In our series - Lifestyle Matters - we're exploring how diet, exercise and other health behaviors affect people who have been affected by cancer.
The series is based on the recently published American Cancer Society Nutrition and Physical Activity Guidelines for Cancer Survivors, which summarizes the latest findings on lifestyle choices.
This installment answers questions commonly asked by folks who have lived with and beyond cancer. Of course, these are only general answers, and specific questions should be answered by healthcare professionals.
There's been a lot of conflicting information about the benefits and harms of drinking alcohol. What's the latest?
You need to look at alcohol and cancer from several perspectives. A number of research studies have found that consuming alcohol is associated with increased cancer risks, including oral (mouth, pharynx, larynx), esophageal, liver, breast and likely colon cancers.
In those who have already been diagnosed, alcohol could impact the risk of developing new cancers in the same area. It's known, for example, that alcohol increases estrogen circulation, which in theory could boost the risk of estrogen receptor-positive (ER+) breast cancers recurring.
Clinical research, though, has resulted in conflicting findings on this topic, with half suggesting that drinking is harmful and half showing alcohol having a benefit or no harm.
Whether drinking during treatment is advisable or not has to do with the type and stage of cancer. In general, it's best to minimize drinking during treatment to avoid potential interactions and toxicity with cancer therapies, including chemotherapy and radiation.
Is a vegetarian or vegan diet recommended?
Diets that emphasize plant-based foods are healthy because they are rich in naturally occurring vitamins, minerals, fiber and nutrients, while being low in fat and calories. There are no studies, though, that show a vegetarian diet is better at preventing cancer recurrence than a diet which includes lots of fruits, vegetables and whole grains, some meat and fish and is low in red and processed meat.
Is a low-fat diet better?
Yes and no. There is some evidence that diets high in saturated fats found in meat and cheese can increase cancer risks. There is little evidence that certain fats, including omega-3 fatty acids found in fish and walnuts and monounsaturated fats in olive and canola oil reduce the risk of cancer. Trans fats found in processed foods are best avoided.
So meat is okay to eat?
Moderation is key. Some studies have found that eating a lot of red and processed meat can increase the risk of developing colorectal, prostate and stomach cancer. Also, frying, grilling or broiling meats at high temperatures releases heterocyclic amines, cancer-causing chemicals.
And while there's no evidence relating to the effect of meat on cancer progression or recurrence, it's best to limit your red and processed meat consumption and avoid cooking high-fat meats at high temperatures, according to the American Cancer Society (ACS) Guidelines.
What about soy?
It's fine to eat soy and soy-based products (tofu, tempeh, soy milk). The latest evidence finds no adverse relationship between soy foods and cancer return or survival. And these foods may offer some positive benefits as they're high in antioxidants, isoflavones and have compounds that combat the cancer process.
What's the scoop on sugar?
You may have heard that sugar feeds cancer. While glucose is involved in cancer growth, it doesn't come from the food we eat. The biggest downside of sugar is its calories and the impact the empty calories can have on weight - which does impact well-being before, during and after cancer.
Do fruits and vegetables lower the risk of recurrence?
Recent research suggests that diets high in fruits and veggies do lower the risk of breast, ovarian and prostate cancers returning and improve overall outlook. These diets are also associated with a lower risk of developing lung, oral, esophageal, stomach and colon cancers.
As a result, the ACS recommends that everyone who has lived with cancer have at least 2 -3 cups of vegetables and 1.5-2 cups of fruits each day. And the more color the better!
Are vitamin and mineral supplements recommended?
DailyRx spoke to Otis Brawley, MD, chief medical officer and executive vice president of the American Cancer Society, by phone regarding the new Guidelines.
He brought up the topic of vitamins. "There's some data that show that some people are harming themselves with what we refer to as hypervitaminosis. They think vitamins must be good so they take a lot of vitamins," Dr. Brawley said.
"Cancer patients have been known to harm themselves by getting into fad diets that involve high doses of vitamin C and high doses of beta-carotene and that sort of thing," he told dailyRx. He added that there's nothing wrong with taking a daily multivitamin or taking additional amounts of a vitamin when there's a known deficiency.
The ACS urges cancer champions to get most of their vitamins and minerals from foods. The Guidelines' authors write, "While dietary supplements are indicated in cases of nutrient deficiency (either that which is confirmed through laboratory testing or through the clinical presence of disease [eg, osteoporosis or osteopenia]), given the growing literature on the adverse effects of nutritional intake beyond normal levels, a concern exists that supplements may do more harm than good."
One Step at a Time
Improving one's lifestyle isn't easy. It takes time, practice, patience and consistency. And what works for one person won't work for everyone.
That's why it's really important to ask questions, seek help and support and take it one step at a time.
Because lifestyle matters.