#45 - Breast cancer and nutrition myth-busting with Tamar Rothenberg, RD

Nutrition is top of mind in any discussion related to cancer, but it can feel overwhelming trying to wade through the information and misinformation that's out there! 

My guest this week is Tamar Rothenberg, MS, RDN, a registered dietitian who specializes in recovery after breast and ovarian cancer in her private practice in Los Angeles. She has a Certificate of Training in Vegetarian Nutrition; and co-led the clinical study, Coping with Cancer in the Kitchen, published in Nutrients. She is the author of a new book, Cancer Diet for the Newly Diagnosed (Rockridge Press, March 2022).

In our chat, we cover some of the most common questions Tamar sees in practice, including two hot-button topics - soy and sugar.

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Transcript

Jenn Huber  0:02  
Hi and welcome to the midlife feast the podcast for women who are hungry for more in this season of life. I'm your host, Dr. Jenn Celine Huber. Come to my table. Listen and learn from me. Trusted guests, experts in women's health and interviews with women just like you. Each episode brings to the table juicy conversations designed to help you feast on midlife. I'm really excited to welcome Tamara Rothenberg, registered dietitian to this week's episode of the midlife feast. Obviously, breast cancer is something that can affect people of any age. But it's a conversation that comes up a lot for those of us in midlife, because we often know someone who has had breast cancer, we know that our risk for breast cancer may change as we go through perimenopause and menopause. And as always, there's so much misinformation about food and nutrition and what we should and shouldn't be eating, whether we've had breast cancer or not. So I hope you've enjoyed this conversation with Tamara. She's definitely an expert in the field. And she brings a lot to the table when we're talking about breast cancer. Hi, and welcome Tamara to the midlife feast. How are you today?

Tamar-Rothenberg  1:10  
Hi, I'm just thrilled to be here, right in the middle.

Jenn Huber  1:16  
I am so so excited. So as I mentioned in the introduction, you and I connected on social media, which I feel like I say about all of my guests on the podcast, because that's where we all meet these days. And you and I think have a very similar message when it comes to food and nutrition and health. But you have a special interest. I don't know if you call it a specialty, but you certainly have a special interest in breast cancer nutrition. So can you tell us a little bit about how you got into that? How did that come about?

Tamar-Rothenberg  1:48  
Well, it really is my focus. And I've you know, really been involved for a couple of years on helping thrivers. But how I got involved was first of all, I was diagnosed with breast cancer. Stage three, and it was a inexperience. So I was always interested in nutrition. And I had been working in high tech for years, doing very well with that. But when I was after I was diagnosed, I said, Okay, now I'm gonna do what I really want to do. And I went back to school in my 50s, by the way, and became a dietitian. And it wasn't easy, especially after chemo with brain fog. But But I did it and I'm, you know, really proud. And then I decided, well, I'm going to give back now and became very involved in helping people through the, you know, experience of breast cancer, which is just a hard thing.

Jenn Huber  2:48  
It is. And I love that in your second season. You took on a second, you know, career essentially. I love that so many, I think so many women and we talk so much about, you know, feasting on midlife, I think so many people feel like their life is winding down. Maybe their career, you know, they think it's to lead or that they need to just kind of stick out what they're doing. But I think it's such a great time to pursue your passions. Because I think for many of us, I know for me, it really is kind of that laser focus on what I want and what I don't want, what's meaningful to me and what's not meaningful. So so I really love that. So now that you're a dietitian, and you're you know, fully recovered from from your diagnosis, I'm assuming you now work with people who have breast cancer or who are recovering from breast cancer. And specifically with nutrition, which anybody who has a conversation about cancer of any kind always wants to know, what can I eat, what can I not eat, but a lot of the conversations that I'm part of or you know, privy to our round fear with food. And since I love myth busting on this podcast. Let's talk a little bit about some of the myths around breast cancer nutrition. So what would you say is the number one myth that you hear in your work?

Tamar-Rothenberg  4:16  
Well, the number one changes. The number one is soy still, but it does change and there's always one to throw me off. I always think I have them covered and then the new one comes in. So soy is number one. And you know that's a biggie because, unfortunately thrivers are still hearing this not just on social media, but sometimes from their medical team who are not up to the you know, the latest research that proves that it's okay for anyone, especially in the younger ages for teenage women. So, you know, I have to sit there and say they're wrong, and it doesn't feel good because you want to trust your medical team. So it's a it's an issue.

Jenn Huber  5:02  
Yeah. So let's talk about that. Because anybody who follows me on social media knows that I regularly mythbuster about soy because it comes up in so many of the conversations that I have. And invariably, whenever I post about it, somebody will say or message me. Oh, but my oncologist told me that I shouldn't ever have soy or that I should stay away from soy. So how do you explain to people about why soy isn't a concern? Even if you've had breast cancer? And even if you've had hormone receptor positive breast cancer?

Tamar-Rothenberg  5:38  
Right, well, I I'm glad they're telling you this. Because my messages, they're not so nice. Like, you know, nothing. But um,

Jenn Huber  5:48  
well, I get some of those, too. Don't

Tamar-Rothenberg  5:49  
worry, really what's happening? Oh, you do? Okay. Good. I feel better. Yeah. Yeah, what's happening is, you know, they're not up on the latest research. So what's happening is we have 25 years of really, really good research showing proving evidence base, that it's safe for, not just for anyone who's ever had a diagnosis, but I also work with women and high risk, hereditary risk, and that's about 10% of the population have hereditary risk from genetic mutations, or we call them pathological variants now, but nobody knows what that means. So I'm still using genetic mutations. So they're a very high risk, right? It's something like 70 80%, you know, may get breast cancer, and there's, it's still safe for them. So, you know, if we look at the we have to look at the what's happening, what are the mechanisms, the physiological mechanisms behind it. And one thing we're seeing now is it even helps with the same pathway as this medication called tamoxifen, which is meant to suppress ovarian use estrogen production. So it works along the same pathways. I'm not saying it's the same as tamoxifen, you still need to take it, but we're seeing it actually accompanies it and helps and why is that? Because it's very fascinating, the research around the breasts research now, because we still don't know a lot about breast, we don't know how many ducks are in the breast. We don't know what happens after pregnancy or breastfeeding, you actually grow new ducks. It's fascinating how much we don't know. Right? So. So the boogey man comes in and tells you soy will grow, you know, cause more estrogen production and grow cancer. And what happens is, in your breasts, you have two different types of receptors, one attaches to estrogen. And that's really how it feeds cancer growth if you're at risk, and the other one attaches to other things. So really, what happens is soy attaches to the, to the other receptor, not the one that actually attaches to estrogen. So works like tamoxifen were actually kind of blocked the other receptor. So we have to understand the mechanisms behind it. Talk to more health professionals really refer to dieticians, because we are up on this nutrition research.

Jenn Huber  8:29  
Yeah, that's a great way to explain it. And just to kind of add to what you were saying, because I've talked before on this podcast and in different posts about those alpha and beta receptors. And the Alpha receptor is generally the one that's more problematic. And the beta receptor is the one that when we can have something that binds to it, it's kind of like a teeter totter. And it helps to balance out some of the effects on the Alpha receptor. So one of the other ways to describe soy is phyto. estrogens are isoflavones from soy is that their estrogen modulators. And so they help to modulate the effects of estrogen, which is a really fascinating thing. And, and I agree with you that there's so much research that reassures us that at worst, it does nothing. And at best, it offers some protection, potentially. So you know, at worst, if it does nothing, then all you have is a tasty food that you can enjoy more often and get so many other benefits from protein, fiber nutrients, but there may actually be some benefit to it for even women who have had breast cancer. So that's, that's really important. So just to reiterate, because I know that this question comes up a lot. This is very well backed by research. And it's not new. This research has been around for a really long time. But it's that you know, one study from a Petri dish 50 years ago that everyone gets hung up on, but that's not really what translates into human research and clinical research. So we've talked to So I, what would you say would be the next most common myth that you're busting in your day to day?

Tamar-Rothenberg  10:10  
Well, the next top one is sugar causes cancer, which is harder to explain, right? And we have to look kind of two steps back. Where did this come from? What's the background and there is a background to it. But it's based on complete misinterpretation. So, you know, some of it goes way back before, you know generations ago, and I'll explain why. But the one that's more prominent now is based on PET scans, right. So before PET scans, they're starting to go to do away with this, but there, they usually tell you not to have any sugar or carbs, because they want to see the activity if there is any around tumors, because cancer growth is based on hyperactivity, and they're using glucose. So from that emerge, this whole don't ever have sugar because of this PET scan. That must mean that sugar causes cancer? Well, first of all, it's a complete misinterpretation of the test. But besides that, it is very scary when you hear that. So I understand that. But really, the point is, you already if you see that, God forbid, on a PET scan, you already have cancer, it didn't cause that. So that's number one. It's already there. Number two, as you and I know, as dietitians, your body loves glucose, that's the fuel, you know, your body needs the primary fuel to survive. So it's going to grab it from anywhere, it's going to take it from broccoli, it's going to take it from chocolate, you can't do away with sugar. Now, you know, when I say this, people were like, but you should cut it out, right, you should have mounts that are comfortable to your body that are you know, make your body function better. But you can't, are you really not going to eat broccoli, because that's what it's down to. If you're saying cut out sugar, don't say cut out refined sugar. So it doesn't really make sense.

Jenn Huber  12:12  
So thank you so much for clearing that up about sugar, because I do hear that all the time. And you know, because so much of the work that I do is around people's relationship with food, that there is very much fear around sugar, and even more so if anybody's received a cancer diagnosis. And so there's often guilt and shame around, wanting it, enjoying it, including it and worrying that they're having too much. So thank you so much for clearing that up. So are there any other myths that you think we should know about? Especially as it relates to sugar?

Tamar-Rothenberg  12:47  
Well, you know, it's a great question. And there's a sort of sordid history about it. As you know, sugar already has a bad history going back to slavery. But but even what I was interested in was where did this initial, you know, sugar cancer link come from? And it is based on something that's, you know, actual research. It's called the Warburg effect. I'm sure you've heard of it. Dr. Warburg, who was a Nobel Prize winner, and he discovered how cells actually use glucose in this hyper active manner. And that's what led to incredible discoveries about cancer growth and what it needs to grow and treatments. So he was, this is based during World War Two. He was operated, he's a German, he was gay. He was half Jewish, and the Nazis really should have killed him just for those one of those two things is enough. But they kept him alive. And they even gave him a lab. So why is that? Because they wanted a cure for cancer. That was their goal, as part of, you know, world domination. So they kept him alive. He, you know, there's different questions of whether he cooperated or not, but he was really just a big science, you know, being. So he discovered this Warburg effect. And he discovered that it uses glucose, but he never tied it to actually dietary sugar. So again, that's a misinterpretation that people love to bring up. Well, it's the Warburg effect, and I'm like, Well, you got it wrong. You know, it's not what he said. And I still see today, there's a new biography about him. That's really fascinating. But the author who's not a nutrition professional, of course, ends with well don't eat any sugar. And you know, he never said that he never brought it up. So I think part of it is related to that and actually what's even more disturbing when you hear about clean eating. That's a that was part of Nazi propaganda. And when you hear it today, it actually gives me makes me very uncomfortable because I know that connection. So that was part of their whole Aryan myth of being perfect and blond and blue eyed, and eating perfectly and eating clean that that was the actual words they use. So I never use those words. I people don't know the history, so I don't blame them. But it's something really we need to stay away from.

Jenn Huber  15:26  
Wow, I did not know that as well. But yeah, I mean, the thing about glucose too, is that if if we're not eating it, our body will make it through gluconeogenesis. And so when you're studying the effect of glucose that is in the blood, on a cell, you're not looking at glucose that we're eating? Right, we're you're just looking at the end product, which can come from food, but can also be made by our liver. So yeah, I think that that's a really important distinction. And,

Tamar-Rothenberg  15:58  
yeah, that's a great point. And that's exactly what that was Dr. Warbucks point, you know, this is nothing to do with anything outside of your body. Really. Yeah.

Jenn Huber  16:06  
And, you know, to your point about, well, people will always ask, you know, hey, you know, am I having too much, or how much is too much. And when, when, when we're talking about intuitive eating, and as you said about, you know, what's what's right for your body, I think it's important to recognize that you can modulate most or any of the effects of sugar, if you want to put it that way, by things that you add to your plate. So you don't have to cut it out in order to modulate the effects of that, whether that's on blood sugar, or energy or anything else. And so including the things that you like, and being able to add things to your plate, especially when you're maybe feeling vulnerable, and maybe having you know, a lot of strong feelings and emotions around a diagnosis, I think we need to normalize, we need to say that it's okay to be comforted by a cookie, there's nothing wrong with you, because you want to eat ice cream. You know, if you're feeling kind of down, that's, you know, those are normal eating responses. Those are, those are normal things. But if we only ate those things, we would probably feel not so great. But if we have permission to include them, when we want them and as part of our normal diet, then it kind of takes away some of the urgency to have all of it all at once. So yeah, so thank you for no, I

Tamar-Rothenberg  17:33  
agree with that. Yes. Yeah. And also, it's, it's doubly hard for cancer thrivers, because they feel like everybody's watching what they're eating and commenting. But should you really be having that, you know, so they have diet culture to contend with? And then they have well meaning friends who are telling them? I don't think you should be eating that. And, and then so I actually roleplay with clients what to say, you know, my oncologist is okay with it. And she saved my life, you know, that kind of, Oh, I

Jenn Huber  18:06  
love that. Yeah, yeah. Because everybody does have an opinion when it comes to food, but not everyone should. That's kind of my my line. And especially when it comes to what you want, or you enjoy or what your body needs, no one can really tell you what you should and shouldn't have. And it certainly shouldn't be a moral choice that you feel that you're having to make.

Tamar-Rothenberg  18:33  
Right, and it becomes even worse when you're diagnosed. Yeah, that moral choice.

Jenn Huber  18:39  
So, so once people are through treatment, because I think that there are some nutrition considerations there that are probably beyond the scope of this, this podcast, but once people are through treatment, and they're they're on the road to recovery, and they're thinking about prevention, what are some of the add ins that you encourage people to explore as part of the playing the long game of cancer prevention? Because that's what it is, right? It's the long game. What are some of the add ins that you'd like to encourage people to try on?

Tamar-Rothenberg  19:14  
Well, you know, it can be very individual. And I don't really focus on prevention, because we don't have 100% prevention. We have I use more often risk reduction, right? So nothing's guaranteed, but there's a lot you can do to gain strength, recover strong. And then if you have to go through treatment, again, you're in a better place. So or depending on your age, you know where you are. So there's actually a lot you can do I feel nutritionally spiritually, you know, all kinds of alternative treatments and I'm not talking about going without medical treatments. I'm talking about adjuncts like you know, acupuncture

Jenn Huber  19:58  
complimentary. integrative, absolutely

Tamar-Rothenberg  20:01  
complementary, right, that are really, really, very strong have a strong effect. We're just beginning to discover more and more things that are helpful. So it's a whole spectrum of treatments, you have to find what works for you. What works for one person doesn't work for the other person, you know, it is very individual. That's why social media is so hard because it's like all or nothing, or this works for everybody. We know that doesn't, that doesn't happen. So in real life,

Jenn Huber  20:34  
yeah, no, absolutely. And so, you know, I think there's, there's a tendency for people to jump back into normal, you know, once they're through that, that really intense period of of diagnosis and treatment. What do you tell people who say, I just, I just want to get back to normal?

Tamar-Rothenberg  20:57  
Well, actually, what people tell that what people tell me is, they know they can't get back to normal because they don't feel normal. So they just want to feel a little stronger. And so, you know, women in general are not allowed to rest, they're not allowed to show weakness, you know, it's a hard, it's a hard thing still. So they, they're used to doing everything, maybe in the household, they can't do that anymore. It's a process, it's gonna take time. A lot of things do come back fatigue does lift, it may take a year, chemo fog does live for the most part, maybe you're not, you know, the other problem is, when you go through treatment, you're, you're aging at the same time, right? So it's hard to distinguish what's really the, the treatment or it's just regular nice menopausal aging, you know. So we really, you know, we have to accept that as well. It's like a double burden, you know, but, and the other thing is, you are for the most part thrown into some menopause, which is like a horror film for you and everyone around. So, there are medications that can help. And really, I would say, rely a lot on these medications, and not just nutrition, they really do help. But it's very hard to accept, it's hard to accept the menopause, that sudden, the consistent hot flashes, you know, they're not normal hot flashes that you have for, you know, the, the sort of slowing menopause. They're very persistent, and they're very strong, and they keep you up at night. So I'm saying all this to tell people that to realize that your friend may not go back to normal the way you want right away, even though they're cancer free. They may be or they may be metastatic. And you're this is more about other people feeling my friends back. She's cancer free. Well, she's not there yet. And just help her along. be her friend, you know, and, and be with her.

Jenn Huber  23:09  
I think that's such great advice. Absolutely. I'm gonna ask you one more question as I'm trying to read the books on your bookshelf. And so I see one about becoming vegan. Which reminds me, yes, your book, which we're going to talk about in a minute, but you know, the question about whether or not people should or, you know, want to become vegan or meatless or reduce me, what do you what do you say to that? Because, you know, I think that that's, that's, again, that's an all or nothing answer sometimes. And, you know, because you can't be a little bit vegan, you can be a little bit vegetarian, but you can't be a little bit vegan. And so what do you tell people about the research around plant based diets and breast cancer? And, you know, just nutrition in general?

Tamar-Rothenberg  23:57  
Yeah, it's a great question. And a lot of people do feel they want to make big changes, you know, that can be good. They're motivated, which is great. I find patients are very motivated after diagnosis. But if you take on too much, it's going to be overwhelming, you already have a lot to contend with. But let's look at the research and I get hate mail about this to the research shows, you do not have to be vegan or vegetarian. That is this is specifically for breast cancer, not for other types of cancer because we're getting more and more into precision medication. But for breast cancer, certainly chicken or fish, as long as you're adding more plants See, that's the caveat that you don't need to completely eliminate them and they have their place. Now if you want to be vegan, vegetarian, I am trained specifically in that I will help you along make sure you have your nutrient needs, but I would never push it and say you have to do that because the research doesn't back it up and I know you'll see black and white messages about that too. Yeah. And they you know, these people have an agenda, which is fine. I think they mean well, but it's confusing to thrivers because they hear those messages. And it's just not true. And this is like the most incredible research that is global that was done in the last just in the last year.

Jenn Huber  25:22  
Yeah, that's really great. And again, just, you know, to remind people that, you know, Netflix is not where you should be getting your nutrition information. Netflix is there to sell you drama, no, and they want you to watch the drama and come back for more drama. And there, the reality is that nutrition research isn't usually dramatic. It's not sexy. It's you know, it's every day, it's the long game. It's, you know, consistency and choices that don't need to be perfect. And that doesn't make for good Netflix drama. So. Okay, before we get to my last question that I asked everyone, if people want to learn and work from you, tell us about your cookbook and kind of tell us how you work with people in this this day and age of the internet, because you're in California, which is, which is fun.

Tamar-Rothenberg  26:11  
I Yeah. Yeah, it is fun. So there's two ways to work with me. Of course, there's privately, you can go to my website, tomorrow, Rothenburg rd.com, I offer a free 15 minute console call. And that's kind of the easy way to contact me, or direct message me on Facebook or Instagram. I also have a private group for thrivers on Facebook called a fresh start for breast cancer thrivers. But the second way is actually also very exciting. And that's a program set up by nonprofit culture share it, and they offer this and through a grant through Cedars Sinai, which is our hospital in LA. You can see one of two dieticians, either me or another stellar dietician, Rachel Beller, for free nutritional coaching, consisting with me, it's going to be three sessions. With Rachel, it'll be a group masterclass options, so you can choose what suits you. And it's been very successful in wonderful, really wonderful, that's fantastic. You can't apply, you can apply through me you have to go through, so share it on their website, there's a quick application and then somebody will contact you. And it's open to anyone, mostly in LA, there are a few out of state spots, but anyone who's ever been diagnosed with breast or ovarian cancer, or anyone at high risk, what we call providers who know they have a genetic mutation. So quite

Jenn Huber  27:46  
a few people, that's great. And we'll include those links in the show notes. So tell us about your cookbook.

Tamar-Rothenberg  27:54  
Oh, so it's actually a cookbook and a guide. So it's it's really not specifically for breast cancers for anyone diagnosed. And I wanted to put in there what I couldn't find what I was looking for information. So it's a lot of good information, charts. And then of course recipes for all different side effects going through treatment. And then beyond for once you've recovered and you want to start focusing more on plant foods and foods you can digest once again. So and then lots of resources. And it was it was hard work but so worth it. I love that it's out there. And you can find it wherever books are sold Amazon

Jenn Huber  28:38  
any great and what's the title because I can see it here on our screen but listeners can

Tamar-Rothenberg  28:44  
it's called cancer diet for the newly diagnosed and integrative guide and cookbook for treatment and recovery.

Jenn Huber  28:54  
Excellent. We'll link to that in the show notes as well. Tamara, thank you so much for sharing your time and your wisdom. And as I always ask my guests guests, what do you think is the missing ingredient in midlife?

Tamar-Rothenberg  29:11  
Well, I think make sure you have a good friend you can laugh with about everything about not remembering things or how you felt when you got up in the morning or your annoying partners, whatever it is. Make sure you can laugh with a friend every day.

Jenn Huber  29:27  
That is great advice. Thank you so much. I will share all of your links in the show notes you our breast cancer nutritionist on Instagram. Did I get that right? Yes. And like I said, I found they're connected with Tamar on Instagram over the last year or two and really enjoy the content that you share, and really enjoy learning from you as well. So thank you so much and have a great day.

Tamar-Rothenberg  29:56  
Thanks, John. It was a pleasure and I really appreciate the opportunity Unity to spread the message through your great audience.

Jenn Huber  30:04  
Thanks for tuning in to this week's episode of the midlife feast. If you're looking