To the Women’s Healthy Eating & Living (WHEL) study participants and all of my patients, thank you! Thank you for helping me strive to learn more and more everyday, to be understanding & compassionate, and guiding me be the best practitioner I can be. You inspire me everyday, yes, each and everyday! Thank you!

Over twenty-five years ago, I began my work with the WHEL Study coordinated by the University of California, San Diego (UCSD) Cancer Center. The WHEL study, a multi-site controlled clinical trial, investigated the effect of diet on the recurrence of breast cancer in women diagnosed with early-stage breast cancer. This study is dear to my heart - who knew it would be the gateway to my career? Early on at UCSD, night after night (grad school during the day), I would sit in my cubicle and talk with women who had been diagnosed with breast cancer strategizing as to how best to adhere to particular dietary goals. Years later, I worked directly with these women at UCSF and Stanford completing their periodic assessments and teaching monthly cooking classes. Through this work, I learned about their lives, their families, their eating habits, and so much more. It was these women, WHEL study participants, who guided me in developing my passion for helping those with cancer. I will always be grateful for the WHEL study - my co-workers and the participants, who led me to fight for the cause.

For those of you facing cancer as well as those caring for and/or supporting one with cancer, let’s empower you! We may not be able to cure your cancer with a healthy nutrition plan, but we can certainly:

• Mitigate potential side effects of cancer therapy

• Augment your cancer therapy with nutrition/dietary supplements

• Increase your energy

• Enhance your immune function

• Improve your quality of life

A few WHEL takeways to highlight Breast Cancer Awareness Month:

* The combination of consuming five or more daily servings of vegetables and fruits and walking the equivalent of 30 minutes 6 days weekly was associated with a 50% reduced risk of death after early-stage breast cancer.

* Early-stage breast cancer survivors who fasted for less than 13 hours overnight had a 36% greater risk of breast cancer recurrence and a 22% increased mortality risk compared with those who fasted for more than 13 hours overnight. Additionally, longer fasting duration was associated with a significantly lower hemoglobin A1C, a marker that assesses blood sugar over the previous 2-3 months. Elevated A1C values have been associated with poorer survivorship.

* When compared with the control group [who followed the "5-a-Day" dietary guidelines], the diet for the intervention group [who attempted to consume 5 vegetable servings plus 16 oz of vegetable juice; 3 fruit servings; 30 g of fiber; and 15% to 20% of energy intake from fat] did not reduce additional breast cancer events or mortality during a 7.3-year follow-up period. 

* Tamoxifen and vegetable intake: While the protective effect of vegetables on the risk of breast cancer recurrence remains to be determined, this secondary analysis in over 3,000 breast cancer survivors reported that baseline vegetable intake may be associated with a reduction in the risk of breast cancer recurrent or new events, particularly for those using tamoxifen.

* Post-diagnostic C-reactive protein (CRP) and breast cancer survivorship - Elevated CRP levels (≥ 10 mg/L), suggestive of acute inflammation, may be an important independent biomarker for long-term survival in breast cancer survivors. Many of you know how I like to regularly assess inflammatory markers; this is one reason why.

* Compared with the least active women, those who were most active at baseline had a statistically significant 53% lower mortality risk. Greater levels of physical activity post-treatment was associated with improved survival.

* The WHEL study was the third epidemiologic study to report no adverse effects of soy foods on breast cancer prognosis. Women who consumed more isoflavones, phytochemicals in soy foods, observed a nonsignificant 54% reduction in risk of death.

* What about hot flashes? Women who consumed a diet high in fiber, were premenopausal, and had high social support reported a decreased severity of hot flashes and night sweats one year after study enrollment.

Healthy Anti-Cancer, Anti-Inflammatory Diet

• Eat 8 to 10 colorful fruit and vegetable servings daily

  • Two to three pieces of fruit

  • One cup, preferably more of vegetables with lunch and dinner

  • 8 fl oz vegetable juice

• Consume 30 to 45 grams of fiber daily

  • You will likely meet your fiber goal if you eat 8 to 10 servings of fruits and vegetables plus one serving of beans/legumes, one serving of chia and/or flax seed, or at least two servings of whole grains daily

• Avoid processed and refined grains/flours/sugar

  • Keep WHITE off your plate: bread, pasta, rice, cream sauces, cakes, and more

• Include lean protein with every meal; plant protein daily

• Limit fatty & processed meats, and dairy

• Include healthy fats like cold-water fish, chia seeds, flaxseeds, walnuts, olive oil, avocados

  • Avoid hydrogenated fats

• Eat chia seeds and ground flax daily — 1-2 Tbsp daily 

• Consume herbs and spices daily

• Limit alcohol consumption

• Drink 1 to 4 cups of green tea daily

• Ask your doctor about having a vitamin D blood test (serum 25 (OH)-vitamin D level). Maintain your level above 40 ng/ml through diet and, if needed, supplements.

• Drink plenty of fluids, water or non-caffeinated beverages, daily to help meet fluid needs

• Aim for 13 hours or more overnight fasting window

• Engage in daily physical activity to help achieve and/or maintain a healthy body weight

Interested in more information? Research? Details? Please refer to the Nutrition & Breast Cancer booklet that I developed for the UCSF Helen Diller Family Comprehensive Cancer Center.

Wishing you all health and happiness!

Be well,
Natalie