Hereâ€™s a sampling of the headlines Iâ€™ve seen over the past few weeks: â€œBreast Cancer: Fruits and Veggies Not the Answerâ€ â€œGrapefruit Increases Breast Cancer Riskâ€ â€œTomatoes Unlikely to Lower Cancer Risk.â€ Itâ€™s enough to make anyone crazyâ€”or go to a cafÃ© and order a huge slice of chocolate cake! Itâ€™s also makes it easy to see why the public feels they never get the true story. One day something is good for you, the next day itâ€™s not. What should you really believe?
Well, when it comes to cancer, we have to back to the basics. The more we learn about this disease the more we realize how complex and tricky it is. Meanwhile, the more we learn about foods and their potential anti-oxidant and anti-cancer effects, the greater our realization that there is no food that is a â€œmagic bullet,â€ that more is not always better, and that vitamins and supplements donâ€™t always provide the same benefits of the actual foods themselves. (You can read a separate article on the findings from the grapefruit study here.)
Last month, the biggest breast cancer news seemed to be that the largest diet prevention study ever conducted, The Womenâ€™s Healthy Eating Living (WHEL), had found that women who ate an extremely low-fat diet rich in fruits and vegetables and fiber were not less likely to experience a cancer recurrence or to die than were women who stuck to the nationally recommended five-fruits-and-vegetables-a-day diet. WHEL was a 10-year randomized trial that enrolled 3000 women between 1995 and 2000. All of the women were 18-70 years old and survivors of early stage breast cancer (up to Stage IIIA). During the study, 256 (16.7%) of those randomized to the group assigned to eat more fruits and vegetables had a recurrence or developed a new tumor, compared with 269 (16.9%) from the group that ate at the typical 5-a-day diet. A total of 315 women, 155 (10.1%) of those on the special diet died, 127 from breast cancer; in comparison, 160 (10.3%) from the 5-a-day group died, 135 of breast cancer.
So, does eating a lot of fruits and vegetables really matter? Yes! What often wasnâ€™t underscored in the media coverage was the fact that even the women in the 5-a-day group were eating more fruits and vegetables than most people typically do. It may be that eating those five servings of fruits and vegetables is sufficient, and that more is not necessarily better. We also shouldnâ€™t forget that fruits and vegetables have other benefits, including reducing the risk of heart disease and diabetes.
The media also didnâ€™t often mention that the women in the intervention group didnâ€™t meet all of their goals, and that there diets were, in some ways, not that different from the 5-a-day group. For example, after being in the study for 72 months, the women in the high fruits and veggies group were eating, on average, 3.4 servings of fruit a day compared with 2.6 servings per day for those in the control (5-a-day) group. Neither group ate the recommended amount of fiber, which research shows may reduce breast cancer risk.
And most of the women in the high fruits and veggies group never reduced their fat intake to 15-20 percent of their calories. Letâ€™s also not forget that this study enrolled women who already were diagnosed with and treated for breast cancer. Itâ€™s possible that any difference eating more fruits and vegetables might make in reducing recurrence pales in comparison to the breast cancer treatments now available. Itâ€™s also possible that losing weight or taking part in an exercise regimen might have made a difference, too. Breast cancer is influenced by more than just one aspect of a womanâ€™s life. It is the complex interaction of all of these factors that is importantâ€”and that we canâ€™t easily study or bottle. I hope that no one who read the headlines thought, Why bother? Instead, the take away message should be that we still have a lot more to learn about the relationship between weight, diet, fiber intake, fat intake, exercise, and breast cancer. There will undoubtedly be more unexpected or disappointing findings along the way. But I still think itâ€™s better to choose an apple over a donut.