Diet is important in Cancer treatment: Shivashankar T.

clinical dietitian

A healthy diet plays an important role in supporting overall health and well-being during cancer treatment. Eating a balanced diet that includes plenty of fruits, vegetables, whole grains, and lean proteins can help maintain a healthy weight and provide the necessary nutrients to support the immune system. Some studies suggest that certain foods, such as cruciferous vegetables (e.g. broccoli, cauliflower), berries, and turmeric, may have anti-cancer properties. However, it is important for cancer patients to work with a healthcare professional, such as a registered dietitian, to create an individualized nutrition plan that takes into account their specific needs and treatment plan.

Shivashankar T. is the Chief Clinical Nutritionist and Dietician at Tata Memorial Cancer Hospital, Mumbai. He is an expert in onco-nutrition and critical care nutrition. He is the vice president of Indian Association of Parenteral and Enteral nutrition (IAPEN) and Chief Programme Officer Onco-nutrition, Core Group. Shivashankar in a conversation with THIP Media emphasises on the role diet plays in the treatment of cancer.

Vegetarian vs. Non-vegetarian. Is there a link to cancer prevention?

There are a lot of studies available that very strongly favour the vegetarian diet, specifically for gastrointestinal and colorectal cancers. In India, we consume very less protein and a lot of carbohydrate in our diet. Whereas the Western diet predominantly consists of red meat and processed meat consumption. It has been seen that there are comparatively more cases of gastrointestinal and colorectal cancers among people who consume a lot of red meats and processed meats. We do not have any such research for white meat as of now. However, we need more research to ensure whether we should completely avoid processed meat.

People these days opt vegan diet and cut off white meat completely, which is a rich source of protein. It is advisable to eat lean meat and white meat. A lot of places that serve meat use certain ingredients that are not permitted. For example, the preservatives, colouring agents, etc. These ingredients and the meat processing procedure that these places may use can lead to gastrointestinal and colorectal cancers. Therefore, it is important to be aware and careful.

Nevertheless, there is no need to be obsessed with vegetarian or vegan diets because of this. One can eat meat in moderation. However, you should prefer white meat over red meat. The best diet which has been proposed as an ‘anti-cancer diet’ is the Mediterranean diet. In this diet, there is less red meat and good amount of white meat.

What is a healthy meal plan during and after treatment?

In cancer patients, when the food intake gets compromised, it impacts the gut health too. It is not easy to revive the health of the gut, and it takes time. The process can take even months, and it may not be completely successful. It is important to add both prebiotics and probiotics in your diet. One has to understand that once your gut health is compromised, no matter how good your diet is, your body will not be able to use all the nutrients. Your gut health will determine the outcome of the nutrition that you are consuming.

A similar view has been shared by Dr Sarthak Moharir, a radiation oncologist in Bilaspur. We asked him about the adoption of a special diet during radiation therapy (a common treatment for cancer). To this, he said that he does not recommend specialized diets for patients going through radiation therapy and cancer treatment in general. This decision is based on the observation that patients frequently experience a marked decrease in appetite and may not be in their optimal physical state. Instead, patients are advised to enjoy foods they prefer, with the caveat of avoiding spicy foods, particularly those infused with ground spices.

There is a culture of using different kinds of spices in Indian cuisine. Do you allow your patients to use such spices in their diet?

Yes, I allow and encourage my patients to include spices. We need to understand the way these spices should be used. Our kitchen spices, like turmeric, peppers, etc., have anti-cancer properties but we use it in the wrong way. These can harm you if your diet is deficient in fibres. And all these phytonutrients work in harmony. So, if you use only one kind of phytonutrient, then it is not going to benefit you in a wholesome way. There are more than 500 types of phytonutrients and you can easily and cheaply find them in your kitchen itself. We should know the correct usage of these so that it benefits our health. For example, I ask my patients to use half of the onion-garlic paste that they have been using for the curry, and sauté it in whichever way they like, and then consume the food after sometime and not immediately. In doing so, there will definitely be some flavour there that they may not like, but it is important to do so. This is because the way we sauté this paste actually ensures that the phytonutrients in it get completely destroyed.

What would be your general diet recommendation for cancer patients?

Although the diet that we prescribe is based on several factors including the type of cancer they have and the type of treatment they are receiving. In general, the diet should consist of good protein. It should not contain simple carbohydrates and inflammatory proteins. However, the diet advice needs to be altered for every patient according to the requirements of their body.

What is your take on sugar intake by cancer patients?

Firstly, sugar does not have any secondary nutrients. Secondly, it has only carbohydrates, and that too harmful ones. Thirdly, it is an inflammatory nutrient. I do not recommend sugar to cancer patients as cancer is an inflammatory disease, and therefore, such nutrients will be harmful for the patients. Currently Omega-3 fatty acids are proving to be effective because it lowers the inflammation. So, if we include Omega-3 fatty acids in a cancer patient’s diet to decrease the inflammation, letting them include sugar in their diet would be detrimental to the process. However, by restriction of sugar intake I mean restricting the intake in excessive amounts. You can consume about 5-10 grams of sugar per day. But consuming sugar more than that will impact your treatment and recovery from cancer. Giving a free hand to the patient to consume as much sugar as they want is wrong. This is because it will limit their protein intake. A high recurrence rate has been observed in patients who consume food with high glycemic index as compared to those who don’t. 

Nevertheless, there are some patients, where I give patients some liberty with food. These include palliative patients, very aged patients, and/or anorexic patients.

Any suggestions?

I would suggest the cancer patients to follow the Mediterranean diet. It has been proven and is accepted worldwide.

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