During the eight years Stacy Shawhan has worked as an
oncology dietitian, she has heard many questions from her cancer patients about
how their diets influence their prognosis. But one question has come up more
than the rest: Will consuming sugary foods and drinks feed my cancer cells,
making my condition worse?
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“Cancer patients are so vulnerable, and some of them are
terrified to eat,” said Shawhan, who practices at the University of Cincinnati
Cancer Center. “They think, ‘If I stop eating sugar, then I can starve my
cancer.’”
The “sugar feeds cancer” narrative goes back to the 1920s,
when a German physiologist noticed that some tumor cells consumed more glucose
than healthy cells did. Soon after, low-sugar diets sprang up claiming to cure
cancer. Recent polls from the United States and Europe suggest about a third of
cancer patients actively avoid sugar.
While experts say that diets high in added sugars may
increase your risk of cancer over a lifetime, cutting out all sugars does not
actually fight existing tumors.
“Every cell requires glucose, our brain requires glucose,”
said Philipp Scherer, a diabetes researcher at UT Southwestern Medical Center
in Dallas.
In other words, the best way to eat if you have cancer — or
are trying to lower your risk of getting it — is with a balanced, healthy diet.
Sugar’s role in cancer riskSugar is not a carcinogen, Scherer said. There is no
evidence showing that eating sugar will cause cancer itself (like, say, smoking
cigarettes would). Besides, Scherer added, “many, many cancers prefer to use
fat as their primary energy source, so even the idea that cancers prefer
glucose is not quite true.”
Still, a limited yet growing body of evidence has linked the
overconsumption of added sugars (the kind found in cookies, cakes, and soft
drinks) to cancer. For example, a large review of studies published in 2018
cited several that linked added sugar and sugary beverage consumption to an
increase in cancer risk.
Excess sugar consumption has been shown to spark chronic
inflammation in some people, which can damage cells that may then become
cancerous, Shawhan said. Overconsumption of added sugars has also been shown to
lower immunity, which can allow cancer cells to more easily spread. And
consuming excess sugar can alter metabolism in ways that may lead to obesity
and diabetes, conditions known to increase the odds of getting cancer.
Sugar and cancer patients
Once you’re diagnosed with cancer, eliminating sugar does
not seem to slow or halt cancer growth in most cases, Shawhan said. “By this
point, it is not sugar intake that is driving cancer growth, but the cancer
itself.”
Additionally, sugar is essential for most living things,
Scherer said. And when it occurs naturally in foods like dairy products,
fruits, and vegetables, it is part of a healthy diet, said Natalie Ledesma, an
oncology dietitian at the UCSF Helen Diller Family Comprehensive Cancer Center.
For the most part, experts agree that there is no need to
abstain from sugars that appear in whole foods.
But Ledesma notes that consuming excess added sugar has been
associated with worse outcomes — including higher mortality rates — in patients
with certain solid tumors like breast, colon and prostate cancers. Other
cancers may also be impacted, she said, but research on rarer cancer types has
been limited.
It is also important that cancer patients manage their diets
without becoming afraid of food, said Dr. Santosh Rao, an integrative oncologist
at University Hospitals Connor Whole Health in Cleveland.
Up to half experience muscle loss as a result of their
disease. And sometimes things that doctors recommend for patients during rounds
of grueling treatments — like Ensure, electrolyte drinks or even potatoes — can
contain a lot of sugars, Shawhan said.
While all people should avoid diets high in added sugars,
cancer patients with certain metabolic diseases should be especially vigilant
because those diseases can affect their prognosis.
“Patients with poorly controlled diabetes tend to have more
aggressive breast cancer,” for example, Rao said. And a meta-analysis suggested
obese patients were more likely to die from colon, breast and uterine cancers.
How to eat more healthfully without depriving yourself
The best way to lower your cancer risk, and to eat if you
have a cancer diagnosis, is to follow a healthy diet that has plenty of whole
fruits and vegetables. Mediterranean diets meet these goals and help reduce
cancer risk, some studies show.
Pairing carbohydrates with protein, fiber, and fat (a dab of
peanut butter on an apple slice, for example) prevents spikes in glucose that
can, over time, wreak havoc on our metabolism and increase cancer risk.
Generally speaking, Shawhan said, it is OK to indulge in a
little added sugar, even on a daily basis, as long as you are getting essential
nutrients from the rest of your diet. She recommends staying within the US
Department of Agriculture’s suggestion of 12 teaspoons of added sugar a day — or
better yet, follow the World Health Organization’s guidance of six teaspoons.
Research on sugar substitutes and their influence on cancer
and cancer risk is inconclusive. Experts suggest avoiding them until we learn
more. Ledesma prefers, instead, to sweeten her recipes with naturally sweet
foods like bananas, frozen berries and applesauce, which frequently feature in
her nondairy ice creams.
“Cinnamon or ginger offer a sweetness with no added calories
or sugar,” Ledesma said.
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