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.

8 Tips for a Healthy Mouth During Cancer Treatment

Four different colored toothbrushes in toothbrush holder.We grow up learning certain truths regarding the need to brush our teeth at least twice a day and visit the dentist on a regular basis, but during cancer treatment, our mouth needs can change.

Cancer treatment is designed to fight the cancer cells in your body, but in doing so can have a wide range of side effects. One of the main side effects of chemotherapy, the standard treatment for prostate, bladder, and testicular cancers, is changes that occur in the mouth. Chemotherapy can lower white blood cell, platelet, and red blood cell counts throughout the body, so patients are at increased risk for infections. Gum diseases, dental abscesses, and cavities are all infections that are prone to worsen during treatment.

While killing cancer cells, cancer treatment can also harm normal cells, such as the cells in the mouth. This can cause problems with your mucosa and gums (the soft lining of your mouth) and the glands that make saliva. Additionally, both chemotherapy and radiation treatment can cause mucositis, a side effect that involves an inflammation of the lining of the mouth and can lead to red, painful sores.

Here are 8 tips to maintain good oral hygiene and ease mouth pain during cancer treatment:

  1. Visit your dentist early in treatment. See if your doctor can identify potential sources of dental infection or irritation prior to starting chemotherapy. Get any dental cleanings, teeth extractions, and fillings at least 2 weeks before starting treatment. This will help to prevent mouth problems so that you can get the most out of your cancer treatment.
  2. Brush your teeth. During treatment, do not neglect brushing your teeth at least 3 times a day. Use a brush with soft bristles and be gentle on your gums. Consider using a toothpaste designed for sensitive teeth and gums, and make sure that your toothpaste contains fluoride to prevent cavities and tooth demineralization, especially if you have a dry mouth. If you wear dentures, make sure that they are adjusted properly with a comfortable fit. Brush and rinse your dentures after meals and do not wear them while sleeping.
  3. Keep your gums healthy. Floss regularly as long as your platelet count is above 20,000. This is to minimize inflammation of the soft tissues in your mouth which can lead to dental disease, bleeding and infection if your blood counts are low. If possible, start a good flossing routine prior to starting chemotherapy so that your gums are healthy going into treatment.
  4. Pay attention to what you eat. What you put in your mouth matters, and not just in terms of maintaining a balanced diet during treatment. Read package labels to find out what’s in the foods you’re eating, as this will help determine what may irritate your mouth. Hot and spicy sauces can increase pain and sensitivity, especially if you have sores in your mouth. Caffeinated beverages and alcohol can increase mouth dryness, and vinegars, citrus and tomato juices have a lot of acidity which can also irritate the mouth. Be in tune with which foods might be triggers, and if eating out, ask whether sauces and dressings can be omitted or served on the side.
  5. Modify your diet as needed. If your mouth is sore, eating soft, bland, room-temperature food may help. If your mouth is dry, you can add extra moisture to foods in the form of sauces, oils, milk or broth to aid in swallowing. Foods such as eggs, yogurt, cottage cheese, soups, cooked vegetables, pudding, milkshakes and smoothies can often be tolerated when your mouth is sore or dry. If you experience taste changes, experiment with different foods at different temperatures.
  6. Cut down on sugar. Avoid foods that have a lot of sugar because your teeth are more vulnerable to infections and cavities during cancer treatment. Beware of sugar content in beverages such as soda, juice, coffee, tea and sports drinks.
  7. Rinse daily with alcohol-free mouthwash. Many types of mouthwash wash contain alcohol, which can burn your mouth and contribute to oral dryness. Keep your mouth moist with an alcohol-free mouthwash. If you suffer from dry mouth, suck on sugar-free lozenges to stimulate saliva flow. Keep your lips moist with a natural lipbalm containing bees-wax or lanolin to prevent chapping or cracking. Do not use petroleum based lip balms as these can contribute to lip dryness.
  8. Know when to speak up. Be sure to reach out to your healthcare team and dentist if you’re experiencing any of the following: Swelling or pain in the mouth or jaw, trouble swallowing, mouth ulcerations that do not heal within one week, white patches in the mouth, a burning mouth sensation, or severe oral dryness.

At Weill Cornell Medicine and NewYork-Presbyterian, we provide supportive oral care before, during and after cancer treatment. To learn more about the services we offer, click here. To make an appointment with a dentist at our center who specializing in treating cancer patients, please call Dr. Heidi Hansen at 212-746-5115.

For additional information about oral care during cancer therapy, visit the below links:
  • NCI: https://www.cancer.gov/about-cancer/treatment/side-effects/mouth-throat
  • American Dental Association: http://www.mouthhealthy.org/en/az-topics/c/cancer-dental-health
  • American Academy of Oral Medicine: Information on Dry Mouth, Information on Mucositis
  • NIH (oral mucositis): https://medlineplus.gov/ency/patientinstructions/000047.htm

Special thanks to Heidi Hansen, DMD for her contributions to this article.

Navigating Dinner When the Food Tastes Worse Than the Plate

By Shayne Robinson, R.D., C.S.O, C.D.N

Food photo_Cancer Taste ChangesSweet, salty, savory and sour are words we often use to describe different flavors in the foods we eat, but cancer and its treatments can turn your sense of taste upside down. It is normal to experience taste changes as a result of cancer and cancer treatment. Some people report a bitter or metallic taste in their mouth, while others find that their overall sense of taste has diminished.

How foods taste and smell can change from day to day, and these changes may affect your appetite. To find foods that are appealing, try experimenting with new foods or cuisines, marinades and spices. It can even help to try new ways of preparing the foods you typically eat. Good oral care is also important.

Here are some tips to help combat common cancer-related taste changes:

Loss of Taste

  • Choose foods with strong and/or tart flavors, such as citrus fruits, vinegar and pickled foods. Marinate meats, chicken and fish to infuse flavor. Try strong flavored greens such as arugula or mizuna greens. Caution: avoid acidic foods if you have a sore mouth or throat.
  • Zinc deficiency can decrease your sense of taste. Discuss testing your zinc level and/or supplementing zinc with your health care provider.

Unpleasant Salty, Bitter, Acidic or Metallic Tastes

  • Add a sweet flavor to foods such as topping salad with fruit. Try topping meats, chicken and fish with a fruit chutney.
  • Use plastic utensils or chopsticks if metal forks and spoons taste unpleasant.
  • Add lemon juice, cucumber slices, cranberries or other flavorings to water.
  • Suck on slices of Granny Smith Apples or frozen chunks of pineapple.

Meat Tastes Strange

  • Choose other protein-rich foods (such as poultry, fish, eggs, dairy products, beans, tofu or soy milk) instead of meat.
  • Marinate and cook meats, poultry and fish in sweet juices, soy sauce, acidic dressings or wine.

Overwhelming Food Odors

  • Choose foods that are served cold, such as sandwiches, crackers and cheese, yogurt and fruit, or cold cereal and milk. Foods served hot often have stronger odors.
  • Carry a handkerchief dabbed with oil that has a pleasant odor such as mint or lavender.
  • Eat in cool, well-ventilated rooms that don’t have any food or cooking odors.
  • Drink oral supplements in a covered cup and with a straw to reduce the odor of the supplement.

Oral Care Tips

  • To keep your mouth clean and healthy, rinse and brush your teeth after meals and before bed (or every four hours during the day).
  • Before eating, rinse your mouth with a solution of 1 quart water, ¾ teaspoon salt, and 1 teaspoon baking soda. This rinse can help keep your mouth clean and improve your sense of taste.

While taste changes can be common during cancer treatment, eating well during treatment can decrease side effects. Good nutrition will help you maintain your weight, your strength, and maximize your quality of life.

If you are struggling with taste changes or any treatment side effects that affect your ability to eat, consult with a Registered Dietitian (RD). Nothing replaces the individualized counseling you will receive from working with an RD on a one-on-one basis. To see a dietitian at the NewYork-Presbyterian Outpatient Nutrition Practice call (212) 746-0838 (physician referral required).