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Answering your questions from our webcast Make Nutrition Count- Eating well when you have cancer

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On March 31 we hosted a webcast, Make Nutrition Count- Eating well when you have cancer, presented by registered dietician Julie Kozmenuick. During the webcast we received a lot of questions for Julie, so many that we were unable to get to them all during the presentation. Over the next few weeks, we're going to be posting Julie's answers to your questions regarding nutrition and cancer. 

Here are Julie's answers to the questions asked during the live webcast:

Q. What is the nutritional benefit of margarine and sugar?

Cancer and treatments can increase the body’s need for energy and nutrients. During the presentation, margarine and sugar were on my list of high calorie (high energy) foods. Both are sources of energy for the body – sugar is a carbohydrate source of energy while the energy from margarine comes from fat. Margarine also has vitamin D and vitamin E for bone and skin health (respectively). Vitamin E is also an antioxidant which can help protect our body’s cells from cancer. Margarine and sugar do not belong in any of the 4 food groups so it’s important to eat these in moderation and add them to healthier food choices from the food groups.

Q. What about diet and diverticulitis during chemo?

I encourage anyone looking for personalized advice on nutrition to consult with a registered dietitian. This situation seems like a one-to-one discussion with a dietitian would be beneficial.
Generally speaking, a person with diverticulitis should be able to continue manage it with the diet they followed prior to chemotherapy. However, symptoms of the condition, like diarrhea and constipation, may be aggravated by the effects of chemotherapy. Be sure to avoid foods that make the diverticulitis worse (for example, nuts, seeds, corn, popcorn are commonly avoided or eaten with caution) . Find out more about managing diarrhea and constipation.

Q. How much vitamin C during treatment 500mg?

For most people, it is fairly easy to get your daily intake of vitamin C through the foods you eat. Foods that are excellent sources of vitamin C include many vegetables and fruit like oranges, grapefruit, tomatoes, strawberries and other berries, broccoli and juices. An adult requires 75-90 mg vitamin C per day. One medium orange can give adults most, if not all, of the recommended amount of vitamin C.
If you are considering taking a supplement of vitamin C, please talk to your doctor first. Vitamin C is an antioxidant which can interfere with cancer treatments. You may be asked to stop taking antioxidant supplements.
There is some great information about vitamin C by Dietitians of Canada.
Q. I currently follow a gluten-free/sugar-free/dairy-free lifestyle. I was recently diagnosed with breast cancer. Will I have to modify this nutritional lifestyle or can I adhere to it?

Yes, you should be able to continue to follow this way of eating. However, this is my simple answer to your question. I suggest you seek the advice of a dietitian in your area. I suspect you replace dairy with soy such as soy milk and cheese. Because of the issue of plant estrogens in soy (that I mentioned during the question period of the presentation), I would want you to discuss this in more depth with the dietitian. To reiterate, there is no evidence that people with breast cancer should avoid soy, but it might be worthwhile control the amount of soy to consume each day until we know more about this.

Q. What is the current thinking on soy products and breast cancer (ie. eat, not eat, limit, etc)?  Is tofu a food to avoid when having breast cancer?  Will the naturally occurring hormones in milk affect the hormonal system or affect hormonal cancers?

We had a few questions about soy and hormones so I would like to address this issue again. Soy contains estrogen-like plant compounds called phytoestrogens. Since some cancers thrive on hormones (hormone-dependent), it is possible that phytoestrogens may accelerate the growth or cause a recurrence of hormone-dependent cancers. Based on the current research, it is not clear what effect phytoestrogens may have on people with hormone-dependent cancers. People with hormone-dependent cancers should talk to their healthcare team if they are unsure about eating soy foods and the amounts that may be consumed. I encourage people to enjoy soy foods in moderation, and avoid soy-based supplements which tend to contain very high concentrations of soy.
Q. I have been prostate cancer free for 20 months. I'm 5 feet 8 inches tall I weigh 194. How much over weight am I?

Congratulations on being prostate cancer free! You are wondering about your body weight. A quick screening tool for body weight is something called body mass index or BMI. It uses you height and weight to classify you into a category. Many websites including Dietitians of Canada, have a BMI calculator. Your BMI is 29.5 which puts you in the overweight category. A BMI over 25 puts you at risk for developing chronic diseases like cancer. Most people should aim for a BMI between 18 and 25. Calculating BMI is only one tool. I also encourage people to gauge weight and weight loss on how you feel about your health, lifestyle and self. Are you eating healthy? Are you physically active most days of the week? How do your clothes fit? Do you feel good about yourself and your body? The number on a scale should not become our focus.
Q. Baking soda and cancer?

The American Cancer Society has a good discussion about baking soda that includes some background behind the relationship. I have not come across any reliable scientific evidence that shows that consuming baking soda is beneficial.
As I said during the presentation, there are problems with the claim that cancer cells thrive in an acidic (low pH) environment and can’t survive in alkaline (base or high pH) surroundings. Baking soda is alkaline but eating these types of foods does not change a body’s pH level. The body’s acid-base balance is tightly regulated by several mechanisms, among them kidney and respiratory functions.
Q. Are almond, soy products a safe replacement for cow's milk?

Many people choose plant-based milks instead of animal milks like cow’s milk. This is especially true when they want to avoid/limit animal foods, lactose and cholesterol. They are a safe alternative to cow’s milk for most people. If dealing with a hormone-dependent cancer like breast cancer, I encourage people to be aware of the servings of soy they are consuming. Until we know more about the effects that soy and phytoestrogens have on these types of cancer, caution needs to be taken with the amount of soy products consumed each day.
Plant-based milks and products tend to have a lot of the same nutrients as animal-based milks, but they are not equal. They have differences, particularly in the type of protein that each contains. Therefore, regardless of the type of milk you consume, enjoy a variety of different foods and beverages. This is what will give you a variety of different nutrients.

Q. I eat a lot of chicken and fish, but have heard to cut down on red meat. Is this true?

Red meat has been linked to an increased risk of certain types of cancer, like colorectal cancer. Find out more about meat on our website. Lean meats, including chicken and fish, can be a part of our meals. They are an excellent source of protein, vitamin B12 and iron. I also encourage people to enjoy plant-based alternatives to meat like legumes (dried beans, peas and lentils). They are still a great source of protein but do not have fat content like meats.
Q. Do you think that ketogenic diet is good for people with cancer?

The ketogenic diet is a very low carbohydrate diet. At this time, there is not enough evidence in humans to show that this type of diet is safe, feasible and beneficial for people with cancer. There have been and continue to be some early clinical trials that are showing promise with the diet in people with brain tumours and advanced cancer. But these trials include only small numbers of people. There needs to be more research in this area. Therefore, I don’t suggest this type of diet for anyone. I especially worry about the risk of malnutrition by restricting carbohydrates so drastically. Malnutrition can lead to many health problems. We also don’t know about the long term effects of this diet on our health and well-being. If you want to read more about the ketogenic diet, I would suggest this article.
Q. Is it true medical marijuana increases appetite and be helpful for some people?

It is true that some people find that medical marijuana helps improve appetite. Find out more about medical marijuana and cannabinoids.
Q. Sometimes it is hard to keep cooking for one person. Any idea where I can find resources about food I can prepare ahead and freeze safely?

Yes, cooking for one can be a struggle. I understand as I live alone and cook for only myself on most days. Making meals and freezing them in single portions is a great way to have healthy homemade meals, especially when you don’t want to cook or feel like cooking. Things that usually freeze very well include casseroles, pasta dishes, soups and stews. I suggest doing an internet search for “freezer meals”. You can find a lot of healthy options to choose from. The following websites may give you some additional ideas on eating for one:
Cooking for one or two
Tasty meals when cooking for one
Q. You have spoken of soy products but how about rice products. Does the consumer reports article negate the use of these?

The consumer reports have talked about the arsenic content in rice and rice products. Both Canada and the US continue to test rice products for arsenic levels. I looked at the following websites to read about rice and how they advise consumers. At this time, rice and rice products seem to be a healthy and safe choice within a well-balanced diet.
Canadian Food Inspection Agency
The levels of arsenic detected in the rice commodities tested herein would not be expected to pose a human health risk to the Canadian public.
US Food and Drug Administration
Is rice safe to eat? Is it safe for children to eat?
Rice is an important staple for many people, and the arsenic levels that FDA found in the samples it evaluated were too low to cause any immediate or short-term adverse health effects. All consumers, including pregnant women, infants and children, are encouraged to eat a well-balanced diet for good nutrition and to minimize potential adverse consequences from consuming an excess of any one food.

Q. Can you talk about vitamin B17?

I’ll be honest, I don’t know a lot about vitamin B17 (Laetrile) other than it is promoted as an alternative cancer treatment. For this reason, I would like to point you in the direction of some reliable resources that discuss Laetrile and the research regarding it:
Memorial Sloan Kettering
American Cancer Society
Q. Is there a connection between cancer and candida/yeast? I have read some theories online and am wondering what your thoughts are on the potential connection?

I apologize for not being able to respond to this question at the time of the live webcast. I was not familiar with the theory. After reading some information about the theory, the basis is that candida or yeast causes cancer. During the years of working in this field, I have not come across any evidence which shows that candida is cause or risk factor of any type of cancer. I know that candida can infect people, but I don’t believe all of these people also have cancer.
The theory also states that baking soda can treat candida. As I said before, I have not come across any reliable scientific evidence that shows that consuming baking soda is beneficial. To my knowledge, baking soda is not a proven treatment for candida infections.
Cancer Research UK talks about this topic. As they do, I also believe this to be a myth because there is insufficient evidence to prove otherwise.
Q. Tips for people with sore mouth lesions

We have information about sore mouth and throat on our website, One of the most important tips is to do regular mouth care. Having bland, cool foods can ease the pain from a sore mouth.
Q. Should people avoid alcohol during treatment?

Because everyone is different and going through different treatments, I suggest that anyone going through cancer treatment discuss the consumption of alcohol with their doctor and healthcare team. Alcohol can interfere with certain treatments and medications you are taking.
Some people find that drinking small amounts of alcohol can help stimulate the appetite. However, it is still important that you check with your healthcare team first to ensure drinking alcohol is safe for you.
Q. Is the research on nutrition for cancer continuing and ongoing, or do we rely on past research summaries as to what is effective and what is not? Asia has the least amount of breast cancer and dairy is not part of their diet, yet it is a big part of ours.

Yes, research in this area is ongoing. The Canadian Cancer Society is funding research related to nutrition. For example, Dr Joanne Kotsopoulos is looking at the role of diet and lifestyle, as well as their interactions with genetic factors. This research includes how they influence breast and ovarian cancer both in high-risk populations (specifically due to BRCA mutations) and in the general population. Also, Dr Caroline Diorio has published research that found that a diet high in sugar may increase breast cancer risk. Dr Diorio’s research showed that dense breasts have larger amounts of connective, gland and milk duct tissues than fatty tissue. Research suggests that the intake of sweet items could enhance cell growth and, therefore, density in breast tissues. The Canadian Cancer Society continues to support research between nutrition and cancer.
I believe it is also important to note that nutrition is likely only one piece of the puzzle. For example, Asian countries often have higher incidences of certain cancers, such as stomach cancer, compared to North American countries. Research shows that stomach cancer if also linked with certain nutrition risk factors like salt.
Q. What is happening in the body if weight gain has become apparent since being diagnosed with cancer (specifically appendix cancer)?

Appendix cancer can be a type of cancer called neuroendocrine. Neuroendocrine cancer or tumours can affect hormone levels in the body. The changes to certain hormones being produced may lead to changes in body weight. This is one possible explanation of weight gain, but the best person to ask this question of would be a doctor.

If you were unable to catch the live webcast, you can watch it on demand by clicking here



We are continuing to update the questions posted above from the webcast. I've just added four more questions answered by Julie, so take a peek to see if the questions you asked are answered above.
  • Posted Thu 09 Apr 2015 11:17 AM EDT
Hi Julie, I have awful acid reflux, now I have a tumor in the lower esp in the GI junction. I have not eaten an orange or anything citric for over 30 years. I take vit C tablets instead. I doubt I ever get enough. Wondering if other have this issue? Nancy
  • Posted Mon 13 Apr 2015 06:30 PM EDT
Hi everyone, we've just posted a few more questions answered by Julie. We'll continue posting these answers over the next few days.
  • Posted Mon 13 Apr 2015 03:35 PM EDT

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