Nutrition and breast cancer

Kellie Curtain [00:00:06] Let's be upfront about breast cancer and diets, Keto, fasting, juicing, just to name a few. There's always a new one making big promises. So which ones are worth doing? And do they carry any additional risks or adverse effects if you have breast cancer? We welcome dietitian and nutritionist, Lauren Atkins. And also joining us is Lana Heath. Lana, like so many women, wanted to make changes to her diet after her diagnosis, but became overwhelmed with all that Google had to offer. Welcome to you both.

Lauren Atkins [00:00:41] Thanks for having us.

Lana Heath [00:00:42] Thank you.

Kellie Curtain [00:00:43] Okay. Lauren, is there a magic cancer diet?

Lauren Atkins [00:00:48] I wish I could say yes. I really do. Certainly, there are particular foods that are best included and also foods that are best limited or avoided. But there's absolutely no one way of eating that has been proven to prevent or cure cancer.

Kellie Curtain [00:01:05] Okay. So, Lana, you were diagnosed at 31 with three very young children. Were you healthy to start with or is it post your diagnosis that you decided, right… I need to change the way I eat?

Lana Heath [00:01:26] I believe I was relatively healthy before my diagnosis. I feel, you know, I was exercising and quite mindful, even as a young child, about, you know, what's healthy, so to speak; foods and what's not so healthy. So, yeah, it was, it was my lifestyle was pretty healthy, I'd say.

Kellie Curtain [00:01:47] So did you want to make specific changes? Was it about trying to stop recurrence? Was it about trying to cope with post treatment?

Lana Heath [00:01:54] To live was the biggest thing, obviously, just to get through it. And then, you know, I'd only heard certain things about chemotherapy, but it was more to manage how sick I was going to be. Being that I am a single parent and, you know, can't lie in bed all day and, yeah, recover that way. So it was to have the energy to, you know, keep being a mum, to keep doing the things I have to do; sports or that sort of stuff. And yeah, just keep me on my feet.

Kellie Curtain [00:02:28] So how did you approach it? Did you go to Lauren first or did you go to Dr Google?

Lana Heath [00:02:35] Well, I did, yeah. I did go to Dr Google first.

Kellie Curtain [00:02:39] And lots of people like to say, no, no, no, no. But it's just...

Lana Heath [00:02:43] It's right there. It's like a big carrot, you know, that's there, you know, 24 hours a day and especially in the middle of the night when you've got all those things running in your head. It's just so easy to, to ask Dr Google.

Kellie Curtain: What were some of the things that Dr Google threw up for you?

Lana Heath [00:03:01] Well, before I was even officially diagnosed, I had my pathology results there in front of me, and I had no idea what any of these words meant. So I'm googling those words to find it in layman's terms, what I actually have and what's going on. Like I didn't know what carcinoma meant or, you know, all those sorts of things. So I'm like, okay, processing that. And then in my head what I thought I had then I was like, what, you know, where do I go from here? Is there, like you said to Lauren; is there a magic cure? Is there things I can be doing at home to prevent this from getting worse, I suppose? And yeah, a juice diet came up. That was one of the first things that popped up on Dr Google.

Kellie Curtain [00:03:43] I'm sure many are familiar with the juice diet. But how radical is it?

Lana Heath [00:03:47] Well, like I said, I had no previous knowledge on any of this. And when it came up, it was, you know, a male doctor from overseas recommending to ... like a juice detox, I guess. To have like 12 different juices a day, and that was it. And because I was quite confident in my own food choices and stuff, I sort of, it was like a little bit of a red flag. I was like, oh, I don't know about that. And then, yeah, a lot of other contradicting information. So that's when I approached Lauren. I was like, I need to get some clarity from a professional about this.

Kellie Curtain [00:04:21] What do you think of the juice diet, Lauren?

Lauren Atkins [00:04:22] Ah, the juice diet. Such a challenge because it sends a big promise. And like Lana said, anything that does promise to cure or makes a radical change to your diet? Red flags, because if you're cutting out food groups or if you're modifying your diet profoundly, it's going to have a huge impact on your lifestyle with very little likelihood of making any difference.

Kellie Curtain [00:04:46] Does that go for all of them? Is that for the Keto, for fasting?

Lauren Atkins [00:04:52] Yeah. Look, they tend to have different levels of scientific information behind them. The juicing diet has very, very little evidence to substantiate that it would make any difference, whatsoever. The concept is very much around cleansing or detoxing the diet and having a really high load of antioxidants through the form of concentrated fruits or vegetables as juice, but that can actually be quite detrimental when undergoing certain types of treatment. So, for example, during radiotherapy, having really high loads of antioxidants when juicing can actually theoretically interfere with the impact of radiation. So there's red flags for a good reason because making profound dietary change and following a diet that's really not balanced can have a huge detriment to your health and how you feel through treatment. So very, very pleased when Lana reached out to me and, very early on in your in your journey because she was yet to start chemo.

Kellie Curtain [00:05:52] So how did you approach educating Lauren on the best way forward with her diet, given that she hadn't started?

Lauren Atkins [00:06:00] Yeah. So a lot of our first session was around actually appreciating what chemotherapy regimen and treatment plan she was planned for and building knowledge around what that might mean from a side effect point of view and how we could then utilise her diet and nutrition choices to reduce the severity of her treatment side effects, potentially manage some of those side effects and help her to recover in between cycles. Because being a busy single mum, she needed to be well and as well as possible. And so we were using good food choices in that fight.

Kellie Curtain [00:06:36] What were some of the things that perhaps surprised you, Lana?

Lana Heath [00:06:42] You know, touching on the juice diet as well. I can see how it, you know, knowing what I know now and how the effects of chemotherapy can, you know, knock you for six. I can see how other women would think juicing would be a good idea, because when you're on chemotherapy, you lose, you know, everybody's different, but for me personally, I had ulcers in my mouth. You lose a lot of sensation and taste in your mouth. So sipping on a cold juice would actually be quite relieving. A lot of the times your mouth is so dry and you can't eat and you can't have a steak like you used to and all these sorts of things. So yeah, I can see how that could be appealing. Like, hey, all I have to do is get down 12 juices a day and that seems easy. But yeah, like Lauren said from a, anti-oxidant point of view and with regards to treatment, you're not so, not so great. So things that surprised me would have been ... everything, to be honest, I mean. Most of what I was doing was was good and was right, Lauren said. But I needed to eat more frequently. And when you're on chemotherapy, that's the last thing you actually want to do is eat.

Kellie Curtain [00:07:52] You know, it's it's a bit like exercise, isn't it? Because traditionally, 20 years ago, it was Iike just have your chemo and take a rest, and don't exercise. And now it's flipped, and it is quite common for people not to want to eat during chemo. But is that something that they should, well, little bits more often?

Lauren Atkins [00:08:13] Yeah. And look, Lana's in a position where she was really motivated to preserve her muscle mass and her lean body mass, which is so important for her strength, her treatment tolerance, her recovery, but also long term for her body's metabolism and ability to maintain a healthy weight, longer term. And so we focused a lot on meeting your caloric needs and particularly your enhanced protein requirements. So the particular treatment that Lana was having meant that she needed somewhere up to 150 per cent of her protein requirements. Which means eating enough protein for one and a half people. At the same time, you probably felt like eating a quarter of that.

Lana Heath [00:08:55] Yeah.

Kellie Curtain [00:08:55] So are you feeling like you were forcing yourself to eat?

Lana Heath [00:08:59] A hundred per cent. I mean, and I love food. I love food. In my mind, towards food hadn't changed; my mindset. I still loved all these foods in my head, you know, and was on board with anything Lauren said. And I was ... I knew how to track calories and knew how to, you know, count macros and stuff. So that part was okay because I already knew how to do that. But actually hitting those numbers and getting that food in, yeah, it was really hard because you just ... for starters, you don't want to make the food. You've got no energy to make all these fantastic meals. And secondly, yeah, to try and actually get them into you was hard.

Kellie Curtain [00:09:36] So have you got maybe a tip or a hack for someone that doesn't feel like eating?

Lauren Atkins [00:09:43] Yeah. And look, I think a lot of the key comes from maintaining the frequency with which you eat. Because every time we eat, it sends messages to our body that we've got food, it moves the next lot along and we get used to regular intake. If we go for long periods of not eating or eating less, your body doesn't expect food as often and so to preserve your appetite, it's actually really important to eat regularly. So one thing I would encourage is every two or three hours, even if it's just a mouthful or a sip of a smoothie, put something in. Because that helps to preserve your appetite. And another really important tip is to wherever you can, build every meal or snack around a source of protein. So whether that's an animal source of protein, so something like poultry, fish, meat, dairy products, or it might be some tofu, some nuts, some seeds, some edamame, eggs, whatever you feel like, small amount often can make a big difference.

Kellie Curtain [00:10:48] And we stick to whole foods?

Lauren Atkins [00:10:49] Ideally whole foods. Yeah. Unless you're somebody in the circumstance where perhaps you're doing a lot of training and physical activity and perhaps you might be doing a lot of strength training during your treatment and your need for protein is quite elevated, in many cases there will be a requirement for a protein supplement. But it's really important to chat to your dietitian or a pharmacist or your doctor about it because certain supplements can absolutely interfere with your treatment.

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Kellie Curtain [00:11:34] What about someone who is overweight? Quite often we have women who are overweight at diagnosis and told to lose weight before surgery or, you know, post treatment want to try and lose weight to reduce the chance of occurrence? Do those principles still apply?

Lauren Atkins [00:11:57] Well, that's actually really key, during treatment to maintain that protein, regular protein intake. Because what we often find is that even those who perhaps may be a little bit overweight pre and during treatment; the altered metabolic needs of the body during chemotherapy, radiotherapy or post-surgery means you're more likely to utilise your muscle stores or deplete your muscle stores. And we know how important muscle is for metabolism and therefore your long term body weight management. And so if you can preserve your muscle mass in the short term during treatment, you're far less likely to put on weight down the track. Which is why it's really valuable to have those conversations early and I guess not try not to fall into the trap of "right, I have no appetite, I want to lose weight. This is great.” And so that can be really challenging and a difficult headspace to get into. And that's where education and knowledge is really important, because if you know that you can make change now to impact you in the future, that's really empowering. And nutrition is something you've got control over during treatment. You lose control over so much, but you do get to decide what you put in your mouth. And I think often we can fall into the trap of [air quotations] "eat whatever you feel like". But what you feel like won't necessarily be what's best for you or what's going to make you feel good. So having that information and knowledge to build your plate in your day and make wise choices can make a really big difference to how you feel both in the short term and the long term.

Kellie Curtain [00:13:43] It must be very tempting for people who are overweight, who are instructed to lose weight, to pick a fad diet.

Lauren Atkins [00:13:54] Absolutely. I mean, anyone is going to lose weight on a tea-detox or juice diet because there's very few calories coming in. But that's short term weight loss that leads to muscle loss, which unfortunately is likely to cause more harm in the long term.

Kellie Curtain [00:14:09] Keto diet is very buzzword.

Lauren Atkins [00:14:12] Very. And the ketogenic diet is based around the concept that by depleting our body of carbohydrates we can in theory starve or reduce the growth of the cancer. And although that may work in a test tube where there's no other energy substrates, once you've depleted glucose, there's no other energy to use in a test tube. In the human body, you've still got access to your fat stores and more likely your muscle stores. And the ketogenic diet is a really challenging one to follow. And it was actually developed back many years ago to help in the management of retractable epilepsy. So it's been shown to be useful to manage seizures in those that don't respond to medication. But in working in that space, what we know is that even those who have therapeutic benefit from seizure control after a few months, compliance can drop to about 50 per cent.

Kellie Curtain [00:15:15] How did it swap over to the magic weight loss diet then?

Lauren Atkins [00:15:19] The magic weight loss diet. Yeah, the theory is around by reducing carbohydrate load, you access your fat stores for fuel. But that theory is actually quite flawed because you've actually got a lot of fat coming in from your diet. It's a really high fat, very low carbohydrate diet. And the analogy I like to make with the ketogenic diet and fat loss is it's like digging a hole while somebody is filling it in on the other side.

Kellie Curtain [00:15:44] That's fun.

Lauren Atkins [00:15:44] Because eating you're eating so much fat. Yeah. So you're trying to burn the fat, but you're also eating so much. And so it does still depend on your overall caloric balance. So you're sort of energy in energy out equation, which is really complicated. But like I said, too, particularly when it comes to the cancer conversation, the evidence is emerging in the space of brain tumours, in particular glioblastoma, because one thing that's unique about our brain is that it can only use glucose or ketones for fuel. The rest of our body can use glucose, protein, fat or ketones. And it takes a hell of a long time to run out of fat and protein. So you're gonna burn through those stores before you even tap in to that ketogenic pathway necessarily.

Kellie Curtain [00:16:38] How could the keto diet have an adverse effect on someone who's having treatment?

Lauren Atkins [00:16:45] All right Lana, I'm going to use you here. So let's say it's day two post chemo and I'm asking you to eat, for breakfast, bacon, eggs. For lunch, I'm asking you to eat avocado, sour cream and maybe a stem of broccolini. For dinner you're going to have, again, bacon or a really fatty cut of meat and an egg and some broccoli cooked in butter.

Kellie Curtain [00:17:12] What about snacks? Does she get snacks?

Lauren Atkins [00:17:15] Yeah. You could snack on maybe some nuts, avocado or sour cream. How are you gonna feel?

Lana Heath [00:17:20] Yeah, no, just. I mean, all those foods sound great now. You're making me hungry. But, yeah, putting my mind back to like you said, day two post chemo treatment. That is the last thing. For starters, like I said, you don't want to be up cooking those things. It's almost like when you're pregnant. The smell of cooking bacon would be enough to put you off and to try and get those oily foods down. You know, I, if I've failed to prepare my meals, I was clutching at McDonald's sometimes, you know. Just to even feed the kids. And I'd have some of that and I'd feel worse than when I did beforehand. You know, the oily, fatty foods would just be sitting in my stomach. And then...

Lauren Atkins [00:18:00] What can be really helpful in post-chemo when you do feel a bit queasy is some bland, starchy carbohydrates.

Kellie Curtain [00:18:09] What about post-treatment? What about 12 months? Two years?

Lauren Atkins [00:18:16] So the evidence isn't there. Particularly in the space of weight loss. What the, the most, the strongest evidence shows is that you will lose weight. So you lose weight on the scales, but you don't lose your fat stores. You're actually more likely to use your muscle stores, which we know might help your weight drop in the short term. But long term, that same argument. You've lost muscle mass, therefore, your metabolism slows. Therefore, you're more likely to put on more weight in the future. And that's what study shows. It's like a 'U'. You lose weight and you put it back on.

Kellie Curtain [00:18:51] Lana, how big a difference do you think your diet made to your ability to tolerate chemotherapy?

Lana Heath [00:19:01] Huge, huge, huge difference. I exercised throughout the whole process as well. Lauren actually referred me on to an exercise physiologist and she helped, you know, just as much as Lauren did with the nutrition side of things. Yeah, just getting, it's just about having energy. Like you just feel so nauseous and you've got, you know, a lot of medications there that they give you. And it's just all so overwhelming. It's all new. You know, you don't know when you're supposed to pop this pill, take that pill. This one's gonna make do this to this. You know, and mask that one. But, you know, I'm not one for taking pills anyway personally. So I thought if I, and I know how good I can feel after a good nutritious meal, you know, I've even got, you know, self-recordings on my phone telling myself, like, 'I just need to eat'. I know how good I can feel off, you know, good, good food. I just need to get it down. That's, you know, the first part. Then let it sit in your stomach and see how you feel. And look, you do have anti-nausea medication if it's not sitting well or, you know, other tablets and things like that. But once it's in and it's done, you do you just feel so different, so much more energetic.

Lauren Atkins [00:20:12] And one thing we also focused on was compensating in the times when she was feeling better for the times when she was just feeling rubbish. So there are absolutely going to be days where you don't eat enough or you don't eat well. But if you can make up for those that make up for those days on the others, then you can put yourself in a really good position. And I don't know, Lana, did you utilise your support networks much to help with meals throughout your chemotherapy?

Lana Heath [00:20:38] Yeah, I did. And that was that was a big thing for me. Reading some of the questions, going into these podcasts today that, you know, challenges that I faced with nutrition was not preparing before you came out? So, I mean, everybody's chemotherapy cycles are different. That, you know, mine were four weeks, but, you know, between each. So I had that time in that last week when you are starting to feel really good again to prepare my meals and to call on support networks. You know, I'm lucky enough to have my family around that could, you know, prepare foods for me. But, you know, just something as simple as a bolognaise sauce. And you can pop it in the freezer and, you know, defrost it. Things like that were just, you know, my mum would make these. I can't talk about them enough. These biscuits are they were based on pumpkin puree and they had all these seeds and nuts and berries and stuff in them. And I call them like a powerhouse biscuit and I'd just snack on them. I had them there at my disposal. So, yeah, it gets quite overwhelming when you are feeling sick to cook. So if you can in your in your good days, I'll reach out to support networks to help prepare meals. Yeah, definitely.

Kellie Curtain [00:21:47] Did you develop any of a few of your own little hacks apart from the magic cookies?

Lana Heath [00:21:51] Those biscuits hands down, even post surgery.

Lauren Atkins [00:21:52] You might have to patent the recipe.

Lana Heath [00:21:54] I think so. She'd love that! Those biscuits and yeah. Just, just meals. Just basic meals. You know, like Lauren said at my at the forefront of my mind all the time, eating was around a protein source first. And I've been like that though. So it can be quite daunting to people that don't know as much. So you're just basically, you know, just a chicken from Woollies in a salad was just so easy and convenient. And that's. Yeah.

Kellie Curtain [00:22:25] Was there any particular food that you found sat really well with you or one that really didn't?

Lana Heath [00:22:31] Smoothies were good on the times that I couldn't, that I couldn't really just couldn't get anything to eat or to chew. Yeah. Smoothie, a banana smoothie. Bananas have always been lifesavers for me. You know, pre / post-cancer diagnosis. A banana was, you know, good to snack on, I guess.

Lauren Atkins [00:22:51] And the difference between a smoothie and a juice is so profound because you think about blending all of those whole foods into a, an actually a dense meal or snack compared to extracting all of the liquid out of an otherwise really nourishing food product. Yeah. Big difference between a smoothie and...

Kellie Curtain [00:23:13] So don't confuse the two.

Lauren Atkins [00:23:13] Don't confuse the two. And if you are juicing, I would encourage you to invest instead in a really good quality blender and pulverise it. The whole thing. Because you're then getting all the fibre. The fibre nutrients, all the antioxidants but bound up in all of the goodness rather than just extracting that liquid juice.

Kellie Curtain [00:23:32] So we know that there's no magic diet to either lose weight or cure cancer or prevent cancer or stop it reoccurring. Are there's some magic single foods that everyone should know about to include in their diet?

Lauren Atkins [00:23:50] There's a bit of magic out there. Absolutely. And look, the area of nutrition in cancer and particularly nutrition and breast cancer is fascinating. And more and more nutrition research is underway to explore what foods, nutrients and ways of eating can impact us and our cancer risk, but also our recurrence risk. So a few little top tips would be ... some particular foods to look out for would be walnuts. They have actually been shown to reduce a pathway that can increase inflammation and drive some cancer pathways. And so walnuts are really useful food and nut to include often daily, if you can, handful a day.

Kellie Curtain [00:24:32] Raw?

Lauren Atkins [00:24:32] Raw, naturally is best. Dry roast, if you like. Try not to do roasted salted just because that can change the profile a little bit. Another food group to look out for are orange or dark green vegetables and fruits. So looking at a particular vitamin group called carotenoids, which is a category of category of vitamin A. And that's a really valuable nutrient that's been explored that can, may be helpful in space of breast cancer as an antioxidant. So things like sweet potato, pumpkin, red capsicums, tomatoes, anything that's really vibrantly orange or red is a very useful food to include. And the food itself is being shown to be more beneficial than taking a supplement. So the whole food is best. Another useful one is oily fish. So things like salmon, mackerel, sardines, the omega-3s that are really rich in those particular oily fish can down regulate some inflammatory pathways and can be useful in the context of breast cancer. In particular, if you're perhaps replacing some of your red meat intake for oily fish. Another useful one can be green tea because the antioxidant profile of green tea again as a whole food or as a tea, tea leaf has shown some benefit in the context of breast cancer. But some women do struggle a little bit with green tea, in particular with hot flushes, and we don't want to have too much of it during radiotherapy.

Kellie Curtain [00:26:11] Thanks to Lauren and Lana for sharing their insights and experience with us. Be sure to listen to our other podcast on nutrition with Lauren. And if you want more, there's links to great resources on our website bcna.org.au. The opinions of our guests in our podcast series are welcome, but not necessarily shared by BCNA. Please contact your health professional with any individual concerns you have. This episode was made with thanks to Cancer Australia. Until next time, I'm Kellie Curtin. Thanks for being upfront with us.