Sugar and cancer, in particular Chronic Lymphocytic Leukaemia (CLL/SLL) – what you need to know

[AussieNeil]

We've had a few questions lately about whether we should avoid sugar after a diagnosis of CLL, from members concerned about the influence of sugar in their diet on their CLL progression and of course because of the simplistic claim that sugar feeds cancer cells, so starving ourselves of sugar will starve the cancer. So what's the real story?

Cancer and sugar: Does changing your diet starve cancerous cells?

You may have heard that 'sugar feeds cancer cells', fuelling their rapid growth.

Or that eliminating sugar from our diet can starve or stymie cancer growth.

But is there any truth to these beliefs?

Well, the oft-repeated claim that sugar feeds cancer cells is true in a strict sense — and that may seem scary. But of course, it's not the whole story.

The reality is that alongside cancer, sugar feeds most cells in the body and is vital to our everyday function.

:

"Stopping sugar getting to cancer cells would also mean that your body's healthy cells get starved of necessary sugars," says the CEO of Cancer Council Australia, Professor Sanchia Aranda.

"I think that would make you lose weight, [and] would make your immune system less efficient and more likely that a cancer would progress."

What's more, our bodies are clever — they have other ways of getting glucose.

Even if you do try and cut it out, the body will just convert fat and protein stores into glucose where necessary.

From Australia's national, independent broadcaster, which is modelled on the United Kingdom's BBC: abc.net.au/news/health/2017...

CLL is a chronic cancer, with CLL cells only slowly multiplying. That's why CT scans rather than PET scans are used for checking CLL and PET scans are used to check for possible Richter's Syndrome/Transformation, where CLL may have transformed into a fast growing large cell lymphoma. PET scans use a radiolabelled glucose molecule,18F-fluorodeoxyglucose or 18F-FDG, which is taken up by the fast growing lymphoma cells. August 2020 update

Solid evidence that sugar does not drive CLL progression: healthunlocked.com/cllsuppo...

By reducing your food intake, you are going to starve many other body cell types before you can hope to affect your CLL. We need a nutritious diet to ensure our bodies continue to function well when we have cancer, particularly when we are under treatment. Note that CLL can interfere with our ability to metabolise what we eat. One of the triggers for starting treatment according to the IwCLL Guidelines is -

Disease-related symptoms as defined by any of the following:

Unintentional weight loss ≥10% within the previous 6 months.

According to this paper on the energy metabolism of CLL, in addition to finding that CLL cells were heterogeneous in this aspect (what a surprise ), "We found that, although CLL cells and B cells have a similar basal glycolytic activity, CLL cells had a significantly higher glycolytic capacity and glycolytic reserve, which are both indicators for the cell’s potential to switch to glycolysis as an energy source when necessary. Interestingly, we also found glycolytic capacity and reserve, but not basal glycolysis, to be novel predictors for OS in our cohort; CLL patients with higher glycolytic capacity and reserve showed worse prognosis."

haematologica.org/content/1...

So my take from that is that CLL cells will survive better than normal B-cells when under energy supply stress.

Sugar and cancer – what you need to know

Where the myth came from, why it's a myth, and why reducing our sugar intake can indirectly reduce our risk of developing cancers.

From the Cancer Research UK - last updated July 2019:

Search for sugar and cancer on the internet and it doesn’t take long to find alarming warnings that sugar is the “white death” and “cancer’s favourite food”.

:

Glucose is the basic fuel that powers every single one of our cells. If we eat or drink things that are high in glucose, such as fizzy drinks, the glucose gets absorbed straight into our blood ready for our cells to use. If a starchy food, such as pasta, is on the menu, the enzymes in our saliva and digestive juices break it down and convert it into glucose. And if for some reason there’s no carbohydrate in our diet, cells can turn fat and protein into glucose as a last resort, because they need glucose to survive.

:

Cancer cells usually grow quickly, multiplying at a fast rate, which takes a lot of energy. This means they need lots of glucose. Cancer cells also need lots of other nutrients too, such as amino acids and fats; it’s not just sugar they crave.

Here’s where the myth that sugar fuels cancer was born: if cancer cells need lots of glucose, then cutting sugar out of our diet must help stop cancer growing, and could even stop it developing in the first place. Unfortunately, it’s not that simple. All our healthy cells need glucose too, and there’s no way of telling our bodies to let healthy cells have the glucose they need, but not give it to cancer cells. (but see final reference below - Neil)

There’s no evidence that following a “sugar-free” diet lowers the risk of getting cancer, or boosts the chances of surviving if you are diagnosed.

:

If cutting out sugar doesn’t help treat cancer, why then do we encourage people to cut down on sugary foods in our diet advice?

That’s because there is an indirect link between cancer risk and sugar. Eating lots of sugar over time can cause you to gain weight, and robust scientific evidence shows that being overweight or obese increases the risk of 13 different types of cancer. In fact, obesity is the single biggest preventable cause of cancer after smoking...

scienceblog.cancerresearchu...

What about ketogenic diets, the Warburg Effect, Dr. Thomas Seyfried, Dr Joseph Mercola? Well it's as usual, more complicated than is portrayed and "the evidence is so darned thin and unconvincing thus far":

sciencebasedmedicine.org/ke...

Note the conclusion - "Clearly, ketogenic diets are not ready for prime time as a treatment for cancer, either alone or in combination with conventional therapy. Unfortunately, that hasn’t stopped it from being touted by all manner of alternative cancer practitioners".

Starving cancer cells of sugar could be the key to future treatment

or how to block cancer cells from taking up sugar while allowing our healthy body cells to continue to do so.

You may have seen articles or websites advocating that starving patients of sugar is crucial for getting rid of tumours or that eating less sugar reduces the risk of cancer. The story is not that simple. Cancer cells always find alternatives to fuel their tank of glucose, no matter how little sugar we ingest. There is not a direct connection between eating sugar and getting cancer and it is always advisable to talk to your doctor if you have doubt about your diet.

:

In a recent study published in Nature Communications we showed that cancer cells stimulate the over-production of the protein known as PARP14, enabling them to use glucose to turbocharge their growth and override the natural check of cell death.

:

This means that a treatment which could block the protein could represent a significant revolution in the future of cancer treatment. What’s more, unlike traditional chemotherapy and radiotherapy, the use of PARP14 inhibitors would only kill cancer cells and not healthy ones. The next step is to design and generate new drugs that can block this protein and work out how to use them safely in patients.

by Concetta Bubici, Lecturer in biomedical science, Brunel University London and Salvatore Papa, Senior scientist, Institute of Hepatology, Birkbeck, University of London: theconversation.com/starvin...

So while it makes excellent sense to aim for a more balanced diet and achieve a healthy weight, do so for the rewards that that brings and not with any expectation that your CLL progression will slow. Don't feel guilty about enjoying the occasional sugary treat! Remember that "There’s no evidence that following a “sugar-free” diet lowers the risk of getting cancer, or boosts the chances of surviving if you are diagnosed."

This is an unlocked post, discoverable on the Internet

Neil

[OwnedByCockerSpaniel]

Thanks AussieNeil.

I have seen so much of this myth, and several friends loaning me books on "How to beat Cancer" and "What Not to eat with Cancer." etc.

They did sound a bit Woo, and had the sniff of someone trying to make some money with a pet theory.

[Newdawn Administrator]

An excellent synopsis Neil and it de-bunks a lot of the tin-pot theories about sugar and the development of cancer.

My own concerns are that sugars like carbohydrates are not created equal and much depends on where we get them from. The ‘empty calorie’ argument where eating sugar products with little nutritional can do our bodies little good. Natural sugar taken from foods is of course preferable to a bag of hard candies which are just processed glucose.

In terms of the possible connection with cancer development, it’s the link between excess sugar, weight and systemic inflammation that concerns me. A high carbohydrate diet leads to those carbs being processed as glucose. Over time, chronic inflammation can, according to authoritative sources, cause DNA damage and lead to cancer. The example cited is usually Chrons Disease and the possible development of colon cancer but there are many more.

I’m not suggesting a direct link between sugar and cancer however but I do have concerns about the possible link between sugar/carbs that more rapidly convert to glucose and inflammation and a possible connection with cancer development. The solid tumour cancers seem more implicated than blood cancers in the literature however.

Newdawn

[AussieNeil Partner Administrator in reply to Newdawn]

There is growing evidence regarding the benefits of reducing the amount of processed food in our diets. It will be interesting to see if there is a measurable reduction in the rates of obesity and type 2 diabetes from the introduction of sugar taxes in the UK, France and a growing list of other countries.

Neil

[Newdawn Administrator in reply to AussieNeil]

I very much doubt it Neil even though I welcome it and a greater availability of low sugar drinks in particular. The main issue is carbs and this is stressed over and over on the Diabetes Forums. People will cut the full sugar soda thinking that’s the answer whilst munching through the burger in a huge white bun!

Newbies to these diabetic sites nearly always have the link between carbs and glycemic control explained.

Newdawn

[ken3015 in reply to Newdawn]

Thanks for this great information.

So much confusion on this topic.

[whitelily22]

Thank you Neil, so PARP14 it is!

Very interesting reading

[JigFettler Volunteer]

Hi Neil - wonderful stuff, presented clearly, and required understanding for the CLL warrior. Its a complex world - the acquisition of nutrition - the avoidance of harmful additives.

Is a good diet the one with fewest additives?

Jig

[studebaker]

As always very interesting synopsis Neil.

That PARP14 if successful might be the magic bullet for most if not all cancers.

In the meantime, I decided to closely watch how many and what kind of carbohydrates my husband (diabetic) and I consume. We find it little tough at times as we do LOVE bread and potatoes.

I love to read interactions between you and Newdawn. Very educational.

Dana

[Hidden in reply to studebaker]

Same here!! We make our own bread twice a week, so we do love bread, and we grow some potatoes. Just harvested some wonderful "new" potatoes that are so very tasty. We don't eat a lot of potatoes but once or twice a week, we do eat home made bread at least once a day. Bread only lasts about 3 days before it starts to mold. We make one loaf at a time.

[Indolent]

Thanks Neil. In a world that so often gets distracted and mislead by false information, it's always good to have clear-headed and proven facts to bring clarity.

[SethB34]

Solid post, Neil.

[Benlewis]

Thanks Neil!

[jsniegocki]

I attended a talk about a week ago by a cancer specialist from the University of Cincinnati, Dr. Rekha Chaudhary. She stated that there was indeed a growing body of evidence linking sugar consumption to the growth of cancer cells, and strongly recommended trying to reduce sugar intake and to get sugar mainly from whole fruits, which is her own dietary practice. She did not speak directly to the issue of sugar in relation to CLL.

[AussieNeil Partner Administrator in reply to jsniegocki]

As I quoted above, from the Cancer Research UK article, "robust scientific evidence shows that being overweight or obese increases the risk of 13 different types of cancer. In fact, obesity is the single biggest preventable cause of cancer after smoking".

Dr. Chaudhary is also doing a clinical trial on the impact of a ketogenic diet on patients with glioblastoma (an extremely aggressive brain cancer) :

clinicaltrials.gov/ct2/show...

M. D. Anderson state:

"5. Myth: The ketogenic diet can cure glioblastoma.

Fact: No diet can cure glioblastoma. A handful of case studies and internet bloggers have claimed the keto diet may have benefits for brain cancer patients, but the idea that you can “starve” glioblastoma through diet is a myth. While the role of diet in cancer is an area of active research, we know that glioblastoma patients need nutrients – including carbohydrates – to keep their bodies strong through treatment."

mdanderson.org/publications...

Apparently, high-grade glioma cells consume mainly glucose and cannot compensate for glucose restriction, hence the active research into using keto diets as an adjuvant to standard chemoradiation treatment of glioblastoma multiforme. I've lost two people very close to me to this rare but extremely aggressive brain cancer (neither survived long), so I hope that the results of her trial are promising for those with this disease. However, you can't extrapolate the outcomes of these trials to CLL, a cancer at the opposite end of the cancer spectrum. Early trial reports into the investigation of keto diets as an adjunct to cancer treatments are providing mixed results: cancertherapyadvisor.com/ho...

I noticed that in one of her earlier lectures, she pointed out that a similar survival improvement was obtained from exercise to adding Rituximab to CHOP treatment for lymphoma patients which resulted in FDA approval of R-CHOP. R-CHOP is used to treat those with CLL who have undergone Richter's Transformation.

Neil

[roszika]

Avoiding sugar to slow cancer- what misleading information- obviously the authors of such information never studied biochemistry

[Hilomom]

Thank you Neil, for this post. Very informative!

[Carole1938]

I was diagnosed with CLL in 2001.been on a watch and wait ever since.3 years ago I cut sugars ,carbs,rice& pasta from my diet ,this was to try and reduce my diabetes.When I had my blood checked I had no readings out of range for my CLL.I was losing too much weight, so I have been trying to balance my diet to stable use my intake of carbs ,I fill my plate with mostly green veg.

Due to see oncologist end of September keeping fingers crossed that CLL is stable

[Peggy4]

Great post Neil. Love the picture 🤣

Peggy 😀

[BeckyLUSA]

Thank you Neil! I think I am going to print some of these out and give to the well meaning friends who say sugar feeds cancer!

BeckyL

[MGirl-Aust]

Thanks Neil, very helpful information - I’ve been wondering about this for a while. I think there are many reasons to reduce one’s intake of simple sugars and carbs, but good to know we don’t need to feel guilty every time we have a (little) sweet treat!

[yazbe]

This is the diet I follow, though I'm not dogmatic about it. It just seems sensible to me. Since it doesn't eliminate whole food groups or attempt to alter body chemistry, it's been sustainable, and I don't feel deprived or hungry. My hubs and I have been following it for about a year now. We've both lost weight and feel well (I am not a paid sponsor). Good luck, all!

drweil.com/diet-nutrition/a...

[AussieNeil Partner Administrator in reply to yazbe]

That looks a fairly balanced approach, but with recent research, I would question the recommended supplements. My particular concern, given our propensity with regard to poor clotting, more so if we are under treatment and especially so with Ibrutinib, is the suggestion to take low dose aspirin.

"Like most medicines, aspirin has side effects. It irritates your stomach lining and can trigger gastrointestinal upset, ulcers and bleeding. And, because it thins your blood, it can be dangerous for people who are at higher risk of bleeding."

hopkinsmedicine.org/health/...

More from heart.org/en/news/2019/03/1...

"According to three significant studies published last year and one major analysis released this year that looked at 10 other studies, the benefit from taking a daily low-dose aspirin was offset by the danger of internal bleeding and other side effects in people considered to be at low or moderate risk for heart disease.

It's good to see the recommendation to talk to your doctor, but realistically that doesn't always happen with over the counter medications.

Neil

[yazbe in reply to AussieNeil]

Completely agree re: aspirin ~ honestly, that escaped my attention. Thanks for pointing this out, Neil.

[Hidden in reply to AussieNeil]

When I was first prescribed Imbruvica the Oncologist stressed NO aspirin, no NSAIDS, which left only Tylenol for mild pain.

[Jonquiljo in reply to AussieNeil]

I was under the impression that low dose aspirin was on the “doctors should stop recommending this” list for anyone but people with major cardiovascular disease likely to get a heart attack or stroke.

I recently read an article that many Drs were not getting the word out fast enough to their patients to stop taking aspirin. Apparently there are quite a few patients who have no clue that aspirin recommendations have been changed. Of course, your Dr should tell you on a case by case basis.

Then again, it took a long time for the medical community to make it clear to patients that trans fats are not good for you. I guess its easier to start these recommendations than to stop them.

[Hidden]

"The next step is to design and generate new drugs that can block this protein and work out how to use them safely in patients." Wouldn't that be wonderful!! I hope some research facility it doing just that!!!!

[Big_Dee]

Hello AussieNeil

Great series of studies. When first diagnosed with CLL I did what many did, jumped on internet and Goggled everything I could find. I read several interesting articles on sugar, but best one was Mayo Clinic, essentially saying same as your articles. Artificial sweeteners were discouraged in favor of natural sweeteners like honey which were a combination of glucose and fructose and being better than refined fructose or refined sucrose table sugar. The point is we need sugars for our body, but should be controlled for weight gain.

[Dynamite1976]

Thanks for the info!!

[deveritt]

Is there any current research on PARP14 inhibitors? I'm guessing, even if there is, it'll be at least 3-5 years before this is available.

[AussieNeil Partner Administrator in reply to deveritt]

PARP14 has been proposed as a target for another B-cell cancer DLBCL, which really needs more and better treatment options. (DLBCL is the usual outcome of Richter's Transformation in CLL). I couldn't find any references specific references to CLL, but no doubt if a drug was successfully developed for DLBLC, it's applicability to CLL would be assessed.

Neil

[Beattiem-UK]

Very clear and informative. Thanks Neil.

[livinglifewell]

My motto is everything in moderation...including moderation.

[Floxxy]

Interesting article thanks.

[Hidden]

I found a related study last week.

While yes your body will manufacture glucose via glyconeogenesis, it will only manufacture to the level your body needs. It is well documented that people who maintain keto diet, maintain a baseline level of blood glucose

However, when we eat carbohydrates, our blood sugar levels elevate far beyond this. If you look at relative blood glucose and insulin comparing the person who eats a meal with carb, and one who eats a keto diet, you see two very different related things:

The person eating carbs has a peak in blood glucose with insulin following the glucose curve.

The person in keto does not have either peak. Blood glucose remains even as does insulin.

So here's the study, which may be pertinent for some CLL patients especially like me with 11q deletion: ncbi.nlm.nih.gov/pmc/articl...

" The INSR (insulin receptors) expressed on CLL cells subsequent to low-dose insulin stimulation activated pro-survival and pro-growth pathways and abrogated CLL apoptosis"

The implication of this is that if CLL cells have extra insulin receptors that are pathobiological, that keeping insulin levels low could be beneficial. How do you keep insulin levels low? Avoid carbohydrate meals which spike blood glucose and hence insulin. I am not saying this is the thing to do, only that it is a possibility.

However, there is potential large complication, which is the pharmokinetics of medications. I do not know enough about this regarding CLL treatment drugs. Some drug's pharmokinetics are adversely affected by fats in a meal (potentiating or inhibiting), and it's possible that a keto state would also be conducive to such problems. So if taking a CLL drug, by going keto you might be potentiating or reducing the drug's effect.

Aside from this, I do not believe that sugar's effect on cancer is the only consideration for avoiding sugar and high glycemic foods in one's diet. It is quite clear that regluar/repeated consumption of high glycemic foods especially in large quantity, stresses the pancreas, leads to insulin resistance, overweight, diabetes, and all related co-morbidities including CVD.

Personally I choose not to eat anything with added sugar, nor any packaged processed foods or those high on the glycemic index, including white flour, rice, potatoes and high glycemic fruits. Rather only those foods lower on glycemic index and in small enough quantity to keep total glycemic load low. YMMV

[Emerfly]

Hi Neil thank you again ! A well balanced diet with treats is how I eat . Unintentional weight loss is a problem for me at the moment and every time someone tells me I look great I feel like being rude . I’ve never approved of society’s obsession with body size , fat or thin . As long as people are healthy what’s the problem with different shapes and sizes. ? A funny story . My youngest daughter worked for a time for the Bill and Melinda Gates foundation. She returned to the Congo after a few months at home . The interpreter she worked with greeted her with a big smile and said ‘Oh you look fat’ ! . She was a bit offended until he said for me that is beautiful because it means you have enough food to eat .

I am personally careful about what type of carbs I eat as wheat does not agree with me , nor does sugar . I break out in hives . So I eat spelt bread and use xylitol instead of sugar ...most but not all of the time ! But I do wish we in the developed world would stop obsessing about fad diets . Someone posted recently about something called the 800 diet . I looked it up out of curiosity . Someone called Dr Mosely recommending you can lose a stone in 21 days by reducing calorie intake to 800 a day ....duh ! Of course IV we eat less we will lose weight but why would we want to do that to our bodies ? Deny it a reasonable amount of calories ...research has shown that the body will react and start storing fat in case there is another ‘famine’ around the corner ...hence we have a culture of yo-yo dieting .

I realise I’ve gone off track a bit here . The post was about sugar . A little of everything might just be good for us and that Belgian chocolate sure looks good !

[Hidden in reply to Emerfly]

"I’ve never approved of society’s obsession with body size , fat or thin . As long as people are healthy what’s the problem with different shapes and sizes. ?"

When that shape or size involves a large amount of visceral fat, you have a problem.

However, some larger girt people have lower ratio of visceral fat. and some thin people have higher relative amounts. So body shape and size are not directly related, but the incidence of higher visceral fat does correlate with obesity and it's related co-morbidities.

duckduckgo.com/?q=visceral+...