Katie Asks Her Nutritionist About Cancer-Fighting Foods

After being diagnosed with breast cancer in the summer of 2022, I was stunned, of course. But then I did what comes naturally to me as a reporter: I tried to find out everything I could. I talked to a host of experts to understand what was going on in my body and make sure I was being proactive about staying healthy. 

I’ve always been interested in nutrition so I have to admit I geeked out when I met with nutritionist Emily Buchholtz, RD, CDN, CSO. She’s the oncology dietitian at NewYork-Presbyterian/Weill Cornell Medical Center, and she’s spent years working with cancer patients to revamp their diets, doling out stellar advice on what to eat more of, which foods to limit (sugar, we’re looking at you), and which foods to avoid entirely. 

I wanted to offer you all the chance to capitalize on her knowledge, so I called her up for a chat. If you’ve been diagnosed with any form of cancer, are in remission, or just want to better understand this thorny and terrifying disease, I highly recommend reading her thoughts on meats, sweets, and treats. Because there’s never a bad time to get a heaping helping of valuable information.

Katie Couric: Emily, can you tell me a little bit about your background? How did you get involved in helping women with nutrition and wellness after they’ve been diagnosed with breast cancer?

Emily Buchholtz, RD, CDN, CSO: I was always fascinated by nutrition, even as a young girl. I got a Bachelor’s degree in Nutrition and Dietetics from Indiana University, and then went on to complete my dietetic internship through the Northwell Health System. Ultimately, I started my career as an inpatient dietitian covering the oncology patient population. 

What I loved so much about taking care of this patient population is the ever-changing and ever-learning science, and the deep connection I get to form with my patients during a challenging and vulnerable time in their life. There’s so much to learn from these patients and there’s so much nutrition that they need that’s ever-changing at various stages of their life and healthcare journey. I have been at NewYork-Presbyterian/Weill Cornell Medical Center for six years, and my role has continued to evolve. I now specialize in women’s health and women’s cancer, focusing on breast and gynecologic cancer malignancies. I also provide care to young women who are at high risk for developing cancer due to genetic mutations like BRCA and Lynch syndrome. With this population, there’s a strong emphasis on making changes to their lifestyle to hopefully reduce their risk of developing cancer.

What are the things you initially try to ascertain when you’re talking to a new patient?

Nutrition and health are so much more than what someone eats on a particular day. So in my initial visit, I’m really trying to get to know the person, their food preferences, and their lifestyle fully, so I can make recommendations. Some things that I would ask include: What’s their budget? What’s their schedule? Are they mostly cooking at home, or going out to eat often? Is exercise a part of their lifestyle? Are they taking any supplements? I also take into account each person’s prescription medications and past medical history. This allows me to understand each patient’s big picture and see which direction we need to go in.

When we first met, you talked to me about eating a lot of fruits and vegetables. I’m pretty good at that, but like most people, I think I could do better.

We know that cancer is an inflammatory illness, and there are many foods we eat that can create inflammation in our bodies. However, there are also many foods we eat that can reduce inflammation in our bodies. The foods that are the most anti-inflammatory are plant-based foods. So the reason I encouraged more fruits and vegetables in your diet is that these provide essential nutrients such as vitamins, minerals, antioxidants, and fiber. Other plant-based anti-inflammatory foods include healthy fats, nuts, seeds, beans, lentils, and whole grains like oatmeal, quinoa, brown rice, black rice, farro, and barley. Then there are natural soy-based foods, which we can talk about later. 

These foods aren’t just beneficial to reduce cancer risk, they also reduce the risk of other chronic diseases, such as high cholesterol, heart disease, and diabetes. Generally speaking, these foods contain little to no saturated or trans fats. Studies show that a diet rich in plant-based foods can also help maintain a healthy weight.

We talked about kale and broccoli because when we first met, I was on a real kale kick. (You gave me a gold star for that.) Why are these such great foods to eat, whether or not you have cancer? 

When discussing vegetables, variety is key! Produce that’s rich in color tends to have more vitamin and mineral content than something dull in color, like iceberg lettuce. When working with clients, I notice that most will gravitate toward their favorite two or three vegetables. However, I encourage everyone to rotate between several different colors of vegetables, to guarantee we’re getting all the different vitamins and minerals we need. For example, dark green vegetables are rich in iron, calcium, and manganese. Vegetables that are red and orange, such as tomatoes and bell peppers, are rich in vitamin C, potassium, and folate. My advice with selecting vegetables is to pick a variety of colors and make sure they’re very rich in color, which will guarantee you’ll get the most bang for your buck, nutrition-wise.

Well then, I have to ask you about cauliflower, because that’s not very colorful.

You’re right! Cauliflower definitely does not have many antioxidants in comparison to other vegetables. However, it still has its benefits. Cauliflower is a cruciferous vegetable, and studies show that incorporating cruciferous vegetables into your diet regularly helps reduce the risk of many types of cancers, particularly GI and colorectal cancers. Cruciferous vegetables are rich in fiber, which helps keep us full. High-fiber foods also help promote good digestion and bowel regularity. 

I guess the consensus is that red meat isn’t very good for you, but I do enjoy a good steak every once in a while. Can I partake without guilt?  

So the short answer to that is yes, you may absolutely do that. But to back up a bit, the American Institute of Cancer Research (AICR) defines red meat as beef, pork, and lamb. The AICR recommends that all people limit red-meat consumption to 12 to 18 ounces per week. That’s because red meat creates inflammation and is high in saturated fat. When we consume too much red meat, it can poorly impact our gut microbiome, which regulates our immune system, metabolism, and digestion. When counseling patients I encourage them to eat as little red meat as possible, with the understanding that it can be enjoyed on occasion — one to two times a week is absolutely appropriate and safe.

And when you say 12 ounces…

12 to 18 ounces is the recommended maximum range per week. 16 ounces is a pound of meat, and if you go to a restaurant, the average serving of beef is about 8 ounces. So just to keep it simple, I usually tell everyone to limit red meat to about two meals per week. 

What about sugar? There’s a body of science that says, “cancer loves sugar.” So what does that mean for me? Because sadly, Emily, I have a terrible sweet tooth.

I’m guilty of that too! The reality is that sugar isn’t actually directly linked to cancer cell development. The average cancer takes many years to develop in someone’s body. So it’s many years of bad habits like desserts, refined carbohydrates, high-fat foods, and excessive alcohol that ultimately stimulates an inflammatory response in our body. This cycle causes chronic inflammation that leads to DNA damage. The more DNA damage our body creates, it increases the risk of abnormal cell growth, also known as cancer cells.

In my practice, I often see people eat relatively well and feel very guilty about consuming small amounts of sweets. But I encourage people to focus much more on eating balanced meals to reduce the risk of cancer. Prioritize making 80-85% of what you eat in a day clean, unprocessed foods, and limit “junk foods” to a small portion.

Okay, so moo-ving on, what about dairy? (Get it?)

The dairy confusion is real! It’s recommended to minimize dairy intake when you have a history of breast cancer, however, some studies show it may be beneficial for GI cancers. Generally speaking, most dairy products are high in fat and increase inflammation. This can create skin concerns and contribute to high cholesterol and weight gain when consumed too frequently. The flip side of that is that fat-free and skim-dairy products contain more sugar, and the “skimming” process concentrates hormones we don’t want to be consuming. 

So I typically tell people who love dairy that if you’re having a little bit of milk or cream in your coffee, less than a full serving, you can pick and choose what you like, whether it’s cream, cow’s milk, or a milk substitute. When consuming other forms of dairy, choose options that are low in sugar, low in saturated fat, and high in protein. Greek or Icelandic yogurt and cottage cheese are good examples of dairy products that can be consumed more frequently, while products such as butter and cheese should be consumed less frequently, due to their low protein and high saturated-fat content. 

Meanwhile, you brought up soy. For a long time, people thought it increased your risk of cancer, but is that no longer true? 

Correct. It’s funny you mention this because I noticed a pattern: When I speak with women who were diagnosed with breast cancer 15 or 20 years ago, they often avoid soy at all costs because that’s what they were told to do. What we now know is that natural soy-based foods like soy, milk, tofu, and tempeh do contain phytoestrogens, but phytoestrogens don’t increase our hormonal estrogen production. These foods are very healthy for us and they’re also really good for men as well. Research shows that natural soy-based foods may be beneficial for hormone-sensitive cancers like breast cancer, gynecological cancers, and prostate cancer. So men don’t have to be afraid of eating soy anymore either.

The aromatase inhibitors I’m taking are really doing a number on my skin. I’ve always had dry skin but now I’m like the Sahara! You recommended I try giving up gluten and dairy and increase my water intake. I haven’t stopped dairy entirely, but I have really been good about limiting gluten. Why did you recommend that?  

So we know that dairy can create inflammation and as I mentioned earlier, it can really exacerbate skin issues: acne, rosacea, blemishes, and dermatitis. The reason I suggested completely cutting out gluten temporarily is that I wanted to see if it helped reduce some of the inflammation because a lot of foods that contain gluten naturally are inflammatory. There happen to be many whole grains that are naturally gluten-free that I thought would be better for you anyway, like oatmeal, brown rice, and quinoa. I know you found that bakery that has great gluten-free bread. So that was the thought process behind recommending that for you.

I got some gluten-free ginger snaps at the farmer’s market on Saturday and they were really good. But should I try to stay away from things like that in general, because even if they’re gluten-free, they contain other things that cause inflammation?

Right, and this is where I think there are a lot of misconceptions. Gluten-free doesn’t mean it’s healthier. We want to try to stay away from processed foods as much as possible. So although those crackers or those cookies are gluten-free, they probably have sugar, butter, and all of those other delicious things that make them tasty. It’s important to remember that sugar and butter can create inflammation in your body. But again, we always have to weigh the pros and cons. Everyone deserves to have a cookie or a sweet treat here and there. In fact, I often support my patients in eating their favorite foods in moderation. That’s really important to me. I want all of my patients to be as healthy as possible, but also to be happy and not feel like they can never eat their favorite foods. So those ginger snaps are a perfect example — I wouldn’t want you to have them every day, but I’m happy you found a treat that was exciting to you.

Finally, Emily, I must confess my favorite food is bacon — and I’m not talking turkey bacon. Do I have to give that up? 

I categorize bacon as a “treat” food. The sad thing about bacon is that the AICR recognizes it as processed meat. And so, unlike red meat where they give us a recommended amount per week, the AICR says to try to avoid processed meat as much as possible, which is hard for many people. So I’ve recategorized bacon for my patients as a treat, meaning I don’t want them to buy it weekly, or have it as a staple in their diet. But once a month, or once every few months is OK.

Once a month, or once every few months? You’re killing me, Emily!

I know, I know. But also remember what I said in the beginning: For a healthy diet, what you eat normally from week to week is much more important than one individual food. Everyone’s going to have that one individual food that they can’t live without, and we can usually make it work. But with processed food, less is more.

So maybe more tomato and less bacon on my BLT? 

Exactly.