The irresponsibly short answer is ‘yes’. An equally irresponsible, dismissive answer is no.
The more reasonable (but somewhat dissatisfying) longer answer is ‘yes, but cancer feeds off everything and sugar feeds everything”.
What exactly do you mean by sugar?
When we say sugar, most people will think of white granules in a bowl or on a teaspoon, not monosaccharides and glycolysis like us special souls. The image below will take you back to Food Chemistry 101. Sincere apologies if this resurfaces any citric acid cycle demons. As dietitians, we know that all carbohydrates from food, whether from a cookie, milk or a carrot, will eventually be metabolised to release glucose, fructose and/or galactose. This is a key concept to articulate when faced with this question – the analogy of simple sugars being the links in a carbohydrate chain can sometimes help.
Figure 1: Carbohydrates can be classified, in simple terms, to 3 main groups. Monosaccharides are single sugar units, disaccharides are 2 units joined together and polysaccharides are more complex carbohydrates made up of many sugar units. A pretty picture of links and a chain can go a long way in getting this message across.
Sugar feeds everything
As we know, carbohydrates, particularly in the form of glucose, are our body’s preferred fuel source. Some cells – red blood cells and cells in our brains – use glucose almost exclusively. Our bodies like carbs so much that if we don’t have carbohydrates coming in from our diet, we have very sophisticated pathways that can generate glucose from other substrates, including amino acids and lactate. Gluconeogenesis: just part of the reason why the ketogenic diet is so hard…
What this means is that if there is insufficient energy supply coming in from carbohydrates, our bodies will switch to breaking down fat and muscle stores for fuel. In someone undergoing cancer treatment, protein is often the preferred source of fuel. This can lead to weight loss, muscle wasting and malnutrition. And it doesn’t slow the cancer growth.
Cancer cells are greedy. They divide rapidly, and grow faster than most healthy cells. This means they require and use more nutrients to grow than the healthy cells that are dividing at a regular rate.
Simple sugars fuel our bodies in a very efficient way. Combine this with the fact that cancer cells are greedy, and it’s no surprise that sugar fuels cancer cells more efficiently than our healthy cells. Anyone who’s had a PET scan explained to them will know that oncologists can use this phenomenon – known as the Warburg effect – to assess for the presence and spread of cancer. It’s no wonder people ask the question if avoiding sugar would hinder cancer growth. We wish it were that simple.
Cancer cells are greedy
Cancer cells are experts at thriving. Yep. Cancer sucks.
Anyone who’s asked me this sugar question would have undoubtedly endured one of my drawings. What I would have attempted to draw (with much enthusiasm but quite poor artistic execution) is something a little like this…
http://cisncancer.org/
Figure 2: Angiogenesis is a process of new blood vessels forming from pre-existing vessels.
Image source: National Cancer Institute.
Angiogenesis is a process of new blood vessels forming from pre-existing vessels. This phenomenon is seen in cancer cells as a means of increasing their supply of nutrients, oxygen and other factors to enhance their growth. Angiogenesis enables cancer cells to thrive more so than healthy cells. Us oncology clinicians hate it. And some very clever medical scientists have developed many anti-angiogenesis therapies (such as bevacizumab (Avastin®)) to use in cancer treatment.
What this means is that even if there is minimal energy and nutrients available within the body, there is more of a chance it will make it to cancer cells than healthy tissue.
Denying the body of carbohydrate foods is likely to have more of an impact on the healthy cells than it will on the cancer. With our brain and our blood cells relying on glucose for fuel, you can imagine the impact on energy levels, mood and performance.
Cancer feeds off everything
Cancer likes carbs. Warburg taught us that. But what many Dr Google’s neglect to mention is that cancer cells will also use protein and fat for fuel in the absence of sugar. This includes muscle mass and fat stores.
If cancer cells, with their superior nutrient supply, can no longer source sugar from the body, they start to break down muscle and fat stores for fuel. Gluconeogenesis (more demons? Sorry!). This translates to unintentional weight loss. Not good. During treatment and recovery this means muscle wasting. Even worse.
So what do we recommend for our patients?
It’s been proposed that the growth of cancer cells may be slowed by starving them of sugar. The problem with that is there’s currently no method of cutting off the supply to cancer cells while keeping it open to normal cells.
Our best suggestion for people undergoing cancer treatment is to ensure the following:
- Sufficient intake of quality protein foods to help preserve lean body mass
- Include low glycaemic index carbohydrates in serves at least about the size of their fist at meals. Fuel the body and the mind.
- Include plant-based fats from nuts, seeds, avocado, extra-virgin olive oil and oily fish. Love Nemo. Be liberal with these if losing weight.
- Reach vitamin, mineral and phytonutrient requirements from a variety of foods, negating the need for supplements.
- Keep well-hydrated.
Meeting nutritional needs from mostly whole, unprocessed foods will help meet nutritional goals and reduce the intake of added sugars.
What about cancer prevention and recurrence?
The World Cancer Research Fund recommends limiting intake of sugar sweetened drinks, ideally avoiding them entirely. Sweetened drinks have been linked to weight gain. Excess body fat increases our risk of 13 different cancers.
https://scienceblog.cancerresearchuk.org/2016/10/11/the-second-biggest-preventable-cause-of-cancer-being-overweight/
Figure 3: The World Cancer Research Fund recommends limiting intake of sugar sweetened drinks to reduce right of weight gain and therefore cancer risk.
Image Source: Cancer Research UK
There is also increasing evidence that high glycaemic index (GI) carbohydrates can increase our risk of certain cancers. The good news is that by selecting lower GI and glycaemic load carbohydrates we can lower our risk.
Whilst is a good move to limit sugary foods and drinks as part of a healthy diet to avoid excess body fat, it’s less likely to have a meaningful impact on the growth or spread of cancer cells already present.
The bottom line
The statement that ‘sugar feeds cancer’ is an oversimplification of a highly complex process.
It suggests that cancer relies solely on sugar for growth. This is inaccurate.
It implies that by avoiding sugar, and therefore all carbohydrates sources, we can starve cancer cells. This may happen in a test tube when there’s no other fuel options, but in a complex human body with muscle and fat stores up for grabs, this simple statement can lead to dangerous food restrictions that can weaken our bodies physically, physiologically and mentally.
For specific advice or guidance for you or your patients, reach out to us today.
Tailor your plate with OnCore – Oncology and Preventative Nutrition
Lauren Atkins
Senior Oncology Dietitian | Accredited Practising Dietitian
Co-founder – OnCore Nutrition
T A I L O R Y O U R P L A T E | B U I L D Y O U R B E S T Y O U
References
- Angiogenesis insights from a systematic overview. New York: Nova Science. 2013.
- McDougall SR, Anderson AR, Chaplain MA. Mathematical modelling of dynamic adaptive tumour-induced angiogenesis: clinical implications and therapeutic targeting strategies. Journal of Theoretical Biology. 2006 Aug. 241(3):564–89.
- Spill F, Guerrero P, Alarcon T, Maini PK, Byrne HM. Mesoscopic and continuum modelling of angiogenesis. Journal of Mathematical Biology. 2015 Feb. 70(3):485–532.
- Sieri S et al. Dietary glycemic index, glycemic load, and cancer risk: results from the EPIC-Italy study. Sci Rep. 2017 Aug 29;7(1):9757.