The lack of diet and nutrition as part of cancer care irks me to no end as a radiation oncologist. About a year ago I submitted an article to a prominent medical journal describing the shortage of nutritional direction within the current state of cancer care. This article revealed that the vast majority of prominent cancer centers made no online nutritional recommendations for patients, while those that did largely contradicted each other. For instance, half recommended a high-calorie or even high-fat diet, while the other half recommended a low-fat, high-carbohydrate diet.
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The latter remains interesting as it has been well established within the world of cancer research that cancer cells feed and thrive on sugar. In fact, we diagnose and track the progression of cancer cells by injecting a radioactive sugar dye into the veins of cancer patients and watching the cancer cells instantly eat it up!
Even more interesting was the response to my article. The first reply was that we do not know if nutrition has any effect on cancer occurrence or treatment. The second response was even worse; diet has no place in cancer care.
The article was eventually published in the journal Nutrition and Cancer.
While it's a respectable journal by all means, I considered this a failure after months of hard work and high hopes. That all changed when a reporter from Dr. Sanjay Gupta’s website called me to discuss the article. When she wrote about it, more calls followed. Before I knew it, the American Society of Clinical Oncology wrote an article on the research in its newspaper. It also received attention from the National Institute of Health, and most recently, the Boston Globe interviewed me for an article on nutrition and cancer care.
While some physicians felt as though diet and nutrition played no part in cancer care, apparently their patients and the general public had different views...
Returning to the first objection that we do not know if diet influences cancer treatment, I would agree that most physicians believe this statement. We have lab data and clinical trials revealing the benefits of chemotherapy and radiation therapy for curing cancer that fill popular journals like the New England Journal of Medicine and JAMA: The Journal of the American Medical Association, but articles on diet and cancer are few and far between. Similar to my article, they get pushed to the back pages or relegated to lesser-known journals.
But is there really no data on the relationship between diet and cancer? According to these physicians, the data revealing the effect of diet on cancer has yet to occur. As any radiation oncologist would tell you, the treatment of cancer with radiation dates back to 1895 when Wilhelm Roentgen discovered X-rays. One month later physicians began using X-rays to treat malignancies. Chemotherapy came much later and was one of the few positive occurrences in World War I. The first documented cancer patient to be treated with chemotherapy received treatment in 1943.
Yet, here we stand over a century after the first radiation treatment and we still have no significant data on the influence diet has on cancer?
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If we look back on the last century, we find that the history of diet’s effect on cancer is nearly double that of chemotherapy and can be traced back to around the first time irradiation was used to kill a tumor. The first recorded instance was in 1907, nearly 40 years before chemotherapy, when Dr. Moreschi showed that sarcomas grew more slowly in mice that were on a restricted diet. Countless studies over the next 50 years revealed the vital link between diet and cancer, when dietary changes, and most notably replacing carbohydrates with fat, led to slowing tumor growth by up to 80% and increasing survival times in animal studies. The actual cancer treatment in these studies was diet — no radiation or chemotherapy was used — yet the results were drastic. While the number of studies was large by the mid-20th century, similar studies have continued to this day.
I recently published an extensive article explaining the connection between radiation therapy and diet down to the finest detail with a considerable list of key scientific studies illustrating this relationship. There were so many studies that we actually had to reduce our references in order to fit within the word limits for the article. The number of studies to pick from was not in the tens or twenties, but hundreds. Studies that reveal the effect of diet on cancer not only exist, but they are rather plentiful. When dietary changes are combined with radiation therapy for breast cancer in animal studies, the results are even more significant.
There are several reasons why medical professionals fail to appropriately follow Maimonides’ words and unite diet with cancer care. The first is ego. As physicians, we invest a great deal of time and money into our educations...
Nutrition plays little to no role in this education and to admit its importance is to admit shortcomings in our training and as physicians. Secondly, nutrition takes some work and dedication from both physicians and patients. It is not as simple as taking a pill, or even driving in for radiation treatments. These are permanent lifestyle changes that take blood, sweat, and tears.
However, as the rates of cancer and obesity continue to soar alongside healthcare costs, it appears that we have no choice but to endure these “hardships” of making meaningful lifestyle changes. In response to the first physician who commented on my article, the question of nutrition's effect on cancer can easily be answered through enlightenment and education. As for the second physician, it is clear to your patients that diet plays an integral part in cancer care, so when will it become clear to you?
Embracing diet and lifestyle is the new face of modern medicine, and it could not have come at a better moment. It’s time for physicians to remember the words of Maimonides and uphold them.
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