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.

2017 Genitourinary Cancers Symposium Day 3

gu_symposium_2017_img_3054The third day of the 2017 Genitourinary Cancers Symposium started with a Best of Journals session on renal cell carcinoma (the most common form of kidney cancer) and the early poster sessions focused on renal cell, testicular, penile, and urethral cancers.

The first major morning session was focused on “novel targets and controversies in advanced testicular cancer.” Experts in the field first discussed actionable targets in testicular tumors, also referred to as germ cell tumors. This session also addressed a debate regarding treatment intensification in the subset of patients with “poor prognosis” – or germ cell tumors whose blood tumor markers do not decline optimally after initial chemotherapy. This subject remains controversial, but fortunately only affects a small number of patients, as in the current treatment era, after initial chemotherapy treatment, approximately 95% of all patients diagnosed with testicular cancer will be cured.

linehanThe Keynote Lecture on renal cell carcinoma was delivered by Dr. Marston Linehan from the National Cancer Institute. He discussed the current state-of-the-art treatment which is based upon decades of research largely led by him on the genetic basis of renal cell carcinoma (RCC). Several of his discoveries about the genomics and biology of RCC have led to the current wealth of drugs available to treat this disease. One such discovery was the importance of the von Hippel Lindau gene in patients with familial cancer syndromes that also affects tumor genomics in most patients with clear cell RCC. This discovery led to investigation in targeting the VEGF pathway which is the backbone of most currently approved drugs.

The session on the diagnosis and treatment of local renal cancer (confined to the kidney) started with a presentation on the role of active surveillance or watchful observation in small renal tumors, and was followed by discussions on imaging and biopsy of renal masses. A talk about the use of ablation in small renal tumors was followed by an abstract presentation on a registry of active surveillance of patients with small renal masses.  In summary, experts in the field discussed strategies and data behind the options of imaging and/or biopsy followed by either close surveillance or minimally invasive treatment strategies for patients with small renal masses.

The oral abstract scientific presentation session featured a presentation that followed up on the morning theme of small renal masses, also discussing surveillance, imaging, and circulating biomarkers. The Mayo Clinic group highlighted the success of treating carefully selected healthy patients with cryoablation in an expert center. A novel computer-assisted technique appears to be useful in assessing response to therapy compared to standard radiology assessment. A collaborative group led by Drs. Pal and Choueiri presented results of a large group of patients who had assessment of circulating tumor DNA (cfDNA) with a commercial platform prior to first-line or subsequent lines of treatment for metastatic disease.  Additionally, an Italian group presented an abstract on changes in tumor burden and prognostic classification when patients with metastatic RCC utilize an active surveillance strategy rather than take medications or undergo a local procedure. This is important to realize that for carefully selected patients, just because there are metastatic (spread) tumors on scans, immediate treatment is not always necessary. Sometimes these remain stable over long periods of time without treatment and this can be discussed with experienced clinicians.

Kidneys_GU Blog_FBThe final session of the conference reviewed the opportunities and challenges in systemic therapy for advanced kidney (renal) cancer. Imaging techniques to optimally evaluate one’s response to targeted therapies was discussed, highlighting examples of successful treatment with very little change in tumor measurements by traditional techniques. For example, it’s possible for a tumor to appear the same size after treatment by standard measurement, but it can be 95% necrotic (dead) tissue and in this scenario, the patient feels better and may live longer. This would be classified as non-response (or stable disease). Unfortunately, for patients with larger or more invasive tumors, many patients are not cured with surgery alone despite normal scans elsewhere in the body. Dr. Karam reviewed the results of recently presented trials utilizing targeted therapy following surgery. While these are not quite ready for primetime, the medical community is currently awaiting the results of other studies well as current studies utilizing immune checkpoint inhibitors in combination with surgery. Drs. Vaishampayan and Jonasch discussed the multiple different treatment options available to physicians and patients with advanced RCC. Physicians were reminded to consider referral to a highly experienced center for high-dose interleukin (IL)-2, a treatment which offers long-term disease-free survival off therapy in a selected subset of patients with advanced kidney cancer. Current studies are ongoing to assess different drug combinations, as well as novel agents. The last presentation of the conference was led by Dr. Powles who presented a late-breaking abstract on the randomized phase II study of atezolizumab with or without bevacizumab versus sunitinib in patients with advanced previously untreated metastatic RCC. While not definitive, the results were intriguing and support the continuing phase III study assessing the use of the combination of atezolizumanb and bevacizumab. There are multiple new studies looking at combinations of drugs and we encourage patients interested in this type of treatment to look for sites that are enrolling.

Overall, the conference was a great opportunity for both academic and community physicians from all different specialties (including medical oncology, urology, radiation oncology, radiology, and pathology) to mix with and learn from each other.  We look forward to participating next February in San Francisco for the 2018 Genitourinary Cancers Symposium.

Cancer Care During Extreme Weather: Precautions and Considerations

Blizzard on the road.With winter upon us, it is important for cancer patients to be prepared in the case of severe weather. During severe weather, such as a blizzard, it may be difficult to get to Weill Cornell Medicine. All of our physician practices have coverage 24 hours a day, 7 days a week, so if you have any urgent questions or concerns, please call the regular number and you will be able to reach the on-call physician.

If you are due for an infusion or injection during an episode of severe weather, we can discuss the risks/benefits of finding a safe way to get to the treatment center vs. delaying treatment vs. finding an alternative temporary treatment center.

Storms can cause travel delays, especially on roads, so consider allowing for extra time and taking public transportation whenever possible. Drive slowly, and remember that injuring yourself in an accident may also impact your cancer care. It may also be an option for you to stay in a hotel near the hospital to avoid hazardous road conditions.

NewYork-Presbyterian Hospital Weill Cornell Medical Center is open to serve patients 24 hours a day, 7 days a week. In the event that the outpatient center is closed or unavailable due a natural disaster (which is rare), the emergency department will likely be open.

If you are uncertain about travel conditions, the emergency hotline is 212-746-WCMC (9262). Travel alerts for road conditions are released by the Metropolitan Transit Authority (MTA). If you are having a medical emergency or need an ambulance, dial 212-472-2222 or 911.

For people undergoing cancer treatment, blizzards and cold winter weather can impact more than just the ability to travel to treatment. Patients are more susceptible to hypothermia since side effects of treatment can be dehydration, fatigue, and anemia. Patients undergoing or having previously received certain types of chemotherapy can experience extreme sensitivity to the cold. Other chemo patients can actually feel less sensitivity to the cold and a decreased sensation in the hands and feet. This may lead to a major problem because it puts you at risk for frostbite since you are unaware of how cold it really is. Also, patients with lower than normal amount of platelets in the blood, might result in more serious bruising or bleeding with an injury or fall.

It’s important that patients feel safe and prepared to “weather the storm” during severe weather, including a loss of power or blackout. When weather or other issues can be anticipated, make sure you have enough medication and food/supplies on hand.

In general, but especially after severe inclement weather, be sure to communicate with your physician and healthcare team if anything out of the ordinary happened. For example, close the communications loop if you ended up going somewhere else for treatment or ran out of medication. This way we can make sure we update your medical records.

Most importantly, trust your instincts and don’t panic in bad weather. Wishing everyone a very safe rest of winter!