Nutritional therapy and cancer care

by SATCC Advisory Board member and Clinical Nutritionist, Stephanie Moore RNT, mBANT, mCNHC

Stephanie is an experienced Clinical Nutritionist as well as a member of SATCC Advisory Board. Here, she discusses the complexity and push-back that registered nutritional therapists (RNTs) often face when working with cancer patients, and how new requirements are in place to ensure any RNTs who work with cancer patients have undergone post-graduate, cancer specific training to ensure the best possible outcomes.

Asking for professional nutritional advice to help with eating a healthy diet seems an obvious and important consideration for anyone living with cancer or going through cancer treatment. However, if you are thinking of consulting with a registered RNT, it is a rather more complicated proposition than it might initially appear because the objectives of cancer treatment and nutritional therapy are often in direct conflict. 

Finding the right RNT for you

There is, without doubt, great value in nutritional therapy for cancer patients at critical times of their process, from supporting gut health to managing inflammation, helping with weight maintenance and improving sleep quality as well as providing tools to increase resilience to the emotional and physical stress of a cancer diagnosis and treatment. 

However, timing is key and an integrated approach is essential. Choosing the right RNT for you – someone with cancer-care expertise who understands the complex interactions of food, supplements, the immune system and chemotherapy and radiotherapy, who can work alongside an oncology team – is now easy and safe. That’s thanks to a new nationwide practitioner directory of cancer-qualified RNTs, taking the guesswork and risk out of finding the right nutritional therapist for you or your loved one.

The complexities of cancer and nutrition

It is no wonder there is so much conflicting opinion regarding nutritional therapy and cancer care. Cancer is a complex condition, its treatment is ever evolving, and there are very many contraindications between cancer medications and supplementation. 

For example, some supplements can increase the effect of chemotherapy while others increase breakdown and excretion of chemotherapy drugs; some supplements can over-stimulate the immune system when cancer treatments need to suppress immune responses, and some supplements increase clotting time while others decrease it. These are all potentially serious issues when undergoing medical procedures. 

Combined with the added complications of the individuality of each patient’s genetics, hormones, and gut microbes, nutritional intervention really needs to be highly personalised to be safe and effective – hence advanced training is now a requirement. 

A historical lack of integrated cancer care

Historically, people undergoing cancer treatment were strongly discouraged by oncologists from undertaking advice from nutritional therapists. Instead, patients were either told that diet had no bearing on their cancer and treatment outcomes, and to continue eating as usual, or cancer patients were directed to the very general ‘healthy eating guidelines’ issued by the NHS, such as the EatWell Guide, which offers no specialised advice for medical conditions. 

A study carried out by Penny Brohn Cancer Care in collaboration with Bath University, titled Mixed Methods Investigation into Perceived Impact and Benefits of Penny Brohn UK Nutrition Advice and Support presented at the Society for Integrative Oncology 2019 conference, found that the vast majority of cancer patients they surveyed would have welcomed more nutritional advice and, in particular, personalised nutritional recommendations based on their treatment and their cancer journey. It was clear that patients felt having strong guidance on food choices would help with their sense of control over their bodies, when cancer and cancer treatment can leave patients feeling at the mercy of their medical team and treatment. Sadly, that guidance was not made available to the cancer patients surveyed. 

This historical lack of integration was largely due to nutritional therapy being categorised as an ‘alternative’ therapy and viewed with scepticism. Thankfully, much progress is being made thanks to increasing clinical trials and other research clarifying the potential benefit of nutritional therapy (NT) strategies for cancer patients. These also show how conventional cancer treatments and NT can, in fact, complement each other incredibly well if done appropriately at all stages of cancer care.

The importance of nutritional therapy training standards

As nutritional therapy has become more mainstream, now considered an integrative rather than alternative therapy, the benefits of targeted nutritional therapy have been much more widely accepted as a powerful and valuable adjunct to all manner of medical conditions, including cancer, throughout the medical world. Medical oncology professionals are also being reassured by the commitment of regulatory bodies overseeing and legislating the training of registered nutritional therapists, providing far more rigorous training standards and directives for their registered NTs.  

Nutritional therapy is a complementary healthcare intervention, based on nutrition and lifestyle sciences. As such, to become an RNT, strict guidelines regarding clinical education and clinical practice, to degree level or above, are in place before anyone can qualify and get registered as a Nutritional Therapist. Once qualified, nutritional therapists can register with the CNHC (Complementary and Natural Healthcare Council), an accredited register by the Professional Standards Authority for Health and Social Care, which allows them to legally work on a one to one basis with clients.

In 2023, BANT, the British Association of Nutrition and Lifestyle Medicine, and the leading professional body for Registered Nutritional Therapy (RNT) Practitioners, updated their Professional Practice Guidelines for those working with individuals with a confirmed or suspected cancer diagnosis. NTs who work with cancer patients are strongly encouraged to undergo specialist post-graduate training in cancer care. Only then are they able to be listed as NTs with skills to work with clients with confirmed or suspected cancer diagnosis on the BANT practitioner register. They write in the BANT Professional Practice Handbook: 

“BANT strongly recommends that only Registered Nutritional Therapy Practitioners and BANT Registered Nutritionists® who have completed an appropriate, accredited or recognised specialist CPD post-qualification should support individuals with a confirmed or suspected cancer diagnosis.”

The role of nutritional therapy in cancer care

What is so important to bear in mind for any nutritional intervention, is that there is no one absolute protocol suitable for everyone. It is essential to clarify that nutritional therapy is supportive and not a substitute for medical monitoring and treatment of cancer. If you come across a nutritional therapist making claims to ‘treat’ or ‘cure’ cancer, do not pursue treatment with this person, as it is a criminal offence to make such claims. Rather, an RNT should discuss with you ways in which they can aid in supporting you in your overall treatment plan, and they should be willing to regularly correspond with your medical team.

Primary prevention

Where nutritional therapy really comes into its own is helping with conditions that greatly predispose people to cancer, such as obesity, type 2 diabetes, low quality, inflammatory diets, and highly stressful lives. Working with people who are concerned about their cancer risk or simply want to do all they can to prevent getting cancer, is known as primary prevention. Such an integrated, preventive approach, done well, can be enormously beneficial and can be carried out by RNTs who have not completed specialist cancer training. The BANT Professional Practice Handbook says:

“BANT members are well equipped to support clients with primary prevention recommendations i.e., nutrition and lifestyle recommendations before the cancer occurs, to help reduce the risk of cancer.”

Secondary prevention

For people who have had cancer, whose treatment is complete, who are looking for nutritional therapy, it’s known as secondary prevention. Here, BANT also stresses the importance of post-qualification, specialist training to ensure practitioners are up to date with the latest scientific developments and on-going medication contraindications. 

For those of you who have completed active cancer treatment and have been discharged from ongoing medical care, you can engage with a nutritional therapist without specific post-graduate cancer training, as all registered NTs will have a good understanding on how to support  specific body systems and overall wellbeing. It is essential to note that nutritional therapy is not a substitute for medical monitoring or treatment, and that your registered NT keeps your GP informed of any recommendations.

Finding a registered nutritional therapist that’s right for you

If you or someone you are supporting with cancer is looking for support in dietary and supplement guidance for your cancer journey, you will find a link below to help you find a local, fully qualified practitioner, who can work with you and your medical team during and after your treatment processes.

To find a cancer care qualified nutritional therapist, go to: https://practitioner-search.bant.org.uk/ and click the Cancer box in Health Concerns. If you are a nutritional professional who is interested in working with cancer patients, or a NT with cancer expertise and training who would like to be in the directory, go to the BANT Professional Practice Handbook on the BANT website.