There's so much to learn and so many decisions to make — it can all feel a bit "much" when you've just been diagnosed with metastatic breast cancer. That's why HealthCentral spoke to oncology dietitian and nutrition educator Julie Lanford, MPH, RD, LDN of Winston-Salem, N.C., to get her best tips for developing an eating plan when you’re living with this cancer.
Lanford is also the founder of CancerDietitian.com and the wellness director for nonprofit Cancer Services aims to help people with cancer regain a sense of control in their lives.
That's what she hopes you'll do with your nutrition, too, and she offers the following nine pieces of advice.
1. Be real
Nutrition can't guarantee you won't get metastatic breast cancer or make it go away, says Lanford, but it’s still important.
"Smart nutrition is a form of risk reduction for everyone; plus, it helps you feel better today and tomorrow,” she told HealthCentral in a phone interview. “It doesn't take the place of proven, effective, traditional treatment, but it may enhance your chances of living longer."
That's according to a July 2017 study in The New England Journal of Medicine that found eating more vegetables, fruits, whole grains, and fish raised participants' diet scores and reduced risk of dying prematurely.
2. A work in progress
You've accepted that you will undergo treatment for the rest of your life, and that some days will be harder than others. If you're "feeling OK," not having a lot of nausea and fatigue, for example, "you can probably eat pretty much like normal," Lanford says. If you're not feeling OK, you'll consume a diet that helps manage those symptoms until you can eat other things.
3. Plant it
You've likely heard about the benefits of plant-based diets. Lanford highly recommends them, as does the American Institute for Cancer Research (AICR). These diets not only reduce the risk of certain cancers, but also heart disease and type 2 diabetes. Plus, they help control weight.
This kind of diet doesn't have to be about all plants all the time — just more of them, says Lanford. All the while, you should also be consuming adequate carbohydrates and protein, spacing meals throughout the day, and staying hydrated with plenty of water.
You can go vegetarian or vegan, or you can include some dairy products, meat products such as lean chicken or turkey, and of course, fish. Eating more plants means you get the benefits of helpful chemical compounds called phytonutrients (also called phytochemicals), that fight disease and can't be taken in a pill, Lanford says.
They protect your body's cells from being damaged and thus being more susceptible to cancer. In fact, plant-based foods are known to contain tens of thousands of these phytonutrient warriors that have anti-inflammatory and antioxidant properties, according to an article in Today's Dietitian.
4. Think before you drink
Moderation is a key to healthy eating and drinking. Follow the recommendations of drinking no more than one alcoholic drink per day for women and two for men. Extensive reviews of research show a strong association between alcohol and several types of cancer, according to the National Cancer Institute.
Try to limit your alcohol consumption to twice weekly.
"My rule of thumb is that if you have something three times a week, it's a habit," Lanford says.
5. 'I'm not hungry'
"If your treatment has caused you to feel nauseous and totally disinterested in food, and if you're losing weight, add extra calories in a heart-healthy way," says Lanford. "That means adding more unsaturated fats such as nuts, seeds, olives, avocados, and fatty fish. But any calorie in this situation is better than no calorie, so if you really feel like eating only a milkshake, then you should have that."
6. Sugar smarts
You may have heard that if you have cancer, you need to completely avoid all forms of sugar, Lanford says. If you did, you would be avoiding candy and sweets, but also important food groups such as fresh fruit and dairy products. Complex carbohydrates are also your friend, found in peas, beans, whole grains, and vegetables. All take less time to break down in your body, so you don't get hungry so quickly, while simple sugars break down quickly.
Too much sugar is associated with weight gain and obesity, which are associated with increased risk of cancer, she says.
7. Be flex about flax
Your pathologist may have tested your breast cancer cells to assess for the presence of receptors whose growth is stimulated by estrogen or progesterone. You may then have been advised to take hormone therapy medications.
"Sometimes I'm asked whether flaxseed interferes with estrogen-blocking or -inhibiting medications," says Lanford. "No, it doesn’t when you eat it in food form. Flaxseed contains healthy fat, and you can feel free to consume all parts of the seed."
She cites this blog from AICR, which recommends eating ground flaxseed and doing so at least an hour or two before you take medication.
8. Safe and soy
"In the late '90s and early 2000s, we heard a lot about soy and isoflavones, a class of phytoestrogens. So if a person was estrogen positive, research suggested soy would increase cancer growth," Lanford says. "That research was conducted in rats, which don't metabolize soy the way humans do."
Later, it was thought that those isoflavones, predominantly found in legumes and beans, were a deterrent to breast cancer. Conversely, some worried that foods with soy might reduce potency of drugs that fight breast cancer, including tamoxifen.
In March 2017, a Tufts University study found that, "in specific circumstances," eating more soy as part of an overall healthy diet could be beneficial. The research did not include supplements.
"Enjoy your soy by eating the whole plant, which has beneficial components," says Lanford, who likes this AICR round-up on soy.
9. Sound middle ground
Try not to go to extremes and obsess about your diet, Lanford says.
For example, don’t say, "I'll use nutrition as the only treatment for my cancer, and I'll obsess about every little detail." The other end of this spectrum to avoid is, "Nutrition doesn't matter, and I'm going to eat what I want when I want."
Work with your dietitian to adopt a sensible philosophy about eating that doesn't consume you, and yet still allows you to enjoy life — and good food. If you find yourself going overboard about every single bite, you may be developing disordered eating because of your need to control all the aspects of your nutrition. Consider talking to a counselor to gain another perspective on this.
"It's important to find the right balance, to nourish our bodies in ways that make us feel well," Lanford says. "What's the point if you can't enjoy the occasional brownie?"