It’s Daffodil Day here in Ireland today and I though it would be a good opportunity to talk about nutrition in the context of cancer.
Whenever I do a talk on cancer and nutrition, I like to present the evidence that- and how- nutrition can make a big difference in a cancer patient’s life. It’s simply not true when we hear that “it doesn’t matter what we eat” and that it’s something that “doesn’t make any difference“, as we sometimes hear in hospitals.
These statements are actually not evidence-based. They’re myth-based or a personal opinion expressed by a medical professional. Sorry to be harsh.
I totally get the point that some well-meaning nurses and oncologists fear that they put even more pressure on a newly-diagnosed patient by imposing some major nutrition and lifestyle changes on them.
“They have enough on their plate as it is, the poor things.” But, to be honest, I was never even asked whether I had enough on my plate or not. And there’s also a certain choice in the matter what we WANT on a plate as a cancer patient. For me personally, having some control over certain things in my life made a huge difference when I was just diagnosed. I would certainly have listened to every little bit of advice on nutrition that I could have received. But I, like most other cancer patients, was never even offered it.
I had to pay to get it. And it was the best 120 Euro that I will probably ever spent in my life!
Numerous studies show that even just taking a bit of time to talk about the very basics of good nutrition can have a big impact on quality of life, treatment effectiveness and survival.
1) The World Cancer Research Fund clearly states in its report that all cancer survivors (before, during and after active treatment) should receive nutritional care from an appropriately trained professional.
Research papers by Paula Ravasco et al show that outcomes in colorectal cancer patients undergoing radiotherapy are clearly improved when they receive dietary counseling. This research team did other studies for different types of cancer and came to the following conclusion: Cancer patients who receive individualized dietary counseling based on regular food
- managed to maintain their weight and protein intake a lot better,
- suffered less from radiotherapy-induced toxicity
- and enjoyed a significantly improved quality of life compared with 2 control groups.
2) Did you know that up to 20% of cancer patients die from the effects of malnutrition rather than from the cancer itself?
The incidence of malnutrition in patients with cancer ranges from 40% to 80%, depending on the type of cancer. It is highest for patients suffering from cancer of the gastrointestinal tract and also of the head and neck area. And also in pancreatic cancer, it affects up to 85% of patients. Of people who die from cancer, up to half have been malnourished.
Malnutrition in cancer patients can be caused by a lack of appetite (usually as a side effect of treatment) and therefore not eating enough, not eating enough of the right things or being unable to use the food that a cancer patient does it. The latter is also caused “malabsorption”, which again can happen when the digestive tract is compromised and therefore isn’t able to digest and absorb nutrients.
One of the problems with malnutrition is that it can lead to cachexia.
This is a specific form of malnutrition involving loss of lean body mass, muscle wasting and impaired immune, physical and cognitive function. Cancer cachexia is a complex syndrome and I’ve seen in patients that once it starts to develop and take its course, it’s very tricky to stop.
Early intervention is crucial to halt malnutrition. Alongside the development of some new drugs, certain nutritional supplements (EPA, anti-inflammatories and possibly certain types of amino acids) have shown to improve outcome. Although we have learned lots about cachexia in recent years, there still is no proven drug or intervention that works for everybody.
3) The possible development of cachexia is not the only problem with malnutrition.
Studies also show that improvement of nutritional status not only leads to better survival in cancer patients but also better response to treatment.
Nutritional intervention is most effective when it is done as early as possible, preferable as soon as a patient is diagnosed and before they start treatment or have surgery.
A while ago, I visited a private integrated clinic in Switzerland that looks after cancer patients and offers both conventional and complementary treatments. Their set up is hugely impressive: as soon as a cancer patient is diagnosed with cancer, they assess- amongst other things- nutritional status and supplement any nutrients that are lacking. If it’s a severe deficiency, they sometimes administer injections or IV treatments. Before somebody starts chemotherapy, they go on a course of probiotics with strains that have been proven to improve response to treatment.
So, for all these reasons, I’m surprised that the medical profession still hasn’t picked up on all this evidence. It would be a way to improve treatment response and quality of life of patients. On top of potentially saving a good chunk of money and gaining more reputation as a medical professional (because of better treatment outcomes)- isn’t it a no brainer?
4) Nutritional therapy can be hugely helpful when dealing with side effects from treatments.
It hasn’t happened just once to me that clients suffered from severe diarrhea (or constipation- it can go one way or the other!) and there was no response to the drugs they were given.
We tried some natural methods that definitely didn’t interfere with treatments and they worked. So, there’s always the option of that if medication doesn’t do its job for some reason.
Some supplements can also be helpful when chemotherapy-related naturopathy starts to creep in or to prevent skin burns from radiotherapy. There are foods that soothe the digestive tract during or after treatment. Nutritional therapists can give tips that help people to relax when they can’t sleep. We can advise cancer patients who can’t eat any fibre how they can increase nutrient intake and keep their bowels going.
I could go on for while on what other tricks we have up our sleeves to help cancer patients but these are just a few!
5) I’ve already written extensively about it but here you go again… Cancer cells rely on glucose for fuel. We know that overdoing it on sugar and carbohydrates doesn’t do any cancer patient a favour.
There are several papers that confirm this, here’s just a sample:
- A high glycemic load- i.e. foods that raise your blood sugars rapidly- is associated with higher cancer risk. And, by the way, this doesn’t just apply to people who already have cancer, but also for healthy individuals who want to protect themselves from the disease. Look at this paper. It shows how increased quantities of glucose and therefore increased glucose receptors on the cell membrane can activate pathways in the cell that drive cancer initiation, not just promotion!
- Data shows that high glucose reduces p53, a tumour-suppressor gene that protects us from cancer.
- Hyperglycaemia is a state of chronically elevated blood sugar levels. If this is the case in a cancer patient- and as we saw possibly also in individuals who don’t have cancer- a poorer prognosis can be expected.
- There is also research that shows that the higher the blood sugar levels are, the more tumour growth is experienced.
- What we already talked about earlier as well is that downregulation of several metabolic pathways leads to better results in chemo- and radiotherapy.
These are just a few “tasters” to show that the evidence for the importance of nutrition in oncology is mounting. Research in this field has increased rapidly in recent years and I know for a fact that there are some young, passionate, highly-skilled and super smart researchers at work that have other life goals than making money. They have professional pride and are genuinely interested in improving cancer patients’ lives.
I’m confident that nutrition will become an important part of cancer support and that there will be more and more tools and help for people who want to take an active role in their health.