Ask the Dietitian

I have stage 4 lung cancer (never smoked) have been under treatment for a year now. I have heard that the pH levels in our blood can help fight cancer. How does one go about doing that, or is that not something I should consider?

Eating an alkaline diet or drinking alkaline water is a very popular trend for preventing and treating cancer but there are problems with the claim. The main problem with this claim is that our kidneys and respiratory system tightly regulates the pH of our blood and altering it is nearly impossible. The evidence for the claim comes from laboratory studies in cells outside of the human body and have not been replicated in humans. An alkaline diet, although it has no evidence for changing blood pH, is made up of foods that are generally healthy like fruits, vegetables, and beans so it is not harmful to follow. A better place to find an evidenced-based diet for cancer survivors is from American Institute of Cancer Research

I am a Metastatic Breast Cancer patient and I have gained 40 lbs in 1 year on these new treatments. I eat under 1400 calories a day on most days but I can’t seem to lose the weight. What is the best diet to aid in weight loss?

Many people assume that cancer treatment will cause weight loss but there are many people like yourself who struggle with the opposite. Losing weight during treatment isn’t always advised and it is best to check with your doctor first.

In general, weight loss requires eating less calories and moving more than you normally do. The amount of calories can vary between different people and can be affected by activity and stress on the body. There is not one particular food or diet that is best for weight loss. If weight loss is advisable by your doctor, I would recommend that you ask for a referral to see a dietitian as that may help you find some new ideas for making changes in your diet.

I was diagnosed with hormone positive breast cancer and would like to know if eating soy, flax seeds are okay as I get contradicting information when reading online.

Consistent findings from population studies have found that eating soy and flaxseeds are safe for all breast and hormone related cancers. The confusion came from the term “phytoestrogen”. The term refers to the chemical structure of isoflavones in soy and lignans in flaxseed that resemble estrogen in a woman’s body. Phytoestrogens are not the same things as female estrogens. Soy and flaxseeds do not contain estrogen and are safe for breast cancer patients to eat.

To read more, check out these resources:

• AICR.orgSoy and Cancer: Myths and Misconceptions
• AICR.orgFlaxseed and Breast Cancer

What are the foods that are good to eat and to avoid for hormone positive breast cancer patients?

There isn’t just one food that is good to eat but we know that it is the quality of your overall diet. Eating a plant-based diet has been shown to reduce the risk of breast cancer coming back. A plant-based diet is a diet made up of mostly fruits, vegetables, and grains. It can include meat, but in smaller amounts. In addition to eating a healthy diet, limit alcohol in the diet as much as possible.

To learn more about a plant-based diet, check out these resources:

• AICR.org What is a Plant-Based Diet? Here’s AICR’s Take

How much protein or calories are required for cancer treatment patients?

There isn’t a consistent calorie or protein requirement for all cancer patients. Protein and calorie needs of cancer patients can depend on the person’s age, sex, weight, diagnosis, treatment, and other individual factors. It is best to talk to your medical provider or dietitian regarding your specific nutrition needs.

I have read that every food item needs to be cooked thoroughly. Is it an issue/problem if a medium rare steak or ahi tuna [cooked medium rare] is eaten once in every 3 months or so?

Cancer patients undergoing treatment are at higher risk for foodborne illness. Undercooked steak and fish are considered a high-risk food option. The recommendation is to not eat undercooked meat or seafood. Eating less often although decreases exposure to the risk doesn’t eliminate the risk completely. The recommended cooking temperature for these foods is listed below.

Steaks	145° F and rest for 3 minutes
Seafood	145° F

For more information for food safety during cancer treatment, check out this resource:

FDA Food Safety for Older Adults and People with Cancer, Diabetes, HIV/AIDS, Organ Transplants, and Autoimmune Diseases

I am making fresh beet juice [beets, cucumbers, parsley] and fresh carrot juice [carrots, apples, celery, fresh ginger] and he drinks it every day [4-5oz. glass]. Assume this is a good practice?

Juicing is a good way to increase fruits and vegetables in the diet. Whole foods are the best option for getting plenty of fruits and vegetables. That isn’t always possible, so juicing is a good alternative. Although juicing is nutritious, it is low in calories and protein. For patients with a poor appetite, juicing may be too filling and lead and not provide enough calories. This article by Oncology Nutrition DPG provides some good tips for juicing.

I hear so much about sugar being the fuel for cancer. Is this a myth or evidence that sugar can assist in the growth of tumor cells?

The simple answer is that there are no studies in people that have shown reducing sugar intake prevents or treats cancer. Research also has not shown that eating too much sugar causes cancer or increases tumor growth.

The issue is more complicated though because every cell in our body, including cancer cells, uses sugar from our bloodstream for fuel. Those sugars come from foods in our diet that contain carbohydrates, including healthy foods like fruits, vegetables, and whole grains. This can make the simple statement that sugar feeds cancer true but not the full story.

There is however an indirect relationship between sugar and cancer risk. Eating high-sugar foods like cakes, cookies, sodas, and candy can lead to excess calories in the diet which can increase excess body fat. Excess body fat is a risk factor for several different cancers.

To read more, check out these resources:

• AICR.org The Sugar and Cancer Connection
• Cancer.net Does Sugar Cause Cancer?

I need help with what eat as my husband was recently diagnosed with walderstrom macroglobulinemia. We have stopped eating extra sweets. We eat whole wheat bread, oatmeal flour, nuts, legumes, vegetables, fruits, and whole wheat pasta. We try to limit meat at our meals. I need some guidance on what to eat. I also would like to know how to the meals with whole grains more enjoyable? I can’t seem to know how to cook brown rice well.

The best information for diet and cancer comes from American Institute of Cancer Research . You referred to many of their guidelines like eating whole grains and limiting meats in the diet. A whole grain is a less processed grain that has more nutrients and fiber. Whole grains include barley, quinoa, wild rice, bulger, and farro.

Here are a few resources for ideas for preparing whole grains:

• Whole Grains Council – How to Cook , Video Recipes 
• Kitchn Has great how-to cook videos. Just search for the particular grain. Here is an example for Farro: https://www.thekitchn.com/farro-recipe-23110148 . Farro is one of my favorites. You are right brown rice can be tricky.
• Follow our Facebook Page as every other month our dietitians offer cooking demos.

Other great places for cancer fighting recipes include: AICR and Cook for your Life .

I have acute myeloid leukemia. I was told to follow a neutropenic diet because my white blood counts are expected to be low during treatment. Can I have pasteurized cheeses? What about seeds like flax, chia, sunflower, and pumpkin? Are these allowed on a neutropenic diet? Is a plant based diet recommended for me, or should I have meat, poultry, seafood, especially before treatment as specified in the frequently asked questions?

The neutropenic diet can be confusing and sometimes the information conflicts. The neutropenic diet is often just referred to as following good food safety guidelines to decrease the risk of foodborne illness. Raw seeds are ok to eat. As well as pasteurized cheeses and other dairy products. Your protein needs are higher during cancer treatment so you should definitely be focusing on eating protein foods at every meal. If you aren’t as hungry eat those foods first prior to eating any other foods. You can still include fruits, vegetables and grains in your diet just make sure you are meeting your protein needs first. Your questions are great ones and you would benefit from seeing a dietitian to help you through this time. You can ask your doctor at your next visit for a referral to a dietitian.

I have breast cancer and am taking tamoxifen. I’ve been experiencing hot flashes since starting. A friend told me that I should try eating rhubarb or start taking dietary supplements. What should I do?

Hot flashes are an uncomfortable feeling that can be a side effect of some breast cancer treatments. Although many foods are promoted on the internet as being helpful to prevent hot flashes, most have little research to support the claims. There is no evidence that eating rhubarb will decrease hot flashes, but try avoiding triggers such as:

• Caffeinated drinks like tea and coffee
• Alcoholic drinks
• Spicy foods
• Hot drinks

Other triggers are smoking, stress, and extreme heat. Focus on ways to reduce triggers like reducing stress with yoga or meditation, wearing lightweight cotton clothes, and using a fan. Staying well-hydrated can also help.

Dietary supplements have not been proven useful for treatment of hot flashes. Some can also interact with your cancer treatments and have unwanted side effects. Talk to your doctor before taking any dietary supplements.

Should I take vitamins during treatment?

It is best to talk with your doctor or dietitian about any vitamins you are taking or want to take. Some vitamins act as antioxidants in the body and have been found to lessen the effectiveness of different cancer treatments. Although antioxidants in pill form may need to be avoided, foods that are high in antioxidants, such as fruits, vegetables, beans and nuts, are all safe to eat during treatment. In addition to possibly interfering with treatment, vitamins can also interact with medications you may be taking.

Should I be using nutrition shakes and protein powders?

Eating foods high in protein is the best way to get enough protein in your diet. Foods high in protein include chicken, turkey, fish, beef, pork, eggs, milk, cheese, yogurt, cottage cheese, beans, tofu, nuts and seeds. If you are unable eat enough protein foods, nutrition shakes and protein powders are a good way to make up what you may be missing. There is a large variety of nutrition shakes and protein powders on the market that vary in calories, protein, vitamins, and minerals. Ask your health care team which ones they would recommend.

Will I lose weight during treatment?

Not every cancer treatment affects one’s ability to eat enough food. In addition, managing side effects of treatment and focusing on good nutrition will help minimize weight loss. If you do start to lose weight during treatment, try to eat small frequent meals and focus on eating foods high in calories and protein. Although a few pounds might not seem like a big deal, rapid weight loss leads to loss of muscle which can contribute to fatigue and weakness.