“Choosing is Confusing! A Six-Point List for Finding YOUR Perfect Protein Powder/Shake/Bar.”

Why does the idea of consuming protein in the form of a powder, meal replacement, bar or pre-mixed shake have such an iron grip on people who eat? And how did selecting the perfect-for-you protein powder, meal replacement, bar or pre-mixed shake become so complicated and fraught with angst?

Even I, a dietitian, feel my head spin off at the bewildering array of ingredients, choices, and miraculous things these products are purported to do, and like I need to bring my biochemistry text with me to confirm fake vs. real nutrition claims. Would that be too weird? Maybe I could choose protein powder like I sometimes choose red wine – get the one with the coolest label.

For those in the breast cancer community, selecting a protein-based ANYTHING feels not only confusing, but a little dangerous. The lack of clarity on breast cancer nutrition leaves many women frozen in scary indecision, what with the well-intentioned yet outdated advice from doctors to avoid ingredients like soy and flax still all too common.

Recently I was tapped to provide guidance for a breast cancer survivor on selecting a protein shake, but rather than offer up any one particular brand as “the best”, I wrote up a quick six-point list of things to consider. In ALL areas of nutrition, the best choice for one person isn’t necessarily the best choice for another, although the protein product manufacturers would have you think so.

What’s The Appeal?

Protein shakes et al. fall under the “health halo” heading (see my July 7, 2017 blog on this topic), meaning the idea of consuming a protein shake confers that it’s a healthy or healthier choice. Here’s a surprise; there’s nothing “magically” healthy about protein replacements, they’re really all about convenience.

Getting 20-30 grams of protein via scoop/can/bar in a portable, non-perishable form makes protein powders and meal replacements extremely appealing in an eat-on-the-fly world; especially at breakfast when running out the door. For example, to get 20-30 grams of protein at breakfast through real food, you’d have to eat any one of the following:

  • 4 – 5 eggs
  • 1.5 – 2 cups plain Greek yogurt
  • 1 – 1.25 cups cottage cheese
  • 1.25 – 1.75 cups cooked lentils
  • 2.5 – 3.75 cups cooked quinoa
  • .33 – .75 cups peanut butter

Obviously you wouldn’t eat ONLY one food to get all 20-30 grams of protein! You’d combine foods, i.e. toast with avocado + two eggs to get closer to that 20 gram minimum suggested by protein supplement packaging. The example I shared shows how 20-30 grams of protein translates into a significant amount of any one “real” food, but not everyone has the appetite, calorie space, or NEED for that much protein at breakfast.

The average adult needs 0.8 grams protein per kilogram body weight. For a 130# woman, that translates to 47 grams of protein PER DAY, although chemotherapy, radiation or surgery could increase that recommendation. Generally, ~15-25 grams of protein per meal is a smart baseline amount, it’s enough to trigger fullness and satiety hormones, prevent insulin spikes, and support (normal) bodily repair functions.

What’s Protein’s Job, Anyway?

Regardless of the type of protein you eat (I’ll get to that in a moment), it ALL performs the same function in your body:

  • provides amino acids that rebuild enzymes, muscles, tissues and the framework of cells
  • supports a strong immune system by stimulating T-cells and other immune cells
  • helps manage appetite by stimulating hunger and satiety (fullness) hormones

Your body requires a combination of 20 amino acids daily, from both essential (must get from food) and non-essential (your body makes them) sources, and the protein replacement world offers them in seemingly countless forms:

  • Pea
  • Egg
  • Hemp
  • Goat milk
  • Whey
  • Soy
  • Casein
  • Sprouted-grain blend
  • Rice
  • Pumpkin seed
  • Coconut
  • Artichoke
  • Cranberry

Within each category there’s even more confusion, er, choice:

  • Paleo
  • Vegan
  • Vegetarian
  • Superfood
  • Organic/non-organic
  • Sport
  • Complete Amino Acid Profile
  • Branched Chain Amino Acids
Three protein powder options that live at my house; two on left purchased by husband (the VEGA ONE is delicious, btw), one on the right is mine.

To help make things a little less confusing when choosing, I present my list of six points to consider:

  1. Is the product animal or plant-based protein, and what’s your preference?
    • Animal: whey, casein, egg, goat milk
    • Plant-based: pea, hemp, soy, sprouted-grain blend, rice, pumpkin seed, cranberry, artichoke, coconut
  2. What’s on the Ingredient List and in what order?
    • Product contains the most volume of the ingredient listed first, with ingredient content decreasing in the order that follows.
    • Protein POWDERS typically have a short ingredient list; they’re simply a way to add straight protein to meals/recipes. Protein MEAL REPLACEMENTS tend to have longer ingredient lists.
    • Is there any ingredient you have an allergy, intolerance or aversion to?
    • Are there unnecessary ingredients or “fillers” like corn syrup solids, artificial flavorings or sweeteners, thickeners, gums, vegetable oils or fats?
    • Are there ingredients you can’t identify?
  3. Are there vitamins and minerals on the Nutrition Facts label you already get in a multivitamin or other supplement?
    • Be aware of duplicate vitamins and/or minerals that could lead to high intake levels. The vitamins/minerals added to protein replacements are considered supplemental and add to the load you’re already taking.
    • If you’re undergoing chemo or radiation, check with your oncology RD re: supplemental vitamins/minerals – yes, even from foods like this (but not real, whole foods – that’s preferred method of obtaining nutrients during treatment); some may interfere with treatment protocol/medication.
  4. Why are you purchasing this product?
    • Convenience.
    • Little or no appetite for “real” food.
    • Drinking nutrition is manageable, but chewing/swallowing is difficult.
    • No energy to prepare food, using as meal “replacement.”
    • Want more muscle from weight training efforts and heard protein replacements are the way to go!
  5. Price
    • Any food made ready-to-eat for you, even outside the protein category, costs more than real food you prepare yourself. Due to the processing and (sometimes) quality ingredients, protein supplements are pricey. All the more reason to determine whether they’re a constant necessity or an occasional option.
    • Less expensive protein supplements may contain more fillers and non-essential ingredients. You get what you pay for – stock up on the better quality products when they’re on sale.
  6. Temporary or Long-Term
    • Temporary: You’re undergoing treatment for breast cancer and don’t feel like making or eating “real” food.
    • Long-Term: You simply like the taste and convenience and intend to make them part of your daily diet.


“3 Breast Cancer Treatment Side Effects That May Increase Your Risk of Heart Disease”

I am very fond of saying, “What you eat for your heart is good for your breasts.” (and vice versa)

It’s not like your body says, “Wait a second – that apple protects against heart disease and stroke, NOT BREAST CANCER – drop it right now, you’re not doing your chest any favors!”

Each time you choose quality, whole food fuel, you elevate the health and function of every cell in your body, from cardiac muscle cells to breast cells.

At ~108,000 beats per day, every minute of every hour, your heart faithfully pumps oxygen and nutrient-rich blood throughout your body while taking harmful waste products like carbon dioxide away from tissues. A healthy, strong heart makes for a healthy, happy life. And through the miracle that is your body? You’re not even aware of that effortless work taking place!

Until you’re aware that there may be a glitch in the effortlessness of that exquisite physiology.

For many survivors, the unfortunate reality is that life-saving treatment for breast cancer may result in heart-damaging side effects – regardless of how many apples eaten.

According to a recent article in the Journal of Clinical Oncology, The Top Killer In Breast Cancer May Surprise You, the leading cause of death in breast cancer patients today is heart disease.

Even for women in their 40’s and 50’s, the combination of radiation plus a variety of medications (i.e. anthracycline and trastuzumab) can result in heart failure, cardiomyopathy, and other cardiotoxicities. With cardiomyopathy the heart muscle becomes enlarged, thick or rigid, causing fatigue and shortness of breath, especially with physical exertion. As the condition worsens, the heart becomes weaker and less able to pump blood through the body and maintain a normal electrical rhythm.

If you’ve had breast cancer treatment, this may be old news; most everyone working with a cancer treatment team recognizes that “treating breast cancer effectively puts the heart at risk.” What is new(er), is the emerging focus on minimizing risk while maximizing the impact treatment has on breast cancer, updated guidelines for medication dosing, providing other pharmacologic agents within a few months of treatment – while disease is still subclinical – to  mitigate or reverse disease, and the emergence of a collaborative effort between oncologist and cardiologist; the subspecialty of cardio-oncology.

Outside of chemotherapy agents and radiation, there are three other breast-cancer-related factors that can increase heart disease risk:

  1. treatment-related early menopause (lose protective effect of estrogen)
  2. aromatase inhibitor therapy (can raise cholesterol and risk of diabetes)
  3. significant weight gain during/post-treatment (may lead to high blood pressure and insulin resistance)

So is there anything you can do, even in the face of breast cancer treatment, to keep your hard-working heart working optimally?


The recommendations below fit EVERYONE (breast cancer patient or not!). While you may not be able to fully protect your heart from treatment (although with targeted radiation and newer medication guidelines, outcomes are improving), adopting these lifestyle factors help reduce your risk of developing heart problems:

  • Eat a plant-based diet (don’t forget apples!)
  • Be diligent and consistent in engaging in aerobic/cardiovascular fitness (see my June 8, 2017 blog post on “Cardiovascular Fitness”)
  • Maintain a healthy weight, or lose weight if you’ve gained
  • Manage blood pressure, cholesterol, HDL/LDL, and triglycerides
  • DON’T SMOKE – stop if you do
  • Reduce and/or manage stress


“The High Price of FREE Snacks”

It’s almost ridiculous, really, how effortless it is to find something to eat at nearly every turn.

Even on a trip to the party store for birthday supplies or a detour through the bookstore, with a few bucks and the rip of a package or pop of a top. . .you. won’t. starve.

We are an epically overfed and overweight nation, yet the ubiquitous prevalence of “something to eat” makes it appear we’re trying to ward off hunger as if it were a communicable disease.

And what about when you’re stalked by snacks, without the need to even open your wallet?  Jackpot! It can feel especially difficult to ignore the siren call of FREE food. “Psst, over here! I’m the crunchy-salty bite you didn’t even know you wanted. Even better? I’m FREE. Come on, dig in, take MORE!”

Inspiration for this post came to me when I did something I do without fail, every four to five weeks.

I went for a haircut.

I love the salon where I have my hair cut; the friendliness, the cleanliness, the location, and of course, most importantly, my stylist. And because it’s such a friendly salon, making their customers feel welcome and cared for is something they do really well. They go the extra mile.

And littering the extra mile? Snacks. FREE snacks.

Don’t get me wrong, I’m not anti-snack. Offering free snacks is a lovely gesture, heck, feeding people is a lovely gesture; a heartfelt way to nurture, nourish, celebrate and care for others.

But what I am is: 1) an observer of human food nature, 2) an “in-the-trenches” nutrition therapist, 3) familiar with psychology of eating behavior research, and 4) on a mission to help women practice self-care to help reduce the risk of breast cancer. Given all of that, I couldn’t help but wonder about the effects of those FREE snacks on the parade of salon patrons scooping piles of goodies into their snack bags.

3 “Costs” To Consider

  1. First of all, that hair salon is a business, so containing expenses and overhead is important. I mean, no offense at all to the gesture, but they aren’t serving organic hummus and wild-caught smoked salmon. Enormous bags of animal cookies, pretzels, and neon-yellow crackers shaped like little salmon assure quantity at budget-friendly prices, not quality. Commit to FUELING your body with nourishing snacks for health and vitality vs. mindlessly FILLING your body with “anything as long as it’s edible.”
  2. You may not even be hungry, yet when you spot (FREE) snacks in your path? It’s likely you’ll eat them anyway. I find simply fascinating, all research highlighting the effects of environment on how much and how often people eat. This research repeatedly suggests you’ll most likely consume all of that snack you serve yourself, irrespective of hunger. In other words, when the snack is gone (or the bag is empty) – you’re full. Have you ever tried the “leave one bite on your plate” challenge? It’s close to impossible for people to stop eating before they’ve cleaned their plate (or emptied their snack bag.) Commit to assessing your TRUE HUNGER before reaching for any food. Your body’s unique hunger cues will let you know whether you’re TRULY HUNGRY (and conversely, when you’ve had enough), or simply giddy at the thought of a FREEBIE.


  3. As your mother always said (you KNOW she was right), “You’ll ruin your dinner.”, and that still holds. The official definition of snack: “A small amount of food, eaten between meals,” is where people get tripped up – they struggle to know how small is small. The ability to eat a small amount of food between meals hinges on many variables, one of which is actually eating an adequate meal around the snack. Let’s say you skipped breakfast and squeezed that haircut in over your lunch hour. Do you think you’ll eat “a small amount of food” from that snack jar? No. What if you scheduled the haircut for after hours, following a working lunch where you “worked” but didn’t “lunch?” No! You’ll be ravenous and fill up on neon-yellow, salmon-shaped crackers leaving little room, let alone appetite, for that veggie and tofu stir-fry you planned for dinner. And that’s a shame. Your body works best fueled with all the nutrients, phytochemicals, antioxidants, vitamins and minerals in that lovely dinner. Missing an opportunity to nourish your body for resilience is a strike against risk reduction. Commit to keeping a nourishing “small amount of food to eat between meals” with you at all times. Nuts and dried fruit are non-perishable, portable, and even when smashed into the bottom of your purse, resist crumbling under pressure. Let them do the same for you.

Did you find this post inspiring? Informational? Educational? Excellent – I’ve done my job. Please share! Thank you ever so much.

“When GI Joe Gets Cancer.”

It’s said that age is the greatest risk factor for developing cancer, with risk increasing significantly after age 50, and half of all cancers diagnosed in people age 66 and above. (1) Currently, there is no single reason why aging bodies are more susceptible to cancer, although longer exposure to carcinogens and mutations in the genome are certainly culprits.

Since the population is aging (isn’t it always because that’s the way it works?) I don’t take issue with that, but will someone please explain to me how a fit, healthy, 25-year old, aging but not aged Army serviceman is diagnosed with testicular cancer?

Or a healthy, fit, aging but not aged 42-year old is diagnosed with pancreatic cancer?

Testicular cancer isn’t actually my area of expertise nor experience. Neither is pancreatic. But in the last 2 weeks alone, and as recently as this morning, I’ve learned of 3 new cancer diagnoses – pancreatic, breast and testicular – in people that I know, are related to people that I know, or who were referred to me for cancer nutrition education by someone that I know.

When. Does. It. Stop.


This informational slide from American Cancer Society Cancer Facts & Figures paints a not-so-pretty picture. And I wanted to share it with you.

If you think for one minute that you’re not a cancer target, I would advise you to re-think. The statistics are ridiculously alarming, and the fact that cancer diagnoses are on the rise, while a sense of urgency devoted to determining what’s causing the increase appears to be lacking, is beyond me.

While I’m grateful for continually improved treatments, pharmaceuticals, and early detection, I must stress that these are not cures, nor are they preventive. Early screening does not prevent cancer, it simply catches it – hopefully before it’s had an opportunity to do too much damage.

I know how complex cancer is, how random, how wily, how varied and virulent – but I don’t care. I want research dedicated to determining causes and outcomes that provide ways to avoid/prevent.

Is that asking too much?


Why Does Cancer Risk Increase As We Get Older?