Episode 116: Fundamentals - Nutrition in Cancer - Tackling the Myths with Chloe Nottingham, Dietitian

🎙️Join us as we return with the excellent Chloe Nottingham to tackle some cancer diet myths.

❌Fasting

❌Alkali diets

❌No sugar diets

🥗Every year there is a new ‘Must Try’ diet to control your cancer.

🔎We look at the Social Media impact on what cancer patients are eating and the potential pitfalls of that.

‼️Nearly 40% of patients are following diet advice from social media that could be doing them harm!!

🤔Does a clever meme make you a good source of safe info???

😫We also look at the ‘Feeding Pressure’ that some patients feel from loved ones who are trying their best to help.

🎙️Chloe talks so much sense we almost think it should be on another podcast!!!

👍Dietitians are an amazing resource to help support patients support themselves.

🥗Healthy eating 🍎alongside exercise 🏃‍♂️remain the best platform for a body to tackle cancer.

📢A must listen for anyone tackling cancer or their loved one.

Enjoy and share!!!

Transcript

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Simply Oncology Podcast Recording Diet in Cancer-20260723_153440-Meeting Recording

July 23, 2026, 2:34PM

Welcome back to part 2 of our 2 part special on nutrition in cancer with the wonderful Chloe Nottingham. In this episode we look to debunk some myths and tackle healthy eating in cancer. I noticed in clinic is that...
 Often the people most worried about nutrition are usually the people around the patient. The patient is often less than, they're not the one vocalizing. Usually it's the family member getting incredibly stressed. And then there's a lot, sometimes a lot of friction actually between those two.
 the patient and the family member who the patient feels like they are being forced to do things and nagged. But there is so much worry about nutrition because you can see it. You can see the change, you can see the hollow cheek, the cheek, you know, the physical change is incredibly difficult to see. And feeding like a loved one is one of the few things that a relative can do. They stand around telling people to rest.
 So I suppose feed them. Yeah. So I don't know. Do you have any sort of pearls of wisdom from your experience of those sort of conversations about both from a patient and maybe a family member point of view about? Yeah, I think that's really common. And specifically I would say in UPPER GI cancers, especially when, you know, patients have just had their
 stomachs removed or pulled up into their chest and they physically cannot eat the volumes that they used to. And so it's really common for, you know, couples to come in and almost arguing because she's constantly telling me I need to eat and I just physically can't. And so it's understanding it from both views and sometimes coming in as that sort of
 Third person, again, just approaching it, explaining the importance.
 But also the new normal, I suppose, because things accepting that things are not always the same as it was before, and how you adapt. Yeah, and the huge impact and barriers that these patients are facing. But like you say, eating and drinking we take for granted. It's something we, you know, celebrate.
 It's something we use to, you know, commiserate when things happen. It's used in our daily lives just without thinking. So when that changes, it's a huge, huge impact on us and everybody around us. So actually, probably a lot of your work you do is actually the psychological side of things rather than just have this supplement.
 Absolutely. Yeah. There's a lot of counselling, a lot of, you know, informing patients and families. And I think it's really important to note that, you know, the psychological side of it does come into play a lot. And so we do often refer patients to sort of the code.
 for that support around, you know, the difficulties. Referring them for psychological input. No, I'm going to say a few provocative things deliberately. Why would I need a dietitian if I've got Instagram, if I've got TikTok, if I've got Facebook?
 Because everywhere we look on the social media sphere is advice on how to manage your diet during cancer or around cancer. So we're going to hit you with a couple. Okay. First up.
 Sugar feeds cancer. Ergo, you should remove sugar from your diet. Go. No. Good, I'm glad you said that, because I've been saying the same thing. Yeah, so there is a huge amount, a really unsafe amount, and governance needs to be much, much tighter.
 on what is said and what people can access out there because, you know, you get a diagnosis and the first people do at home is Google, what can I be eating? What shouldn't I be eating? The World Cancer Research Fund recently did an analysis and found that over 40% of NHS staff come into contact with patients on a weekly basis.
 with incorrect or uninformed nutrition information and it can be so dangerous. So sugar, so cutting out sugar does not stop cancer from growing. Restricting glucose to our cancer cells does not stop tumour growth or metastasis or
 And actually what it does do, because sugar is found in so many foods, so many important foods like complex carbohydrates, dairy products, fruit and vegetables, they contain the nutrients that are really important. So fibre, protein, vitamins and minerals that we know can A, prevent cancer, but B, help nourish us to get us through that cancer treatment. So
 Yeah, sugar, reducing sugar does not cure cancer. Absolutely. And just on a serious note, you know, all you're doing is kind of depriving your actual body around the cancer of what it needs. Of what it needs. Yeah. So, but I thought I had to bring that one up. I mean, sugar is integral to your metabolism. Your body will, if you don't take in sugar, your body will create sugar. Yeah. If you don't have a headache.
 Sugar, protein, and fat. You don't have the building blocks of life. Yeah, another one.
 I was going to say alkali. Well, I was going to say alkali diet. Yeah, so again, that's quite a common one. And what is this? So this is misinformation that the foods that we eat can suppress or change our blood's pH level, which in turn will help prevent cancer. So again, incorrect. And for me, this is a real bug there along with the term sort of
 detox diet. We have an incredibly, well-equipped body with many different organs and systems that control, you know, the pH of our body. And by pH we mean the acid levels. Yeah, the acid levels. And so there is
 nothing that we can eat and drink that will change the pH of our body. And what do these diets recommend? So again, cutting out food groups, so it might be, you know, increasing, it's mainly sort of like whole grains and fruit and veg and not having things like meats. And so again, any diet
 that cuts out whole groups, I would be extremely wary of. Any diet that has a cost implication. So selling a product that claims to, you know, detox, again, is the big marketing money makers. So you don't like detox diets? Do not. No.
 No. Fasting. Fasting, yeah. That is very fashionable right now. Yeah, so fasting is another big one. We do not at current recommend fasting and actually we recommend the complete opposite. So regular patterns of eating and drinking, you know,
 three meals a day if you can, and snacks in between that and specifically sort of protein and carbohydrates before bed in order to stop a fasting period. And again, if you think of the first meal we eat in a day as breakfast, breakfast, you know, it's really important to be getting those nutrients in and not going long periods of time without them.
 especially when naturally patients during chemotherapy, if you're coming in every day for treatment, etc, you are going to be skipping meals and missing out on, you know, food. So yeah, regular eating is really important.
 supplements, nutritional supplements, masquerading as treatments. Yeah, so high dose turmeric, turkey tail, lion's meat and mushrooms. So again, at present, there is no specific.
 food, herb, vitamin or supplement that can either prevent a cancer, cure a cancer when you've got it or slow down its growth or spread. You know, we almost hope that there was because it would be much easier to, much easier, much cheaper. But
 We've actually shown that an increase in some supplements like high level antioxidants can interfere with chemo treatment itself and actually make it less efficient. And that again, doses of certain supplements have shown to increase rates of cancer, such as lung and skin.
 So it's really important if, again, you're making any big changes, including supplementation just before or during treatment that you do let, you know, one of the team know. And Chloe, why do you think there is such an appetite for these diets, for sometimes very extreme diets?
 Whenever you're asking, and I sometimes feel like in the NHS we are like, we're like slightly boring because we are always saying in moderation, do some exercise. There's no evidence. You know, you know, and I think people want some control over a situation that feels like it's out of control, but there's such an appetite.
 Excuse the pan, that wasn't unintentional, but for these really sometimes quite extreme diets.
 That's A tricky one. I think a lot of it is out of desperation. I think a lot of it is, like you say, control. You know, what we eat and drink is something that we can manage ourselves. And so, you know, finding something that almost gives you that opportunity is, you know, whether it's
 A placebo effect or not.
 Yeah. Well, I think there's also some pretty nefarious practises happening, isn't there? You know, there's very clear, you know, the Cancer Act is very clear about what we can and can't advertise from a treatment point of view, but because it's food, it's not regulated that way. But actually, it can have just as a
 a detrimental impact as giving some completely unevidence-based drug, can't it? So I suppose one of the things is, you mentioned before, is some regulation on this as to allowing and fact checking people who are putting this stuff out there. And I also think, you know, some of the influencers or, you know, nutrition experts.
 experts that are out there giving this information look very professional. The website look, you know, and so it is really difficult for people to identify, you know, that sort of evidence-based reliable information out there.
 No, I'm going to move on to another topic.
 So I say, for instance, I was treating a lady with ovarian cancer and they were really struggling with their nutrition. Sometimes I might also give them some medication to improve their appetite. And I often wonder how that interfaces with dietetic services. So
 I'm thinking 2 drugs in particular, maybe 3. I'm thinking steroids, our old friend in oncology. Low dose of steroids can often stimulate appetite and well-being in a short-term basis. I'm thinking olanzapine, which I have used a few times quite successfully.
 And metoclopramide, not so much, but you know, it's said to stimulate the gut and help with appetite. How do you guys feel in the dietetic world about us oncologists like giving so many people steroids?
 I think there is definitely a time and a place for them. And we absolutely see, like we said, those higher risk patients that, you know, are really struggling, losing ground. We've had to reduce chemo doses or delays, etc. Then yes, there is a time where we need that extra bit of help. And like you say,
 you know, some patients react really well to a small dose of steroid and it gives them that boost and their appetite picks up and then that has a rolling effect. I would like to think that we are doing it in conjunction, having those discussions and it, you know, it isn't a blanket thing, you know, it really is for those patients that are, you know, close to admission. We're thinking about feeding tubes, you know, this is, we've tried
 food first, we've tried fortifying diets, we've tried a range of nutritional supplements. I think it's now time, you know, for that extra help. So cautiously accepting. Yeah, cautiously. So we've talked a lot about, you know, what various interventions that you can do. We've talked about
 the kinds of diets that we'd be advocating. I suppose when you're, if patients, carers listening to this episode are sort of looking at their loved one or looking at themselves and going and what are the sort of warning signs that should be sort of prompting? I think actually I need
 I need to highlight, I need to flag this because obviously we, whilst we want to try and provide as good care as possible, it is also important that the patients can and their carers can also advocate for their health. So what are the things, first of all, what should they be worried about? Second of all, what could be a first port of call they could potentially refer to? We've talked about lots of misinformation, but where is good information?
 on this and then yeah, who are they going to escalate to? Yeah, so I think that's a really good one. I think so there are lots of useful ports of information out there. You know, we are we always encourage patients to use websites such as the British Dietetic Association, Macmillan, World Cancer Research,
 NHS, that would be a sort of before you referred and see a specialist, you know, those websites give evidence-based recommendations. Your GP would be a first port of call. If you are under an oncology team, then any member of the MDT can refer you.
 to a dietitian. I think things to look out for would be really any sort of changes in interest in eating and drinking, a general sort of reduction in appetite or intake, any symptoms associated with eating and drinking. So if there's any
 you know, pain or nausea or difficulty swallowing, anything new around, you know, eating and drinking that wasn't there before. And then, you know, more obvious things like weight loss. And that might be things like having to do up belts, you know, a couple of notches more, watches or jewellery becoming looser, things like collarbones looking a little bit more prominent.
 you know, are they more tired than normal? Do they seem a little bit more withdrawn? Are they not as interested in activities that they used to do? There are a lot, yeah, I would say anything which wasn't considered normal for them to always raise. Because I suppose the big message is that...
 there are things that you can do about it and it is not just part, although it is very common in cancer, it shouldn't be accepted as, well you've got cancer, you should be losing weight. That's the thing to challenge, isn't it? And nausea should be, like if you're on chemotherapy and you've got nausea, actually we are very good at controlling that with the right medication. If you're having radiotherapy and you're struggling,
 there are other means of getting you efficient. So there's always, like we do have plenty of tricks up our sleeve. Yeah, and I think, you know, other things, so not just the types of foods that you're eating, but, you know, things like you are going to be tired and you are going to be exhausted and you're not going to easily think about what am I going to eat for dinner today? So using things like...
 You know, ready-made meals for periods of time is absolutely fine. Delivery services for your shopping. You know, if you've got friends or family or neighbours that are offering help, accept it. You know, you'll start to notice patterns around your chemotherapy of days where, you know,
 after day three of chemotherapy is when you start to go downhill a little bit and it might last for two or three days or longer, will then start eating much, much better on good days. So using those days where you feel more well to sort of, you know, help balance out the days that you know that you're not going to be managing.
 Yeah, great and.
 Say we finish our treatment. You know, we've been through our treatment and we want to live our best life. We always want to live our best life. In fact, Hollywood won't allow us to want anything else. Everything now has to be best life. But we want to live our best life. What kind of, what is a...
 Good. So I can't not bring this up, the Zoe project. Okay, so we hear a lot about this, like 40 different plants a week or something. That is some undertaking, especially, you know, if you're under any kind of tight budget, actually your whole week would be taken up trying to do that. But what would be a...
 Thoughts on the Zoe project?
 Too much hard work on another podcast. You're not allowed to tackle the Zoe Project as a dietitian. Well, like a whole hour. What kind of advice would we be saying to somebody as they hopefully set sail into the sunset and go and live a good life?
 Cancer sort of survivorship. There isn't an awful lot of research around nutrition, but it is growing and a lot of the research is similar to actually the eating and drinking and the lifestyle to prevent cancer in the 1st place. And like you say, you know, we do need to consider things like the postcode lottery and
 deprivation and finances around food. So you'd like to say there are things that you can do to cut out and those are free things you can do to improve your lifestyle. So like you said, smoking, alcohol, you know, saturated fats, processed foods. And then there are things that you can do.
 to add in. So that would be things like increasing your fibre intake. So, you know, the gold standard from the Zoe project may say 40 different plants, but you know, if you're only having one portion of fruit and veg a day, up it to two. Every little helps in the long term. Anything to help achieve a healthy weight, maintain a healthy weight,
 And like I keep saying, nutrition and physical activity, you know, go hand in hand and that's where the best outcomes are going to be. Can I ask another question? I'm going to anyway. We have talked several times on this podcast about the gut microbiome. Now we probably don't have enough time for this, but I'm squeezing it in.
 What kind of food? Are you? I'm into it. I think it's great. And we've seen some evidence that it may help. Are you about to say kombucha, Tom? Kimchi. How do we get our gut microbiome?
 Activated, so eating a range of, you know...
 I don't think there is anything.
 special or unachievable about nutrition, you know, that can help, but that won't help in an oncology patient, if that makes sense. You know, there's...
 In theory, it is that well-balanced diet and it doesn't have to be specific, fermented, really expensive foods, but just eating a range of different types of fibres, fruits and vegetables. I would say in oncology patients just being careful with things like probiotics if you're neutropenic.
 But...
 Yeah, anything, you know, those products that you've mentioned are going to provide a benefit to the gut. So that's a great point, actually. We're not really in favour of probiotics as part of a healthy diet or as gut microbiome. In fact, I think when we had Monty Pal on, he was
 saying that they're actually slightly worse. So actually better to get that from a dietary, natural stuff. Dietary variation. Everything is, you know, like the supplements. Again, there is no guideline around a specific supplement. It is all food first. You know, we will get the best outcomes from eating food.
 And if we can't get to where we need to, that's when, you know, the sort of artificial oral nutritional supplements and natural feeding, etc. comes in. Chloe, this has been such a good episode. It's been so much to talk about. I do apologize. We had given some themes we were going to talk about, but I got a bit excited.
 I think we asked one of the questions that we had talked about, but that's because this is so emotive and everybody's got some skin in this game because we've all eaten at some point. Now, Chloe, if you were going to give us three...
 Takeaway points.
 to kind of help wrap this conversation about nutrition and cancer, what would you tell us? I would say... Would you like to be found while you do that? Absolutely. I would say, you know, any concerns at all, speak with the MDT and get a referral into the dietitian.
 maintaining weight is the most important thing or maintaining a, achieving a healthy weight. And, you know, there isn't a specific food or supplement that's going to do that alone. It is a wide range and a variety. And that, you know, unfortunately, it's not just the cancer diagnosis, but the treatments do come
 with huge side effects that impact your eating and drinking. And so there is a lot of need for specialist dietetic input because you can't do this on your own. You know, it is a really big impact and you may end up on things like supplements and feeds.
 but it's important to, you know, be open to accepting and thinking of that nutrition as important as the treatment that you are on.
 John, I want to give her a wish. Can I do that? A wish. We're going to have to give a wish. Chloe, if you could have one wish, try and improve nutrition in cancer within the NHS, what would that be?
 Can it be as obvious as throw some money at dietetics because we have shown how, and it really can be easy, you know, the treatment and the information that we give our patients to make changes to get them through curative pathways.
 and that we know that without dietetic input, not all patients will complete that curative pathway that we thought they were first going down. So resourcing dietetics in all oncology departments. And that's a great wish. And just remind me, the must score, can patients fill that out themselves?
 Does that have to be done by, you know, a healthy health, you know, person, like a clinician? Yeah, all screening should be done by...
 And...
 staff in clinic, there are tools that patients can fill out themselves, that's ported tools, and that is, like I said, something we are working on to introduce here. But because hearing you today, I think I'm involved in a like a support app called My Sunrise and it's got a website and things.
 Absolutely. I think that would be a perfect way of getting that out there because it doesn't need a healthcare assistant or a consultant or a dietitian to screen. You are the one suffering. You know your body, you know the impact that you are having with your eating and drinking and whether you've lost weight or not.
 Because if we can see more numbers of people identifying problems, then we can say you actually might get your wish. That's right. And get the resources to get more dietitians. If we can say, look, the issue is five times bigger than you first thought it was. Yeah, because, you know, unfortunately, the numbers of patients that we currently have on our caseload should probably be triple, quadruple.
 that, you know, there isn't the service and that is something that myself and Michael are really pushing at the moment. Well, let's not finish on a negative. We're going to push forward. We're going to try and within our hands lies the ability to eat better to improve outcomes.
 Absolutely. Chloe, thank you so much. Thank you. Fantastic. Thank you so much, Chloe.