Breast Cancer Nutrition Quiz

The Answers and Explanations

Lisa Schwartz, MD

Here are the answers to your quiz!I know you might be surprised by some of these, but they are backed up by clinical research. I hope you had fun taking the quiz and learned something at the same time.

Please let me know if you have any questions about lifestyle changes that breast cancer survivors can make to reduce the risk of recurrence. You can contact me at support@lisaschwartzmd.com.

Now read on to find out what you can do to reduce the risk of a breast cancer recurrence and live your best life!

Lisa Schwartz, MD

2©2019 MES Media, LLC. All rights reserved.

1. It’s ok for women with estrogen positive breast cancer to consume soy. TRUE

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Soy can actually be good for breast cancer survivors.While the research information on soy has been conflicting at times, the current informed thinking is that eating whole soy foods does not increase your risk of breast cancer or a breast cancer recurrence.

There are reasons why this has not been so clear

in the past though.

The interest in soy started with the studies that

showed that Asian countries had a lower

incidence of breast cancer than Western

countries. Women in Asian countries consume

more soy than their counterparts in Western

countries so some concluded that soy

consumption should be the reason for that

difference in breast cancer incidence.

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Soy can actually be good for breast cancer survivors. (cont)Now it should be obvious that soy consumption is

not the only lifestyle difference in women in

Asian countries and those in Western countries.

Asian diets are typically much healthier in

general, Asians tend to be less overweight

(especially when compared to Americans), and

they are typically more physically active. All of

those things contribute to a lower incidence of

breast cancer no matter what country you live in.

So the lower incidence of breast cancer among

Asian women cannot necessarily be attributed to

soy and is not a reason by itself to recommend

soy consumption for breast cancer prevention.

Another concern from the past has been that soy

contains phytoestrogens (plant estrogens). These

can act as weak estrogens in the body. Women

with “hormone fed” breast cancers (those that

express receptors for estrogen and progesterone

known as ER or PR positive) were cautioned that

eating soy may make their tumors grow. In fact,

the opposite is probably true. The reason for this

is that there are several different types of

estrogen receptors in the body, some protect you

from breast cancer and others promote breast

cancer growth. It turns out that the weak

estrogens in soy foods may stimulate the

estrogen receptors that protect you from breast

cancer.5

Soy can actually be good for breast cancer survivors. (cont)Finally, studies on soy food consumption done in

women without breast cancer and in breast

cancer survivors show that there is no increased

risk of developing breast cancer or of having a

breast cancer recurrence with one to two

servings of soy food a day.

Soy food is important here. Soy supplements and

powders provide a much higher concentration of

phytoestrogens and their safety has not been

determined. Soy foods include soy milk, tofu,

tempeh, soy nuts, and edamame and are a healthy

source of plant proteins.

A serving is one cup of soy milk, half a cup of

edamame, a half cup (about 4 oz) of tofu, or one

ounce of soy nuts.

Highly processed soy foods found in things like

tofurky and some veggie burgers or veggie

substitutes for other foods are not good for you

and should be avoided. Avoid foods made from

“concentrated soy protein” or “soy protein

isolates”. Soybean oil, soy sauce, and foods made

with soy lecithin do not contain any

phytoestrogens.

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2. Sugar feeds cancer. FALSE (sort of)

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Sugar and cancer is a little more complicated.Well, technically, sugar does feed cancer, but only because sugar feeds all the cells in your body. The real myth is that eating sugar makes a cancer grow, and that is NOT true. Here’s how it works.

Sugar is the fuel for all the cells of your body. All

the food you eat (proteins, fats, and

carbohydrates) can be broken down to sugars to

feed your cells. In general though, your body uses

carbohydrates to meet its immediate energy

needs. If there is not enough carbohydrate

consumed, then protein and fat can be converted

to a sugar the cells can use.

Eating a balanced diet containing carbohydrates,

proteins, and fats allows your body to use these

macronutrients most efficiently without robbing

proteins and fats to make sugar. No matter what

you eat your body tries to find balance to meet its

needs.9

Sugar and cancer is a little more complicated.The “sugar feeds cancer” myth likely comes from

the fact that cancer cells divide much more

rapidly than normal cells and therefore consume

relatively more sugar in order to feed that

dividing process. Cancer cells are also not as

efficient at using sugar and need more for basic

functions. Again, the sugar is not promoting this

process. The fact that cancer cells grow in an

uncontrolled fashion promotes this process.

But, not all sugar is good for you whether you

have cancer or not.

Here’s the scoop. Carbohydrates can be

categorized according to how quickly they

release sugar into the bloodstream. A spoonful of

table sugar gets absorbed into the bloodstream

very quickly and rapidly raises blood sugar levels.

As a consequence, your body releases a big batch

of insulin to bring the blood sugar down to a

normal level. Insulin takes the sugar out of the

bloodstream and puts it into the cells for them to

use.

The sugar from an apple gets absorbed into the

bloodstream more slowly because of its fiber

content.

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Sugar and cancer is a little more complicated.Your digestive system has to work harder to

break down the fiber and get to the sugars. This

leads to a slower increase in your blood sugar

levels and a slower release of insulin to bring your

blood sugar into a normal range.

This slower release of insulin is very important at

reducing your risk of “insulin resistance”. Insulin

resistance occurs when cells see so much insulin

around all the time that they become less

sensitive to it. This means that when insulin tries

to take sugar from the bloodstream and place it in

a cell for it to use, the cell actually refuses unless

there is a lot of insulin to overcome the

resistance. Eventually, the cells’ resistance to

insulin gets worse and there is not enough insulin

to get sugar into the cells. This causes a high

blood sugar and subsequently, type II diabetes.

While diabetes is something to be avoided as

well, what has all of this got to do with breast

cancer? A lot. In fact, there have been specific

studies in breast cancer patients demonstrating

this link between breast cancer and insulin

resistance. And the news is not good. Patients

with breast cancer and insulin resistance or

diabetes have a greater risk of dying from breast

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Sugar and cancer is a little more complicated.cancer. For this reason, I have dedicated a good

bit of time on how to deal with this situation (or

avoid it altogether) in my program on thriving

beyond breast cancer.

So what can you do about this right now? There is

a simple way to know which foods containing

carbohydrates will cause a sudden spike in blood

sugar and which carbohydrates will release the

sugar into the bloodstream more slowly. It is

called the glycemic index. More precisely, when

considering a healthy carbohydrate, you want to

look at the glycemic load of that food (this takes

into account the volume of that food in a normal

serving). Eventually you will come to know which

foods have a higher glycemic load than others,

but to get started, here’s a helpful guide from

Harvard: http://bit.ly/HarvardGIGuide.

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3. Consuming dairy does not increase your risk of breast

cancer. TRUE

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Dairy really is ok for breast cancer survivors.Some women are concerned that the growth hormones which are given to cows to increase milk production will increase their risk of breast cancer if they drink cow milk.

There is NO evidence that milk consumption increases your risk of breast cancer.

Dairy consumption is part of a healthy diet. Milk

is a great source of protein, calcium, and other

vitamins and minerals.

Cows produce growth hormone naturally, but

some dairy producers administer extra growth

hormone to cows to increase milk production. So

far, the US Food and Drug Administration, the

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Dairy really is ok for breast cancer survivors.World Health Organization, and National

Institutes of Health have reported that the

supplemental hormones given to cows are safe

for human consumption at the amounts present

in milk.

The hormone known as recombinant bovine

growth hormone has been banned in the EU,

Canada, Australia, Japan, and New Zealand. This

ban was based on animal health concerns rather

than human health concerns. There is still no

evidence that it is harmful to humans. Neither

natural nor synthetic bovine growth hormone has

been found to affect human growth hormone

receptors. If you are really interested in learning

more about this controversy, I found this

interesting summary from the Connecticut Office

of Legislative Research.

According to the USDA, from 2000-2005, only

about 17% of dairy farms in the US used

supplemental growth hormones. Organic milk in

the US is produced from cows who have not

received supplemental growth hormones. All milk

contains miniscule amounts of the naturally

occurring female hormones estradiol and

progesterone (but much, much less than women

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Dairy really is ok for breast cancer survivors.have in their bodies). Consumption of milk does

not appear to affect human blood levels of

hormones.

And, drum roll please...Milk consumption has not

been linked to breast cancer. In fact in one recent

review, there was an inverse relationship

between dairy consumption and breast cancer.

Finally, to address another big misconception:

there are no antibiotics in milk. Dairy cows are

treated with antibiotics only when they are sick.

They are separated from the herd and their milk

is discarded until the antibiotics have cleared

their systems. All milk must test negative for

antibiotics. Antibiotic use in animals used for

meat production is a different story.

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4. Acidic diets cause cancer and alkaline diets prevent

cancer. FALSE

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“Alkaline diets” don’t prevent cancer.This false recommendation has been incredibly persistent in spite of the fact that it cannot be supported by basic biology. Let me give you a quick rundown on the thoughts behind the myth

and the sensible evidence for the impossibility that the myth has any basis in reality. (That’s my way of saying this myth is not true.)

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“Alkaline diets” don’t prevent cancer.The myth says that cancer cells exist in an acidic

environment, and in fact, thrive there. If you eat

acidic foods, then you are feeding the cancer

cells. The myth also holds that the converse of

this is true: if you eat alkaline foods, then you are

not feeding the cancer cells (and presumably

starving them of the acid they need).

So let’s discuss the first part of the myth. Cancer

cells exist in an acidic environment. True. But they

don’t like it any more than a normal cell would. In

fact, the acidic environment in which they live is

of their own making. You see, cancer

cells divide uncontrollably and use up resources

like food and oxygen much faster than normal

cells. In fact, they metabolize these resources so

quickly that the waste they create builds up. In

addition, cancer outgrows its blood supply which

is the main way that it receives food and oxygen

and gets rid of its waste. What might that waste

be? You guessed it: acidic stuff. So cancer cells live

in an acidic environment that they create, but

they don’t thrive there. In fact, the cancer cells at

the center of a tumor mass are dead (in med

speak, “necrotic”). The cancer cells that are still

living are at the outer edge of the tumor mass

where they can still get a blood supply to receive

nutrients and dispose of acidic waste.19

“Alkaline diets” don’t prevent cancer.So, on to part two of the myth. I’ll simplify it just a

little. Eating an acid or alkaline diet can have an

impact on the acidic environment of the cancer

cells. To tackle this, let me give you some

background on how your body works.

Every human being has a blood pH of 7.4. The pH

is a measure of how acid or alkaline a substance

is. Middle of the road is 7, so blood is ever so

slightly alkaline. As a walking, breathing,

nondistressed human being, your blood pH is

always 7.4. Not 7.3. Not 7.5. Always 7.4. How can

I make this statement with such certainty and

specificity? Because if your blood pH should

deviate from 7.4 by even a tenth of a point, you

are sick. Generally, you and your doctors know

that you are sick--it is not a subtle change. And

your body is using every mechanism at its

disposal (and there are many) to get your blood

pH back to 7.4, ASAP.

The kidneys and the lungs play major roles in this

regulation of blood pH, but if they are not

working well (say, because you are in shock, on a

ventilator, or in kidney failure) then you can get

your blood pH out of whack and end up in the

Intensive Care Unit.

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“Alkaline diets” don’t prevent cancer.What you eat on a day to day basis has NO

significant impact on your blood pH (short of

some psychological condition involving the

voluntary consumption of a deadly amount of

acid or alkaline substances). Nor would you want

your diet to impact your blood pH. It would be too

difficult to regulate and always keep the pH at

7.4. So your body takes care of that complicated

task for you.

And feeding a cancer cell alkaline food (if you

could actually invite one to dinner) has no impact

on how its metabolism works. It still produces

acid as waste.

Will an alkaline diet hurt you? Absolutely not. It

also will have no impact on your blood pH or the

survivability of any cancer cells in your body.

However, there are a lot of foods labeled

“alkaline” by the promoters of this diet that are

indeed very healthy. This food group includes

fruits, nuts, legumes, and vegetables. All very

healthy and may prevent cancer and other

chronic diseases. But not because of any impact

on the acid-alkaline balance in the body.

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5. Smoothies and juices really are not that healthy.

They tend to be sugar bombs. TRUE

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Sorry, but put that glass down. I hate to disappoint you on this one. Smoothies and juices can be calorie packed, devoid of any meaningful fiber, and loaded with sugar (especially those that are commercially made).

I know you’re trying to be healthy. Juicing and

smoothies seemed to be the perfect solution to

getting all those fruits and veggies into your diet.

And that juicer salesman said he lost 50 pounds

by juicing! So what’s the real scoop.

First, let’s talk about “juices” which means the

juice of a fruit or vegetable separated from its

pulp and fiber. First the good news...you are

getting some vitamins and minerals when you

drink that juice. But no real fiber. The sugars that

are in your juice get absorbed very quickly into

the bloodstream because there is no fiber to slow

things down. (For a refresher on how the rapid

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Sorry, but put that glass down. absorption of sugar into the bloodstream leads to

an increased risk of diabetes and other chronic

diseases, see myth #2 about sugar and cancer in

this same guide.) When you eat a piece of whole

fruit, you’re also consuming fiber, and the sugar is

more slowly absorbed.

But what about smoothies? By “smoothies” I

mean throwing whole fruits and veggies into a

blender and drinking the blended result. What

could possibly be wrong with that? In this case,

you’re still getting the fiber from the whole fruits

and vegetables, but that fiber has now been

pulverized by your blender. So it’s still there, but

intact fiber slows the absorption of the sugar

more than fiber that has been pulverized. So it’s

probably better than juicing, but you’re still not

doing something as healthy as eating the whole

fruits and vegetables.

The other benefit to eating the whole fruits and

vegetables is that you take more time to eat the

whole fruit or vegetable. When you drink a

smoothie or juice, you’re drinking down a whole

lot of calories in a short amount of time. If you

had been eating the fruits or veggies, you might

have felt full earlier and stopped eating so that

you would not have consumed as many calories.

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Sorry, but put that glass down. And the last thing I want to mention is that many

commercially available smoothies or juices often

have added sugar. Not only do they have the

sugars from the fruits and veggies, but a lot of

manufacturers will actually add sugar.

In summary, eat your fruits and veggies, don’t

drink them.

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6. You should eat whatever you want to keep your weight

up during therapy. FALSE

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This is a time to focus on being healthy.I am truly sorry about this one...but, no, it’s not okay to put on a few extra pounds during chemotherapy. Nor is it ok to eat all the things that taste good to you--cookies, cake, ice cream, french fries, pizza...

While it is true that most docs don’t want you to

lose weight during chemotherapy, gaining weight

is not helpful. Your body does require a little

extra energy to fight off infections and you might

miss a few meals around your chemo dose, but

that’s not enough calories to go hog wild.

In fact, this is a time when you want to make sure

you are getting the best nutrition possible for

your body to be in top form. You need to be

making white and red blood cells, regrowing hair,

healing your GI tract, and recovering from

fatigue. This is a time for healthy foods, not crap.

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This is a time to focus on being healthy.The other really unfair thing about this breast

cancer business is that patients undergoing

breast cancer treatment usually gain a little

weight. Go ahead...let it out...

There are many reasons for the weight gain.

Some of the meds make you eat more. Most

women go through some hormonal change with

treatment that contributes to weight gain. Your

activity level probably declined during treatment.

And then there’s stress eating. But the low down

is that the better you eat, the better you will feel,

and the sooner you will recover. Maintaining a

healthy weight actually decreases your risk of

recurrence as well. Much more on that in my

program on how to thrive beyond breast cancer.

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7. Now that I’ve been through treatment, I’ve done

all I can to prevent a recurrence. FALSE

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There is so much more you can do... I’ve saved the best for last. And it’s not just a nutrition question here. There is so much that you have control over that can have an impact on your risk of recurrence and your overall health.

The changes that you make in your life right now

can reduce your risk of recurrence by 30% to

50%. Yes, really. That might be as much of a risk

reduction as you got with chemotherapy or

radiation. Here’s what you can do:

Follow a diet rich in fruits and vegetables, lean

proteins, healthy oils (from avocados, olives,

seeds, and nuts), and whole grains. Avoid

processed and “fast” foods as much as possible.

Get the minimum recommended 30 minutes of

exercise a day. This can be 30 minutes of walking

2-3 mph or any equivalent.

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There is so much more you can do... Relax. I recommend that you learn how to

meditate and do so every day for at least 10

minutes. Learn some breathing exercises for

those particularly stressful moments in your day.

If you are troubled with fearful and negative

thoughts, don’t hesitate to reach out for support.

There is probably a breast cancer support group

at your hospital or you can ask your doc for a

recommendation for a therapist. Don’t suffer in

silence.

Because it is so important to dispel this last myth,

I have developed an entire program on how to

implement the necessary life changes to do all

that you can to prevent a breast cancer

recurrence. I will be sending you more

information about it very soon. Look for it.

In the meantime, you can find more helpful

information about breast cancer and healthy

living on my website LisaSchwartzMD.com.

Take care and be well.

Lisa Schwartz, MD

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About Dr. SchwartzLisa M. Schwartz, MD is an internist and radiation

oncologist who has treated, cared for, and advised cancer

patients for over two decades. Her focus is on helping

breast cancer patients recover their wellness through

lifestyle changes such as good nutrition, physical activity,

and a mindset shift. Her interest in how patients deal with

their diagnosis and treatment both emotionally and

physically led her to investigate many forms of

complementary therapies and patient support strategies.

She has a master’s degree in Traditional Chinese Medicine

and completed an associate fellowship in Integrative

Medicine under Dr. Andrew Weil at the University of

Arizona.

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*suggestions for myths accessed from: https://foodandnutrition.org/blogs/stone-soup/5-myths-nutrition-breast-cancer/