quite finish everything, but darn it, we did our best (hence the meal that kept us full forEVER).

Even without eating a huge volume of food, eating lots of plants prepared by a chef who is not shy with the olive oil will keep you satiated for hours, thanks to the fat and high fiber – living proof right here.

Silky hummus (they must use skinless chickpeas), crispy, garlicky roasted potatoes, the best mejadra I’ve ever eaten (completely destroyed my ability to enjoy this dish at any other restaurant, ever again), and a mind-numblingly delicious freekah salad brimming with peppers and corn created the bulk (no pun intended) of our meal.

After such a robust repast, our plan was to walk to our evening destination, but this being Portland with its predictable unpredictable torrential downpours, there was no chance of walking off dinner until later, when we finally did. Eat here.

Silky hummus and mushrooms
Mejadra (lentils, onions, rice, spices)

“Mediterranean Exploration Company”

______________________________

4. Cha! Cha! Cha!

One evening we weren’t super hungry, but knew we would be if we didn’t have a little something (don’t you hate that between-hungry/full feeling?), and found this friendly taqueria within walking distance of our condo. I actually wished I were MORE hungry so that I could have eaten MORE of the most delicious veggie tacos and steaming bowl of tortilla soup (which I couldn’t finish) I’ve had in ages. Their food is FROM SCRATCH, their commitment is to health, sustainability and giving back to the community – what’s not to love? Next visit, I’m saving my appetite for a FULL meal at this spot, for sure.

Veggie taco + tortilla soup.

“Cha! Cha! Cha!”

___________________________

5. Gilda’s

Happy 27th anniversary to us!

Celebrating the day we said “I do” was the reason behind this trip in the first place, and how we found ourselves at this great neighborhood spot. Earlier in the week we’d had Italian that was disappointingly not. very. good. This was beyond. good.

Pre-dinner salads were fresh and not drowning in gloppy dressing, the pasta perfectly al dente and authentic. That’s what happens when the chef learns, trains, and works in Italy before settling back in the U.S. to wow folks with his food. Thank you, chef Marco.

Gnocchi with mushrooms, garlic, shallots.
Pasta w/red sauce, roasted Brussels sprouts.

“Gilda’s Italian Restaurant”

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Totally Random Portland

I think one of the best things about traveling is how your mind scoops up new ideas and experiences. Here’s a collection of things that interested me, I participated in, and spoke (mostly) to the idea of “health in mind” as well. . .

  • Green Zebra Grocery

Remember “White Hen” convenience stores? Green Zebra is that, only stocked full of fresh produce, a salad bar, vegan/vegetarian/healthier packaged items, and a hot food counter/bar (like Whole Foods, only smaller and much less $$.) We need these in Chicago!

  • Food Fight Grocery

A 100% vegan grocery store selling vegan “junk” food. This I had to see. And seriously? I cracked up at the sign on the front door (read carefully below!)

There were some “un-junky” items to be sure, like this nut-butter combo you see below, but ‘ya know – organic, vegan, non-GMO candy bars and chips are still candy bars and chips – not the foundation of a balanced vegan diet. But you already knew that. And it sure was fun to peruse.

  • Co-ops and (other) interesting grocery stores carry unique items:

Like organic multigrain tempeh in “bulk”, a steal at $15.99.

Bulk tempeh.
  • Coffee – fabulous coffee (and adorable indie coffee shops) on practically every corner; a welcome respite from. . .you know. . .S*#RB+@S.

  • Stunning hiking trails and ocean views.
Forest Park
Cannon Beach, OR
Ecola State Park, Cannon Beach, OR
  • Hood River County “Fruit Loop” orchard tour.

  • Painted buildings sport inspired “art” – a feast for your eyes.

  • I discovered 100% chocolate.

  • Serenity of the “Portland Japanese Garden.”

  • Perky painted houses all in a row – nothing to do with health, but everything to do with order, surprise, and spunkiness – three often opposing concepts I adore.

  • A fully tricked out in-house fitness center.

  • Taking a barre3 class with a room full of women I didn’t know (no pics, but here’s the link.) “barre3 Portland”

And there you have it, a (mini)tour of my action-packed week in Portland. If you’re traveling there anytime soon, I’m jealous!! And I hope my (mini)guide helps point you to nourishing food and fun, healthy times.

If you want more nutrition and breast cancer information and updates on programs and services, shoot me an email at cathy@cathyleman.com.

I’ll subscribe you to my weekly newsletter, and as a thank you, send along my “25 Ways To Strike Back At Breast Cancer.”

You can follow me here. . .

Twitter: @cathylemanrd

Facebook: https://www.facebook.com/eatwellgetstrong/

Easy. Peasy. 

 

 

“Maple Syrup, Honey, and Agave: The Sweet Truth Behind the 3 Most Commonly Recommended “Healthy” Sweeteners”

Ok, it really wasn’t my plan to quite so quickly pen a follow-up to last week’s “The SWEET Guide to Navigating Breast Cancer & Sugar”, but the response to that information has been so overwhelmingly positive, I still have A LOT to say/share, and I’m up to my eyeballs in sugar research, so I thought, what the hell, I’ll add this information, and then give the sweetness a rest for a bit.

This week, though, I’m narrowing it down and profiling what I would classify as “the big three” most common sweeteners grandstanded in the social media world (the not-always-so-sciencey part of that world) as the always “healthier”, “better”, “more nutritious” choice, and well, let me just clear some of that up so you can make the best decision for YOU.

Start with “WHAT”?

When you choose a sweetener for its “healthfulness”, ask yourself what sort of “healthy” you’re looking for; weight management, lower or stable blood sugar for diabetes control, reducing breast cancer risk, favorable lipid profiles (i.e. cholesterol, triglycerides), or perhaps simply to support general good health. “Healthy” means different things to different people, so get clear on what you want to accomplish by adding (or removing) a particular sweetener to or from your diet.

In my experience, when someone asks me “Is _____ food “good” for you?”, they’re not asking me if the food confers health benefits, rather, they’re referring to weight, as in, “Will____ food make me gain weight?” 

For those of you in my breast cancer community, I can say with fairly strong confidence that your “what” is risk reduction, yet you may also be managing other medical conditions (like diabetes or heart disease), so don’t forget to include that piece when making your selections.

And finally, there are many variables that can alter your individual response to eating sugar, in any form.

For example:

  • total calorie intake level (or total “load” as we call it in the RD world)
  • type of sugar
  • disease state (i.e. cancer, diabetes, fatty liver disease, metabolic syndrome, etc.)
  • genetics
  • ethnicity
  • race 
  • physical activity level

Agave Nectar/Syrup

What’s it made of?

  • Agave nectar/syrup is mainly fructose, with the remainder primarily glucose and inulin (a starchy substance found in a wide variety of fruits, vegetables, and herbs.) The high amount of fructose, together with inulin results in a low GI (glycemic index), yet because agave is rarely eaten in isolation (it’s consumed WITH other foods), its glycemic rating should be only one consideration in your decision as to whether or not to include agave in your sweetener lineup. 

~~ Calories in 1 teaspoon? 20

What’s its health implication?

  • A recent study on mice suggested that agave nectar/syrup promotes better metabolic responses than sucrose, and a 2014 animal study demonstrated that supplementation with agave fructans prevented bone loss and improved bone formation.  (1, 2)

Honey

What’s it made of?

  • Honey is a combination of glucose and fructose, as well as tiny amounts of “other” carbohydrates. Its actual composition can vary depending on the variety and “type” of flower contributing to a particular honey’s creation. In rat studies, relative to sugar, honey has been demonstrated to promote improvements in risk factors for weight gain, lipid profiles, and triglycerides.

~~ Calories in 1 teaspoon? 21

What’s its health implication?

  • A very small (10 subjects) human study conducted in 2003 concluded that honey increased antioxidant and iron levels, and decreased fasting blood sugar. (3, 4, 5)

Maple Syrup

What’s it made of?

  • Maple syrup is a boiled sap that contains a mix of sucrose and the invert sugars glucose and fructose (the actual amount of each type of sugar varies with the source and the method of production), that result from the heating process.

~~ Calories in 1 teaspoon? 17

What’s its health implication?

  • Up to 53 different types of phytochemicals that are naturally present in maple tree sap have been identified, and a 2011 study suggests that certain extracts from maple syrup may have potential in type 2 diabetes management. (6, 7)

The Take-Away

There you have it, a brief overview of “the big three” sweeteners that are heavily promoted as always the best choice for cooking, baking, tea, and pancakes.

Here’s my take:

The fact that honey and maple syrup both have been shown to contain antioxidant properties makes them my first choice for positively impacting breast cancer at the cellular level; antioxidant activity from any food can help reduce free radical cellular damage. However, they’re not calorie-free (extra calories from ANY food can lead to weight gain, a breast cancer risk factor) and although they’re natural, they’re still sugar, and tend to be found in foods that aren’t typically as nutritionally robust as others; i.e. cakes, cookies, etc.

If you like the flavor and consistency of agave nectar/syrup (it’s “runnier” than honey), there’s no reason not to enjoy it. The GI (glycemic index) of agave nectar is good to know, yet it doesn’t hold too much importance. The GI of a food is determined on a “single food” status, meaning the GI rating is based on how much of a particular food is eaten on its own. That could be meaningful if you were to add agave as a sweetener to your tea or coffee, but enjoying a slice of cake or a sandwich with that tea or coffee renders a shift in the GI.

In the end, regardless of which of these three sweeteners you choose, remember the guideline from last week’s blog; limit daily CALORIES from added sugar (each of these is considered ADDED sugar; they don’t naturally occur in any one food) to 10% or less of your daily calorie intake. For most women, that comes out to 180-210 CALORIES per day from added sugar.

__________________

“You’re a Fancy-Pants Dietitian, I Bet You NEVER Eat Anything Sweet. But In The Event That You Do, What Would It Be?”

Mmmmm, love my extra dark chocolate.

I lean more toward a “crunchy, salty” food preference – although I’m always and forever a chocolate fan – but since starting my post-treatment AI’s, I seem to have a slightly increased taste for sweet. 

For some WHOLE FOOD ideas to manage your sweet tooth, here are my standard “go-to” sweet bites:

  • Medjool dates dipped in unsalted almond butter, often paired with 85% dark chocolate (dark chocolate has LESS sugar.)
  • Dried Turkish figs dipped in unsalted peanut butter OR melted 85% dark chocolate.
  • Frozen bananas dipped in melted 85% dark chocolate.
  • Mission figs dipped in melted 85% dark chocolate; let the chocolate harden, eat.
  • Green and Black’s 85% Cacao Bar straight up, no chaser (only 5 grams of sugar per serving).
  • Any baked good that I make at home. I cut sugar DRAMATICALLY in recipes because I don’t like oversweet treats, and use dates, honey or maple syrup in place of sugar as often as I can.
  • Homemade raw energy balls/bars sweetened with dates and/or honey.
  • Chopped apple, walnuts, cinnamon, honey drizzle heated in the microwave for ~30 seconds.

If you want more nutrition and breast cancer information and updates on programs and services, shoot me an email at cathy@cathyleman.com.

I’ll subscribe you to my weekly newsletter, and as a thank you, send along my “25 Ways To Strike Back At Breast Cancer.”

You can follow me here. . .

Twitter: @cathylemanrd

Facebook: https://www.facebook.com/eatwellgetstrong/

Easy. Peasy. 

SOURCES

    1. “Effects of agave nectar versus sucrose on weight gain, adiposity, blood glucose, insulin, and lipid responses in mice. 
    2. “Agave Fructans: Their Effect on Mineral Absorption and Bone Mineral Content”
    3. “Effects of daily consumption of honey solution on hematological indices and blood levels of minerals and enzymes in normal individuals.”
    4. “The Long-Term Effects of Feeding Honey Compared with Sucrose and a Sugar-Free Diet on Weight Gain, Lipid Profiles, and DEXA Measurements in Rats”
    5. “Honey promotes lower weight gain, adiposity, and triglycerides than sucrose in rats.”
    6. “Further Investigation into Maple Syrup Yields 3 New Lignans, a New Phenylpropanoid, and 26 Other Phytochemicals”
    7. “In vitro evaluation of phenolic-enriched maple syrup extracts for inhibition of carbohydrate hydrolyzing enzymes relevant to type 2 diabetes management”

 

 

“A SWEET Guide To Help You Navigate Breast Cancer & Sugar.”

Sugar, in all its stark white, sparkling glory is an enormously popular, widely misunderstood, and hotly-debated topic in the breast cancer world.

Rarely a week passes when I don’t hear or read “Sugar feeds breast cancer” proclaimed with absolute certainty. People appear to accept this declaration as truth, yet I ask; does it really? With October host to the annual convergence of breast cancer awareness AND Halloween, I think now is the perfect time for sprinkling sweet words of wisdom to my readers about this ubiquitous ingredient we love to hate and debate.

Before we dive in, let me make one thing clear. When I write about nutrition and food, the first thing I do is hit the research. I’m a dietitian. I have a bachelor of science degree in nutrition. I will say this until the day I leave this earth – nutrition is a science, not an opinion. While everyone rightly deserves their own opinion about nutrition (and food), I’m not “everyone.” I’m a nutrition professional AND a breast cancer survivor. I have a professional obligation to write from the science, and a personal obligation to share evidence-based nutrition information that serves the breast cancer community. I take both very seriously.

That said, I asked myself what non-sugar-coated nutrition information would be most helpful for someone newly diagnosed with breast cancer, feeling frustrated and confused because she couldn’t get a straight answer about whether sugar helps or harms, and grappling with “must I completely avoid sugar to keep the cancer from growing?” or “is it even possible to eat sugar and be as healthy as I can right now?” between the time of diagnosis and start of treatment.

What would someone want to know, who perhaps doesn’t give a rats ass about the science, but did hear (somewhere) that sugar does indeed drive cancer growth? Someone who wants a definitive and reliable answer, yet because overwhelm and impatience have become forces of nature, and an inability to focus has rendered the inclination to sift through pages of (conflicting) online nutrition information as appealing and effective as herding cats, she just wants to be told what to do.

Start Here. . .

There are literally hundreds of studies and reams of information on sugar and breast cancer; there’s no way I could possibly cover it all in this single blog. I’ll continue to write about this topic, but for today, here are my goals:

  • Provide a quick “Carbohydrates 101.”
  • Give you a tiny taste of the current research/science.
  • Provide a sweet guide to help you put this information into practice.

A Little Carbohydrate Background

Carbohydrates are one of three macronutrients (protein and fat are the other two) necessary in the diet to support energy, growth, and life, and include a wide range of starches, sugars and fiber. Some sugars are NATURALLY OCCURRING, like the sugar found in fruits, vegetables, whole grains, and some dairy products. Other sugars, such as high fructose corn syrup, are produced commercially and then ADDED to foods.

“Carbohydrate” is a category that includes a wide range of starches, sugars (both naturally occurring and commercially produced), and fiber. There are many types of sugar, which are classified by chemists according to their chemical structure, i.e. monosaccharides (single, simple sugars) and disaccharides (two simple sugars joined together), and several forms of sugar, i.e. glucose, fructose and galactose, which come together to create even more forms of sugar, like the lactose in milk (glucose + galactose), and the maltose found in molasses (glucose + glucose.)

The concern for newly diagnosed and metastatic patients is that sugar “feeds” cancer, making it grow faster and uncontrollably, hastening its potential and/or further spread throughout the body. For patients undergoing treatment, there may be concern that sugar interferes with chemo and/or radiation. For women without a breast cancer diagnosis or are “NED” (no evidence of disease) post-treatment, the concern is that sugar will “cause” a cancer diagnosis or recurrence.

A (very small) Taste of The Current Research

  1. Including “naturally occurring” sugars in your diet from fruits, vegetables, whole grains and dairy (i.e. PLAIN cow’s milk versus chocolate or other “flavored” milks which have ADDED sugar) is an eating pattern you can feel comfortable about. These naturally sweet (or “savory” whole grain) foods not only provide energy-rich carbohydrates, they’re loaded with vitamins, minerals, fiber, antioxidants, and phytochemicals versus only the empty calories of most added sugars. (1)
  2. Sugar does indeed feed cancer cells, as well as ALL of your other cells. Every cell in your body uses glucose (the “broken down” form of carbohydrate) for energy. Even on a no/low carbohydrate diet, your body transforms protein and fat into usable glucose (blood sugar) to support the function of your brain (which can use ONLY carbohydrate for energy) and all your other tissues.
  3. Because cancer cells are especially “hungry and hyperactive,” they consume glucose more quickly than non-cancerous cells. With the help of a radioactive compound very SIMILAR to glucose that allows detection of the metabolic activity (hungriness and hyperness) of cancer cells, medical professionals are able to see this phenomenon during a PET (Positron Emission Tomography) scan.
  4. Cells use sugar like cars use gasoline. Normal cells use a reasonable amount of gas, but because cancer cells divide at faster rates than normal cells, they’re gas (sugar) guzzlers. (2)
  5. Compelling epidemiologic studies have shown that dietary sugar intake has a significant impact on the development of breast cancer, but the data is inconsistent and the mechanism is unclear. One proposed mechanism for how sugar impacts breast cancer is through inflammation (obesity is a strong driver of systemic inflammation.) In one study, sugar did accelerate and promote the development of breast cancer in mice fed the equivalent of the average sugar consumption by the American population – 70 pounds/person/year according to this particular study – through changes in metabolic signaling pathways and the expression and production of certain proteins linked to the inflammatory response. Takeaway: sugar DID NOT DIRECTLY cause breast cancer, rather, it exerted influence on a particular signal and pathway involved in promoting its development. (3)
  6. Another very small study, again, done on mice and only certain types of breast cancer cells in culture and for select chemo medications, indicated that sugar may interfere with the body’s response to and effectiveness of chemotherapy, calling for further investigation to achieve definite outcomes and practices for real-life applications. (4)
  7. When carbohydrates are eaten, the body increases its output of insulin to help return post-meal blood sugar levels to normal. Failure of insulin levels to return to normal after the blood sugar is cleared indicates insulin resistance and high levels of insulin remaining in the blood. Insulin resistance can result from obesity and inactivity; insulin resistance is associated with higher breast cancer recurrence risk. (5)

A SWEET Guide To Help You Navigate Sugar Challenges

  • Aim to keep your ADDED sugar intake to 10% or less of the TOTAL calories you eat daily:
    • For example, if you eat 2,000 calories per day, all the calories you eat from ADDED sugar for the entire day would equal 200 calories. Remember, that’s CALORIES not grams, there’s a difference (see below.)
  • Added sugars are found in:
    • candy, cookies, cake, pie, brownies, muffins, sweet rolls and pastry, ice cream, sorbet, gelato, sweetened beverages like juice-drinks, fruit punch, sports drinks, sweetened iced tea, bottled smoothies, soda and coffee drinks, cereals, some breads, ketchup, barbeque sauce, spaghetti and tomato sauces, flavored milks (plant-based and cow), flavored yogurt, protein and cereal bars, salad dressing, canned baked beans (this is NOT a definitive list – check your ingredient labels!)
  • 1 gram of sugar has 4 calories:
    • If a food label shows 5 grams of sugar in one serving, that food gives you 20 calories of sugar (5 grams x 4 calories.)
  • When choosing packaged foods, look at the “ingredients” label.
    • If you see any of the following terms, you’ll know there is ADDED sugar: brown sugar, corn sweetener, corn syrup, dextrose, fructose, glucose, high-fructose corn syrup, honey, invert sugar, malt syrup, maltose, molasses, raw sugar, sucrose, trehalose, turbinado sugar.

What 200 calories/day of Added Sugar Looks Like

Breakfast

  • 1 packet instant maple and brown sugar oatmeal; 12 grams sugar (48 calories from sugar)
  • 1 cup vanilla almond milk; 13 grams sugar (52 calories from sugar)

Lunch

  • 2 tablespoons honey dijon dressing; 5 grams sugar (20 calories from sugar)
  • Mixed greens salad with 1 ounce candied walnuts and 2 tablespoons dried cranberries; 9 grams sugar + 13 grams sugar (88 calories from sugar)

Surprise! You’re already at 208 calories from sugar and your day’s not even over.

This example isn’t meant to prevent you from eating ANY added sugar, rather, to give you an idea of how added sugars can creep in without you being aware. This is an easy fix!

Fix It Like This. . .

Choose plain instant oatmeal and add 1 teaspoon honey, use plain (no-sugar-added) vanilla almond milk. Add olive oil and balsamic vinegar to your salad, raisins vs dried cranberries (raisins have natural vs. added sugar) and non-sugared, toasted walnuts.

Sources

  1. “Does Sugar Feed Cancer?” 
  2. “Does Sugar Feed Cancer? It’s Not That Simple.”
  3. “Dietary sugar induces tumorigenesis in mammary gland partially through 12 lipoxygenase pathway”
  4. “Modification of dietary sugar on the chemotherapeutic potential in breast cancer”
  5. “Obesity, Insulin Resistance and Insulin”

If you want more nutrition and breast cancer information and updates on programs and services, shoot me an email at cathy@cathyleman.com.

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Easy. Peasy.