Kellie Curtain [00:00:06] Let's be upfront about breast cancer and nutrition. There's so much information out there and a lot of conflicting advice. It's hard to know what foods you should or shouldn't eat. Not to mention the effects of alcohol and breast cancer. Joining me today is Lauren Atkins. She's an accredited practising dietitian and nutritionist. She's going to debunk a few myths, as well as provide some great tips on how to stay on top of the latest rumours and research. Welcome, Lauren.
Lauren Atkins [00:00:35] Thank you so much. Kellie, lovely introduction. It's a pleasure to be here.
Kellie Curtain [00:00:38] So the space is very crowded, isn't it?
Lauren Atkins [00:00:42] Incredibly so, not just by health professionals, but by influencers and well-meaning members of society who have something to say.
Kellie Curtain [00:00:52] And I guess it's also what works for one person isn't necessarily going to work for another. So even though it might come from a good and honest intention ...
Lauren Atkins [00:01:04] Yeah, everybody eats, and so everybody has an opinion about food and how it impacts on their body. And like you said, well-meaning willingness to share can sometimes cause more harm than good. More confusion than clarity.
Kellie Curtain [00:01:19] Okay, so why don't we start with rumour versus research? How do you know which is which?
Lauren Atkins [00:01:30] Yeah, so particularly if you're looking online for information. There are a few things to be aware of and to look out for. So certainly reputable sources of information will very often be provided by credentialed health professionals. So if you're reading information or listening to information, the person offering that advice, if they're offering their credentials from a medical space and referencing that information with scientific literature, that's a really good sign. If they're not, that's often less of a good sign. Looking for sites with things like .org or .edu.au on the end of them will often mean you're getting information from a reputable source. And looking for really red flags in the information that you're reading. So if something is promising to cure or prevent cancer or if it's a massive change or overhaul to your diet, if it's cutting out particular food groups or if it's likely to have a financial or social strain on you, or if it sounds too good to be true, it quite possibly is. And one other kind of alarm bell is that if something somebody is trying to sell you something alongside their advice, take that information with a grain of salt.
Kellie Curtain [00:02:49] So how important is nutrition, when you have been diagnosed with breast cancer or you're undergoing treatment or post treatment?
Lauren Atkins [00:03:00] Nutrition has a huge impact during and after breast cancer. So there's lots of evidence suggesting that good nutritional status during treatment can reduce the severity and duration of toxicities or side effects. It can enhance recovery between cycles and after treatment, can improve your energy levels, your functional capacity. So your ability just to get by. There's also growing evidence and really sound research suggesting that good nutrition after a breast cancer diagnosis can impact on the recurrence risk, but also long term health outcomes. So your long term health from a sense of other chronic diseases, but also your body composition, your weight status up can certainly be impacted by nutrition. And in fact, the World Cancer Research Fund suggests that all individuals who've been touched by cancer, either past or present, should receive nutrition advice from a trained professional. So blanket it would benefit everyone. And so that's, I think, something really important to be aware of, that knowledge is power when it comes to nutrition during and after breast cancer.
Kellie Curtain [00:04:16] Ok, so is there any train of thought that has changed recently? Years ago, it used to be that you shouldn't or there was no need to exercise during treatment. Has there been any shift in what foods you should or shouldn't eat?
Lauren Atkins [00:04:36] Look, I think there has been and I think there will continue to be ongoing shifts with particular trends in the more general public often then translates more specifically to that niche area of cancer care. So particularly things like plant-based eating or vegan diet are really prominent at the moment as is styles of eating like the ketogenic diet or intermittent fasting, mostly because they've got a lot of traction more broadly in the public and the application of those diets or eating styles to cancer care and cancer prevention is an area that has ongoing research. I think our direction will continue to change. And that's really exciting because we learn more and more as more research comes out to improve the health of our entire population and particularly those going through cancer treatment.
Kellie Curtain [00:05:32] So is there a difference in approach to someone who is seeking to be at their optimum during treatment versus someone who needs to lose weight to either receive treatment?
Lauren Atkins [00:05:48] Mm hmm. Look, they often is and depending on the individual's goals and their therapeutic need. So if there is a necessity to particularly reduce fat surrounding organs, particularly with relation to surgical risk, then there are dietary and interventions that perhaps would be recommended in that short period of time that might not otherwise be recommended. And so everyone does have really unique needs depending on their individual situation; both their pre-existing health status, their diagnosis, their treatment plan, their lifestyle and their particular preferences when it comes to food and nutrition.
Kellie Curtain [00:06:34] Is it as simple as just saying, okay, well, I'm going to eat, or make better food choices? Or do you actually need a dietitian to give you a specific program?
Lauren Atkins [00:06:50] I don't think it's necessarily essential. It certainly is recommended and I would encourage anyone who has access to seek that advice, because what can be really challenging is compressing all of the information, that huge amount of knowledge that's out there and applying it to you. Where a trained, accredited practising dietitian actually that's their job. They do all of the hard work when it comes to keeping up to date with the scientific literature and have the clinical skills to actually digest that and apply it to your individual case. So it's like having a little coach or a cheerleader in your corner doing all the hard work for you, because while nutrition is something everybody does, it is quite complex. And when you've got lots of other things on your plate, having someone provide you with some guidance and really some answers to a lot of those big burning questions; that can take a lot of strain off mentally but also physically.
Kellie Curtain [00:07:49] How big an impact can your diet have on your ability to tolerate chemotherapy and other treatments?
Lauren Atkins [00:07:56] Yes, certainly it's been shown to be very effective, particularly if you can preserve your muscle mass and your nutritional status. You can reduce the likelihood of developing chemotherapy/radiotherapy induced side effects and also recover more quickly from those. So it's very important to be aware of that, because we all, we often talk about food as medicine, but food certainly can act in conjunction with your medical care.
Kellie Curtain [00:08:24] What are some of the foods that could perhaps be viewed as medicine for the body?
Lauren Atkins [00:08:31] So there are certain nutrients and food groups that have shown benefit, particularly during chemotherapy for management of nausea and vomiting. So there's growing research in the space of ginger. So particular doses of ginger and more commonly in its fresh form can actually help to relieve chemotherapy induced nausea and vomiting.
Kellie Curtain [00:08:54] So do you chop off a piece and put it in some boiling water and have his tea or do you ...?
Lauren Atkins [00:08:59] Spot on. You could blend it to a smoothie, you could add it to your breakfast or you stir fry. Building it into foods that you're already having is a really great way of getting in extra ginger throughout the day.
Kellie Curtain [00:09:11] And does that help someone who's already feeling nauseous? Or is it a bit of a preventative?
Lauren Atkins [00:09:15] Bit of both. Yeah. So again, it's an area that's got growing traction. So research is underway. But as it stands, it looks to be quite useful in managing nausea that already exists as well as helping to prevent it.
Kellie Curtain [00:09:30] What's another one? Turmeric has got a bit of hype.
Lauren Atkins [00:09:35] Yeah, turmeric's got a lot of hype. And, look, for reasonably good reason. So turmeric has some different properties in it that actually have been shown to down regulate cancer growth. So they can actually act on particular pathways that help to kill cancer cells, reduce cell replication, so reduce cell growth. But what's interesting when it comes to turmeric is that a lot of the therapeutic benefit is shown to be more profound, particularly with relation to breast cancer when we eat the food as a spice rather than as a supplement. So when you isolate the, one of the active ingredients, curcumin, from turmeric and take that individually, it might not have as big an effect as if you were just to put some turmeric in your curry. Or in a smoothie.
Kellie Curtain [00:10:24] Okay. And how much do you need?
Lauren Atkins [00:10:26] So really depends on your particular scenario, but a reasonable dose of turmeric would be about one teaspoon per day of the actual ground spice. You don't need a huge amount.
Kellie Curtain [00:10:39] Is more better? What if you can stomach three teaspoons?
Lauren Atkins [00:10:42] More is not always better and even some is important to be aware of if you're having particular types of chemotherapy or if you're on any blood-thinning medications, it can interfere with some of those. That's why we always like to choose the whole food as opposed to a supplement, which is far more likely to cause interactions with other therapies you're having. So three teaspoons would be certainly reasonable, but if it's becoming ... if it's just displacing other foods. So if you're having bucket loads of it, not a good idea, but really hard to overdo turmeric.
Kellie Curtain [00:11:15] And is that a general rule that we should follow? The whole foods is much better than a supplement?
Lauren Atkins [00:11:21] Look, in many cases, when individual nutrients are studied compared to the food that that nutrient has come from, there is a lot of benefit in having the whole food. Because if you think about, for example, a chickpea: if you were to isolate the protein from that chickpea ... great, you've got some protein. But the chickpea as a whole has prebiotic fibres that are great for our gut health, has folate and B vitamins that are really important for our metabolism and our immune function. So whole foods are far more complex than individual nutrients. So always opt for the whole food. And even more argument for that is that it's far harder to overdo a whole food than it is a supplement.
Kellie Curtain [00:12:07] You must be fun to go out to dinner with. Okay. So what about meat? There's always a discussion over meat, whether it's red meat or processed meat.
Lauren Atkins [00:12:20] Yeah. And look, there's a lot of research, particularly in the area of colorectal cancer that's explored processed meat and red meat. And the link with potentially causing or enhancing the risk of cancer recurrence. But there is some emerging evidence in the area of breast cancer also demonstrating that perhaps a reduction in our red meat intake and potentially even swapping out our red meat for poultry or seafood might be beneficial for our breast cancer risk and our breast cancer recurrence risk. So a recommendation would be to try and aim for less than 500 grams of red meat per week.
Kellie Curtain [00:13:01] That's not much, is it?
Lauren Atkins [00:13:02] Well, if you think about if you went out for steak, you might get a 300 gram eye fillet if you're lucky. You've almost, you're two thirds of the way there. So certainly bearing that in mind when planning your meals for the week can be useful. And I think there's a lot to say about reducing red meat because of some of those pathways that can happen. That are being explored that might increase risk of cancer, but the swap is where it's really profound. Because if you're replacing that red meat for poultry, seafood, legumes, perhaps tofu that have added benefit, you're doing even more good for yourself by swapping it out.
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Kellie Curtain [00:14:00] What about soy? There's a lot there's been sort of to-ing and fro-ing over the years over whether it's a hindrance or help ...
Lauren Atkins [00:14:10] So as it stands, the research is actually in favour of soy and the concern around it came from the concept that the isoflavones, which can activate oestrogen pathways in the body, might increase our risk of hormonally driven cancers. What happens in a test tube and what happens in mice models is actually quite different to what happens in the human body. And in fact, the research is demonstrating that soy intake does the opposite in the body and it might actually down regulate some of our natural oestrogen-driven pathways. And so soy products are recommended for those who may be at risk or have or recovering from breast cancer.
Kellie Curtain [00:14:57] Is that soy in any form like dairy or as a ...
Lauren Atkins [00:15:00] Yeah. Ideally we want it is in its most unprocessed form. So things like it edamame beans, tofu, tempeh, certainly soy milk, are really good choices to include. And one thing that's important to be aware of is that like anything, what we don't want to do is go from zero to 100 or from 100 to zero. So if you’re someone who hasn't included soy your whole life, ease your way into it. And similarly, if you wanted to cut back on your soy intake.
Kellie Curtain [00:15:30] And why is that? What to avoid stomach upset? Or.
Lauren Atkins [00:15:34] No more related to those hormonal pathways that might be triggered by an increase or decrease? So we just want to wherever we can, not to put shock on the body. And slow and steady transitions are always recommended.
Kellie Curtain [00:15:49] Is there some hype around fruit, is there a magical fruit?
Lauren Atkins [00:15:55] There is a so-called miracle fruit or a miracle berry, have you heard of that one before.
Kellie Curtain [00:16:00] I have heard of. Is that the goji berry? No
Lauren Atkins [00:16:02] No, it's a bit different to the goji berry. So miracle fruit is actually being harvested from western Africa.
Kellie Curtain [00:16:08] So it's actually called miracle fruit.
Lauren Atkins [00:16:10] It's called miracle fruit. Not for the reason that you think, though. So the reason it's been named miracle fruit is because it's got an active ingredient called miraculin. Which can actually ...
Kellie Curtain [00:16:20] Sounds like a miracle.
Lauren Atkins [00:16:22] It sounds like a miracle. Yeah. So the reason it could be considered a miracle is because it can actually change the way we perceive taste. And it can bind to the sweet receptors in our, on our taste buds in our tongue and can make sour foods taste sweet.
Kellie Curtain [00:16:39] Can it do the reverse as well?
Lauren Atkins [00:16:43] So I've tried it before many times actually to workshop with a group of 100 people and got them all having lemon and sour cream before and after the miracle fruit. And it's fascinating. It makes lemon taste like lemonade.
Kellie Curtain [00:16:55] Really? This could be the miracle for a sweet fix. For those with a sweet tooth.
Lauren Atkins [00:17:02] Well, there's lots of research underway. Very, very small studies at this stage because the funding isn't there for the poor miracle fruit farmers, but the ...
Kellie Curtain [00:17:14] Where did you say it's in?
Lauren Atkins [00:17:15] Western Africa? There are some farms in northern Queensland that harvest miracle fruit. You can certainly buy them online if you're wanting to do a little experiment at home. It's quite fun.
Kellie Curtain [00:17:25] Does it have nutritional benefit?
Lauren Atkins [00:17:27] So it is quite a, it's a very sweet berry. So about four times the sweetness of the blueberry. And so the theory is that you would need less of it and it would taste sweeter. And so there is some benefit potentially to use as a low-calorie sweetener and in diabetes management. But where it's very interesting for me is around chemotherapy-induced taste changes.
Kellie Curtain [00:17:52] Wow. Yes, of course.
Lauren Atkins [00:17:53] Yes. And there's been, again, some really small studies. Only about eight and 28 people have been tested in different scenarios where, during chemotherapy they were given the miracle fruit and asked if their taste improved or not and showed some reasonably promising results. The challenge is particularly with dairy products. Some people reported they actually tasted worse. So something that's already has a sweet profile or sugar in it might not necessarily respond well to that alteration in your taste buds. And one thing just to be aware of, is if you are undergoing any platinum-based chemotherapies or radiotherapy, having really large doses of miracle fruit will give you a high antioxidant load, which isn't necessarily beneficial or worthwhile or even encouraged at all when you're undergoing those type of treatments.
Kellie Curtain [00:18:47] So on the sugar topic. Does it cause breast cancer?
Lauren Atkins [00:18:54] It's a question I get asked daily; multiple times a day. So anyone who's had a PET scan will appreciate that in being given a glucose-based syrups or sugar-based solution, that allows us to explore cancer growth and activity in the body. And there is a concept that sugar feeds cancer. And while that is absolutely accurate, it's not the whole story. And so, yes, glucose or sugar is cancer's preferred source of fuel. But it's our entire body's preferred source of fuel. And what's really key to know is that if we starve our body of sugar or glucose, we're more likely to starve our vital organs than we are the cancer. And that's for a couple of reasons. So if we put cancer cells on a petri dish and we starved them of sugar or glucose, they grow less. But they don't have access to fat stores, to muscle stores to then get a different source of fuel. And what we often find is that particularly during treatment, when the body prefers to break down protein for fuel, is that by limiting your carbohydrate or your glucose intake, you're actually more likely to burn through your muscle stores. And that can lead to things like malnutrition, changes in your body composition, weakness and reduced tolerance to treatment. The other thing that's really challenging is that cancer is really greedy and it can certainly get energy from your fat stores, from your muscle stores, from other substrates, but it's also very good at developing its own nutrient supply so it can undergo a process called angiogenesis, which means it develops its own blood vessels to enhance the supply of nutrition to those cancer cells that want to grow really rapidly. And so, again, by reducing your sugar intake, it's more likely to impact your healthy cells than it is those cancer cells.
Kellie Curtain [00:21:01] Wow. Is there any difference if you're using artificial sweeteners?
Lauren Atkins [00:21:05] So there's another argument around artificial sweetener. Particularly there was some concern many years ago with regard to the aspartame levels and the concern that that might be that drive carcinogenesis process, processes. And that's actually really been really well studied. And organizations like the World Health Organization have undertaken sound research and found you would have to have somewhere like 18 cans of diet cola per day to reach a, an unsafe level of aspartame in your diet. So artificial sweeteners, they don't necessarily cause harm from a cancer perspective, but they can predispose us to want sweet things. And they can drive a bit of a dopamine response in the brain. That means right, I've had something sweet. I feel good. And so it can predispose you to want more sweet foods, which isn't necessarily a good place to be.
Kellie Curtain [00:22:01] So back on that whole foods thing, would you always recommend sugar versus an artificial sweetener?
Lauren Atkins [00:22:07] Look, not necessarily. It depends on your individual needs. If you were someone who was looking to reduce their body weight and had a large intake of soft drinks or sugar-sweetened beverages, actually a transition to a diet soft drink source, artificially sweetened beverages would actually be a step in the right direction. But even better than that would be opting for something like a water. I know, I'm so fun. Sparkling ice tea. So getting some of those flavoured tea bags and adding that to a soda water or mineral water, tea, herbal tea. Far better options. But certainly a step in the right direction would be a diet soft drink for many.
Kellie Curtain [00:22:50] So is organic food better?
Lauren Atkins [00:22:54] Mm hmm. Another good question. And organic food has been studied on quite an observational level. So lots of long term data in large groups of people. And what, we what we've found is that while organic produce certainly has an altered level of chemicals and pesticides in it, the non-organic produce, particularly in Australia has levels of chemicals and pesticides that are well within safe limits. And the health profile of organic versus non-organic is reasonably similar. In some cases some nutrients are higher in organic produce, but there are some minerals that are lower in organic. When we look at the impact that organic versus non-organic produce has on our overall health, the large long term data suggests that there actually is no impact on cancer risk. And when we look at smaller studies that perhaps where smaller numbers of people or not done so well, it's actually really hard to isolate organic produce as the driving force for health improvement.
Kellie Curtain [00:24:00] Which is big, isn't it, because to be organic is actually labour intensive and costly.
Lauren Atkins [00:24:08] Very. Yeah. And if you look at the perhaps the profile of somebody who might choose organic produce, they are far more likely to be well-educated. Higher SES. They get their health checks. They go to their doctors and get screened. They exercise regularly. And so to attribute the health benefit to the organic produce alone is really hard because it could just be that they're looking after themselves in other ways as well. So our recommendation when it comes to organic versus non-organic is if it's within your means and you prefer to eat organic produce please by all means. But if it's a choice between eating lots and lots and lots of fresh produce that's not organic versus a small amount that is, choose the lots and lots and lots. Because we know with good evidence that those whole foods will enhance our health.
Kellie Curtain [00:24:58] And for the really big question. Alcohol.
Lauren Atkins [00:25:03] Yeah, it's a challenging one, and particularly the evidence around alcohol during breast cancer is that less is certainly more. And there is a recommendation that we reduce alcohol intake after breast cancer to about six grams per day.
Kellie Curtain [00:25:22] Six grams, let's talk in wineglasses here.
Lauren Atkins [00:25:24] Definitely always. So about 60 mls of wine per day. So one standard drink is about 10 grams of alcohol. So it's really not a lot. And that can be very challenging information to hear after your life has been overhauled. And what I think is important is that everyone's aware of that. Firstly, we don't talk about it enough and knowledge is power. You can then take that and make your decision. And any step towards that is really helpful. But absolutely appreciate that that's not going to be everyone's cup of tea and it won't fit everyone's lifestyle. And that's okay, too.
Kellie Curtain [00:26:04] If you're going to drink alcohol, is there a better choice over ...
Lauren Atkins [00:26:09] With regard to breast cancer risk? Not so much. But I guess when it comes to your alcoholic beverage choice and maybe the impact it might have on calorie intake and weight, then yes, there is. So something like a spirit and soda, dry wine or a champagne would be a better choice than, say, a spirit and soft drink. So a whisky and coke or dry ginger ale because of that sugar and calorie load that comes with it. Something like a gin and tonic is similar. A cider would have lots and lots of sugar. So significant calorie load that you could easily drink, you know, multiple ciders in one sitting and you might have had the same amount of calories as, you know, up to a loaf of bread without really realising it.
Kellie Curtain [00:26:59] What about red wine? I mean, there's been lots of hype about a glass of red wine is actually good for you.
Lauren Atkins [00:27:06] We like to find goodness in red wine, in chocolate, and we bundle it up with the title antioxidants and polyphenols. I agree. Absolutely, we need to find goodness in food.
Kellie Curtain [00:27:19] Selective goodness.
Lauren Atkins [00:27:20] Absolutely. And in fact, red wine is also a reasonable source of a particular antioxidant nutrient called resveratrol, which has been shown to be useful in the context of longevity and anti-ageing. So, yes, the antioxidant argument is there, but still recommended to keep our levels lower if we can. So like I said, any step in the right direction. Alcohol-free days per week would be worthwhile because really, once you've had one glass, it's easy to have the second. Where if you can keep maybe three or four days a week clear of alcohol, then it allows you to enjoy the other days a little bit more freely.
Kellie Curtain [00:28:02] And just finally. Out of pocket costs for breast cancer, we know can be huge. And looking after one's health or through nutrition can come a little way down the list. What are the options available to people who would like to seek expert advice?
Lauren Atkins [00:28:26] Yes, certainly. And like you said, it's, it's really helpful, but it's not necessarily priority one. And we completely understand that. What I would encourage anyone to do who is still linked in with a trading hospital is to request a referral to see their dietitian. May or may not have access to that care, particularly depending on the resource constraints of that organisation. But if they are unable to see you, they'll point you in the right direction of somewhere else, perhaps locally, that might be able to support you. There's community health services that can be of support. And certainly one thing I would encourage all women or anyone undergoing cancer treatment or recovering from cancer to access would be what's called a chronic disease management plan; which is a supportive plan developed or devised in conjunction with your GP that can provide you with five Medicare-subsidised allied health visits per year. Of which you could certainly choose to allocate some or all of those to seek some support from an Accredited Practising Dietitian. And I think even if it's one appointment to get a little bit of knowledge and polish off some of your nutritional choices and make you feel really in control of your food choices can make such a big difference both physically but also psychologically.
Kellie Curtain [00:29:46] Some great advice there, Lauren. Thank you for joining us today. And if you'd like to dive deeper into nutrition, why not have a listen to Lauren's podcast - OnCore Nutrition Two Peas In A Podcast. As always, the opinions of our guests are welcome, but not necessarily shared by BCO. And please contact your health team with any individual concerns you have. This episode was made with thanks to Cancer Australia. For more information about nutrition and breast cancer, you'll find valuable links and resources on our website bcna.org.au. I'm Kellie Curtain. Thanks for being upfront with us.
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