As a cancer patient, I have grave concerns about the current advice being given to many cancer patients in this country. The Irish Nutrition and Dietetic Institute (INDI), who consider themselves “the only qualified health professionals that assess, diagnose and treat dietary and nutritional problems” in Ireland, have two fact sheets relating to cancer and diet. One is focused on changes in appetite for palliative care. The other aims to, “Reduce your risk of cancer”.
Some of the advice that INDI recommends as contained in that fact sheet (also recommended by The Irish Cancer Society) is as follows:
- The bulk of your diet should include highly processed, high carb food such as pasta, rice, sliced pan, cereal.
- The above recommendation is an endorsement of foods that turn into glucose and dramatically affect blood glucose.
- These same foods are foods that require a large amount of insulin to be metabolised.
- Beneficial herbs & spices are not even mentioned.
- Cruciferous vegetables are given same weighting as baked beans, which are full of sugar or artificial sweeteners.
- Oily fish and healthy fats are heading towards a “negative” zone.
- Branded foods, like Weetabix and sliced pan, are given prominence.
- Low fat products, including low fat milks and processed spreads, are recommended instead of full fat ones.
- It is recommended to follow the food pyramid, as this is “part of a healthy lifestyle”.
- Eat carbohydrates at every meal.
- Tinned fruit in syrup can be part of your “five a day”.
This is the same organisation that not only suggests high-carb diets are acceptable for cancer patients, but also that foods such as Weetabix & Digestive biscuits are “healthy alternatives” for Type 2 diabetics to snack on.
In the interest of cancer patient welfare, I urge INDI and The Irish Cancer Society to re-visit these fact sheets and amend their advice as necessary.
Here are ten things cancer patients should be made aware of:
- The food pyramid is a sacred cow as far as most dieticians are concerned. Yet it is flawed and represents many food companies’ interests. It is not solely based on science. https://www.irishtimes.com/opinion/domini-kemp-beware-of-nutribabble-in-revised-food-pyramid-1.2896417
- There are numerous scientific papers that support the approach of limiting sugar or other glucose forming foods from the diet for cancer patients. Check out this paper that discusses the role of carbohydrate restriction for cancer patients and its promising effects in a lot more detail.
- There are numerous studies showing the benefits of low carb diets for weight loss. Weight is an important factor for cancer patients. Being overweight increases your cancer risk. This study demonstrates that some people benefited from each approach but more people benefited from LCHF (low carb/high fat) and fewer people gained weight again. There are now over 40 randomized controlled trials (RCTs) comparing LCHF diets to other dietary practices.
- The dietary guidelines for the last 40 years have been found to be wanting in many respects. http://thebigfatsurprise.com/concern-science-dgas/
- If current trends continue, we will be the fattest nation in Europe by 2030.
- We are lagging way behind other countries that are recognizing the benefits of low carb diets in relation to obesity and T2 diabetes and are implementing low carb dietary guidelines (Iceland, Czech Republic, Sweden).
- There are many bi-directional links between cancer & diabetes.
- There are currently 261 studies relating to metformin & cancer in both prevention and treatment: Metformin is a T2 diabetes drug that controls blood sugar.
- There’s a simple way to control blood sugar in your diet, and insulin spikes, and that is by eating a low carb diet.
- There are studies showing that post diagnosis, some patients revert to worse eating habits and lifestyles. Prevention is not just about primary cancer, but also about preventing secondary.
CONFLICTS OF INTEREST
Too many healthcare professionals with conflicts of interest arising from relationships with food companies have hijacked this worldwide argument leading to poor decisions and poor advice being offered. And it completely obfuscates the real problem.
My interest in this whole debate is as a cancer patient. I am an advocate for better and more up-to date information regarding nutrition and exercise to be in the hands of cancer patients.
INDI is a dieticians association and lobbying group. They have failed to answer several of my emails relating to questions about their sponsorship arrangements.
Just Google some of these words: “dieticians” + “sponsorship” + “food companies”. You’ll see lots of back and forth, but Marion Nestle (absolutely no connection with Nestle foods!) has a good piece here on why transparency and disclosure of financial supports are so important regarding nutritional information and recommendations.
INDI made a complaint about Patricia Daly, my co-author of “The Ketogenic Kitchen”, relating to her website and the “claims” she made pertaining to the efficacy of the Ketogenic diet (KD) in relation to cancer. The ASAI has ruled that Patricia cannot refer to the efficacy of the KD in relation to cancer treatment until she holds appropriate evidence to substantiate the claim. We have told the following oncologists, scientists and researchers that an Irish Advertising Authority will not allow anyone based in Ireland to refer to the efficacy of KD as an adjunct to conventional treatment.
- Dr Adrienne Scheck (Cancer researcher Phoenix barrow Institute)
- Dr Colin Champ (Oncologist, MIT grad)
- Dr Rainer Klement (MD, Radiation oncologist)
- Prof Dominic d’Agostino (Cancer researcher University South Florida)
- Dr Georgia Ede (MD)
- Prof Dawn Lemanne (Oncologist)
- Prof Thomas Seyfried (Cancer researcher, Boston College)
Let me be crystal clear: Patricia is merely reporting the evidence from these leading oncologists, cancer researchers and scientists. It is not her science. She does not make these “claims”. But it is what she bases her dietary guidelines on. Our book and her courses guide people and introduce them to the benefits but also limitations of Low carb cooking and lifestyle.
She gave numerous published papers and references, but the ASAI explained that the way in which we presented our response was not clear enough. They explained that they were not obliged to extrapolate the evidence contained in these papers. We should have been a lot more prescriptive in our responses and a lot less thorough. This seems contrary to the rules of natural justice, in my opinion.
Sadly, the ASAI are missing the point. Patricia did not go into a lab and concoct some theory about low carb diets all by herself. She relies on up-to-date nutritional research and adapts her dietary recommendations as and when new evidence becomes available.
Patricia – in summary – recommends people get educated and that if they do want to follow a very low carb diet, that they do it under supervision. She has always stressed that in no way should a diet replace conventional treatment and that the KD is limited, will only work for some, and that evidence is pre-clinical and case study based. Like most areas in cancer nutrition are, by the way! Her expertise in this field is why oncologists from all over the world send her clients. To help them with safe implementation of a challenging diet. To do it safely and effectively with good intake of nutrients.
I believe the ASAI are not equipped to make decisions about emerging evidence in the field of oncology & nutrition. I believe they have done a grave disservice to patients in Ireland, by preventing them from obtaining all relevant information.
It is unfortunate that many dieticians in Ireland seem so unwilling to adapt their dietary recommendations. I believe this resistance to change is to the detriment of cancer patients.
It is my hope that this letter will prompt INDI and The Irish Cancer Society to reflect upon the advice currently available for cancer patients in Ireland.
(Fine E and Feinman RD (2015) Insulin, carbohydrate restriction, metabolic syndrome and cancer. Expert Review of Endocrinology and Metabolism, Vol 10, Iss 1)
(Gardner C.D. et al. Comparison of the Atkins, Zone, Ornish, and LEARN diets for change in weight and related risk factors among overweight premenopausal women. The Journal of the American Medical Association, 2007. 297(9): p969-977)
Habib S and Rojna M (2013) Diabetes and Risk of Cancer. ISRN Oncology, Article ID 583786.