Integrative Oncology Nutrition

Emily Biever, MS, RD, LDN
Senior Clinical Dietitian
Dana-Farber Cancer Institute

She brings her integrative approach, love of fitness, and appreciation for the complexity of our relationships with food to the Dana-Farber dietitian team. Em works one-on-one with patients to optimize nutrition, while managing common side effects of cancer treatment.

Integrative oncology nutrition is an approach that acknowledges the multiple influential factors affecting a cancer patient’s nutritional wellbeing, including, but not limited to, their macro/micronutrient needs, personal relationship with food, cultural understanding of food and disease, food availability/accessibility, etc.

“The word integral means comprehensive, inclusive, non-marginalizing, embracing.”
– philosopher Ken Wilber¹

Integrative oncology nutrition is an approach that acknowledges the multiple influential factors affecting a cancer patient’s nutritional well-being, including, but not limited to, their macro/micronutrient needs, personal relationship with food, cultural understanding of food and disease, food availability/accessibility, etc.

The image below shows one possible way to visualize an integrative approach to oncology nutrition.

It can be seen here then, if we only look at what someone is eating (“dietary intake”), we may be missing other important pieces of the puzzle.

For instance, sleep duration and sleep quality can have an impact on not only the amounts and types of foods we choose to eat, but also on how our bodies process these foods. Research has shown that inadequate sleep increases brain activity in the presence of food, and increases calorie intake, primarily from foods high in sugar and fat. 2 , 3 ,4 Including a discussion of sleep, therefore, can shed light on other ways to support healthier eating, particularly for cancer survivors aiming to prevent weight gain. When necessary, healthcare professionals can make referrals to sleep specialists to best support their patients.

Our ability to manage stress is another variable that can impact nutrition. “Stress-induced eating” is a common experience for many people with a tendency towards eating higher fat/higher sugar-containing foods. Hormones, like cortisol and ghrelin, tend to increase in stressful situations, with studies showing a connection between greater intake of calorie-rich foods and higher circulating levels of these hormones.5,6 While occasional use of foods to bring comfort and relieve overwhelm can be helpful for some, for others, sweets and snack foods can become a primary means of coping.

Some people, however, may experience a loss of appetite in the setting of significant stress, which can compound unintentional weight loss during treatment.

On the surface, whether over- or under-eating, the food choices themselves may be identified as the issue, while the underlying reason behind the choices may be the most fruitful piece of the pie to focus on. Acknowledging stress and becoming curious as to what tools are most supportive for working with it can attenuate unintentional weight gain or weight loss during cancer treatment.

Finding a companion to talk through difficult feelings, as well as support groups, social workers and therapists can all help prevent isolation after a cancer diagnosis. Additionally, meditation and meditation apps, physical activity and other forms of self-care are powerful tools to reduce stress and enable more healthful eating habits.

There are too many components of integrative oncology nutrition to cover in this article, but one final component worth noting is how family and cultural views of food are impactful after a cancer diagnosis.

In many family systems and cultures, home-cooked meals are a way of expressing love and support during difficult times. Some possible side effects of cancer treatments, like nausea, loss of appetite, and taste changes, however, can render familiar comfort foods unpalatable, leaving friends and family at a loss for how to care for and nurture their loved one. As a result, tension and frustration for all parties involved can add to the lack of desire to eat. In this instance, it’s helpful to have a dietitian acting as a “third party” of sorts to help find ways to make foods more nutrient-rich and palatable, so mealtimes become less stressful and more about connecting and communing.

It’s clear that there are many factors influencing our nutrition journey. The greatest benefits from an integrative oncology nutrition approach arise when we tease out which pieces of the pie are the most influential and need the most attention and care.

References:

1. Visser F. (2003). Ken Wilber: Thought as passion. Albany, NY: SUNY Press
2. St-Onge M, Mikic A, Pietrolungo CE. Effects of diet on sleep quality. Adv Nutr Int Rev J (2016) 7(5):938-49.
3. Chaput JP. Sleep patterns, diet quality and energy balance. Physiol Behav (2014) 134(1):86-91.
4. Dashti HS, Scheer FA, Jacques PF, et al. Short sleep duration and dietary intake: epidemiologic evidence, mechanisms, and health implications. Adv Nutr (2015) 6(6):648-59.
5. Rabasa C, Dickson S. Impact of stress on metabolism and energy balance. Beh Sci (2016) 9:71-77.
6. Masih T, Dimmock JA, Epel ES, et al. Stress-induced eating and relaxation response as a potential antidote: a review and hypothesis. Appetite (2017) 118:136-142.