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Anita Vincent

It’s the diagnosis everyone dreads – cancer. But can we really do much to pre­vent it, or once diagnosed, can we alter the course of the disease? Definitive answers may not exist on the role of nutrition and cancer but many believe that it can make a difference.

As more and more discoveries are made about the micronutrients (vita­mins, minerals, organic acids) and phy­tochemicals in plant-derived foods, their anti-inflammatory effects and the role they may play in our health, population stud­ies point to lowering the risk of chronic diseases, including cardiovascular disease, diabetes, osteoporosis and cancer, through a diet predominantly plant derived. It’s a strategy that has borne on-going study but it could be years before hard evidence catches up with public interest.

Cancer Risk Factors • Growing older • Tobacco • Sunlight • Ionizing radiation • Certain chemicals and other substances • Some viruses and bacteria • Certain hormones • Family history of cancer • Alcohol • Poor diet, lack of physical activity, or being overweight Source: National Cancer Institute

The number of cancer survivors is rapidly increasing in the U.S. Currently there are 12 million – up from 3 million in 1971. Survivors face a number of health issues and although there is no proof that nutrition and dietary changes halt the progression or recurrence of cancer, the chronic diseases which cancer patients can be more susceptible to, such as cardiovas­cular disease, diabetes and osteoporosis, can be prevented or managed through nu­tritional intervention - and this is known.

The Journal of the American Dietetic Association recently reported that two separate expert panels were assembled by the American Cancer Society and the World Cancer Research Foundation, which included the American Institute of Cancer Research. They both concluded that the guidelines for cancer prevention are applicable for cancer survivors. Data is insufficient to draw up specific evidence-based guidelines for survivors because the field is relatively new. Historically, numbers of survivors living long enough have been insufficient to follow.

Anita Vincent, RD, CSO, LDN, is one of 200 certified specialists in oncol­ogy nutrition in the U.S. As a nutrition consultant she has worked at Wings Cancer Foundation at The West Clinic for 12 years. Her specialty is in­dividual nutrition coun­seling for cancer patients and their families on all nutritional issues including managing side effects, promoting healing and reducing the risks of recurrence.

One third of all cancer deaths are re­lated to malnutrition – a little known fact. And 65-70 percent of cancer patients suf­fer from malnutrition. The major causes of cancer are related to environment, to­bacco and lifestyle – when you combine the environment and lifestyle, 2/3 of can­cers are considered preventable.

Resources: American Institute of Cancer Research www.AICR.org Environmental Working Group www.ewg.org Wings Cancer Foundation/The West Clinic www.wingscancerfoundation.org; www.westclinic.com A Dietitian ’s Cancer Story by Diana Dyer, RD Anticancer – A New Way of Life by David Servan-Schreiber, MD, PhD

According to Vincent, after receiving a cancer diagnosis, nutrition is probably more important than it has ever been in the recipient’s life. Expert panels back her up, stating that it is even more important for survivors to follow the recommenda­tions for preventing, and now surviving, cancer in order to mitigate their risk for other chronic diseases. Fortunately, most are in a receptive state to listen to how nutrition can affect healing, recovery and recurrence of the cancer. “People with cancer are very compliant… very inten­tional. The cancer diagnosis got their at­tention. It’s a positive step,” said Vincent.

Something few physicians or nurses do is talk to a patient one-on-one about the science of food and how to apply it to a particular individual. “Everyone knows that diet impacts disease and plays an im­portant role in healing, risk of recurrence and prevention, but registered dietitians have the training to individualize a plan for the patient and to use what applies to that patient,” said Vincent. Nor do other health professionals have the time – Vin­cent typically meets with patients for an hour to assess, develop a plan and answer questions. “Food is a complex issue – it’s not as simple as telling someone to eat this, not that. I try to meet the patients where they are – it is a process.”

Nor does she overwhelm the patient with an unrealistic plan. But good nutri­tion is essential because food nourishes the body. “This is a way of looking at food that our culture is unaccustomed to. Most of us think we don’t need to pay attention to what we eat unless we need to lose weight.

I think the biggest problem is that people do not take nutrition seriously…and with cancer, they don’t think it matters, ex­cept from the perspective of keeping their weight up and they are going to do that with milkshakes and cheeseburgers. This sort of thinking is not optimal. The time of the cancer diagnosis is the time to shift your thinking about food towards support­ing you physically through treatment and to NOURISH your body.”

Vincent knows that people are emo­tional about food and do not need addi­tional stress added to their lives because of it. “We incorporate real food into their plan – add more of the ‘cancer fighters’ (fruits, vegetables, whole grains and nuts) – and try to get rid of the junk, or food that doesn’t nourish the body.” She cited the anticancer (and anti-inflammatory) diet as consisting of 2/3 from plants and 1/3 or less from animal derived food, as recom­mended by the AICR and also described in David Servan-Schreiber, MD, PhD’s book, Anticancer – A New Way of Life, though she disagrees with some of his statements about sugar, she confided.

Something people find surprising is that overweight or obese people can be malnourished, according to Vincent. The most common problem she sees in cancer patients is related to weight loss. “The ma­jority of cancer patients will lose weight at some point in their treatment. The prob­lem is, if you are substantially overweight, you may not see this as a problem. After treatment, when they are eating (normally) again and put on weight, what they gain back is not muscle. It contributes to an on­going feeling of malaise, fatigue and poor health.”

Uniform Recommendations for Cancer Prevention and Cancer Survivors • Maintain healthy body weight • Physical activity every day – minimum of 30 min of moderate to vigorous exercise (more when weight loss is needed) • Healthy diet predominantly plant-derived (fruits, vegetables, whole grains, legumes) • Limit consumption of red meat and processed meat • Drink alcohol in moderation (one drink/daily for women, 2 or less for men) It is also recommended that nutrients be primarily obtained from foods rather than supplements since there have been studies linking certain supplements to increased mortality in some cancers. A cautionary note by the panel: as cancer progresses through stages, the impact of nutritional and other changes can be different so what could be beneficial at one stage may not be at another. Source: Journal of the American Dietetic Association

Vincent continued, “The role of good nutrition and eating well is to sup­port the body through treatment. A well nourished body tolerates treatment better, allowing the patient to complete all their treatments and to feel stronger in the pro­cess. If a patient loses too much weight or is too sick to get their treatment, it has to be postponed or stopped, and not being able to complete their treatment can af­fect the quality of their outcome. Weight loss is one indicator that a person is not being optimally nourished – even when they are overweight. Good nutrition is more complex than feeding people lots of calories.”

It is important that patients maintain their muscle mass and Vincent indicated that many studies have been conducted on exercise during treatment revealing its importance. “It is frustrating to see a patient who is pretty advanced in weight loss and lean muscle loss,” she said. Some things which may alter the metabolism to stop weight loss are consuming adequate calories and protein, light strength train­ing, omega-3-FAs and in some cases, if appropriately prescribed by the physician, anabolic steroids.

The thing Vincent wants physicians to realize most is the influence they have on their patients. “A lot of people sit down in front of me and when I ask, ‘why are you here?’ They say, ‘My doctor said I needed to come.’ A doctor’s words have so much power.” Nutrition is a huge fac­tor for patients with cancer. If a dietitian is included as part of the treatment plan, well maintained nutrition can prevent and reduce side effects of chemotherapy or radiation – including taste changes, di­arrhea, or nausea. The newer antiemetic drugs are better but there are also foods that can help. Doctors are aware that weight is a big issue in cancer and nutri­tionists can help with weight management before it becomes a problem.

Reducing complications of treatment can reduce costs as well. Though the cost of nutrition counseling is often not reim­bursable, any cost to the patient is more than offset by time off from work or greatly reduced quality of life due to preventable complications. Malnutrition affects patient outcomes.

“There is so much you can do to im­prove your health and it’s very simple – it doesn’t take anything fancy – it’s about making informed choices,” said Vincent. Most cancer clinics do not have an oncol­ogy nutritionist but if there’s one thing Vincent would say to physicians, it’s for them to tell their patients that, “You can really help yourself get through your treat­ment by eating very well – making good food choices – maintaining your weight and staying active.” And, if they need help with that, or, at the first sign of a problem, let a dietitian intervene so that some of the issues related to nutrition during treatment can be prevented. Reduced risk of recur­rence is also a good reason to consult with a specialist in oncology nutrition. It’s the perfect time for life-affirming change, and patients listen to healthcare professionals. Lifestyle changes can reduce risks…and possibly do more.

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Anita Vincent Anita Vincent, CSO, LDN Wings Foundation West Clinic Oncology and Nutrition Recommendati, MD David Servan-Schreiber, MD, PhD, RD

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