Carlyn Kappy

Carlyn Kappy is a Registered Dietitian, and Certified Clinical Research Professional. She earned her Bachelor of Science in Nutrition and Dietetics from Georgia State University, and completed the Georgia Public Health Dietetic Internship.

Carlyn has experience in developing individually designed nutrition plans to promote healthy body weight, participating in community out-reach wellness programs, educating clients on the appropriate use of nutritional supplements, and treatment of appetite change and meeting nutritional needs when on chemotherapy. Carlyn is currently the Dietitian at Turning Point Women's Healthcare in Alpharetta, Georgia, where she specializes in providing care for women dealing with the challenges of breast cancer.

Questions & Answers:

Question 8: I have heard that sugar feeds cancer. Should I cut all sugar out of my diet? If so, does that include carbohydrates, too?

There is nothing in the research that supports the theory that sugar feeds cancer. This is a misconception that has been around for years. Now with that said, a diet high in sugar usually is a diet low in nutritious foods. A diet high in processed sugar consists of empty calories that can lead to weight gain.

This does not mean you cannot consume these foods in moderation, but the majority of the time your diet should consist of plenty of fruits, vegetables, whole grains, lean meats and low fat dairy choices. It is also important to remember to include plenty of exercise in order to help maintain a healthy body weight.

Question 7: I was told that when undergoing chemo I need to eat lots of protein. Can you give me some ideas of the best types to eat?

Protein plays a key role in our body. It is used for many functions the body performs including tissue repair, fighting infection and growth. During treatments such as chemotherapy, radiation or surgery, protein needs may increase.

Protein can be found in both animal and plant foods. Some examples of animal sources are meat, poultry, fish, eggs and dairy products. Plant sources of protein include nuts, seeds, tofu and legumes (dried beans, peas and lentils). Grains (cereals, breads and rice) and vegetables contain a little protein.

It is important to remember to eat enough calories from a variety of foods. If you are not consuming adequate calories from foods rich in carbohydrates, protein and fat, then your body will use the extra protein you consume for energy instead of for supporting important body functions such as growth and tissue repair. If you are currently going through chemotherapy and you are being told to increase your protein, I would ask to speak with a dietitian. He or she will be able to assess your dietary intake and make sure you are consuming enough calories and protein.

Question 6: Does drinking alcohol have an effect on recurrence and survival rates?

Few studies have been done to evaluate the role of alcohol consumption in breast cancer survival. The findings of these few studies are inconsistent, which make it difficult to make any specific recommendations. Overall, the impact of alcohol consumption on breast cancer survival is uncertain. Alcohol Consumption and Breast Cancer Survival, written by Elisa V. Bandera and David A. August from the Division of Surgical Oncology, The Cancer Institute of New Jersey and Robert Wood Johnson Medical School, New Brunswick, NJ, does a nice job reviewing some of this literature.

However, it is well documented in the literature that alcohol has been shown to increase the risk of developing breast cancer and other cancers as well. A study done by Marilyn L. Kwan, PhD and colleagues called Life After Cancer Epidemiology (LACE) Study: a cohort of early stage breast cancer survivors (United States), found that cancer is 34% more likely to come back in breast cancer survivors who drink more than three drinks a week, compared with those who abstain or drink less.

As you can imagine there are pros and cons to all subjects on the Internet. I do think it is safe to conclude that when it comes to alcohol consumption and breast cancer, it is important to refrain from alcohol or only consume on an occasional basis.

Links related to this topic:

Alcohol Consumption and Breast Cancer Survival (Journal of Clinical Oncolgy)

Alcohol and Breast Cancer in Women (The Journal of the American Medical Association)

Question 5: There are so many differing opinions on flax seed. Do I eat it? Do I avoid it?

Flax seed is traditionally known for being a great source of dietary fiber. Many people do not realize it, but flax seed also contains lignans and an omega-3 fat called "alphalinolenic acid" (ALA), two anticancer components.

Lignans are plant-based estrogens that may protect cells that may become damaged when in contact with female estrogens. The term phytoestrogen is used when talking about plant-based estrogen. The research continues to be conflicting on whether a person should avoid foods high in phytoestrogens when they have estrogen receptor positive (ER+) breast cancer. Based on the literature, I feel it is safe to say that flax seed can be consumed in moderation if a person does have ER+ breast cancer. There are too many nutritional benefits of eating flax seed to omit it from the diet due to the phytoestrogens.

An omega-3 fatty acid, alphalinolenic acid (ALA), is a polyunsaturated fat that can help reduce inflammation. It is not made in the body and must come from food. Flax seed is a good source of ALA and when included in a well balanced diet, may be helpful in the prevention of cancer.

Question 4: I was diagnosed with ER+ breast cancer, and I worry about eating red meat, both because of the fat content and because of the hormones given to cows. Is this really a concern?

The association between eating red meat specifically and breast cancer is unclear. I do feel that recent data show that diet can play an important role in development and recurrence of breast cancer. With that being said, I would not recommend a diet high in red meat consumption because red meat does tend to be higher in fat. When consuming red meat, it should be done in moderation. I would also recommend a leaner cut of red meat such as tenderloin and flank steak. I think the most important point to get across is a well balanced diet, one rich in whole grains, fruits and vegetables, lean meat and low fat dairy sources. I would recommend this type of diet to women with any form of breast cancer.

The data is conflicting on the impact of hormones in meat and the effects on ER+ breast cancer. For those individuals who are concerned about the hormone content of meat and dairy products, there is the option of organic products that are hormone free.

Flax seed can be added to the diet by sprinkling on foods such as salads and oatmeal. It can also be ground and added to batters such as those used to make pancakes, breads and waffles. It is important to remember when adding flax seed, you are adding fiber, and you need to drink plenty of water to avoid constipation.

Question 3: I have been told that women with estrogen receptor positive (ER+) breast cancers should avoid eating any soy or soy-based products. It is difficult to avoid soy completely, because it's an ingredient in so many food products, including many of my favorite foods like salad dressings and energy bars. What are your thoughts on this?

This is a common misconception among women who have ER+ breast cancer. Soy contains phytoestrogens. Phytoestrogens are sometimes referred to as "dietary estrogens." The phytoestrogens found in soy, along with several other plant based foods, have similar properties to the estrogen found in our bodies; therefore, having the potential to negatively impact breast cancer patients who have ER+ breast cancer.

In order to completely eliminate phytoestrogens all together, it would require eliminating a wide variety of foods, which could negatively impact a person's health. The literature available on this subject is very conflicting. After reviewing the medical literature, total elimination of soy would not be something I recommend.

I think it is reasonable in this situation to recommend sticking to natural food choices in moderation. I would also recommend avoiding supplements high in phytoestrogens. I always encourage patients to speak to their doctor before starting any type of supplements. It is important to remember that more is not necessarily better. I find that to be a huge misconception as well.

Ouestion 2: I am five years out of my breast cancer treatment, but I have had a challenge losing weight. I am on tamoxifen and about 30 pounds over my goal weight. I do interval training, follow a strict 1,500 calorie, high protein, "clean" diet and drink lots of water. I have been told that my hormones are still out of alignment. Do you have any recommendations for how I might further alter my nutritional lifestyle? Should I follow a formal weight loss plan or diet such as Weight Watchers?

I think overall you are on the right track. Although I do feel a reputable weight loss program such as Weight Watchers can be helpful, it really depends on the individual person and what works best for them. A diet rich in a variety of fruits and vegetables, complex carbohydrates, lean protein sources and good fat sources such as those foods rich in monounsaturated and polyunsaturated fat is the best diet for weight loss and overall health.

With that said, too much of a good thing can inhibit weight loss. Although 1,500 calories does not sound like a lot, it may be more than you need to lose weight. I would recommend seeing a registered dietitian for an individualized meal plan including a metabolic test.

A person's metabolism can change due to inactivity, age, disease state, and certain medical treatments. Small frequent meals, exercise, and 8-12, 8 ounce glasses of water can help increase our metabolism. Metabolic testing is the gold standard for determining a person's caloric needs and resting energy expenditure. There are a variety of different machines on the market now used at weight loss clinics around the United States. I would check with either your physician or a registered dietitian in your area.

Question 1: When I eat cruciferous vegetables is there a nutritional benefit if I eat them raw versus cooked?

In order to receive the most benefit from the nutrients and fiber in cruciferous vegetables, it is best to eat them raw or lightly steamed. During the cooking process, there is a loss of some vitamins, minerals and fiber.

Cruciferous vegetables are especially rich in phytochemicals such as flavanoids and carotenoids. Phytochemicals provide potential health benefits including a decrease in the risk of cancer. This is why getting the most out of what you eat is very important.