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I Want to Fight My Lung Cancer: What Should My Diet Be, and


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I Want to Fight My Lung Cancer: What Should My Diet Be, and What About Supplements?

March 24th, 2013 - by Dr. Jack West

http://expertblog.lungevity.org/2013/03 ... pplements/

The question of what and how to eat is one of the most common ones patients and caregivers have about how to manage cancer, and that’s understandable: we want to exert control in an all-too-uncontrollable situation. There’s also a lot of conflicting information out there, including some pretty grand claims of what dietary modification will do to help people, including some even suggesting that cancer can be reversed or even cured with certain diets. So what should a patient do, how should they eat, if they want to help themselves? And what about all of the supplements I read or hear about that are immune-boosters and claim to fight cancer?

I’ll qualify my comments by saying that it’s important to know the source and their motivations: everyone (myself included) has their biases, and allopathic (conventional Western medicine) doctors are trained to generally follow evidence from clinical trials. Most Western docs are paid to give chemotherapy or do interventions like surgery or radiation, and there’s far more research about these kinds of interventions for fighting cancer than there is evidence from clinical trials to speak to the potential value of a diet or supplement. These days, the vast majority of cancer research is sponsored by big pharma companies or the manufacturers of radiation equipment, with some general support for big questions from the government. Without a financial incentive for any backer of quinoa or kale, there isn’t an engine for studying whether certain foods fight cancer. Perhaps some marketers of various purported anti-cancer supplements could run clinical trials, but such trials really don’t exist, whether it’s because they would be very costly to do properly or there’s really a suspicion by those who market these supplements that exposing them to a higher level of examination would lead to a good reason for the skepticism that most conventional physicians view them with.

Moreover, conventional/allopathic medicine providers are trained with a core tenet primum non nocere — “above all, do no harm” — a concept that stems from the concept that the body is largely self-healing and that we may or may not be able to intervene effectively, so we should be cautious about recommending things that could potentially be harmful. The extension of this is that most doctors don’t recommend things for which there isn’t enough evidence to say that it’s significantly beneficial — it might be helpful or harmful, but if we don’t know, doctors shouldn’t take the chance of giving a treatment that could be more harmful than not doing it. It’s fair to say that Western medicine doctors tend to become trained to be conservative in their thinking and their treatment (and even lifestyle) recommendations.

Obviously, this mindset isn’t for everyone, and I think that a big part of the appeal of conventional and alternative medicine approaches is that many people are looking more for hope and the promise of something potentially better than hard evidence to support it. ”Twas ever thus”: there has always been a yin/yang relationship between conservative medicine practices and alternative medicine strategies, always a need to fulfill based on the gulfs in conventional medical care.

So my comments will come from the perspective of a well trained allopathic medical oncologist, not the word from on high, but I’ll be circumspect and try to be fair.

The short answer is that there is no good evidence that focusing on a specific diet will lead to a better outcome in lung cancer than just eating what you want. A “Western diet” heavy in meats and animal fat and calories is clearly a major culprit in the higher rates of many cancers that we’ve seen in the US over time and compared with other cultures, and I’ll say that I’ve shifted my own diet to a vegetarian one for health reasons (and there’s some evidence that a vegan one may be even more healthful, though much harder to pursue longitudinally). A diet with far less animal fat is likely to be beneficial for cancer prevention over the long term, but there’s only the occasional study, such as one called the Women’s Intervention Nutrition Study (WINS) that looked at breast cancer patients, that supports the idea that a low-fat diet is associated with a better outcome for people with a diagnosis of cancer already. In general, there is extremely little evidence that changing your diet leads to a better outcome if you have cancer.

That doesn’t mean that we recommend people max out on Pop Tarts, Twinkies, and Velveeta. Whether fighting cancer, heart disease, or otherwise for general health, a diet lower in animal fats, processed foods, and refined sugars makes sense, but there isn’t a clear value to approaching diet in a militantly rigid way. A balanced, varied diet is great, and nearly all cancer experts I know recommend this and prefer to just see patients maintain their weight. In many, many studies, the people who lose a lot of weight over time are those with the worst prognosis.

If people want to follow a diet to feel that they’re playing an active role in fighting their cancer, that’s perfectly great, as long as it isn’t so restrictive that they’re becoming malnourished. But I think it’s important for people to understand that there is not a meaningful amount of high quality evidence to support that dietary changes fight active cancer in a significant way. The zealous advocates of various diets can point to evidence of anecdotal cases of people here and there who are doing very well on whatever diet they’re promoting, but there’s a good reason that medically knowledgeable people dismiss anecdotes. Remember that “even a broken clock is right twice a day”: there will always be a few people who defy expectations no matter what happens, but that doesn’t mean that these results are broadly applicable. There are also various pre-clinical studies (test tube or animal models, not in humans) that can support the principles of one diet or another, but these results are notoriously poorly correlated with actual results in studies with real human patients. It’s helpful for people to be very skeptical about the claims made about what various diets will do, especially if the recommendations come with lofty promises and costs.

Then there are a nearly endless number of vitamins and supplements. Some are studied in some limited fashion, but many/most are not. They often come with anything from a vague innuendo claiming that the pill is an immune booster (a claim that can be made about any item at the local farmer’s marker) to a huge vertical marketing platform pushing it. Again, I can’t say that these treatments aren’t or couldn’t be effective, but they require a level of faith that something will be beneficial in the absence of high quality evidence. Essentially, it boils down to the concept that most naturopathic or complementary and alternative medicine (CAM) practitioners tend to have a different threshold of evidence than most conventional physicians. CAM practitioners typically extoll an approach that if there’s a potential value and a reasonable premise, it’s fine and potentially advisable to pursue an intervention, while allopathic practitioners are typically far more conservative and gun-shy about recommending something that doesn’t already have evidence to demonstrate its efficacy.

In the end, an informed patient is certainly within their rights to do whatever they want to pursue. As I said in the beginning of this post, it’s understandable to want to exert some control in a humbling, uncontrollable situation like cancer, but I think the key is the INFORMED part. The evidence really supports that there’s no clearly beneficial diet or supplement, but on the other hand, “absence of proof isn’t proof of absence”. It’s worth being aware of the limitations of the realistic evidence to support the claims being made, and otherwise just remembering the motivations and knowledge base of the person making recommendations to you.

Good luck!

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