4 Strategies for Effective Nutrition Counseling for Cancer Patients

When counseling a patient dealing with a cancer diagnosis, nutrition can be a tricky subject.  In the face of medications, procedures, and treatments, food can easily be overlooked, leaving patients feeling as if what they are eating is not important to their overall health.  On the other hand, many providers recommend a stringent, restrictive diet from Day 1, leaving patients feeling overwhelmed, confused, and paralyzed by the amount of change recommended.

I have been fortunate to work with many people seeking to optimize their nutrition in the face of a cancer diagnosis.  Below, you will see my four top recommended strategies to help you help your clients and patients feel their best. 

1. Set Attainable Goals

As caregivers, we often want to give our clients and patients every last bit of information we think will be helpful, but so often, that leads to them being handcuffed by a sense of overwhelm.  We must remember that change is a process, and that it may take the client time to absorb and apply the nutrition strategies that we provide.

I recommend suggesting SMART (specific, measureable, attainable, realistic, timely) goals for your patients, ideally creating them together in the office before they leave.  Once you have identified an appropriate goal, dive deeper into how to make that goal a reality.  If you can help them think through the process of achieving the goal, they will be far more likely to actually change. 

For example, if you want the patient to start eating more vegetables, rather than simply suggesting a number of servings per day, ask the patient what he usually has for lunch.  Let’s say he usually drives through McDonald’s to pick up a hamburger and fries.  Ask him if they may start trading the fries for a salad.  If he is open to that, see if he will trade his trip to McDonald’s for a trip to the make-your-own salad restaurant.  If he is open to that, see if he can start preparing a salad at home a few days per week and bringing it in for lunch, then give him some recipes and tips on preparing the salad.  Once you align on a goal, set a time period for when it needs to be done (such as, “by the next time you come in, I would like to hear that you are bringing your lunch in 4 times per week, and I would love to see a picture of a salad you bring if you could snap one with your phone”).

2. Dramatically Reduce Sugar

Numerous research studies show the benefits of a low-sugar diet on cancer development, progression, and recurrence.  Cancer cells use glucose as a primary source of energy (this is known as the Warburg effect), and dramatic linkages between sugar intake and patient outcomes are noted in scientific literature.  Thus, limiting dietary sugar intake helps make it more difficult for cancer cells to get what they need to reproduce.

While some practitioners advise avoiding even vegetables and fruits to eliminate sugar completely, I suggest starting with added sugars (both those found in sweet treats like desserts and those sources of hidden added sugars, such as yogurt and tomato sauce).  I also suggest adding in healthy fats to moderate the impact of a blood sugar rise from the naturally occurring sugars in fruits and vegetables, and choosing lower glycemic load produce when possible.  Diets with a high glycemic index and high glycemic load have been shown to increase the risk of cancer significantly, compared to diets with a low glycemic index or load, particularly in prostate, colorectal, rectal, and pancreatic cancers (“Glycemic index, glycemic load and cancer risk.” Ann Oncol. 2013 Jan;24(1):245-51.)  Another study at the Center for Gastrointestinal Oncology indicated that higher glycemic load and carbohydrate intake were associated with increased recurrence and mortality of patients undergoing chemotherapy.

3. Increase Antioxidant Consumption

Studies show that those who intake the highest amount of vegetables, particularly cruciferous vegetables have a reduced risk of cancer development and recurrence, particularly for prostate, colorectal, lung, and breast cancers.

I suggest that my clients aim for 8-12 fist-sized servings of vegetables and fruits per day, with 2/3 or more of those servings coming from non-starchy vegetables (as opposed to starchy vegetables like corn and potatoes, or fruit).  Advise your clients to start with one serving with each meal, and provide specific options of what they can include.  For example, breakfast might be a simple egg scramble with several fresh vegetables included, or a green smoothie with spinach, kale, cucumber, celery, or other produce blended in.  Lunch may be a traditional salad, lettuce wraps, or a sampler of different vegetable-based salads.  Dinner may be grilled vegetables and fish, a soup or chili loaded with vegetables, or unique options like zucchini noodles or lettuce wraps.  If these seem overwhelming, some clients may choose to simply add a side of roasted vegetables or a side salad to whatever they are already eating.

For those experiencing a reduced appetite due to chemotherapy or other treatments, I recommend getting a broad spectrum of antioxidants through smoothies or blended soups, which often seem more palatable.  Choosing nutrient-dense, darker-colored vegetables helps maximize the nutritional impact of each serving.  If even smoothies and soups are difficult to digest, or if the patient simply isn’t getting in 8-12 servings per day, I suggest greens supplements like Juice Plus+ (bit.ly/MLjuiceplus).

4. Empower Patients

One very effective way of empowering patients is to employ Motivational Interviewing, a style of counseling where practitioners try to get patients to develop intrinsic motivation to change their own behavior.  The clients explore their own ambivalence and ultimately come to the conclusion that their habits need to change.

This works in contrast to many traditional doctor-patient relationships, which suffer from the “righting reflex,” where the listener (or patient) automatically starts developing counter arguments in his or her head.  For example, if a doctor is saying “you must stop eating chocolate ice cream every night.  You have to eat less sugar because it dramatically increases your risk for cancer recurrence,” the patient may be mentally formulating a long list of reasons why giving up chocolate ice cream sounds horrific.  Unfortunately, we are many times more likely to believe what we say, either in our heads or out loud, than what we hear.  So if we can stop this client’s internal dialogue, and instead get her to speak about why she wants to reduce sugar, we will be much more successful. This is often called patient-centered questioning or care.

There is enormous value in simply listening, and in letting the client come to her own decision about what she needs to do with her health.  Many studies link a sense of hope and optimism with improved patient outcomes, including conditions as diverse as cancer recurrence, weight loss, smoking cessation, depression reduction, blood pressure reduction and more. 


In conclusion, we must learn to balance communicating the tremendous impact that lifestyle can have on physical health outcomes, without overwhelming patients and adding more pressure and fear to their lives.  Ultimately, a few steps in the right direction (as a result of setting attainable, realistic goals) are far better than a sense of overwhelm, paralysis, and inaction. 

- Megan Lyons

The information in this article is not intended or implied to be a substitute for professional medical advice, diagnosis or treatment. All content is for general information purposes only.

Megan Lyons is a Certified Holistic Health Coach, owner of The Lyons’ Share Wellness, motivational and educational speaker, and author of “Start Here: 7 Easy, Diet-Free Steps to Achieve Your Ultimate Health and Happiness.” To learn more, contact her at Megan@TheLyonsShare.org, or visit her website, www.thelyonsshare.org.