Karen Sabbath Answers Questions about Survivorship and Nutrition

November 20, 2009

The Connecticut Challenge team posed a question to Karen Sabbath, Registered Dietician at the Harold Leever Regional Cancer Center in Waterbury, CT.


Dear Karen:

I'm wondering if you saw an article by Gina Kolata in Sunday's NYTimes
(11/15).  The article was titled "Medicines to deter some cancers are not
taken."  In the article she says:
"But other measures that are often assumed - and marketed - as ways to
prevent cancer may not make much difference, researchers say.
For example, public health experts for years recommended eating five
servings of fruits and vegetables a day to prevent cancer, but the evidence
is conflicting, at best suggestive, and far from definitive.
Low-fat diets were long thought to prevent breast cancer. But a large
federal study randomizing women to a low-fat or normal diet and looking for
an effect in breast cancer found nothing, said its director, Ross L.
Prentice of the Fred Hutchinson Cancer Research Center in Seattle.
Fiber, found in fruits, vegetables and grains, is often thought to prevent
colon cancer, even though two large studies found no effect.
"We thought we would show relationships that were strong and true," said Dr.
Tim Byers, professor of epidemiology at the Colorado School of Public
Health, "particularly for dietary choices and food and vegetable intake. Now
we have settled into thinking they are important but it's not like saying
you can cut your risk in half or three-quarters." Others wonder whether even
such qualified support is misplaced."

Click here to read the article

Karen's reply:

You bring up very relevant issues; ones that we see on a day to day basis
with our patients.  "What can I take to boost my immune system?"  "Take a
look at this supplement that I bought to prevent cancer"  "I eat 5 servings
a day of fruits and vegetables and I still got cancer".  Gina Kolata has
pointed out the less than hoped for outcomes of many studies, but I have a
different spin on it.

It is my opinion that cancer isn't caused or prevented by doing one thing.
Since we don't know what causes cancer (with the exception of
lung/cigarettes/asbestos), it is impossible to guarantee that by following
several dietary or lifestyle recommendations, we will be guaranteed a
reduction in risk.  We all know the person who was an avid athlete,
vegetarian, non-smoker and non-drinker who was diagnosed with breast cancer.

What we do know is that if you look at population trends, there appear to be
associations with total lifestyles/diets and disease incidence in general.
For example, people who follow the lifestyle described above are less likely
(statisically) to be diagnosed with any diseases, but that doesn't mean that
bad things won't happen.  Just exercising won't help if a person is obese
and eats lots of processed foods.  Just eating fruits and vegetables won't
help if a person drinks excessively and consumes large amounts of red meat.
Supplements do not make up for a bad diet and can (as the article points
out) be harmful.  Then, there is the issue of the environment...pollution?
Plastics/BPA?  Pesticides?  What is their role and do these factors
exacerbate abnormal cells independently or synergistically to multiply?  How
do you measure that?  You can begin to see that isolating one factor is
unlikely to show anything of significance in the big picture.

All this being said, and knowing that there are no guarantees, do we tell
people to give up and do whatever they want?  Absolutely not.  We recommend
a healthy lifestyle which includes maintaining a good weight (we do know
that excess fat produces excess estrogen which increases the risk of
recurrence for an ER+ breast cancer patient), exercise on a regular basis,
as well as a plant based diet, where some meat is allowed, but does not
represent the main focus of the meal.  We have people avoid processed foods,
excessive alcohol and too much sugar, bad fats and salt.

We stress that supplements are medications and have side effects and
interactions with prescription meds that need to be evaluated one by one.
As pointed out in the NYTimes article, they can be harmful as well.  We urge
people to get the benefits of antioxidants in food from the FOOD, not the
bottle.  There are exceptions to this rule (Vitamin D for example) that are
reviewed with patients based on the data we have available to us now.

By going over each of these issues as they relate to our patients, we teach
them that they may not be able to prevent cancer or a recurrence, but they
can give it their best shot; sometimes that is the best it can be.  It may
not be as "sexy" a message as the colorful bottles of pills that are sold to
patients, but the recommendations are more likely to play a role in
preventing many chronic diseases than to follow the "unhealthy" diets and
lifestyles.


Karen

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