“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”

 

“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.

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

And you can follow me here:

Twitter: @cathylemanrd

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

Easy. Peasy.