312018
1
Fact or Fiction Nutrition amp Cancer Myths
Stacy Kennedy MPH RDLDN CSOSenior Clinical Nutritionist
Dana-Farber Cancer InstituteBrigham amp Womenrsquos Hospital
Co-Founder Wellness Guides
Adjunct Faculty Simmons College
Fitness Expert Trainer
StacyKennedyRD
The Power of Nutrition
Prevention Treatment Survivorship
Symptom Management
Nausea Fatigue Bowel irregularities Taste amp Appetite
changes
Weight management
Boost energy levels
Support immune system
Overall health and wellness
Stacy Kennedy MPH RD CSO LDN
Stacy Kennedy MPH RD CSO LDN Stacy Kennedy MPH RD CSO LDN
Stacy Kennedy MPH RD CSO LDN
312018
2
Stacy Kennedy MPH RD CSO LDN
Stacy Kennedy MPH RD CSO LDN
Stacy Kennedy MPH RD CSO LDN
Cruciferous Vegetables
Broccoli Cauliflower
Cabbage Brussels Sprouts
Radishes Arugula Kale
Collard Greens Mustard
Greens Wasabi
Potent phytochemicals
Sulforaphane Indole-3-
Carbinol 33rsquo-
diindolylmethane (DIM)
Promote natural Liver
Detoxification
Support Immune System
Stacy Kennedy MPH RD CSO LDN
Stacy Kennedy MPH RD CSO LDN
Symptom Management
Nausea
Bowel Concerns (constipation diarrhea gas
bloating pain)
Fatigue
Taste Changes
Swallowing Problems Dry Mouth Mouth Sores
Stacy Kennedy MPH RD CSO LDN
312018
3
Stacy Kennedy MPH RD CSO LDN
Stacy Kennedy MPH RD CSO LDN
Stacy Kennedy MPH RD CSO LDN
Breast Cancer Data
bull Processed Meats Modest Consumption
= risk
bull Red meat consumption is not
associated with breast cancer
incidence
Red and processed meat consumption and breast cancer UK Biobank cohort
study and meta-analysis
Jana J Anderson a Narisa DM Darwis a Daniel F Mackay a Carlos A Celis-
Morales b Donald M Lyall a Naveed Sattar b Jason MR Gill b Jill P Pell a
European Journal of Cancer 90 (2018) 73e82
Dairy amp Cancer Data
Prostate Cancer
Excessive intakes of whole milk appear to raise risk of mortality from prostate cancer
The evidence that a higher consumption of dairy products increases the risk of prostate cancer is limited
The evidence that diets high in calcium increase the risk of prostate cancer is limited
Colorectal Cancer
Consumption of dairy amp calcium supplements is protective against incidence
Gastric cancer no association or modest risk reduction
Ovarian Cancer
Potentially reducing exposure and choosing low-fat or lactose free may be associated with reduced risk of developing certain types of ovarian cancer
Lung Cancer
No association
Breast Cancer
Highest intake vs Lowest = statistically significant lower risk of developing breast cancer
Stacy Kennedy MPH RD CSO LDN
Dairy products intake and cancer mortality risk a meta-analysis of 11 population-based cohort studies [Lu et al Nutrition Journal (2016)
AICRrsquos Continuous Update Project
Calcium intake and colorectal cancer risk Results from the Nursesrsquo Health Study and Health Professionals Follow-up Study [Zhang et al International Journal of Cancer (2016)]
Dairy Consumption and Gastric Cancer Risk A Meta-Analysis of Epidemiological Studies [Guo et al Nutrition and Cancer (2015
Milk Yogurt and Lactose Intake and Ovarian Cancer Risk A Meta-Analysis [Liu et al Nutrition and Cancer (2015) amp Dairy calcium vitamin D and ovarian cancer risk in Africanndash
American women [Qin et al British Journal of Cancer (2016)]
Caini et al Critical Reviews in OncologyHematology (2016)
The Association between Dairy Intake and Breast Cancer in Western and Asian Populations A Systematic Review and Meta-Analysis [Zang et al Journal of Breast Cancer (2015)
Recommendations on Dairy
If consuming dairy choose low-fat
Fermented dairy products such as yogurt and
kefir
Plant-based sources of calcium
Ex spinach kale swiss chard dried
beans legumes soymilk and tofu
Stacy Kennedy MPH RD CSO LDN
Does Sugar Feed
Cancer Human body requires glucose
Lack of RCTs demonstrating causal link
between sugar amp cancer
Indirect link of excess refined sugar and
obesityrsquos contribution to cancer risk
Earlier studies examining relationship of
diets high in fructose or glycemic load
May risk of pancreatic colorectal amp
prostate cancers
Worse overall survival in overweight colon
cancer patients undergoing chemotherapy
Stacy Kennedy MPH RD CSO LDN
Aune D1 Chan DS Vieira AR Navarro Rosenblatt DA Vieira R Greenwood DC Cade JE Burley VJ Norat T Dietary fructose carbohydrates glycemic indices and pancreatic
cancer risk a systematic review and meta-analysis of cohort studies Ann Oncol 2012 Oct23(10)2536-46 Epub 2012 Apr 26
Michaud DS1 Fuchs CS Liu S Willett WC Colditz GA Giovannucci E Dietary glycemic load carbohydrate sugar and colorectal cancer risk in men and women Cancer
Epidemiol Biomarkers Prev 2005 Jan14(1)138-47
Hu J1 La Vecchia C Augustin LS Negri E de Groh M Morrison H Mery L Canadian Cancer Registries Epidemiology Research Group Glycemic index glycemic load and
cancer risk Ann Oncol 2013 Jan24(1)245-51 doi 101093annoncmds235 Epub 2012 Jul 25
Meyerhardt JA1 Sato K Niedzwiecki D Ye C Saltz LB Mayer RJ Mowat RB Whittom R Hantel A Benson A Wigler DS Venook A Fuchs CS Dietary glycemic load and
cancer recurrence and survival in patients with stage III colon cancer findings from CALGB 89803 J Natl Cancer Inst 2012 Nov 21104(22)1702-11 doi
101093jncidjs399 Epub 2012 Nov 7
312018
4
Recommendations on Sugar
bull Eat balanced meals and snacks
bull Include a protein-rich and fiber-rich food with each
meal and snack
bull Stay well hydrated Consider infused waters
bull Include walking and other physical activity regularly
bull Eat plenty of vegetables and other plant-based foods
bull Limit added sugars lt25 gmday women amp lt36gmday
men
bull Plain Greek yogurt + berries amp nuts vs flavored yogurts
bull Choose whole grains and starchy vegetables like
quinoa brown rice or sweet potatoes over refined
grains like white rice breads and potatoes
bull Use fresh or dried herbs and spices like cinnamon to
flavor foods and add nutrients
bull Focus on getting adequate sleep and managing stressStacy Kennedy MPH RD CSO LDN
Is Organic Better Eat Locally
wwwewgorg Stacy Kennedy MPH RD CSO LDN
Organic Label Does Not
Guarantee Itrsquos Healthy
Stacy Kennedy MPH RD CSO LDN
Soy amp Breast Cancer
Stacy Kennedy MPH RD CSO LDN
Safe Insufficient Data
Tofu X
Edamame X
Miso X
Tempeh X
Soy Milk (Unsweetened) X
Soy Oil Lecithin Soy
Sauce
X
Soy Protein Powders
(Isolated Soy Protein)
Common Sources Protein
Powder Bars Veggie
Burgers Breads ldquoHigh
Proteinrdquo Packaged Foods
X
Stacy Kennedy MPH RD CSO LDN
Superfoods Nutrition
Superstars or Brilliant
Marketing
Synonymous with ultra-healthy nutrient-packed plant-based
foods and supplements
Advertised as having exceptional powers for fighting or
preventing common health conditions like cancer
Preliminary or complete lack of data In Vitro animal studies
Lack of evidence in humans
While superfoods may not always live up to their hypehellip
Enjoy as part of a well-balanced diet to offer new and
interesting options for delicious plant-based foods
Stacy Kennedy MPH RD CSO LDN
312018
5
How to include superfoods in
your everyday diet
Drink Chaga mushroom or green tea once or twice a day
Add goji acai sea buckthorn currant or other berries to oatmeal cereal salads baking or smoothies
Add chia hemp or ground flax seeds to salads smoothies baked goods hot or cold cereals
Include seaweed in soups or as a snack paired with avocado
Drink Kefir or Kombucha for a fun treat
Add cacao powder to smoothies waffle or pancake mix oats muffins breads desserts or other baking for chocolate flavor without added sugars
Swap brown rice with teff in stir-fry bowls or side dishes
Stacy Kennedy MPH RD CSO LDN
Probiotics amp Cancer
Severity of treatment related diarrhea (CRC)
Duration of diarrhea symptoms during chemo
(CRC)
Diarrhea amp boost QOL in long term symptom
management for patients with IBS
Lack of sufficient evidence linked to cancer
prevention or promotion of survivorship
Preliminary In Vitro animal model studies
looking at risk
Stacy Kennedy MPH RD CSO LDN
Stacy Kennedy MPH RD CSO LDN
FAKENEWS Alcohol amp Cancer Breast Cancer Risk Specifically
Risk with 3-6 Drinksweek (lt1day) or 10 for every 10 gm
Higher with early or later in life exposure
Daily consumption of alcohol increases the risk
Moderate drinking ndash Low risk for alcohol problems - General
Women ndash lt2 drinks per day
Men ndash lt3 drinks per day
People age ge65 ndash lt2 drinks per day
14 to 15 grams of alcohol (05 to 06 fl ounces) =
12 ounces of beer
5 ounces of wine
15 ounces of 80 proof liquor
Stacy Kennedy MPH RD CSO LDN
Alcohol amp Breast Cancer
bullInsignificant differences between type of alcohol and risk
bullConsuming Folic Acid may help reduce associated riskbullEspecially ER- Breast Cancers bullMultivitamin Recommended bullUS Food Supply Fortification
Stacy Kennedy MPH RD CSO LDN
==
Alkaline Diets
Promote avoidance of processed foods excess meats
amp dairy and abundance of plant-based foods
Biologic Plausibility Can You Change Your Blood pH
Reliability of home testing
Bottom Line
Stacy Kennedy MPH RD CSO LDN
312018
6
Ketogenic Diet
bullPopular use in weight loss athletic performance may allow body to
burn fat for energy vs carbssugars
bullTherapeutic use in pediatric seizure treatment
bullAcute risks GI Discomfort Nausea Vomiting Fatigue Elevated
blood ketones hypoglycemia trace mineral deficiencies
bullLong term risks Increased LDL Bone mineral loss kidney stones
decreased IGF-1 renal damage
Stacy Kennedy MPH RD CSO LDN Allen B et al Ketogenic diets as an adjuvant cancer therapy History and potential mechanism RedoxBiology2(2014)963ndash970
Ketogenic Diet amp Cancer
Research bullLack of data for safety of long term use
bullPreliminary research investigating benefits for cancer patients and evaluating safety in preclinical and animal models
bullHuman studies are needed amp underway Currently 21 studies variety of cancer dx
bullData supporting Mediterranean Diet
bullContradicts previous Low-Fat Dietary recommendations for Breast Cancer especially for those with ER-
Stacy Kennedy MPH RD CSO LDN
Todayrsquos Dietitian September 2017 Issue Ask the Expert Ketosis for Weight Loss By Toby Amidor MS RD CDN Vol 19 No 9 P 12
A Nutritional Perspective of Ketogenic Diet in Cancer A Narrative Review Camila L P Oliveira MSc Stephanie Mattingly PhD Ralf Schirrmacher MD Michael B Sawyer MD Eugene J Fine MD Carla M Prado PhD RD J Acad Nutr Diet 2017
BG AllenetalRedoxBiology2(2014)963ndash970
Mediterranean Diet - Effects on Health Outcomes of a Mediterranean Diet With No Restriction on Fat Intake A Systematic Review and Meta-analysis Hanna E Bloomfield MD MPH Eva Koeller BA Nancy Greer PhD Roderick MacDonald MS Robert Kane MD and Timothy J Wilt MD MPH Annals of Internal
Medicine 2016165491-5008WINSWHEL studies J Am Diet Assoc 2009 Apr 109(4) 688ndash696
How to Create a Balanced
Keto-Friendly Diet for
Patients
Higher in healthy fat moderate in lean proteins
lower in carbohydrates without compromising
phytonutrient intake Adjust macro s as
appropriate individually
Focus on increasing fiber and reducing added sugars
Consider logistics for adherence safety for
individual patient duration you would suggest
Stacy Kennedy MPH RD CSO LDN
Intermittent Fasting Common Practices
Cultural amp Historical Prevalence
12-16 hour window between eating (overnight)
Circadian IF regimens (100 total daily calories 8a-2p)
2 Daysweek lt500 calories
Focus on Eating PatternTiming
Potential Benefits
Improved insulin sensitivity
Fat metabolism appetite and hunger management
Preliminary research looking at potential benefits during chemotherapy treatment amp in overall survivorship and prevention
Potential Risks
Meeting elevated nutrition needs during treatment
Logistics of scheduling meal prep familycultural eating patterns
Consider options individually with patients
Stacy Kennedy MPH RD CSO LDN
BMC Med 2017 May 2415(1)106 doi 101186s12916-017-0873-x
Adv Nutr 2016 Jul 157(4)690-705 doi 103945an115011767 Print 2016 Jul
Food vs Supplement
Stacy Kennedy MPH RD CSO LDN Stacy Kennedy MPH RD CSO LDN
XRT Chemo Immuno-therapy
Food Source
Curcumin X X
DriedFresh Turmeric + Black Pepper in cooking
High Dose Vitamin C E carotenes
X X
Colorful veggies fruits nutsseeds
Vitamin D OK OK OK Dairy Fortified Non-Dairy Mushrooms Sardines
Probiotics OK OK OK Plain Greek Yogurt Kefir Kombucha Fermented Foods
May be drug-specific however until more research is conducted NCI ACS amp ASCO suggest all high dose antioxidant supplements be discouraged during radiation and chemotherapy J Natl Cancer Inst 2008 Jun 4100(11)773-83 doi 101093jncidjn148
Epub 2008 May 27
Many patients undergoing clinical trials sp recent BMT dx GVHD pancytopenia severe neutropenia may have additional contraindications Check with
team
Potential Contributions of Antioxidants to Cancer Therapy Immunomodulation and Radiosensitization Anita Thyagarajan-Sahu PhD Ravi P Sahu PhD Integrative Cancer Therapies First Published March 20 2017 Review Article
No specific data for examples Keytruda (Pembrolizumab amp Nivolumab)
Popular Supplements amp Treatment Contraindications
312018
7
Reliable Information for RDs amp
Patients
DFCI Nutrition App Website amp Social Media Insight Blog Podcasts
MSKCC About Herbs App for Supplements
CNC Cancer Nutrition Consortium e-Newsletter amp Print
AND ONC DPG amp Listserv (RD only)
cancergov National Cancer Institute
cancerorg American Cancer Society
aicrorg American Institute for Cancer Research
consumerlabscom Supplement Evaluation
Natural Medicine Database Supplement Research
Up to Date Evidence Based Information
Stacy Kennedy MPH RD CSO LDN
Dana Farber Nutrition Media
Bringing tech to patients caregivers
Patient filters recipes by goal symptom sensitivities
selects recipe amp can build shopping list amp share
Ask the Nutritionist amp Resources
Award-winning App Free iphone amp android
Eating Well During Cancer Series
Social Media Podcasts blogs amp Web Chats Twitter
chats DanaFarber wwwdana-farberorgnutrition
Stacy Kennedy MPH RD CSO LDN
Guide to Evaluate
Supplements
bull Safety First Efficacy Second
bull Communicating to patients that supplements
are not federally regulated for purity safety
or content
bull Natural Medicine Database
bull ConsumerLabscom
bull Memorial Sloan Kettering Cancer Centerrsquos
About Herbs app
Stacy Kennedy MPH RD CSO LDN
Resources for Patients
Local Grocery Store Online
Order amp Delivery
Peapod Roche
National Online Order amp
Delivery
Thrive Market Amazon
Pantry Instacart
Meal Kits
Hello Fresh Blue Apron
Plated Purple Carrots
Stacy Kennedy MPH RD CSO LDN
How to help your patients
build a healthy eating plan
Well Balanced Plant based diet
Schedule timing of meals and snacks
Consider taste changes preferences
Factor in ease of preparation
Motivational Interviewing open-minded non-judgemental
conversations
Address questions concerns internet-nutrition myths
Follow up for feedback to customize the plan
Stacy Kennedy MPH RD CSO LDN
Stacy Kennedy MPH RD CSO LDN
wwwdana-farberorgnutritionStacyKennedyRDgmailcom
StacyKennedyRD
DanaFarber
312018
2
Stacy Kennedy MPH RD CSO LDN
Stacy Kennedy MPH RD CSO LDN
Stacy Kennedy MPH RD CSO LDN
Cruciferous Vegetables
Broccoli Cauliflower
Cabbage Brussels Sprouts
Radishes Arugula Kale
Collard Greens Mustard
Greens Wasabi
Potent phytochemicals
Sulforaphane Indole-3-
Carbinol 33rsquo-
diindolylmethane (DIM)
Promote natural Liver
Detoxification
Support Immune System
Stacy Kennedy MPH RD CSO LDN
Stacy Kennedy MPH RD CSO LDN
Symptom Management
Nausea
Bowel Concerns (constipation diarrhea gas
bloating pain)
Fatigue
Taste Changes
Swallowing Problems Dry Mouth Mouth Sores
Stacy Kennedy MPH RD CSO LDN
312018
3
Stacy Kennedy MPH RD CSO LDN
Stacy Kennedy MPH RD CSO LDN
Stacy Kennedy MPH RD CSO LDN
Breast Cancer Data
bull Processed Meats Modest Consumption
= risk
bull Red meat consumption is not
associated with breast cancer
incidence
Red and processed meat consumption and breast cancer UK Biobank cohort
study and meta-analysis
Jana J Anderson a Narisa DM Darwis a Daniel F Mackay a Carlos A Celis-
Morales b Donald M Lyall a Naveed Sattar b Jason MR Gill b Jill P Pell a
European Journal of Cancer 90 (2018) 73e82
Dairy amp Cancer Data
Prostate Cancer
Excessive intakes of whole milk appear to raise risk of mortality from prostate cancer
The evidence that a higher consumption of dairy products increases the risk of prostate cancer is limited
The evidence that diets high in calcium increase the risk of prostate cancer is limited
Colorectal Cancer
Consumption of dairy amp calcium supplements is protective against incidence
Gastric cancer no association or modest risk reduction
Ovarian Cancer
Potentially reducing exposure and choosing low-fat or lactose free may be associated with reduced risk of developing certain types of ovarian cancer
Lung Cancer
No association
Breast Cancer
Highest intake vs Lowest = statistically significant lower risk of developing breast cancer
Stacy Kennedy MPH RD CSO LDN
Dairy products intake and cancer mortality risk a meta-analysis of 11 population-based cohort studies [Lu et al Nutrition Journal (2016)
AICRrsquos Continuous Update Project
Calcium intake and colorectal cancer risk Results from the Nursesrsquo Health Study and Health Professionals Follow-up Study [Zhang et al International Journal of Cancer (2016)]
Dairy Consumption and Gastric Cancer Risk A Meta-Analysis of Epidemiological Studies [Guo et al Nutrition and Cancer (2015
Milk Yogurt and Lactose Intake and Ovarian Cancer Risk A Meta-Analysis [Liu et al Nutrition and Cancer (2015) amp Dairy calcium vitamin D and ovarian cancer risk in Africanndash
American women [Qin et al British Journal of Cancer (2016)]
Caini et al Critical Reviews in OncologyHematology (2016)
The Association between Dairy Intake and Breast Cancer in Western and Asian Populations A Systematic Review and Meta-Analysis [Zang et al Journal of Breast Cancer (2015)
Recommendations on Dairy
If consuming dairy choose low-fat
Fermented dairy products such as yogurt and
kefir
Plant-based sources of calcium
Ex spinach kale swiss chard dried
beans legumes soymilk and tofu
Stacy Kennedy MPH RD CSO LDN
Does Sugar Feed
Cancer Human body requires glucose
Lack of RCTs demonstrating causal link
between sugar amp cancer
Indirect link of excess refined sugar and
obesityrsquos contribution to cancer risk
Earlier studies examining relationship of
diets high in fructose or glycemic load
May risk of pancreatic colorectal amp
prostate cancers
Worse overall survival in overweight colon
cancer patients undergoing chemotherapy
Stacy Kennedy MPH RD CSO LDN
Aune D1 Chan DS Vieira AR Navarro Rosenblatt DA Vieira R Greenwood DC Cade JE Burley VJ Norat T Dietary fructose carbohydrates glycemic indices and pancreatic
cancer risk a systematic review and meta-analysis of cohort studies Ann Oncol 2012 Oct23(10)2536-46 Epub 2012 Apr 26
Michaud DS1 Fuchs CS Liu S Willett WC Colditz GA Giovannucci E Dietary glycemic load carbohydrate sugar and colorectal cancer risk in men and women Cancer
Epidemiol Biomarkers Prev 2005 Jan14(1)138-47
Hu J1 La Vecchia C Augustin LS Negri E de Groh M Morrison H Mery L Canadian Cancer Registries Epidemiology Research Group Glycemic index glycemic load and
cancer risk Ann Oncol 2013 Jan24(1)245-51 doi 101093annoncmds235 Epub 2012 Jul 25
Meyerhardt JA1 Sato K Niedzwiecki D Ye C Saltz LB Mayer RJ Mowat RB Whittom R Hantel A Benson A Wigler DS Venook A Fuchs CS Dietary glycemic load and
cancer recurrence and survival in patients with stage III colon cancer findings from CALGB 89803 J Natl Cancer Inst 2012 Nov 21104(22)1702-11 doi
101093jncidjs399 Epub 2012 Nov 7
312018
4
Recommendations on Sugar
bull Eat balanced meals and snacks
bull Include a protein-rich and fiber-rich food with each
meal and snack
bull Stay well hydrated Consider infused waters
bull Include walking and other physical activity regularly
bull Eat plenty of vegetables and other plant-based foods
bull Limit added sugars lt25 gmday women amp lt36gmday
men
bull Plain Greek yogurt + berries amp nuts vs flavored yogurts
bull Choose whole grains and starchy vegetables like
quinoa brown rice or sweet potatoes over refined
grains like white rice breads and potatoes
bull Use fresh or dried herbs and spices like cinnamon to
flavor foods and add nutrients
bull Focus on getting adequate sleep and managing stressStacy Kennedy MPH RD CSO LDN
Is Organic Better Eat Locally
wwwewgorg Stacy Kennedy MPH RD CSO LDN
Organic Label Does Not
Guarantee Itrsquos Healthy
Stacy Kennedy MPH RD CSO LDN
Soy amp Breast Cancer
Stacy Kennedy MPH RD CSO LDN
Safe Insufficient Data
Tofu X
Edamame X
Miso X
Tempeh X
Soy Milk (Unsweetened) X
Soy Oil Lecithin Soy
Sauce
X
Soy Protein Powders
(Isolated Soy Protein)
Common Sources Protein
Powder Bars Veggie
Burgers Breads ldquoHigh
Proteinrdquo Packaged Foods
X
Stacy Kennedy MPH RD CSO LDN
Superfoods Nutrition
Superstars or Brilliant
Marketing
Synonymous with ultra-healthy nutrient-packed plant-based
foods and supplements
Advertised as having exceptional powers for fighting or
preventing common health conditions like cancer
Preliminary or complete lack of data In Vitro animal studies
Lack of evidence in humans
While superfoods may not always live up to their hypehellip
Enjoy as part of a well-balanced diet to offer new and
interesting options for delicious plant-based foods
Stacy Kennedy MPH RD CSO LDN
312018
5
How to include superfoods in
your everyday diet
Drink Chaga mushroom or green tea once or twice a day
Add goji acai sea buckthorn currant or other berries to oatmeal cereal salads baking or smoothies
Add chia hemp or ground flax seeds to salads smoothies baked goods hot or cold cereals
Include seaweed in soups or as a snack paired with avocado
Drink Kefir or Kombucha for a fun treat
Add cacao powder to smoothies waffle or pancake mix oats muffins breads desserts or other baking for chocolate flavor without added sugars
Swap brown rice with teff in stir-fry bowls or side dishes
Stacy Kennedy MPH RD CSO LDN
Probiotics amp Cancer
Severity of treatment related diarrhea (CRC)
Duration of diarrhea symptoms during chemo
(CRC)
Diarrhea amp boost QOL in long term symptom
management for patients with IBS
Lack of sufficient evidence linked to cancer
prevention or promotion of survivorship
Preliminary In Vitro animal model studies
looking at risk
Stacy Kennedy MPH RD CSO LDN
Stacy Kennedy MPH RD CSO LDN
FAKENEWS Alcohol amp Cancer Breast Cancer Risk Specifically
Risk with 3-6 Drinksweek (lt1day) or 10 for every 10 gm
Higher with early or later in life exposure
Daily consumption of alcohol increases the risk
Moderate drinking ndash Low risk for alcohol problems - General
Women ndash lt2 drinks per day
Men ndash lt3 drinks per day
People age ge65 ndash lt2 drinks per day
14 to 15 grams of alcohol (05 to 06 fl ounces) =
12 ounces of beer
5 ounces of wine
15 ounces of 80 proof liquor
Stacy Kennedy MPH RD CSO LDN
Alcohol amp Breast Cancer
bullInsignificant differences between type of alcohol and risk
bullConsuming Folic Acid may help reduce associated riskbullEspecially ER- Breast Cancers bullMultivitamin Recommended bullUS Food Supply Fortification
Stacy Kennedy MPH RD CSO LDN
==
Alkaline Diets
Promote avoidance of processed foods excess meats
amp dairy and abundance of plant-based foods
Biologic Plausibility Can You Change Your Blood pH
Reliability of home testing
Bottom Line
Stacy Kennedy MPH RD CSO LDN
312018
6
Ketogenic Diet
bullPopular use in weight loss athletic performance may allow body to
burn fat for energy vs carbssugars
bullTherapeutic use in pediatric seizure treatment
bullAcute risks GI Discomfort Nausea Vomiting Fatigue Elevated
blood ketones hypoglycemia trace mineral deficiencies
bullLong term risks Increased LDL Bone mineral loss kidney stones
decreased IGF-1 renal damage
Stacy Kennedy MPH RD CSO LDN Allen B et al Ketogenic diets as an adjuvant cancer therapy History and potential mechanism RedoxBiology2(2014)963ndash970
Ketogenic Diet amp Cancer
Research bullLack of data for safety of long term use
bullPreliminary research investigating benefits for cancer patients and evaluating safety in preclinical and animal models
bullHuman studies are needed amp underway Currently 21 studies variety of cancer dx
bullData supporting Mediterranean Diet
bullContradicts previous Low-Fat Dietary recommendations for Breast Cancer especially for those with ER-
Stacy Kennedy MPH RD CSO LDN
Todayrsquos Dietitian September 2017 Issue Ask the Expert Ketosis for Weight Loss By Toby Amidor MS RD CDN Vol 19 No 9 P 12
A Nutritional Perspective of Ketogenic Diet in Cancer A Narrative Review Camila L P Oliveira MSc Stephanie Mattingly PhD Ralf Schirrmacher MD Michael B Sawyer MD Eugene J Fine MD Carla M Prado PhD RD J Acad Nutr Diet 2017
BG AllenetalRedoxBiology2(2014)963ndash970
Mediterranean Diet - Effects on Health Outcomes of a Mediterranean Diet With No Restriction on Fat Intake A Systematic Review and Meta-analysis Hanna E Bloomfield MD MPH Eva Koeller BA Nancy Greer PhD Roderick MacDonald MS Robert Kane MD and Timothy J Wilt MD MPH Annals of Internal
Medicine 2016165491-5008WINSWHEL studies J Am Diet Assoc 2009 Apr 109(4) 688ndash696
How to Create a Balanced
Keto-Friendly Diet for
Patients
Higher in healthy fat moderate in lean proteins
lower in carbohydrates without compromising
phytonutrient intake Adjust macro s as
appropriate individually
Focus on increasing fiber and reducing added sugars
Consider logistics for adherence safety for
individual patient duration you would suggest
Stacy Kennedy MPH RD CSO LDN
Intermittent Fasting Common Practices
Cultural amp Historical Prevalence
12-16 hour window between eating (overnight)
Circadian IF regimens (100 total daily calories 8a-2p)
2 Daysweek lt500 calories
Focus on Eating PatternTiming
Potential Benefits
Improved insulin sensitivity
Fat metabolism appetite and hunger management
Preliminary research looking at potential benefits during chemotherapy treatment amp in overall survivorship and prevention
Potential Risks
Meeting elevated nutrition needs during treatment
Logistics of scheduling meal prep familycultural eating patterns
Consider options individually with patients
Stacy Kennedy MPH RD CSO LDN
BMC Med 2017 May 2415(1)106 doi 101186s12916-017-0873-x
Adv Nutr 2016 Jul 157(4)690-705 doi 103945an115011767 Print 2016 Jul
Food vs Supplement
Stacy Kennedy MPH RD CSO LDN Stacy Kennedy MPH RD CSO LDN
XRT Chemo Immuno-therapy
Food Source
Curcumin X X
DriedFresh Turmeric + Black Pepper in cooking
High Dose Vitamin C E carotenes
X X
Colorful veggies fruits nutsseeds
Vitamin D OK OK OK Dairy Fortified Non-Dairy Mushrooms Sardines
Probiotics OK OK OK Plain Greek Yogurt Kefir Kombucha Fermented Foods
May be drug-specific however until more research is conducted NCI ACS amp ASCO suggest all high dose antioxidant supplements be discouraged during radiation and chemotherapy J Natl Cancer Inst 2008 Jun 4100(11)773-83 doi 101093jncidjn148
Epub 2008 May 27
Many patients undergoing clinical trials sp recent BMT dx GVHD pancytopenia severe neutropenia may have additional contraindications Check with
team
Potential Contributions of Antioxidants to Cancer Therapy Immunomodulation and Radiosensitization Anita Thyagarajan-Sahu PhD Ravi P Sahu PhD Integrative Cancer Therapies First Published March 20 2017 Review Article
No specific data for examples Keytruda (Pembrolizumab amp Nivolumab)
Popular Supplements amp Treatment Contraindications
312018
7
Reliable Information for RDs amp
Patients
DFCI Nutrition App Website amp Social Media Insight Blog Podcasts
MSKCC About Herbs App for Supplements
CNC Cancer Nutrition Consortium e-Newsletter amp Print
AND ONC DPG amp Listserv (RD only)
cancergov National Cancer Institute
cancerorg American Cancer Society
aicrorg American Institute for Cancer Research
consumerlabscom Supplement Evaluation
Natural Medicine Database Supplement Research
Up to Date Evidence Based Information
Stacy Kennedy MPH RD CSO LDN
Dana Farber Nutrition Media
Bringing tech to patients caregivers
Patient filters recipes by goal symptom sensitivities
selects recipe amp can build shopping list amp share
Ask the Nutritionist amp Resources
Award-winning App Free iphone amp android
Eating Well During Cancer Series
Social Media Podcasts blogs amp Web Chats Twitter
chats DanaFarber wwwdana-farberorgnutrition
Stacy Kennedy MPH RD CSO LDN
Guide to Evaluate
Supplements
bull Safety First Efficacy Second
bull Communicating to patients that supplements
are not federally regulated for purity safety
or content
bull Natural Medicine Database
bull ConsumerLabscom
bull Memorial Sloan Kettering Cancer Centerrsquos
About Herbs app
Stacy Kennedy MPH RD CSO LDN
Resources for Patients
Local Grocery Store Online
Order amp Delivery
Peapod Roche
National Online Order amp
Delivery
Thrive Market Amazon
Pantry Instacart
Meal Kits
Hello Fresh Blue Apron
Plated Purple Carrots
Stacy Kennedy MPH RD CSO LDN
How to help your patients
build a healthy eating plan
Well Balanced Plant based diet
Schedule timing of meals and snacks
Consider taste changes preferences
Factor in ease of preparation
Motivational Interviewing open-minded non-judgemental
conversations
Address questions concerns internet-nutrition myths
Follow up for feedback to customize the plan
Stacy Kennedy MPH RD CSO LDN
Stacy Kennedy MPH RD CSO LDN
wwwdana-farberorgnutritionStacyKennedyRDgmailcom
StacyKennedyRD
DanaFarber
312018
3
Stacy Kennedy MPH RD CSO LDN
Stacy Kennedy MPH RD CSO LDN
Stacy Kennedy MPH RD CSO LDN
Breast Cancer Data
bull Processed Meats Modest Consumption
= risk
bull Red meat consumption is not
associated with breast cancer
incidence
Red and processed meat consumption and breast cancer UK Biobank cohort
study and meta-analysis
Jana J Anderson a Narisa DM Darwis a Daniel F Mackay a Carlos A Celis-
Morales b Donald M Lyall a Naveed Sattar b Jason MR Gill b Jill P Pell a
European Journal of Cancer 90 (2018) 73e82
Dairy amp Cancer Data
Prostate Cancer
Excessive intakes of whole milk appear to raise risk of mortality from prostate cancer
The evidence that a higher consumption of dairy products increases the risk of prostate cancer is limited
The evidence that diets high in calcium increase the risk of prostate cancer is limited
Colorectal Cancer
Consumption of dairy amp calcium supplements is protective against incidence
Gastric cancer no association or modest risk reduction
Ovarian Cancer
Potentially reducing exposure and choosing low-fat or lactose free may be associated with reduced risk of developing certain types of ovarian cancer
Lung Cancer
No association
Breast Cancer
Highest intake vs Lowest = statistically significant lower risk of developing breast cancer
Stacy Kennedy MPH RD CSO LDN
Dairy products intake and cancer mortality risk a meta-analysis of 11 population-based cohort studies [Lu et al Nutrition Journal (2016)
AICRrsquos Continuous Update Project
Calcium intake and colorectal cancer risk Results from the Nursesrsquo Health Study and Health Professionals Follow-up Study [Zhang et al International Journal of Cancer (2016)]
Dairy Consumption and Gastric Cancer Risk A Meta-Analysis of Epidemiological Studies [Guo et al Nutrition and Cancer (2015
Milk Yogurt and Lactose Intake and Ovarian Cancer Risk A Meta-Analysis [Liu et al Nutrition and Cancer (2015) amp Dairy calcium vitamin D and ovarian cancer risk in Africanndash
American women [Qin et al British Journal of Cancer (2016)]
Caini et al Critical Reviews in OncologyHematology (2016)
The Association between Dairy Intake and Breast Cancer in Western and Asian Populations A Systematic Review and Meta-Analysis [Zang et al Journal of Breast Cancer (2015)
Recommendations on Dairy
If consuming dairy choose low-fat
Fermented dairy products such as yogurt and
kefir
Plant-based sources of calcium
Ex spinach kale swiss chard dried
beans legumes soymilk and tofu
Stacy Kennedy MPH RD CSO LDN
Does Sugar Feed
Cancer Human body requires glucose
Lack of RCTs demonstrating causal link
between sugar amp cancer
Indirect link of excess refined sugar and
obesityrsquos contribution to cancer risk
Earlier studies examining relationship of
diets high in fructose or glycemic load
May risk of pancreatic colorectal amp
prostate cancers
Worse overall survival in overweight colon
cancer patients undergoing chemotherapy
Stacy Kennedy MPH RD CSO LDN
Aune D1 Chan DS Vieira AR Navarro Rosenblatt DA Vieira R Greenwood DC Cade JE Burley VJ Norat T Dietary fructose carbohydrates glycemic indices and pancreatic
cancer risk a systematic review and meta-analysis of cohort studies Ann Oncol 2012 Oct23(10)2536-46 Epub 2012 Apr 26
Michaud DS1 Fuchs CS Liu S Willett WC Colditz GA Giovannucci E Dietary glycemic load carbohydrate sugar and colorectal cancer risk in men and women Cancer
Epidemiol Biomarkers Prev 2005 Jan14(1)138-47
Hu J1 La Vecchia C Augustin LS Negri E de Groh M Morrison H Mery L Canadian Cancer Registries Epidemiology Research Group Glycemic index glycemic load and
cancer risk Ann Oncol 2013 Jan24(1)245-51 doi 101093annoncmds235 Epub 2012 Jul 25
Meyerhardt JA1 Sato K Niedzwiecki D Ye C Saltz LB Mayer RJ Mowat RB Whittom R Hantel A Benson A Wigler DS Venook A Fuchs CS Dietary glycemic load and
cancer recurrence and survival in patients with stage III colon cancer findings from CALGB 89803 J Natl Cancer Inst 2012 Nov 21104(22)1702-11 doi
101093jncidjs399 Epub 2012 Nov 7
312018
4
Recommendations on Sugar
bull Eat balanced meals and snacks
bull Include a protein-rich and fiber-rich food with each
meal and snack
bull Stay well hydrated Consider infused waters
bull Include walking and other physical activity regularly
bull Eat plenty of vegetables and other plant-based foods
bull Limit added sugars lt25 gmday women amp lt36gmday
men
bull Plain Greek yogurt + berries amp nuts vs flavored yogurts
bull Choose whole grains and starchy vegetables like
quinoa brown rice or sweet potatoes over refined
grains like white rice breads and potatoes
bull Use fresh or dried herbs and spices like cinnamon to
flavor foods and add nutrients
bull Focus on getting adequate sleep and managing stressStacy Kennedy MPH RD CSO LDN
Is Organic Better Eat Locally
wwwewgorg Stacy Kennedy MPH RD CSO LDN
Organic Label Does Not
Guarantee Itrsquos Healthy
Stacy Kennedy MPH RD CSO LDN
Soy amp Breast Cancer
Stacy Kennedy MPH RD CSO LDN
Safe Insufficient Data
Tofu X
Edamame X
Miso X
Tempeh X
Soy Milk (Unsweetened) X
Soy Oil Lecithin Soy
Sauce
X
Soy Protein Powders
(Isolated Soy Protein)
Common Sources Protein
Powder Bars Veggie
Burgers Breads ldquoHigh
Proteinrdquo Packaged Foods
X
Stacy Kennedy MPH RD CSO LDN
Superfoods Nutrition
Superstars or Brilliant
Marketing
Synonymous with ultra-healthy nutrient-packed plant-based
foods and supplements
Advertised as having exceptional powers for fighting or
preventing common health conditions like cancer
Preliminary or complete lack of data In Vitro animal studies
Lack of evidence in humans
While superfoods may not always live up to their hypehellip
Enjoy as part of a well-balanced diet to offer new and
interesting options for delicious plant-based foods
Stacy Kennedy MPH RD CSO LDN
312018
5
How to include superfoods in
your everyday diet
Drink Chaga mushroom or green tea once or twice a day
Add goji acai sea buckthorn currant or other berries to oatmeal cereal salads baking or smoothies
Add chia hemp or ground flax seeds to salads smoothies baked goods hot or cold cereals
Include seaweed in soups or as a snack paired with avocado
Drink Kefir or Kombucha for a fun treat
Add cacao powder to smoothies waffle or pancake mix oats muffins breads desserts or other baking for chocolate flavor without added sugars
Swap brown rice with teff in stir-fry bowls or side dishes
Stacy Kennedy MPH RD CSO LDN
Probiotics amp Cancer
Severity of treatment related diarrhea (CRC)
Duration of diarrhea symptoms during chemo
(CRC)
Diarrhea amp boost QOL in long term symptom
management for patients with IBS
Lack of sufficient evidence linked to cancer
prevention or promotion of survivorship
Preliminary In Vitro animal model studies
looking at risk
Stacy Kennedy MPH RD CSO LDN
Stacy Kennedy MPH RD CSO LDN
FAKENEWS Alcohol amp Cancer Breast Cancer Risk Specifically
Risk with 3-6 Drinksweek (lt1day) or 10 for every 10 gm
Higher with early or later in life exposure
Daily consumption of alcohol increases the risk
Moderate drinking ndash Low risk for alcohol problems - General
Women ndash lt2 drinks per day
Men ndash lt3 drinks per day
People age ge65 ndash lt2 drinks per day
14 to 15 grams of alcohol (05 to 06 fl ounces) =
12 ounces of beer
5 ounces of wine
15 ounces of 80 proof liquor
Stacy Kennedy MPH RD CSO LDN
Alcohol amp Breast Cancer
bullInsignificant differences between type of alcohol and risk
bullConsuming Folic Acid may help reduce associated riskbullEspecially ER- Breast Cancers bullMultivitamin Recommended bullUS Food Supply Fortification
Stacy Kennedy MPH RD CSO LDN
==
Alkaline Diets
Promote avoidance of processed foods excess meats
amp dairy and abundance of plant-based foods
Biologic Plausibility Can You Change Your Blood pH
Reliability of home testing
Bottom Line
Stacy Kennedy MPH RD CSO LDN
312018
6
Ketogenic Diet
bullPopular use in weight loss athletic performance may allow body to
burn fat for energy vs carbssugars
bullTherapeutic use in pediatric seizure treatment
bullAcute risks GI Discomfort Nausea Vomiting Fatigue Elevated
blood ketones hypoglycemia trace mineral deficiencies
bullLong term risks Increased LDL Bone mineral loss kidney stones
decreased IGF-1 renal damage
Stacy Kennedy MPH RD CSO LDN Allen B et al Ketogenic diets as an adjuvant cancer therapy History and potential mechanism RedoxBiology2(2014)963ndash970
Ketogenic Diet amp Cancer
Research bullLack of data for safety of long term use
bullPreliminary research investigating benefits for cancer patients and evaluating safety in preclinical and animal models
bullHuman studies are needed amp underway Currently 21 studies variety of cancer dx
bullData supporting Mediterranean Diet
bullContradicts previous Low-Fat Dietary recommendations for Breast Cancer especially for those with ER-
Stacy Kennedy MPH RD CSO LDN
Todayrsquos Dietitian September 2017 Issue Ask the Expert Ketosis for Weight Loss By Toby Amidor MS RD CDN Vol 19 No 9 P 12
A Nutritional Perspective of Ketogenic Diet in Cancer A Narrative Review Camila L P Oliveira MSc Stephanie Mattingly PhD Ralf Schirrmacher MD Michael B Sawyer MD Eugene J Fine MD Carla M Prado PhD RD J Acad Nutr Diet 2017
BG AllenetalRedoxBiology2(2014)963ndash970
Mediterranean Diet - Effects on Health Outcomes of a Mediterranean Diet With No Restriction on Fat Intake A Systematic Review and Meta-analysis Hanna E Bloomfield MD MPH Eva Koeller BA Nancy Greer PhD Roderick MacDonald MS Robert Kane MD and Timothy J Wilt MD MPH Annals of Internal
Medicine 2016165491-5008WINSWHEL studies J Am Diet Assoc 2009 Apr 109(4) 688ndash696
How to Create a Balanced
Keto-Friendly Diet for
Patients
Higher in healthy fat moderate in lean proteins
lower in carbohydrates without compromising
phytonutrient intake Adjust macro s as
appropriate individually
Focus on increasing fiber and reducing added sugars
Consider logistics for adherence safety for
individual patient duration you would suggest
Stacy Kennedy MPH RD CSO LDN
Intermittent Fasting Common Practices
Cultural amp Historical Prevalence
12-16 hour window between eating (overnight)
Circadian IF regimens (100 total daily calories 8a-2p)
2 Daysweek lt500 calories
Focus on Eating PatternTiming
Potential Benefits
Improved insulin sensitivity
Fat metabolism appetite and hunger management
Preliminary research looking at potential benefits during chemotherapy treatment amp in overall survivorship and prevention
Potential Risks
Meeting elevated nutrition needs during treatment
Logistics of scheduling meal prep familycultural eating patterns
Consider options individually with patients
Stacy Kennedy MPH RD CSO LDN
BMC Med 2017 May 2415(1)106 doi 101186s12916-017-0873-x
Adv Nutr 2016 Jul 157(4)690-705 doi 103945an115011767 Print 2016 Jul
Food vs Supplement
Stacy Kennedy MPH RD CSO LDN Stacy Kennedy MPH RD CSO LDN
XRT Chemo Immuno-therapy
Food Source
Curcumin X X
DriedFresh Turmeric + Black Pepper in cooking
High Dose Vitamin C E carotenes
X X
Colorful veggies fruits nutsseeds
Vitamin D OK OK OK Dairy Fortified Non-Dairy Mushrooms Sardines
Probiotics OK OK OK Plain Greek Yogurt Kefir Kombucha Fermented Foods
May be drug-specific however until more research is conducted NCI ACS amp ASCO suggest all high dose antioxidant supplements be discouraged during radiation and chemotherapy J Natl Cancer Inst 2008 Jun 4100(11)773-83 doi 101093jncidjn148
Epub 2008 May 27
Many patients undergoing clinical trials sp recent BMT dx GVHD pancytopenia severe neutropenia may have additional contraindications Check with
team
Potential Contributions of Antioxidants to Cancer Therapy Immunomodulation and Radiosensitization Anita Thyagarajan-Sahu PhD Ravi P Sahu PhD Integrative Cancer Therapies First Published March 20 2017 Review Article
No specific data for examples Keytruda (Pembrolizumab amp Nivolumab)
Popular Supplements amp Treatment Contraindications
312018
7
Reliable Information for RDs amp
Patients
DFCI Nutrition App Website amp Social Media Insight Blog Podcasts
MSKCC About Herbs App for Supplements
CNC Cancer Nutrition Consortium e-Newsletter amp Print
AND ONC DPG amp Listserv (RD only)
cancergov National Cancer Institute
cancerorg American Cancer Society
aicrorg American Institute for Cancer Research
consumerlabscom Supplement Evaluation
Natural Medicine Database Supplement Research
Up to Date Evidence Based Information
Stacy Kennedy MPH RD CSO LDN
Dana Farber Nutrition Media
Bringing tech to patients caregivers
Patient filters recipes by goal symptom sensitivities
selects recipe amp can build shopping list amp share
Ask the Nutritionist amp Resources
Award-winning App Free iphone amp android
Eating Well During Cancer Series
Social Media Podcasts blogs amp Web Chats Twitter
chats DanaFarber wwwdana-farberorgnutrition
Stacy Kennedy MPH RD CSO LDN
Guide to Evaluate
Supplements
bull Safety First Efficacy Second
bull Communicating to patients that supplements
are not federally regulated for purity safety
or content
bull Natural Medicine Database
bull ConsumerLabscom
bull Memorial Sloan Kettering Cancer Centerrsquos
About Herbs app
Stacy Kennedy MPH RD CSO LDN
Resources for Patients
Local Grocery Store Online
Order amp Delivery
Peapod Roche
National Online Order amp
Delivery
Thrive Market Amazon
Pantry Instacart
Meal Kits
Hello Fresh Blue Apron
Plated Purple Carrots
Stacy Kennedy MPH RD CSO LDN
How to help your patients
build a healthy eating plan
Well Balanced Plant based diet
Schedule timing of meals and snacks
Consider taste changes preferences
Factor in ease of preparation
Motivational Interviewing open-minded non-judgemental
conversations
Address questions concerns internet-nutrition myths
Follow up for feedback to customize the plan
Stacy Kennedy MPH RD CSO LDN
Stacy Kennedy MPH RD CSO LDN
wwwdana-farberorgnutritionStacyKennedyRDgmailcom
StacyKennedyRD
DanaFarber
312018
4
Recommendations on Sugar
bull Eat balanced meals and snacks
bull Include a protein-rich and fiber-rich food with each
meal and snack
bull Stay well hydrated Consider infused waters
bull Include walking and other physical activity regularly
bull Eat plenty of vegetables and other plant-based foods
bull Limit added sugars lt25 gmday women amp lt36gmday
men
bull Plain Greek yogurt + berries amp nuts vs flavored yogurts
bull Choose whole grains and starchy vegetables like
quinoa brown rice or sweet potatoes over refined
grains like white rice breads and potatoes
bull Use fresh or dried herbs and spices like cinnamon to
flavor foods and add nutrients
bull Focus on getting adequate sleep and managing stressStacy Kennedy MPH RD CSO LDN
Is Organic Better Eat Locally
wwwewgorg Stacy Kennedy MPH RD CSO LDN
Organic Label Does Not
Guarantee Itrsquos Healthy
Stacy Kennedy MPH RD CSO LDN
Soy amp Breast Cancer
Stacy Kennedy MPH RD CSO LDN
Safe Insufficient Data
Tofu X
Edamame X
Miso X
Tempeh X
Soy Milk (Unsweetened) X
Soy Oil Lecithin Soy
Sauce
X
Soy Protein Powders
(Isolated Soy Protein)
Common Sources Protein
Powder Bars Veggie
Burgers Breads ldquoHigh
Proteinrdquo Packaged Foods
X
Stacy Kennedy MPH RD CSO LDN
Superfoods Nutrition
Superstars or Brilliant
Marketing
Synonymous with ultra-healthy nutrient-packed plant-based
foods and supplements
Advertised as having exceptional powers for fighting or
preventing common health conditions like cancer
Preliminary or complete lack of data In Vitro animal studies
Lack of evidence in humans
While superfoods may not always live up to their hypehellip
Enjoy as part of a well-balanced diet to offer new and
interesting options for delicious plant-based foods
Stacy Kennedy MPH RD CSO LDN
312018
5
How to include superfoods in
your everyday diet
Drink Chaga mushroom or green tea once or twice a day
Add goji acai sea buckthorn currant or other berries to oatmeal cereal salads baking or smoothies
Add chia hemp or ground flax seeds to salads smoothies baked goods hot or cold cereals
Include seaweed in soups or as a snack paired with avocado
Drink Kefir or Kombucha for a fun treat
Add cacao powder to smoothies waffle or pancake mix oats muffins breads desserts or other baking for chocolate flavor without added sugars
Swap brown rice with teff in stir-fry bowls or side dishes
Stacy Kennedy MPH RD CSO LDN
Probiotics amp Cancer
Severity of treatment related diarrhea (CRC)
Duration of diarrhea symptoms during chemo
(CRC)
Diarrhea amp boost QOL in long term symptom
management for patients with IBS
Lack of sufficient evidence linked to cancer
prevention or promotion of survivorship
Preliminary In Vitro animal model studies
looking at risk
Stacy Kennedy MPH RD CSO LDN
Stacy Kennedy MPH RD CSO LDN
FAKENEWS Alcohol amp Cancer Breast Cancer Risk Specifically
Risk with 3-6 Drinksweek (lt1day) or 10 for every 10 gm
Higher with early or later in life exposure
Daily consumption of alcohol increases the risk
Moderate drinking ndash Low risk for alcohol problems - General
Women ndash lt2 drinks per day
Men ndash lt3 drinks per day
People age ge65 ndash lt2 drinks per day
14 to 15 grams of alcohol (05 to 06 fl ounces) =
12 ounces of beer
5 ounces of wine
15 ounces of 80 proof liquor
Stacy Kennedy MPH RD CSO LDN
Alcohol amp Breast Cancer
bullInsignificant differences between type of alcohol and risk
bullConsuming Folic Acid may help reduce associated riskbullEspecially ER- Breast Cancers bullMultivitamin Recommended bullUS Food Supply Fortification
Stacy Kennedy MPH RD CSO LDN
==
Alkaline Diets
Promote avoidance of processed foods excess meats
amp dairy and abundance of plant-based foods
Biologic Plausibility Can You Change Your Blood pH
Reliability of home testing
Bottom Line
Stacy Kennedy MPH RD CSO LDN
312018
6
Ketogenic Diet
bullPopular use in weight loss athletic performance may allow body to
burn fat for energy vs carbssugars
bullTherapeutic use in pediatric seizure treatment
bullAcute risks GI Discomfort Nausea Vomiting Fatigue Elevated
blood ketones hypoglycemia trace mineral deficiencies
bullLong term risks Increased LDL Bone mineral loss kidney stones
decreased IGF-1 renal damage
Stacy Kennedy MPH RD CSO LDN Allen B et al Ketogenic diets as an adjuvant cancer therapy History and potential mechanism RedoxBiology2(2014)963ndash970
Ketogenic Diet amp Cancer
Research bullLack of data for safety of long term use
bullPreliminary research investigating benefits for cancer patients and evaluating safety in preclinical and animal models
bullHuman studies are needed amp underway Currently 21 studies variety of cancer dx
bullData supporting Mediterranean Diet
bullContradicts previous Low-Fat Dietary recommendations for Breast Cancer especially for those with ER-
Stacy Kennedy MPH RD CSO LDN
Todayrsquos Dietitian September 2017 Issue Ask the Expert Ketosis for Weight Loss By Toby Amidor MS RD CDN Vol 19 No 9 P 12
A Nutritional Perspective of Ketogenic Diet in Cancer A Narrative Review Camila L P Oliveira MSc Stephanie Mattingly PhD Ralf Schirrmacher MD Michael B Sawyer MD Eugene J Fine MD Carla M Prado PhD RD J Acad Nutr Diet 2017
BG AllenetalRedoxBiology2(2014)963ndash970
Mediterranean Diet - Effects on Health Outcomes of a Mediterranean Diet With No Restriction on Fat Intake A Systematic Review and Meta-analysis Hanna E Bloomfield MD MPH Eva Koeller BA Nancy Greer PhD Roderick MacDonald MS Robert Kane MD and Timothy J Wilt MD MPH Annals of Internal
Medicine 2016165491-5008WINSWHEL studies J Am Diet Assoc 2009 Apr 109(4) 688ndash696
How to Create a Balanced
Keto-Friendly Diet for
Patients
Higher in healthy fat moderate in lean proteins
lower in carbohydrates without compromising
phytonutrient intake Adjust macro s as
appropriate individually
Focus on increasing fiber and reducing added sugars
Consider logistics for adherence safety for
individual patient duration you would suggest
Stacy Kennedy MPH RD CSO LDN
Intermittent Fasting Common Practices
Cultural amp Historical Prevalence
12-16 hour window between eating (overnight)
Circadian IF regimens (100 total daily calories 8a-2p)
2 Daysweek lt500 calories
Focus on Eating PatternTiming
Potential Benefits
Improved insulin sensitivity
Fat metabolism appetite and hunger management
Preliminary research looking at potential benefits during chemotherapy treatment amp in overall survivorship and prevention
Potential Risks
Meeting elevated nutrition needs during treatment
Logistics of scheduling meal prep familycultural eating patterns
Consider options individually with patients
Stacy Kennedy MPH RD CSO LDN
BMC Med 2017 May 2415(1)106 doi 101186s12916-017-0873-x
Adv Nutr 2016 Jul 157(4)690-705 doi 103945an115011767 Print 2016 Jul
Food vs Supplement
Stacy Kennedy MPH RD CSO LDN Stacy Kennedy MPH RD CSO LDN
XRT Chemo Immuno-therapy
Food Source
Curcumin X X
DriedFresh Turmeric + Black Pepper in cooking
High Dose Vitamin C E carotenes
X X
Colorful veggies fruits nutsseeds
Vitamin D OK OK OK Dairy Fortified Non-Dairy Mushrooms Sardines
Probiotics OK OK OK Plain Greek Yogurt Kefir Kombucha Fermented Foods
May be drug-specific however until more research is conducted NCI ACS amp ASCO suggest all high dose antioxidant supplements be discouraged during radiation and chemotherapy J Natl Cancer Inst 2008 Jun 4100(11)773-83 doi 101093jncidjn148
Epub 2008 May 27
Many patients undergoing clinical trials sp recent BMT dx GVHD pancytopenia severe neutropenia may have additional contraindications Check with
team
Potential Contributions of Antioxidants to Cancer Therapy Immunomodulation and Radiosensitization Anita Thyagarajan-Sahu PhD Ravi P Sahu PhD Integrative Cancer Therapies First Published March 20 2017 Review Article
No specific data for examples Keytruda (Pembrolizumab amp Nivolumab)
Popular Supplements amp Treatment Contraindications
312018
7
Reliable Information for RDs amp
Patients
DFCI Nutrition App Website amp Social Media Insight Blog Podcasts
MSKCC About Herbs App for Supplements
CNC Cancer Nutrition Consortium e-Newsletter amp Print
AND ONC DPG amp Listserv (RD only)
cancergov National Cancer Institute
cancerorg American Cancer Society
aicrorg American Institute for Cancer Research
consumerlabscom Supplement Evaluation
Natural Medicine Database Supplement Research
Up to Date Evidence Based Information
Stacy Kennedy MPH RD CSO LDN
Dana Farber Nutrition Media
Bringing tech to patients caregivers
Patient filters recipes by goal symptom sensitivities
selects recipe amp can build shopping list amp share
Ask the Nutritionist amp Resources
Award-winning App Free iphone amp android
Eating Well During Cancer Series
Social Media Podcasts blogs amp Web Chats Twitter
chats DanaFarber wwwdana-farberorgnutrition
Stacy Kennedy MPH RD CSO LDN
Guide to Evaluate
Supplements
bull Safety First Efficacy Second
bull Communicating to patients that supplements
are not federally regulated for purity safety
or content
bull Natural Medicine Database
bull ConsumerLabscom
bull Memorial Sloan Kettering Cancer Centerrsquos
About Herbs app
Stacy Kennedy MPH RD CSO LDN
Resources for Patients
Local Grocery Store Online
Order amp Delivery
Peapod Roche
National Online Order amp
Delivery
Thrive Market Amazon
Pantry Instacart
Meal Kits
Hello Fresh Blue Apron
Plated Purple Carrots
Stacy Kennedy MPH RD CSO LDN
How to help your patients
build a healthy eating plan
Well Balanced Plant based diet
Schedule timing of meals and snacks
Consider taste changes preferences
Factor in ease of preparation
Motivational Interviewing open-minded non-judgemental
conversations
Address questions concerns internet-nutrition myths
Follow up for feedback to customize the plan
Stacy Kennedy MPH RD CSO LDN
Stacy Kennedy MPH RD CSO LDN
wwwdana-farberorgnutritionStacyKennedyRDgmailcom
StacyKennedyRD
DanaFarber
312018
5
How to include superfoods in
your everyday diet
Drink Chaga mushroom or green tea once or twice a day
Add goji acai sea buckthorn currant or other berries to oatmeal cereal salads baking or smoothies
Add chia hemp or ground flax seeds to salads smoothies baked goods hot or cold cereals
Include seaweed in soups or as a snack paired with avocado
Drink Kefir or Kombucha for a fun treat
Add cacao powder to smoothies waffle or pancake mix oats muffins breads desserts or other baking for chocolate flavor without added sugars
Swap brown rice with teff in stir-fry bowls or side dishes
Stacy Kennedy MPH RD CSO LDN
Probiotics amp Cancer
Severity of treatment related diarrhea (CRC)
Duration of diarrhea symptoms during chemo
(CRC)
Diarrhea amp boost QOL in long term symptom
management for patients with IBS
Lack of sufficient evidence linked to cancer
prevention or promotion of survivorship
Preliminary In Vitro animal model studies
looking at risk
Stacy Kennedy MPH RD CSO LDN
Stacy Kennedy MPH RD CSO LDN
FAKENEWS Alcohol amp Cancer Breast Cancer Risk Specifically
Risk with 3-6 Drinksweek (lt1day) or 10 for every 10 gm
Higher with early or later in life exposure
Daily consumption of alcohol increases the risk
Moderate drinking ndash Low risk for alcohol problems - General
Women ndash lt2 drinks per day
Men ndash lt3 drinks per day
People age ge65 ndash lt2 drinks per day
14 to 15 grams of alcohol (05 to 06 fl ounces) =
12 ounces of beer
5 ounces of wine
15 ounces of 80 proof liquor
Stacy Kennedy MPH RD CSO LDN
Alcohol amp Breast Cancer
bullInsignificant differences between type of alcohol and risk
bullConsuming Folic Acid may help reduce associated riskbullEspecially ER- Breast Cancers bullMultivitamin Recommended bullUS Food Supply Fortification
Stacy Kennedy MPH RD CSO LDN
==
Alkaline Diets
Promote avoidance of processed foods excess meats
amp dairy and abundance of plant-based foods
Biologic Plausibility Can You Change Your Blood pH
Reliability of home testing
Bottom Line
Stacy Kennedy MPH RD CSO LDN
312018
6
Ketogenic Diet
bullPopular use in weight loss athletic performance may allow body to
burn fat for energy vs carbssugars
bullTherapeutic use in pediatric seizure treatment
bullAcute risks GI Discomfort Nausea Vomiting Fatigue Elevated
blood ketones hypoglycemia trace mineral deficiencies
bullLong term risks Increased LDL Bone mineral loss kidney stones
decreased IGF-1 renal damage
Stacy Kennedy MPH RD CSO LDN Allen B et al Ketogenic diets as an adjuvant cancer therapy History and potential mechanism RedoxBiology2(2014)963ndash970
Ketogenic Diet amp Cancer
Research bullLack of data for safety of long term use
bullPreliminary research investigating benefits for cancer patients and evaluating safety in preclinical and animal models
bullHuman studies are needed amp underway Currently 21 studies variety of cancer dx
bullData supporting Mediterranean Diet
bullContradicts previous Low-Fat Dietary recommendations for Breast Cancer especially for those with ER-
Stacy Kennedy MPH RD CSO LDN
Todayrsquos Dietitian September 2017 Issue Ask the Expert Ketosis for Weight Loss By Toby Amidor MS RD CDN Vol 19 No 9 P 12
A Nutritional Perspective of Ketogenic Diet in Cancer A Narrative Review Camila L P Oliveira MSc Stephanie Mattingly PhD Ralf Schirrmacher MD Michael B Sawyer MD Eugene J Fine MD Carla M Prado PhD RD J Acad Nutr Diet 2017
BG AllenetalRedoxBiology2(2014)963ndash970
Mediterranean Diet - Effects on Health Outcomes of a Mediterranean Diet With No Restriction on Fat Intake A Systematic Review and Meta-analysis Hanna E Bloomfield MD MPH Eva Koeller BA Nancy Greer PhD Roderick MacDonald MS Robert Kane MD and Timothy J Wilt MD MPH Annals of Internal
Medicine 2016165491-5008WINSWHEL studies J Am Diet Assoc 2009 Apr 109(4) 688ndash696
How to Create a Balanced
Keto-Friendly Diet for
Patients
Higher in healthy fat moderate in lean proteins
lower in carbohydrates without compromising
phytonutrient intake Adjust macro s as
appropriate individually
Focus on increasing fiber and reducing added sugars
Consider logistics for adherence safety for
individual patient duration you would suggest
Stacy Kennedy MPH RD CSO LDN
Intermittent Fasting Common Practices
Cultural amp Historical Prevalence
12-16 hour window between eating (overnight)
Circadian IF regimens (100 total daily calories 8a-2p)
2 Daysweek lt500 calories
Focus on Eating PatternTiming
Potential Benefits
Improved insulin sensitivity
Fat metabolism appetite and hunger management
Preliminary research looking at potential benefits during chemotherapy treatment amp in overall survivorship and prevention
Potential Risks
Meeting elevated nutrition needs during treatment
Logistics of scheduling meal prep familycultural eating patterns
Consider options individually with patients
Stacy Kennedy MPH RD CSO LDN
BMC Med 2017 May 2415(1)106 doi 101186s12916-017-0873-x
Adv Nutr 2016 Jul 157(4)690-705 doi 103945an115011767 Print 2016 Jul
Food vs Supplement
Stacy Kennedy MPH RD CSO LDN Stacy Kennedy MPH RD CSO LDN
XRT Chemo Immuno-therapy
Food Source
Curcumin X X
DriedFresh Turmeric + Black Pepper in cooking
High Dose Vitamin C E carotenes
X X
Colorful veggies fruits nutsseeds
Vitamin D OK OK OK Dairy Fortified Non-Dairy Mushrooms Sardines
Probiotics OK OK OK Plain Greek Yogurt Kefir Kombucha Fermented Foods
May be drug-specific however until more research is conducted NCI ACS amp ASCO suggest all high dose antioxidant supplements be discouraged during radiation and chemotherapy J Natl Cancer Inst 2008 Jun 4100(11)773-83 doi 101093jncidjn148
Epub 2008 May 27
Many patients undergoing clinical trials sp recent BMT dx GVHD pancytopenia severe neutropenia may have additional contraindications Check with
team
Potential Contributions of Antioxidants to Cancer Therapy Immunomodulation and Radiosensitization Anita Thyagarajan-Sahu PhD Ravi P Sahu PhD Integrative Cancer Therapies First Published March 20 2017 Review Article
No specific data for examples Keytruda (Pembrolizumab amp Nivolumab)
Popular Supplements amp Treatment Contraindications
312018
7
Reliable Information for RDs amp
Patients
DFCI Nutrition App Website amp Social Media Insight Blog Podcasts
MSKCC About Herbs App for Supplements
CNC Cancer Nutrition Consortium e-Newsletter amp Print
AND ONC DPG amp Listserv (RD only)
cancergov National Cancer Institute
cancerorg American Cancer Society
aicrorg American Institute for Cancer Research
consumerlabscom Supplement Evaluation
Natural Medicine Database Supplement Research
Up to Date Evidence Based Information
Stacy Kennedy MPH RD CSO LDN
Dana Farber Nutrition Media
Bringing tech to patients caregivers
Patient filters recipes by goal symptom sensitivities
selects recipe amp can build shopping list amp share
Ask the Nutritionist amp Resources
Award-winning App Free iphone amp android
Eating Well During Cancer Series
Social Media Podcasts blogs amp Web Chats Twitter
chats DanaFarber wwwdana-farberorgnutrition
Stacy Kennedy MPH RD CSO LDN
Guide to Evaluate
Supplements
bull Safety First Efficacy Second
bull Communicating to patients that supplements
are not federally regulated for purity safety
or content
bull Natural Medicine Database
bull ConsumerLabscom
bull Memorial Sloan Kettering Cancer Centerrsquos
About Herbs app
Stacy Kennedy MPH RD CSO LDN
Resources for Patients
Local Grocery Store Online
Order amp Delivery
Peapod Roche
National Online Order amp
Delivery
Thrive Market Amazon
Pantry Instacart
Meal Kits
Hello Fresh Blue Apron
Plated Purple Carrots
Stacy Kennedy MPH RD CSO LDN
How to help your patients
build a healthy eating plan
Well Balanced Plant based diet
Schedule timing of meals and snacks
Consider taste changes preferences
Factor in ease of preparation
Motivational Interviewing open-minded non-judgemental
conversations
Address questions concerns internet-nutrition myths
Follow up for feedback to customize the plan
Stacy Kennedy MPH RD CSO LDN
Stacy Kennedy MPH RD CSO LDN
wwwdana-farberorgnutritionStacyKennedyRDgmailcom
StacyKennedyRD
DanaFarber
312018
6
Ketogenic Diet
bullPopular use in weight loss athletic performance may allow body to
burn fat for energy vs carbssugars
bullTherapeutic use in pediatric seizure treatment
bullAcute risks GI Discomfort Nausea Vomiting Fatigue Elevated
blood ketones hypoglycemia trace mineral deficiencies
bullLong term risks Increased LDL Bone mineral loss kidney stones
decreased IGF-1 renal damage
Stacy Kennedy MPH RD CSO LDN Allen B et al Ketogenic diets as an adjuvant cancer therapy History and potential mechanism RedoxBiology2(2014)963ndash970
Ketogenic Diet amp Cancer
Research bullLack of data for safety of long term use
bullPreliminary research investigating benefits for cancer patients and evaluating safety in preclinical and animal models
bullHuman studies are needed amp underway Currently 21 studies variety of cancer dx
bullData supporting Mediterranean Diet
bullContradicts previous Low-Fat Dietary recommendations for Breast Cancer especially for those with ER-
Stacy Kennedy MPH RD CSO LDN
Todayrsquos Dietitian September 2017 Issue Ask the Expert Ketosis for Weight Loss By Toby Amidor MS RD CDN Vol 19 No 9 P 12
A Nutritional Perspective of Ketogenic Diet in Cancer A Narrative Review Camila L P Oliveira MSc Stephanie Mattingly PhD Ralf Schirrmacher MD Michael B Sawyer MD Eugene J Fine MD Carla M Prado PhD RD J Acad Nutr Diet 2017
BG AllenetalRedoxBiology2(2014)963ndash970
Mediterranean Diet - Effects on Health Outcomes of a Mediterranean Diet With No Restriction on Fat Intake A Systematic Review and Meta-analysis Hanna E Bloomfield MD MPH Eva Koeller BA Nancy Greer PhD Roderick MacDonald MS Robert Kane MD and Timothy J Wilt MD MPH Annals of Internal
Medicine 2016165491-5008WINSWHEL studies J Am Diet Assoc 2009 Apr 109(4) 688ndash696
How to Create a Balanced
Keto-Friendly Diet for
Patients
Higher in healthy fat moderate in lean proteins
lower in carbohydrates without compromising
phytonutrient intake Adjust macro s as
appropriate individually
Focus on increasing fiber and reducing added sugars
Consider logistics for adherence safety for
individual patient duration you would suggest
Stacy Kennedy MPH RD CSO LDN
Intermittent Fasting Common Practices
Cultural amp Historical Prevalence
12-16 hour window between eating (overnight)
Circadian IF regimens (100 total daily calories 8a-2p)
2 Daysweek lt500 calories
Focus on Eating PatternTiming
Potential Benefits
Improved insulin sensitivity
Fat metabolism appetite and hunger management
Preliminary research looking at potential benefits during chemotherapy treatment amp in overall survivorship and prevention
Potential Risks
Meeting elevated nutrition needs during treatment
Logistics of scheduling meal prep familycultural eating patterns
Consider options individually with patients
Stacy Kennedy MPH RD CSO LDN
BMC Med 2017 May 2415(1)106 doi 101186s12916-017-0873-x
Adv Nutr 2016 Jul 157(4)690-705 doi 103945an115011767 Print 2016 Jul
Food vs Supplement
Stacy Kennedy MPH RD CSO LDN Stacy Kennedy MPH RD CSO LDN
XRT Chemo Immuno-therapy
Food Source
Curcumin X X
DriedFresh Turmeric + Black Pepper in cooking
High Dose Vitamin C E carotenes
X X
Colorful veggies fruits nutsseeds
Vitamin D OK OK OK Dairy Fortified Non-Dairy Mushrooms Sardines
Probiotics OK OK OK Plain Greek Yogurt Kefir Kombucha Fermented Foods
May be drug-specific however until more research is conducted NCI ACS amp ASCO suggest all high dose antioxidant supplements be discouraged during radiation and chemotherapy J Natl Cancer Inst 2008 Jun 4100(11)773-83 doi 101093jncidjn148
Epub 2008 May 27
Many patients undergoing clinical trials sp recent BMT dx GVHD pancytopenia severe neutropenia may have additional contraindications Check with
team
Potential Contributions of Antioxidants to Cancer Therapy Immunomodulation and Radiosensitization Anita Thyagarajan-Sahu PhD Ravi P Sahu PhD Integrative Cancer Therapies First Published March 20 2017 Review Article
No specific data for examples Keytruda (Pembrolizumab amp Nivolumab)
Popular Supplements amp Treatment Contraindications
312018
7
Reliable Information for RDs amp
Patients
DFCI Nutrition App Website amp Social Media Insight Blog Podcasts
MSKCC About Herbs App for Supplements
CNC Cancer Nutrition Consortium e-Newsletter amp Print
AND ONC DPG amp Listserv (RD only)
cancergov National Cancer Institute
cancerorg American Cancer Society
aicrorg American Institute for Cancer Research
consumerlabscom Supplement Evaluation
Natural Medicine Database Supplement Research
Up to Date Evidence Based Information
Stacy Kennedy MPH RD CSO LDN
Dana Farber Nutrition Media
Bringing tech to patients caregivers
Patient filters recipes by goal symptom sensitivities
selects recipe amp can build shopping list amp share
Ask the Nutritionist amp Resources
Award-winning App Free iphone amp android
Eating Well During Cancer Series
Social Media Podcasts blogs amp Web Chats Twitter
chats DanaFarber wwwdana-farberorgnutrition
Stacy Kennedy MPH RD CSO LDN
Guide to Evaluate
Supplements
bull Safety First Efficacy Second
bull Communicating to patients that supplements
are not federally regulated for purity safety
or content
bull Natural Medicine Database
bull ConsumerLabscom
bull Memorial Sloan Kettering Cancer Centerrsquos
About Herbs app
Stacy Kennedy MPH RD CSO LDN
Resources for Patients
Local Grocery Store Online
Order amp Delivery
Peapod Roche
National Online Order amp
Delivery
Thrive Market Amazon
Pantry Instacart
Meal Kits
Hello Fresh Blue Apron
Plated Purple Carrots
Stacy Kennedy MPH RD CSO LDN
How to help your patients
build a healthy eating plan
Well Balanced Plant based diet
Schedule timing of meals and snacks
Consider taste changes preferences
Factor in ease of preparation
Motivational Interviewing open-minded non-judgemental
conversations
Address questions concerns internet-nutrition myths
Follow up for feedback to customize the plan
Stacy Kennedy MPH RD CSO LDN
Stacy Kennedy MPH RD CSO LDN
wwwdana-farberorgnutritionStacyKennedyRDgmailcom
StacyKennedyRD
DanaFarber
312018
7
Reliable Information for RDs amp
Patients
DFCI Nutrition App Website amp Social Media Insight Blog Podcasts
MSKCC About Herbs App for Supplements
CNC Cancer Nutrition Consortium e-Newsletter amp Print
AND ONC DPG amp Listserv (RD only)
cancergov National Cancer Institute
cancerorg American Cancer Society
aicrorg American Institute for Cancer Research
consumerlabscom Supplement Evaluation
Natural Medicine Database Supplement Research
Up to Date Evidence Based Information
Stacy Kennedy MPH RD CSO LDN
Dana Farber Nutrition Media
Bringing tech to patients caregivers
Patient filters recipes by goal symptom sensitivities
selects recipe amp can build shopping list amp share
Ask the Nutritionist amp Resources
Award-winning App Free iphone amp android
Eating Well During Cancer Series
Social Media Podcasts blogs amp Web Chats Twitter
chats DanaFarber wwwdana-farberorgnutrition
Stacy Kennedy MPH RD CSO LDN
Guide to Evaluate
Supplements
bull Safety First Efficacy Second
bull Communicating to patients that supplements
are not federally regulated for purity safety
or content
bull Natural Medicine Database
bull ConsumerLabscom
bull Memorial Sloan Kettering Cancer Centerrsquos
About Herbs app
Stacy Kennedy MPH RD CSO LDN
Resources for Patients
Local Grocery Store Online
Order amp Delivery
Peapod Roche
National Online Order amp
Delivery
Thrive Market Amazon
Pantry Instacart
Meal Kits
Hello Fresh Blue Apron
Plated Purple Carrots
Stacy Kennedy MPH RD CSO LDN
How to help your patients
build a healthy eating plan
Well Balanced Plant based diet
Schedule timing of meals and snacks
Consider taste changes preferences
Factor in ease of preparation
Motivational Interviewing open-minded non-judgemental
conversations
Address questions concerns internet-nutrition myths
Follow up for feedback to customize the plan
Stacy Kennedy MPH RD CSO LDN
Stacy Kennedy MPH RD CSO LDN
wwwdana-farberorgnutritionStacyKennedyRDgmailcom
StacyKennedyRD
DanaFarber