Top 5 Diet and Cancer Myths

By Shayne Robinson, RD, CSO, CDN and Jackie Topol, MS, RD, CSO, CDN

RefrigeratorWe know that there is a great deal of conflicting information about nutrition that patients may receive from various sources. As Registered Dietitians who are board certified in oncology nutrition, we are here to clear up some of the confusion. Here are some of the most common nutrition myths we hear from patients:

Myth # 1 – Sugar feeds cancer.

Within the body, all carbohydrates break down to sugar which both healthy and cancer cells use for fuel. Research shows that the body responds to a high sugar intake by making more insulin and related growth factors, which influence cancer cell growth. However insulin levels also depend on genetic factors, physical activity, BMI (body mass index), metabolic syndrome (a group of medical conditions linked to insulin resistance) and the type of sugar you eat. Therefore just avoiding sugar is not the right plan for everybody. It’s important to maintain healthy blood sugar and insulin levels during cancer treatment and in general. In prostate cancer, hormonal therapy is associated with weight gain and the way the body processes sugar, so it’s important to be mindful of this when making dietary choices. Ongoing research is looking to target some of these pathways.

The key question to ask is “How much and what type of carbohydrates should I eat?” A Registered Dietitian who is specially certified in oncology nutrition (RD, CSO) can help you design a well-balanced eating plan that best fits your needs.

Reference: https://www.oncologynutrition.org/erfc/healthy-nutrition-now/sugar-and-cancer/

Myth #2 – I need to avoid raw fruits and vegetables.

Raw fruits and vegetables that have been washed can be eaten while you are receiving chemotherapy and/or radiation. If you have a very low neutrophil count (known as “neutropenia”) or a recent bone marrow transplant, your doctor or dietitian may recommend a low microbial diet. On the low microbial diet, you can eat most raw vegetables and most raw fruits that have a smooth skin or a thick peel. The fruits and vegetables we advise not consuming on the low microbial diet are the ones you cannot wash thoroughly or those that may have mold such as raw mushrooms, sprouts, strawberries, blueberries, raspberries, grapes, peaches, and plums. In the current era of treatment for genitourinary cancers, most targeted therapies do not suppress the immune system or require a low microbial diet. Not all cancer patients will have to follow these guidelines since they are specifically for leukemia and bone marrow transplant patients. If you are not sure whether you should be following a low microbial diet or how long you should follow it for, we encourage you to speak to your doctor or dietitian. Additionally, there are certain oral treatments for kidney cancer that are linked with gastrointestinal side effects such as diarrhea. There are ways to include fruits and vegetables in the diet while taking these factors into account. There are many health benefits that go hand-in-hand with eating fruits and vegetables, so make sure to include them in your diet! If you are concerned that you may not be meeting your nutritional needs, you can make an appointment with one of our dietitians who can help.

Reference: https://www.foodsafety.gov/risk/cancer/index.html and NewYork-Presbyterian’s “Guidelines for the Low Microbial Diet”

Myth # 3 –  Certain foods will increase my white blood cell count.

Chemotherapy drugs, radiation therapy, and cancers of the blood and bone marrow can damage bone marrow and lower white blood cell counts. These cells recover with time.  Blood counts are low because the bone marrow isn’t working properly, not because the body lacks the nutrients to make blood cells.

No specific foods or nutrients increase production of white blood cells, but if you have low blood counts it is very important that you eat well because a well-nourished person recovers quicker from treatment than a malnourished person. Specific foods or nutrients won’t speed up the recovery of your bone marrow, but you do want to eat well so that when your bone marrow recovers all the nutrients that are the building blocks for cells are available for your body to make the white blood cells. A Registered Dietitian specially certified in oncology nutrition (RD CSO) can help you ensure you are eating well and in turn optimize your white blood counts.

Reference: http://www.oncologynutrition.org/erfc/eating-well-when-unwell/white-blood-count-diet/

Myth # 4 – Cancer survivors must eat only organic produce.

Organically grown produce have lower pesticide residues and synthetic (man-made) food additives, but following an organic diet does not guarantee a healthy diet. In fact, avoiding conventionally grown produce may eliminate some healthy food options. In a study looking at 50 years of scientific articles about the nutrient content of organic and conventionally grown foods, the researchers concluded that organic and conventionally grown foods are not significantly different in their nutrient content. There have not been any direct studies on humans to show that organically grown produce can prevent cancer or other diseases any more effectively than conventionally grown foods.

What does this mean in terms of your grocery list? If you go into the market to buy a fresh organic apple, and they only have conventionally grown produce, don’t walk out with a bag of processed organic chips or cookies… A conventionally grown apple is a better choice than organic processed foods.

References:  www.mayoclinic.com/health/organic-food/NU00255
www.foodnews.org  (from the Environmental Working Group)

Myth # 5 – I need to avoid soy foods.

It is safe to eat soy! Research has shown that moderate consumption is safe for women with a history of breast cancer, including women previously diagnosed with estrogen receptor positive breast cancer, and that soy consumption may even decrease the likelihood of breast cancer recurrence. Confusion about soy arises from the term “phytoestrogens.” Some soy nutrients have a chemical structure that look a bit like the estrogen found in a woman’s body. This is where the term phytoestrogen originated. However, phytoestrogens are not the same thing as female estrogens. Soy foods do not contain estrogen. Men with prostate cancer who are taking hormonal therapies also commonly inquire about the impact of eating soy, but again, soy is okay to eat. If you consume soy products, we recommend choosing whole soy foods such as such as soymilk, tofu, tempeh, edamame, soy nuts, and miso. You can have up to two servings per day.  One serving would be 1 cup of soymilk; ½ cup of tofu, tempeh, or edamame; ¼ cup of soy nuts; or 1 tablespoon of miso paste. It is best to get soy directly from foods sources; we do not recommend taking a soy isoflavones supplement.

References: http://www.oncologynutrition.org/erfc/hot-topics/soy-and-breast-cancer/; http://www.oncologynutrition.org/erfc/hot-topics/soy-and-hormone-related-cancers/

Nothing replaces the individualized counseling you will receive from working with an RD on a one-on-one basis. We’re here to help you.

shayne Robinson_head shot 2Shayne Robinson RD, CSO, CDN is an oncology dietitian at New York-Presbyterian.  To make an appointment, call the Outpatient Nutrition Practice at (212) 746-0838 (physician referral required). 

Jackie Topol RD_Headshot_jgt9003
Jackie Topol, MS, RD, CSO, CDN is an integrative dietitian at
Integrative Health at NYP – Weill Cornell Medicine, located at 211 East 80th Street. To make an appointment, please call: 646-962-8690.

Using Radiation, Radioimmunotherapy and Radioactive Isotopes such as Lutetium 177 to Treat Prostate Cancer

Radiation is a mainstay in the treatment of prostate cancer. In men with localized prostate cancer (confined to the prostate gland), using radiation can help cure the cancer. In men with advanced disease, radiation can improve survival and help to manage pain.

Radiation can be delivered a variety of different ways. For example, there are external beams that can be used to deliver radiation from an external machine into the prostate, radioactive “seeds” that can be implanted, or ways to inject special radioactive isotopes directly into the bloodstream.

In the United States (U.S.), there are older FDA-approved treatments utilizing radioactive isotopes for men with prostate cancer that has spread to the bones to decrease pain, called samarium-153 (brand name Quadramet) and strontium-89 (Metastron). More recently, a bone-targeted alpha particle called radium-223 (brand name Xofigo®) was approved because it leads to longer overall survival in men with symptomatic metastatic castration-resistant bone metastases. These bone-targeted radioisotopes have been useful because prostate cancer commonly spreads to bone. However, those drugs cannot treat other sites of tumors such as in the prostate, lymph nodes, or lung.

We are also able to use parts of the immune system as a way to deliver radioactive particles or other targeted cancer treatments to the prostate cancer. We have engineered very specific monoclonal antibodies and molecules that will bind only to PSMA, leading to the opportunity for “molecularly targeted” radiotherapy for prostate cancer. When we combine immunotherapy with monoclonal antibodies with radioactive isotopes, we call the treatment approach radioimmunotherapy. Radioimmunotherapy involves attaching a radioactive isotope (such as Lutetium 177) to a cancer-targeting antibody or small molecule that binds only to a specific cancer-related molecule on a tumor cell. This is similar to a “lock and key” scenario, where the antibody or molecule serves as a key that will only recognize a very specific lock (the cancer-related molecule). In prostate cancer, nearly all cells have a specific “lock” that lives on the surface of each cell called prostate-specific membrane antigen (PSMA).

j591_psmaFor nearly 15 years, we have been utilizing a monoclonal antibody known as J591, which is a version of a specific key that will only recognize and enter cells with the specific lock PSMA. We successfully utilized this antibody tagged with small radioactive particles to either visualize or treat prostate cancer tumors within the prostate, bone, lymph nodes, and other sites in the body. Our initial studies demonstrated safety and signaled anti-tumor efficacy. In addition, we showed that the antibody went to virtually all sites of tumors (sometimes discovering new ones) and did not target other normal organs (with the exception of the liver which helps clear the drug from the body). Subsequently, our larger studies have shown responses in larger numbers of patients. In Europe, physicians picked up on our results and Lutetium 177 (also known as Lu-177, 177-Lu or 177 Lutetium) has become a very popular radioactive particle that can be directed to prostate cancer via PSMA. It has been used to kill prostate cancer cells and treat hundreds of prostate cancer patients. This commonly-used approach uses a small molecule which recognizes PSMA to deliver Lu-177 to prostate cancer cells (termed radioligand therapy or radioimmunotherapy therapy).

Lutetium-177 PSMA therapy is associated with a good prostate cancer response and many men travel from all over the world to Europe in order to access this treatment. In the U.S. it is only available via clinical trials, and for more than 10 years, Weill Cornell Medicine and NewYork-Presbyterian have been one of the few centers in the U.S. to offer Lutetium 177 and other targeted treatments using radioactive particles.

Learn more about how this treatment works in this video:

Hi-Tech Blood Biomarker Signals When a Strategic Switch in Chemotherapy Will Benefit Prostate Cancer Patients

For men with metastatic prostate cancer that grows despite hormonal therapy (also referred to as castration-resistant prostate cancer), chemotherapy has been a mainstay. The class of chemotherapy that has consistently proved to improve survival for men with advanced prostate cancer is called “taxanes.”

Taxanes target microtubules, which are structures in cells that are involved in cell division, as well as the trafficking of important proteins. In prostate cancer, one of the main ways taxane chemotherapy works to kill the cancer cells involves blocking the movement of the androgen receptor (AR) along the microtubule “tracks” towards the cell nucleus, a mechanism we discovered here at Weill Cornell Medicine.

There are two taxanes FDA-approved to treat prostate cancer, docetaxel (brand name: Taxotere) and cabazitazel (brand name: Jevtana). While the drugs are similar, men whose tumors have grown despite taking one drug often respond to the other. The challenge for oncologists has been pinpointing when exactly to switch treatments.

ScottTagawa_ASCO2016_TAXYNERGYDr. Scott Tagawa presented exciting results from a phase II clinical trial at the 2016 American Society for Clinical Oncology (ASCO) annual meeting demonstrating the power of this treatment switch, and when to make the switch.

This research came to be because we thought that we might be able to increase the number of men who respond to taxane chemotherapy with an early assessment and by changing the drug for those who have a sub-optimal response. Simply put, those with no response or only an initial minor response had their drug changed at a much earlier time point then standard practice. This resulted in a higher response rate for the patients in the study.

Top Boxes_Taxynergy
In the photos from a sub optimally responding patient, almost all of the androgen receptor (AR, labeled in green) is in the nucleus (indicated by the arrow which is overlayed in blue on the right), meaning that the taxane chemotherapy treatment was unable to block AR from moving to the nucleus and thus unable to kill the prostate cancer cells.

In addition, it’s very exciting that we can examine cancer cells from a simple blood test, a process also referred to as collecting circulating tumor cells or CTCs. This allows us to assess the ability of a drug to target the pathway in real time and to tell us whether there is a positive tumor response or resistance.

These circulating tumor cells provide an opportunity for real-time molecular analysis of taxane chemotherapy and at Weill Cornell Medicine we’ve pioneered a way to examine the AR pathway with a simple blood test.

To do this we use an extremely specialized technology that captures the very small fragments or rare circulating tumor cells on a “chip.” From this chip we are able to determine which cells are responding to treatment.

Bottom Boxes_Taxynergy
In real time, we can see taxane chemotherapy kept the (green) AR out of the (blue) nucleus area in cells from a responding patient. 

In cancer care, we are always trying to maximize treatment response rates by targeting the right cells at the right time. This promising precision medicine approach offers us one more tool to better personalize treatment and improve outcomes.