Prescribing a Diet to Conquer Cancer
It’s January. Are you among the many people resolved to change your diet in the new year? Dr. Neil Iyengar and Dr. Nadja Pinnavaia commit to promoting healthy lifestyles every day in their work to prevent cancer and keep it from returning in patients who have already conquered it. In this episode of Your Stories, they prescribe lifestyle changes influenced by their expertise in disease intervention and share details about their partnership to simplify healthy living for breast cancer survivors. It's January. Are you among the many people resolve to change your diet in the new year? Dr. Neil Iyengar and Dr. Nadja Pinnavaia commit to promoting healthy lifestyles every day in their work to prevent cancer and keep it from returning in patients who have already conquered it. Dr. Iyengar is a leading oncology researcher studying the links between obesity and breast cancer. Dr. Pinnavaia left a career in finance to launch a meal and coaching service to transition people into a healthy way of life. In this episode of Your Stories, they prescribe lifestyle changes influenced by their expertise in disease intervention and share details about their partnership to simplify healthy living for breast cancer survivors. Nadja, could you tell me a little bit about your history with cancer-- I know it's been present in your family-- and how that has colored your upbringing and your current philosophy? Cancer touches so many of us these days and often creates a new path for us. My mother was diagnosed with breast cancer 30 years ago. And she was triple negative. And she died 20 years ago. And then four years ago, my sister was diagnosed with breast cancer. And she was operated. And I, at that point, went to be tested genetically. And I'm BRCA2, and I had a prophylactic double mastectomy. Then more recently, my mother-in-law, whom I'm very close to because both my parents have passed away, was diagnosed with stage 3b kidney cancer. And that actually opened up a new world for me of research and learning about what is it that we can do on top of the great clinical strides that we're making with chemotherapy in order to help our chances of surviving cancer. I'm curious to understand your decision making around the genetic testing and what really prompted you. I understand the family history. But what really made you decide now's the time for me to go get tested? Cancer today is a makeup of genes and our environment. I didn't realize how much environment impacted our cancer journey. But if I have cancer coming my way, I'd rather know about it and be on the lookout for it and encompass some changes in my life. I've been impressed with the way that you have taken your experience and really forged a way forward to take control of some of our environmental factors like diet, for example. Well, when my mother-in-law was diagnosed with kidney cancer, it was really a stimulus to try and do something to be helpful, not just stand around and keep my fingers crossed for the chemotherapy. Up until that point, I didn't have an awareness of how much lifestyle and environment impacts our ability to stave off cancer cell growth when we have cancer and also increase our odds of survivorship. It was a learning experience for me to understand how much nutrition, exercise, mental health, and sleep are factors that can strengthen our immune system, keep inflammation low, which are two of the major foundations behind our body that's always staving off rogue cancer cell growth until it can't. So when I learned that, it became my mission to try and help people transition their lifestyle where we can increase odds of survivorship. I'm curious how you really got to the execution phase. You have this wonderful plant-based approach. But you also take a deeper dive into how people view their lifestyle and how you might be able to change behaviors. First was the awareness of how much lifestyle impacts us. I was learning that sugar is not empty calories. So I now understand that what we eat is really important to our immune system, inflammation, and not just for cancer, but for the whole host of other chronic diseases. Today's modern diet that's filled with sugar and refined grains and doesn't have a lot of natural fiber in it means that we're generating insulin very quickly because it's quickly broken down to our bloodstream. We're storing it as fat. And the brain is actually telling us to eat more. The conventional advice of eat less, move more when the brain's saying eat more, move less doesn't work. So we give people nutrient-dense food, the stuff that's going to make them feel great, going to satisfy the brain, going to make them feel full and satiated without the brain saying eat more, eat more. Well, we've done that through education and coaching. People come out where they feel good. They've lost weight. They're now used to eating in a different way. They're changing those habits, grabbing the bag of nuts as opposed to the cookie in the afternoon. So we're trying to get people to go back to basics. So with that kind of background, I became very interested in the work that you're doing nutritionally. I'm very excited about the opportunity for us to collaborate and start thinking about how we can incorporate the dietary philosophy that you have operationalized so well with the exercise prescriptions after a cancer diagnosis. I have the ultimate respect for the work that you've done as a scientist, as an oncologist, very focused on clinical studies, yet with the open mind to understand how we can build in lifestyle factors to complement the clinical work. Well, thank you. As you point out, lifestyle is such an incredibly important part of prevention and also improving responses to therapy and prevention of resistance and recurrence. The problem is we have a lot of work to do scientifically. We don't have specific personalized recommendations yet to advise people what they should be doing specifically with their diet, what they should be specifically doing with their physical activity patterns and other lifestyle factors. And I think a lot of that stems from the fact that we're just starting to learn more about the biology behind our metabolisms and the promotion of cancer growth. We're starting now in the oncology world to look at the human as a whole rather than zeroed in on the tumor. And part of that is really looking at lifestyle and environmental factors and the interplay with prevention and standardized care after a cancer diagnosis. We've been able to take these fields of tumor and host biology as well as nutrition, physical activity, and lifestyle and start to offer interventions to hopefully improve cancer prevention and cancer outcomes. And so we're taking people who've been diagnosed with breast cancer after their surgery and chemotherapy who are struggling with their weight. We will randomize them to two different types of intervention. One is a intervention where you and I are collaborating to provide the food for the participants. We will also provide the supervised exercise prescription that's individualized for each patient. And the control will still be an intervention, counseling patients via telephone and some personal visits to help advise them in what we think they should be doing in terms of their diet and their physical activity pattern. I think that our collaboration on this is incredibly important because what you provide is a mechanism for people to operationalize recommendations that are given to them and also even a referral source for caregivers and physicians. So ultimately, I hope that we generate real-world data. Yeah, absolutely. When you think about this trial, what are the markers that you are most interested in observing? We've talked a bit about how fat levels tell us more than a person's weight. So we'll be looking at changes in body composition. But we're particularly interested in the biology of the breast. We know that obesity is associated with not only a metabolically-unhealthy breast, but an inflamed and proestrogenic microenvironment that is ripe for the growth of tumors. And so we're very interested in determining whether or not the intervention that we're testing can reverse that process in the breast. We have adequate data to suggest that healthier eating patterns and exercise can bring down circulating levels of insulin and proinflammatory molecules. If we can show that such an intervention does improve the landscape of the organ and thereby reduce the likelihood of developing cancer, I think we'll be standing in a place where we can make significant clinical impact. I'm very excited. I've got two little kids. And probably if I dig deep, the reason I started is because I want to do everything I possibly can so that I'm around as long as I can be for my children. I don't want them to experience what I experienced as a child. And so if you can start with the food component, you feel better. And everything else comes beautifully into place. I think that's so important. One of the great things about this type of intervention is the impact that it has on a person's life as a whole. There's no downside. That's right. As Dr. Pinnavaia reminds us, how we fuel our body matters. Choose the bag of nuts over the bag of cookies today. Dr. Iyengar is proof that fueling the progress of cancer research matters too. His studies to better understand metabolic health in cancer were funded by Conquer Cancer donors. And there's still so much to understand about how to treat cancer but, most importantly, how to stave it off from the start. You can learn more about Dr. Iyengar's research at conquer.org. Hearing the experiences of others can help people cope with the challenges cancer brings. Help others find these inspiring stories by leaving a review of the podcast. And subscribe today on iTunes or Google Play to hear every new episode. Thanks for listening to Your Stories-- Conquering Cancer. The purpose of this podcast is to educate and to inform. This is not a substitute for professional medical care and is not intended for use in the diagnosis or treatment of individual conditions. Guests on this podcast express their own opinions, experience, and conclusions. The mention of any product, service, organization, activity, or therapy should not be construed as an ASCO endorsement.