Everything you wanted to know about cancer diets

While there is no magic diet that will cure or prevent cancer, intervention in a patient’s diet will help them maintain an acceptable quality of life – as long as that intervention comes from a medically qualified professional with no vested interests. Which brings us to the case of Australian blogger Belle Gibson, who is facing legal action for “unconscionable conduct” after promoting a book in which she talked of curing herself of multiple cancers by eating the right things. The publisher, Penguin, paid more than A$ 264,000 (£160,000) for the book and Gibson also made more than A$ 420,000 from app sales before it emerged that she had never had cancer. Her claims to have donated over A$ 300,000 to charities also turned out to be false.

In contrast, a recipe book for cancer patients experiencing weight loss from University College, Cork, and one for patients with swallowing difficulties from Breakthrough Cancer Research have been developed by dieticians and are available free of charge.

What is an oncology dietician?

Oncology dieticians provide expert, evidence-based advice to cancer patients to help maintain their strength, wellbeing and quality of life. They can, for example, develop plans using fluids or tube feeding to help maintain weight and muscle mass. They also address side effects of treatment that affect a patient’s ability to eat. Qualifying as an oncology dietician involves a four-year undergraduate degree in human nutrition and dietetics, with a hospital placement. Alternatively, people with a related science degree can obtain a postgraduate qualification in dietetics, followed by at least three years of post-qualification hospital work.

Ruth Kilcawley and Fiona Roulston are oncology dieticians. Frustratingly, says Kilcawley, much of the misinformation about diet and cancer her patients receive comes from well-intentioned loved ones, while Roulston’s patients often get information online. “If you enter ‘nutrition and cancer’ into Google, you get over 123m results. With so much conflicting information, it makes it so confusing and overwhelming for cancer patients at an already stressful time.”

What about a vegan diet?

There isn’t currently any strong evidence that eating too much red meat causes cancer. Some studies have shown a weak possibility that red meat may be associated with colorectal cancer in men. But an association is not a cause. There is some evidence that vegan diets may aid weight loss in certain people (though this may partly relate to vegans simply being more aware of what, and therefore how much, they eat). However, a healthy diet hinges on avoiding overindulgence and ensuring that we get enough nutrients to meet our essential needs. The few scientific studies on veganism and vegetarianism refer to a lack of data on vegan diets, but some vegan diets have been shown to result in calcium levels that are below minimum dietary regulations. In a small study of men with early-stage prostate cancer, a vegan diet resulted in vitamin D deficiency.

“Unnecessary diet restrictions of food groups are not recommended during cancer treatment,” says Roulston. Kilcawley adds: “The negative consequences include accelerating muscle loss. This leads to reduced ability to tolerate treatment, inadequate micronutrient intake (particularly calcium, which may compound bone mineral density issues with some types of chemotherapy), lack of energy, low mood and fatigue.”

But surely we all know that sugar is carcinogenic

Eating too much fatty and sugary food is not good for anyone. But the idea that cancer has a sweet tooth and that a patient can “starve” their cancer by cutting all sugars and carbohydrates is a gross oversimplification for a complex disease that behaves differently from patient to patient. It simply isn’t the case that cake feeds cancer while eggs feed healthy cells, and cutting carbs completely puts patients at increased risk of malnutrition. A study of more than 1,000 patients across three Irish hospitals found alarming levels of malnutrition amongst cancer patients.

The case study of a 65-year-old woman who recovered from a brain tumour has been used to promote the idea that a low-carb, high-fat “ketogenic diet” is a cure for cancer. However, this patient had also received standard chemotherapy and radiotherapy. Disturbingly, a proponent of this diet, Dr Thomas Seyfried of Boston College, has said it “can replace chemotherapy and radiation for almost all cancers”.

Nutrition is complex. Patients should seek advice on their individual needs from a qualified professional. No competent professional will ever tell a patient to forgo evidence-based medicine in favour of a diet.

What about supplements and superfoods?

Anything that alters how your body works is a drug, even if it’s “natural”. Supplements not recommended by a dietician can interact with other drugs, including anti-cancer therapies, and make them less effective. The Memorial Sloan Kettering Cancer Centre urges patients to stop taking any herbal supplements before starting treatment and lists some of the dangerous effects such “natural remedies” can have. The term “superfoods” is simply part of a marketing strategy, not based on science.

“There is huge manipulation of people’s emotions going on when someone tries a fad diet, hoping against hope it will cure them, and then subsequently fails because it is restrictive, unpalatable, or the patient is simply too ill,” says Kilcawley. “They risk blaming their own failure in keeping to the diet on any progression of disease, which is excessively cruel of those promoting diets without sufficient evidence that the diet if kept to would be effective. I see this a lot.”

Further information: Cancer Research UK, Macmillan and the Irish Cancer Society are all reliable sources for advice and support.

Everything you wanted to know about cancer diets

Emily wanted to die when her son was taken. Nurses gave her a future

“If my children were ever taken off me, I wouldn’t survive the day,” was my sister’s emotive, yet understandable, comment when we were discussing the impact losing your children could have on your mental health. It made me think of a woman I had worked with, Emily.

Emily had her son taken off her after she had attempted to kill herself. The boy, Jacob, was pre-school, and the decision by social services was made in her best interests. Emily had been in an abusive relationship and was struggling to cope. She had serious mental health problems as well as a history of childhood abuse, so coping was not something she was good at. She had always refused to engage with mental health services for fear that it would result in Jacob being taken away. The tragedy is that engaging with services was probably the only thing that would have kept their family together.

After further attempts to take her own life, Emily was detained under the Mental Health Act and admitted to the mental health ward where I worked. At this point, Jacob had been taken away by social services. Emily was told Jacob would be adopted; she could have phone contact until then and one final visit to say goodbye.

Initially she could not accept this and just wanted to die. It was one of the hardest cases I have experienced. She was right – what did she have to live for now she had lost Jacob? How could she continue feeling this pain and despair for life? As a team – nurses, doctors, occupational therapists and psychologists – we worked tirelessly with her to instil some sense of a future. Jacob was going to grow up loved, in a safe and secure environment unlike anything Emily had ever experienced. Her son had a positive future and she could take some comfort in that.

We focused on preparing Emily for her last contact with her son. She made her own plans about what she wanted for the two of them, and we supported her to achieve it. Emily was brave and made sure she could hold it together until Jacob had left, and then her world came crashing down.

Part of the preparation included talking to Emily about her suicidal thoughts and talking to her about what we could do to minimise the risk. We kept her safe while she grieved the loss of her daughter. We then worked with her to create the positive future she wanted for herself. This started with her keeping herself safe on the ward, one day at a time. We then looked at a longer term placement where she could get the intensive psychotherapy she needed to manage her mental health issues, heal from the hurt of the past and come to terms with losing Jacob.

Every day mental health nurses help people like Emily, who feel they have nothing to live for. Every day mental health nurses save lives. According to a report by the Mental Health Taskforce Strategy (2016) more than 14,000 people who have killed themselves between 2003 and 2013 had been in contact with mental health services; this is only just over a quarter of all suicides in that time. The same report acknowledges that suicide rates for mental health inpatients are declining, but sadly it is only the people we don’t manage to save that make the headlines. I am glad that we were able to help Emily and she hasn’t become another statistic.

Names and some details have been changed

If you would like to contribute to our Blood, sweat and tears series which is about memorable moments in a healthcare career, please read our guidelines and get in touch by emailing sarah.johnson@theguardian.com.

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Emily wanted to die when her son was taken. Nurses gave her a future

Bitter irony: I wanted to speak out about mental health but my anxiety stopped me | Marian Faa

I think and write a lot about mental health. Since being diagnosed with anxiety and clinical perfectionism, writing has become an important way of coming to terms with my own psychiatric ailments, while trying also to raise public awareness. It’s not an easy task. Despite my eagerness and many importunate attempts to give a voice to mental illness, I am often left feeling like the world isn’t ready to listen.

But when mental health week ticked around this year, ears pricked up. My news feed was awash with articles about mental health, friends brandishing popular hashtags and events popping up all around my city.

Finally, a week where mental health was a hot topic, where my issues were on the frontline. If ever there was a time when my humble opinions on the human brain might count for something, this was sure to be it. I panicked.

Determined to seize the opportunity, I started bashing out stories and pitches with intensity, like I was trying to give my computer’s motherboard some kind of frantic deep tissue massage. My mind turned cartwheels. Within 20 minutes I had chewed all my fingernails back to the quick and yanked out a few generous handfuls of hair – telltale symptoms of my escalating anxiety.

I forgot to have lunch. I forgot to pick my little sister up from school. I missed two calls from my partner. But somehow I still managed to singlehandedly pluck all the tiny hairs on my leg, another delightful habit I tend to deploy with fervour whenever I need to curb my anxiety.

As time ticked by and the pressure mounted, I realised I was heading for a nervous breakdown. Maybe I was making too big a deal of mental health week, but that is the very nature of my mental illness – the tendency to inflate and catastrophise. It was a bitter irony: my anxiety was the very thing that stopped me from writing about it.

So I closed my laptop and resolved to stay silent for mental health week. I decided that protecting my own mental state was more important than writing about it. And I reassured myself there would be other opportunities.

See, that’s just it with mental illness. Often we cannot talk about it when the world wants us to – whether that be our families, therapists or the media. And when we are ready to speak up, we can’t find the ears.

Even with efforts to reduce stigma, mental health is an extremely sensitive topic. It takes a long time to develop the personal insight and vocabulary to be able to communicate about our mental states. In my experience, you can only really talk (or write) about it on your own terms and in your own time. This means we need a culture that is receptive to discussions the year round, not just at designated calendar points.

While initiatives like mental health week are exceedingly important, they are not always as beneficial to sufferers in the ways they intend to be. The sudden spike in publicity may feel like a fleeting injection of sympathy that leaves us even more isolated once the week is over and our issues fall into the background once again.

The ephemeral support for mental illness shines with a suspicious veneer, tarnished by the knowledge that talking about mental illness might earn you a hundred likes on Facebook on one day but compromise your job application the next.

On the other hand, the sudden spotlight on mental health can also cause people with mental illness to cringe and withdraw, unnerved (so to speak) by the unfamiliar pressure of public exposure. And then there is the risk of triggers that comes with a disordered flurry of news articles and tweets about mental health.

I am not disputing the merits of mental health week and the media’s reporting of it. I think these initiatives are noble and necessary. I think they are crucial to creating a society that makes it easier to live with a mental illness. But if listening to people with mental illness and understanding their experiences is the most important step in dissolving the silence and stigma, we need to be open on a more general, everyday basis.

We need a culture that is attuned to the nuances of mental illness and accepting of the silences as well as the disclosures. We need a world where mental health is an acceptable topic regardless of time and place, beyond the field days and short-lived social media campaigns.

Bitter irony: I wanted to speak out about mental health but my anxiety stopped me | Marian Faa

DfE emails show officials wanted to silence mental health tsar

Department for Education (DfE) officials appear to have been working to sack Natasha Devon, the government’s schools’ mental health champion, over her criticism of government policies even as they publicly denied doing so, according to internal emails obtained by Devon.

Devon, who was dropped from her role after she repeatedly argued that the government’s own education policies were contributing to poor mental health among young people, said the DfE emails confirmed her fears that the department had been trying to silence her.

In March, two months before her role was axed, one DfE official wrote that although they wanted to avoid the appearance that the department was dropping her because of her criticism, “it cannot be feasible that she continues”.

In another email a month later, an official writes: “Every day is another day she could be saying something damaging – and if that happens we will kick ourselves for not acting sooner.” But after the Guardian broke the news that Devon would be axed, she received a text that read: “What the Guardian have printed is ludicrous – We want to work with you more, not less!”

After reading the emails, Devon said they showed that the government’s policies on children’s mental health was little more than “a PR exercise” and confirmed her fears at the time that the department had been trying to silence her.

She said the emails revealed a government more worried about her comments on Twitter than the crisis in mental health among young people. “I can’t believe the ineptitude,” she said. “It’s like a script from [the BBC political satire] The Thick of It.”

Devon, who was appointed with some fanfare by the government in August 2015 to raise awareness of and reduce the stigma surrounding young people’s mental health, put in a subject access request to see government emails concerning her role after her dismissal in May.

At one point one official exclaims: “I know I keep saying this but please can everyone monitor her Twitter?”

Elsewhere the tone changes. After the news broke that her role was being cut, one DfE email read: “I think we now need to take ND down a peg or two.” A couple of days later, another said: “She is having her fifteen minutes and hopefully she is nearly at the end.”

Devon, who has almost a decade of experience of working in schools as the founder of the Self-Esteem Team and Body Gossip which deliver mental health education to young people, said her experience of working with government had “played havoc” with her own mental health.

When she was appointed she was told it was an important role – though unpaid to ensure impartiality – and would give her an opportunity to influence policy. In the end, it was “window dressing”, to help the government get coverage on GMTV and in other lifestyle media, she said.

Though Devon was hired because of her ability to talk to young people, department officials objected to her choice of language on social media.

When she uses the word “dickwad” in response to a story about a young woman being bullied for speaking out about sexism, one DfE email reads: “It is obviously totally unacceptable for a government-endorsed champion to swear and use offensive terms as she does … I have just called Natasha and she was surprisingly unapologetic.”Asked on Friday to respond to the internal emails and Devon’s criticism of the government’s policies on young people’s mental health, a DfE spokesperson said: “Natasha did a great job of helping us to raise the profile of young people’s mental health during her appointment.

“Since that time, the independent NHS taskforce report has been published which recommended that a cross-government mental health champion be created – for this reason we had to reconsider the department’s own role.”

Devon has now compiled a comprehensive report on children’s and young people’s mental health based on what she uncovered during her nine-month tenure as government mental health champion and her own work in schools.

She said of the government’s approach to young people’s mental health: “They talk a good game but they don’t get it. There was no real understanding of the severity of the situation. They would say the words, but I did not feel there was any kind of urgency.”

DfE emails show officials wanted to silence mental health tsar

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