Author name: laura@lauracipullo.com

Understanding and Managing Bloating and Inflammation Through Diet by Laura Cipullo, RD, CDCES, CEDRD-S, RYT-500 Identifying Different Types of Bloating Oh! There are so many types of “bloat”. Women get the premenstrual bloat, but we all get the belly bloat. Belly bloating can be from a few different things. First, when we eat fiber, our bacteria (part of the microbiome) attempt to break down the dietary fiber and food byproducts thereby releasing hydrogen gas; this literally causes belly distention. You can expect to have some distention after any meal with a complex carbohydrate such as whole grains or a non-starchy vegetable like Brussels.  Another normal reaction to eating is the passage of partially digested food through your small intestine and then into and through the large intestine. The presence of food and food’s by-products passing through the gastrointestinal track will naturally cause distention that may appear as bloat.   Finally, there is bloating from anxiety. Yes, that is correct. Stop stressing over your stomach’s appearance because the more you stress, the more likely you are to throw your microbiome out of balance and cause a leaky gut with bloating. There is a bi-directional relationship between the gut and brain axis that is responsible for stress induced bloating, which likely affects 90% of the population with diagnosed irritable bowel syndrome.  In addition to belly bloating, you may experience edema, a form of swelling in your hands, feet, face, and sometimes your belly the day after drinking too much alcohol. The alcohol actually blocks the release of a hormone known as vasopressin causing you to urinate more and thus become dehydrated. The body reacts to this state by conserving water and sometimes, too much water, making us puffy and bloated. Recognizing Functional Bloating: Rome III Criteria If these bloating symptoms feel familiar and persistent, ask your doctor about functional bloating! The following criteria known as the Rome III help physicians to identify individuals with persistent bloating unrelated to other medical conditions.  The criteria include recurrent feeling of bloating or visible distention for at least 3 days per month, onset of symptoms at least 6 months prior to diagnosis, presence of symptoms for at least 3 months, and insufficient criteria to establish a diagnosis of irritable bowel syndrome, functional dyspepsia, or any other functional gastrointestinal disorder. Recognizing Functional Bloating: Rome III Criteria So then what about inflammation? Inflammation is usually an internal response experienced by the body as a result of the presence of some sort of irritant. Of course, you may see signs of inflammation when someone experiences a fall or a great force resulting in swelling, aka inflammation. However, the inflammation most people refer to when discussing their bloating or their gut, relates to gastrointestinal tract, most often their stomach, small intestine and or colon. Gastritis, also known as inflammation of the stomach lining and or a “leaky gut” resulting from inflammation consistent with irritable bowel syndrome are just two examples of this internal mechanism signifying poor wellness. Bloating and inflammation intersect when inflammation results in bloating. For instance, you may have an inflamed stomach lining that leads to bloating or inflammation of the small intestine causing flattened villi as seen in celiac disease which results in poor nutrition absorption causing bloating, diarrhea and vitamin and mineral deficiencies. Dietary Influences on Bloating and Inflammation What we eat most definitely affects bloating and or inflammation. Dietary factors that affect bloating specifically include chronic alcohol ingestion, intolerances to lactose and fructose, consumption of nondigestible sugars known as oligosaccharides, eating any type of plant fiber, and of course, eating gluten. Typically, the body responds with inflammation which then presents itself as bloating. Best Foods for Reducing Bloat To ensure your belly will be without bloat for your evening event, eat an easier to digest protein and fat combination. Think 2-3 eggs for breakfast and a chicken hummus wrap for lunch. There is no dietary fiber in protein and most fat sources. This means the bacteria in our bodies will be limiting their gas production! Use a white, not whole grain wrap for this one day! A white wrap has limited fiber unlike a whole grain wrap that can have as much as 5 grams fiber/wrap. No gas, no bloat. The friendly green leaf: Need a green veggie to eat when feeling bloated? Choose spinach! Sauté the spinach in olive oil on low heat, until it melts. This is the best vegetable to meet your green needs while not exacerbating belly discomfort and bloating. Spinach is considered a low FODMAP food (fermentable oligosaccharides, disaccharides, monosaccharides and polyols). Foods high in FODMAP carbohydrates are harder to digest and can cause cramping and bloating. Check out the Monash University FODMAP diet app for all questions and answers related to irritable bowel syndrome and the low FODMAP diet.   Natural Anti-Inflammatory Foods and Spices Fight inflammation with the best anti-inflammatory food, sardines (not salmon). The best way to counter the production nitric oxide (NO) and tumor necrosis factor alpha (TNFα) production also known as pro-inflammatory agents, is to eat a diet rich in the polyunsaturated fatty acids known as omega 3. These essential fatty acids are associated with decreasing the occurrence and even the severity of inflammatory diseases such as cancer, diabetes and heart disease.   Get spicy with ginger, black pepper and turmeric! Add these spices to hot water, green tea or use as condiments when attempting to fight inflammatory conditions such as rheumatoid arthritis, gastritis and esophagitis. Ginger and it’s spice friends inhibit the body from making pro-inflammatory chemicals known as cytokines.       References: Lacy BE, Gabbard SL, Crowell MD. Pathophysiology, evaluation, and treatment of bloating: hope, hype, or hot air?. Gastroenterol Hepatol (N Y). 2011;7(11):729-739 Bishehsari F, Magno E, Swanson G, et al. Alcohol and Gut-Derived Inflammation. Alcohol Res. 2017;38(2):163-171.and Lacy BE, Gabbard SL, Crowell MD. Pathophysiology, evaluation, and treatment of bloating: hope, hype, or hot air?. Gastroenterol Hepatol (N Y). 2011;7(11):729-739. Ahmad TB, Rudd D, Kotiw M, Liu L, Benkendorff K. Correlation between Fatty

Optimizing Post-Workout Recovery: The Role of Nutrition by Rebecca Jaspan, MPH, RD, CDN, CDCES   Whether you just completed the New York City marathon, your Sunday long run, or a good strength session in the gym, post workout nutrition is paramount to recovery.  Race recovery begins the moment you have crossed the finish line.  Right after your workout or race, you should aim to replace fluids lost through sweat and restore glycogen stores.  This can be done with water and pretzels, chocolate milk, or a sports drinks.  Within 45 minutes to 2 hours after, you should incorporate protein along with carbohydrates to rebuild muscles, tendons, and ligaments, and reduce muscle soreness.1  As a rule of thumb, aim for snacks or meals that have a 3:1 ratio of carbohydrates to protein.2   Post-workout nutrition focuses mainly on protein and carbohydrates, so where does fat come in?  While fat is an important macronutrient for absorption of fat soluble vitamins, hormone production, and reduction of inflammation, there is some evidence for limiting fat consumption right after an intense workout or race.  Fat slows gastric emptying, which would decrease the rate at which carbohydrates enter the bloodstream to replenish glycogen stores.  After eating carbohydrates, insulin spikes, which plays an important role in building muscles and beginning the repair process.  Fat blunts this insulin spike, slowing the shift from catabolism, or breaking down, to anabolism, building back up.  Additional studies show that fat doesn’t play a large role in the recovery process, but having some fat in your post-workout meal or snack won’t reduce muscle protein breakdown and hinder your recovery.3   Protein bars are quick and convenient forms of recovery nutrition.  Here are six of our favorites to meet your recovery needs.   Kind Protein Bars   These Kind bars are similar to the original variety in their texture and crunch, but have double the amount of protein.  They also have 17 grams of carbohydrates and 6 grams of fiber to keep you full.  These bars come in four different flavors, dark chocolate, crunchy peanut butter, almond butter dark chocolate, and caramel nut.   Clif Builders Bars   Clif Builders Bar have a whopping 20 grams of protein to jump start your recovery.  They also contain 20% of your daily iron needs, which helps promote healthy muscle recovery.  These bars are also gluten free and contain complete plant-based protein.   Kind Energy Bars   Kind Energy bars are a combination of five different grains in chocolate or peanut butter flavors.  They contain 10 grams of protein and 34 grams of carbohydrates, perfect for replenishing and refueling.   Picky Bars   Picky Bars were created with performance nutrition in mind.  They combine fast-acting carbohydrates with plant-based protein to aid recovery.  These bars have 24 grams of carbohydrates and 7 grams of protein and come in a variety of delicious flavors.   GoMacro Bars   GoMacro Bars are made with different nut butters, nuts, and seeds to create a wholesome and easy post-workout snack.  With 39 grams of carbohydrates and 11 grams of protein, they meet the 3:1 ratio needs for post-run recovery. 6. NuGo Bars   NuGo bars have a rice krispie-like texture with 11 grams of protein.  They are also low in fat and are packed with important recovery nutrients such as calcium, B vitamins, vitamin C and potassium.   In addition to nutrition, don’t forget about post-race hydration.  You’ll want to include a drink with electrolytes to replenish any you lose through sweat.  For reduction of muscle soreness, give tart cherry juice a try.  Studies show that runners who drink tart cherry juice immediately following a marathon had less muscle damage, soreness, inflammation and they also recovered faster.4   Have questions about post-race nutrition?  Want a plan that is specific to your individual needs and goals?  The dietitians at Laura Cipullo Whole Nutrition Services can work with you to create a plan to set you up for successful racing and recovery.   References: Kerksick C, Harvey T, Stout J, et al. International Society of Sports Nutrition position stand: nutrient timing [published correction appears in J Int Soc Sports Nutr. 2008;5:18]. J Int Soc Sports Nutr. 2008;5:17. Published 2008 Oct 3. doi:10.1186/1550-2783-5-17 Ivy JL, Goforth HW Jr, Damon BM, McCauley TR, Parsons EC, Price TB. Early postexercise muscle glycogen recovery is enhanced with a carbohydrate-protein supplement. J Appl Physiol (1985). 2002;93(4):1337-1344. doi:10.1152/japplphysiol.00394.2002 Capaldo B, Gastaldelli A, Antoniello S, et al. Splanchnic and leg substrate exchange after ingestion of a natural mixed meal in humans. Diabetes. 1999;48(5):958-966. doi:10.2337/diabetes.48.5.958 Howatson G, McHugh MP, Hill JA, et al. Influence of tart cherry juice on indices of recovery following marathon running. Scand J Med Sci Sports. 2010;20(6):843-852. doi:10.1111/j.1600-0838.2009.01005.x  

Navigating Nutrition in the Fight Against Breast Cancer by Laura Cipullo, RD, CDCES, CEDS-S, RYT   After having been diagnosed with Estrogen Positive, HER2 Positive Breast Cancer in October of 2019, I had to reevaluate my food intake and even my lifestyle. While no one food, gene or specific stressor can be solely to blame, I needed to research the latest studies regarding diet and breast cancer. I accepted that the gene for my Er+, Her2+ cancer had yet to be identified, if ever. I accepted that I also needed to slow down, hence work less. But was there new information regarding red meat, soy, dairy, or even juicing?   Yes, there was new nutrition information available. I found a plethora of science pointing at what to include and sometimes, what to minimize. I also read that most women who developed breast malignancy (around 80%) do not have a family history of breast cancer.1 I was not alone and you are not alone. I encourage you to create balance. Focus on what to include just as much as what to exclude or decrease.   Below, I highlight 5 areas of food and nutrition that deserve your attention, warrant additional reading and discussions with your oncologist as well as your registered dietitian.     Ground Flaxseed   Consuming about 1- 2 tbsp of ground flaxseed daily, especially for postmenopausal women and premenopausal women may help prevent cancer growth.  Flaxseed must be ground to be absorbed by the body. Known as a rich source in omega 3 fatty acids and lignans, these nutrients have the potential to suppress the growth, size, and proliferation of cancer cells.2   Lignans are found in whole grains, sesame seeds, vegetables, and fruits. However, flax has approximately 100 times more lignans than other foods. These lignans are considered phytoestrogens, similar to soy foods, and bind to the estrogen receptor site in the human body. Bacteria in your gastrointestinal tract convert the lignan into forms of estrogen known as enterolactone and enterodiol. These forms are unlike estradiol and have a weak estrogenic affect in the body, thus helping to prevent the growth of estrogen positive cancer cells.   Soy Foods The soy controversy remains. Some say avoid soy, but recent research presented in the July 2020, issue of the International Journal of Environmental Res Public Health associates a lower incidence of hormone-related tumors, including breast cancer, with properties of isoflavones and phytoestrogens, like that from soy.  The umbrella review found consistent evidenced associating a protective effect of soy food sources such as tofu, edamame, tempeh, soy milk, miso, and soy sauce, in the diet especially among postmenopausal women and in the Asian population. When a phytoestrogen binds to the estrogen receptor site, the plant compound is preventing the hormone, estrogen, from binding. This agonist action aids in the decreased risk of estrogen receptor positive/progesterone receptor positive breast cancer.3      Vitamin D   About 20 different cancers have incidence rates inversely related to solar UV-B doses and serum vitamin D concentration.4  The Institute of Medicine guidelines suggest that individuals are at risk of vitamin D deficiency if 25(OH)D concentration is below 30 nmol/L, inadequacy at serum 25(OH)D concentration between 30 and 50 nmol/L, and individuals are considered sufficient at concentration 50 nmol/L or higher. One study compared women with sufficient serum vitamin D and deficient serum vitamin D.  Compared to patients with sufficient serum vitamin D (>30 ng/ml), women with serum vitamin D deficiency (<20ng/ml), had a higher risk of breast cancer.  Women with history of vitamin D supplementation one year prior to enrollment, had significant protective effect against breast cancer.5 Research recommends getting vitamin D through sun exposure and supplementation of at least 400 IU to decrease breast cancer risk and recurrence.6  If you do not have adequate access to sun exposure, you may need a larger vitamin D supplement dose.  Be sure to speak with your oncologist for the recommendation to meet your specific needs.   Calcium Calcium is an essential nutrient found in a number of foods, especially dairy products.  The bones and teeth contain over 99% of all calcium in the body.  The heart, nerves, and blood-clotting systems also need calcium to function properly.  Bones are constantly breaking down and rebuilding themselves and calcium is needed for this process. While research does not show calcium having an effect on reducing the risk of breast cancer risk, it does play a role in keeping the body healthy while undergoing treatment and after.  Taking supplements and eating foods with calcium and vitamin D reduces bone density loss in people using corticosteroid treatments.  Research recommends calcium supplementation of 1200-1500mg daily.  Additionally, it can help prevent osteoporosis and help protect people with osteoporosis from fractures.7   Red Meat   Research shows a link between red meat consumption and breast cancer risk.  Eating red meat helps to increase estrogen production in the body, so you may want to limit red meat consumption to decrease breast cancer risk.8  Women who ate one serving a day of red meat had a 22% increased risk of developing premenopausal breast cancer.  Those who ate poultry during the same period had a decreased risk of developing breast cancer.  Of course red meat consumption is just one risk factor for breast cancer incidence.9  Red meat eaten at least once a week along with other types of animal proteins such as chicken and fish, and adoption of a healthy lifestyle, including drinking less alcohol, not smoking, and engaging in regular movement, can help to decrease risk.   References Shareef M, Ashraf MA, Sarfraz M. Natural cures for breast cancer treatment. Saudi Pharm J. 2016;24(3):233-240. doi:10.1016/j.jsps.2016.04.018 Cotterchio M, Boucher BA, Kreiger N, Mills CA, Thompson LU. Dietary phytoestrogen intake–lignans and isoflavones–and breast cancer risk (Canada). Cancer Causes Control. 2008;19(3):259-272. doi:10.1007/s10552-007-9089-2 Buja A, Pierbon M, Lago L, Grotto G, Baldo V. Breast Cancer Primary Prevention and Diet: An Umbrella Review. Int J Environ Res Public Health. 2020;17(13):4731. Published 2020 Jul 1. doi:10.3390/ijerph17134731 Atoum M, Alzoughool F. Vitamin D and Breast Cancer: Latest Evidence and

Nutrition Tips for Chemotherapy Patients: Managing Side Effects Through Diet By Reva Schlanger MS, RD, CDN   Having chemotherapy can lead to a lot of temporary but unwanted side effects. Nausea and fatigue can lead many to struggle with eating when having chemotherapy. It is important to eat well, AKA getting enough nutrition of what is tolerable for you. Nutritious food keeps up your strength, fights fatigue, and helps your body heal. Once you start treatment, it may become hard to follow your usual diet. You may need to liberalize your diet (add different types of foods and drinks) to get the nutrition you need. There currently isn’t enough research to know that restrictive diets (diets that avoid certain foods or nutrients) are safe for people who have cancer. The most important thing is to make sure you get the calories and protein you need to keep your body strong during your treatment.   Here are 10 tips and tricks to help get enough nutrition:   Nausea fighting foods It’s difficult to eat when the thought of food makes you queasy. To help with an upset stomach, try to eat dry foods like crackers. Try to keep a stash of crackers by your night table to eat first thing in the morning followed by every few hours to help prevent nausea. Ginger, lemon, and peppermint can also help settle your stomach so it might be helpful to. Have some lemon ginger tea or peppermint sucking candies nearby.   Capitalize on favorite foods While going through chemo, your appetite and the foods that appeal to you can vary from day to day. Remember it is okay to eat calorically dense foods that you might normally avoid/have in smaller quantities. Right now, eat what sounds good to you. The most important thing is to get enough nutrition from any food.   Small meals With a decreased appetite, it is difficult to eat the typical 3 big meals that you may be used to. Embrace the idea of having six to eat small meals every few hours. This can help keep nausea at bay while providing the body with consistent nourishment.   Taking it easy is OK Fatigue is a big side effect and can leave you dreading the grocery store or cooking. Plan and keep your pantry and fridge stocked with easy to prepare foods (oatmeal, canned soups, pasta are all easy to make meals). On days you feel well enough to cook, try to make extras and freeze them for later. Remember there is no shame in enlisting family and friends to help as well. Online grocery shopping is also a time saver and something you can do from the comfort of your bed!   Hydrate mindfully Staying hydrated helps your body get rid of toxins and feel better. Drinking too much at once though can make you too full to eat. Try to drink most of your fluids in between meals and snacks. While water is a great source of hydration, if you or your doctor notice weight loss, it might be better to drink higher calorie liquids like milkshakes, fruit juices, or creamy soups.   Bulk up foods Your body needs fat to keep up energy stores and move vitamins through your blood. Add olive oil or butter to rice and pasta or dip your bread into it. Liquid meal replacements (like Boosts, Kate Farms, Ensures, or milkshakes) can be another good option.   Increase protein Protein needs usually increase while going through chemotherapy as protein helps repair body tissue and keeps your immune system healthy. Snack on peanut or almond butter with fruit. Add chopped or ground nuts to baked goods, salads, or ice cream. Other easy options include cheese and crackers, egg salad, or a bowl of cereal with milk.   Accommodate taste changes Chemotherapy can change your sense of smell and taste for a while. Maybe you get a bitter, metallic taste with some foods. To solve this, try plastic silverware rather than metal. Choose frozen or fresh vegetables and fruit over canned. Try foods you’ve never eaten before, so you won’t notice if they taste “off”.   Mealtimes can be anywhere Chemo can zap your energy which may leave you struggling to get out of bed. Food is still necessary to keep your energy up so it’s okay to eat in bed. Have friends or family help bring you some foods to eat or keep a drawer full of snacks by your bedside table. While we normally promote mindfulness, when it comes to nutrition during chemo the rule is do whatever is easiest! Eat while you watch TV or listen to music. At the end of the day, the most important thing is to keep eating, even when you do not feel like it.   Ask the experts Ask your doctor about seeing a registered dietitian. They can make an eating plan, suggest vitamins and supplements (if tolerable), and help you mitigate the negative chemotherapy side effects. While the above help with eating, you may be wondering what the deal is with dietary supplements (vitamin, mineral, and herbal supplements). You can get all the nutrients you need from a well-balanced diet, and a supplement, besides from Vitamin D, is not recommended while going through chemotherapy. Depending on your specific cancer treatment, taking a a dietary supplement can harm you or change the way your treatment works. If you’re thinking about taking any dietary supplements, talk with your doctor first. A registered dietitian or pharmacist can also answer your questions.   References: Eating well during your cancer treatment. Memorial Sloan Kettering Cancer Center. https://www.mskcc.org/cancer-care/patient-education/eating-well-during-your-treatment. Accessed October 16, 2022. de Vries, Y.C., van den Berg, M.M.G.A., de Vries, J.H.M. et al.Differences in dietary intake during chemotherapy in breast cancer patients compared to women without cancer.Support Care Cancer 25, 2581–2591 (2017). https://doi.org/10.1007/s00520-017-3668-x Barrera S, Demark-Wahnefried W. Nutrition during and after cancer therapy. Oncology (Williston Park). 2009 Feb;23(2 Suppl Nurse Ed):15-21. PMID: 19856583; PMCID: PMC2770876. Ambrosone CB, Zirpoli GR, Hutson AD,

Alcohol and Breast Cancer: Understanding the Connection by Rebecca Jaspan, MPH, RD, CDN, CDCES   Can alcohol intake increase your breast cancer risk?  There is increasing research showing a link between alcohol intake and increased risk of breast cancer.  Alcohol intake accounts for 6% of all cancers in the United States and moderate alcohol consumption is linked to 30-50% increased risk of breast cancer. Moderate alcohol consumption is defined as 15-30 grams of ethanol or 1-2 drinks per day .1  Ethanol is the type of alcohol found in alcoholic drinks. The standard size for one drink is 12 ounces of beer, 5 ounces of wine, and 1.5 ounces of 80-proof liquor.  The amount of alcohol someone drinks on a daily basis, not the type, is the most important factor attributed to raising breast cancer risk, according to the research.   How does alcohol increase breast cancer risk?   There are likely a number of different ways alcohol may increase breast cancer risk but the mechanism isn’t fully understood at this point.  What we do know is that alcohol acts an irritant in the body and can damage cells.  When these cells try to repair themselves, DNA can possibly be changed and thus lead to cancer. Drinking alcohol leads to oxidative stress in cells, which is associated, with an increased risk of breast cancer.   Alcohol has an effect on the body’s ability to absorb certain nutrients.  Of particular interest is folate, which is important for healthy cell growth and function, including red blood cell formation and research shows that women with daily dietary folate intake between 153 and 400 micrograms showed a significant reduced breast cancer risk than those who consumed less than 153 micrograms.2  Consuming alcohol can decrease folate absorption, putting individuals at higher risk of breast cancer. Even taking in a higher amount of folate regardless amount of folate you take in, if youre drinking alcohol you have decreased absorption of folate and that will put individual at higher risk of breast cancer.  Add men and women!!   Alcohol can raise estrogen levels, which is common in hormone-linked breast cancers such as estrogen positive breast cancer.  Other risk factors include older age, family history of breast or ovarian cancer, lack of physical activity, and cigarette smoking. This makes it challenging to separate alcohol intake from these other risk factors in the development of breast cancer.3   What about after cancer treatment?   There is not enough strong evidence to suggest that alcohol consumption after chemotherapy will increase the risk of recurrence.  It is recommended for individuals undergoing treatment to avoid alcohol.   Alcohol will irritate mouth sores and an already irritated GI tract caused by chemotherapy. Further, many chemotherapy drugs used to treat breast cancer are broken down by the liver.  Alcohol is also processed by the liver and can cause liver inflammation.  This inflammatory response could impair the effectiveness of chemotherapy.   Does this mean you need to avoid alcohol completely?  The American Cancer Society recommends that people who choose to drink alcohol should have no more than 2 drinks per day for men and 1 drink per day for women.4  We encourage you to make your owns decision with your oncologist and your registered dietitian.   References   McDonald JA, Goyal A, Terry MB. Alcohol Intake and Breast Cancer Risk: Weighing the Overall Evidence. Curr Breast Cancer Rep. 2013 Sep;5(3):10.1007/s12609-013-0114-z. doi: 10.1007/s12609-013-0114-z. PMID: 24265860; PMCID: PMC3832299. Chen P, Li C, Li X, Li J, Chu R, Wang H. Higher dietary folate intake reduces the breast cancer risk: a systematic review and meta-analysis. Br J Cancer. 2014 Apr 29;110(9):2327-38. doi: 10.1038/bjc.2014.155. Epub 2014 Mar 25. PMID: 24667649; PMCID: PMC4007237. Sun YS, Zhao Z, Yang ZN, et al. Risk Factors and Preventions of Breast Cancer. Int J Biol Sci. 2017;13(11):1387-1397. Published 2017 Nov 1. doi:10.7150/ijbs.21635 Alcohol Use and Cancer. American Cancer Society

Lignans and Breast Cancer: Latest Research Insights By Rebecca Jaspan, MPH, RD, CDN, CDCES   Eating a plant-based diet is known to confer a number of health benefits.  One reason for this is the contribution of polyphenols found in plant foods.  Polyphenols are high in antioxidants that help to prevent various diseases including cardiovascular disease and cancer and they are classified into groups such as stilbenes, flavonoids, phenolic acids, and lignans.  Of particular interest to researchers studying breast cancer are lignans.  Health benefits attributed to lignans include decreased risk of heart disease, menopausal symptoms, osteoporosis and breast cancer.1  What kinds of foods are lignans and what’s the latest research on their role in preventing breast cancer?   Breast cancer is one of the most common cancers and the second most responsible for cancer mortality worldwide.2  Lignans have been one of the most studied foods regarding possible associations with decreasing breast cancer risk.  Lignans are present in seeds such as flax, pumpkin, sunflower, poppy, and sesame, whole grains, beans, fruit, vegetables, and beverages like tea, coffee, and wine.  They are found in higher concentrations in sesame and flax seeds.3   Lignans are considered phytoestrogens, meaning that they mimic the effects of estrogen in the body, but are substantially weaker than the hormone.1  Phytoestrogens may be beneficial for the prevention of breast cancer as studies show that they could help block estrogen synthesis and metabolism to slow cancer cell growth.4  In one study, women who consumed the highest amount of lignans had 40-50% lower odds of breast cancer compared with those consumed the lowest amount.5   In addition to lignans’ phytoestrogen properties, foods such as flaxseeds have a number of cancer preventing health benefits and are widely studied for breast cancer prevention.  Flaxseeds and flaxseed oil are high in omega-3 fatty acids, an essential heart healthy fat.  Best known for their role in heart healthy and decreasing inflammation, research also suggests omega-3 fatty acids may protect against cancer as well.  One study suggests that omega-3 fatty acids could improve the effectiveness of some chemotherapy drugs and may help kill breast cancer cells by blocking a specific pathway involved in cell growth.6  Flaxseeds are also high in fiber, which may protect against breast cancer. In one review of 20 studies, higher total fiber intake was associated with 8% lower risk of developing breast cancer in pre and postmenopausal women.7   Conversely, there is some evidence against lignan consumption with breast cancer.  For those diagnosed with estrogen receptor positive breast cancer, some oncologists recommend against consuming phytoestrogen-containing foods as there is evidence that these compounds may interact with anti-cancer drugs.8  Always be sure to speak with your doctor before consuming lignan-containing foods if you have a breast cancer diagnosis.   Many studies have found an association between flaxseed consumption and reduced risk of breast cancer due to their fiber, lignan, antioxidant, and omega-3 fatty acid content.  However, a variety of factors can contribute to breast cancer development including age, genetics, medical history, and lifestyle.  Flaxseeds can be incorporated into a well-rounded diet that contains a variety of nutrient-dense foods.  They have a mild, nutty flavor and adds texture to meals and snacks.  When buying flaxseeds, look for ground flaxseeds as these are best absorbed in the gastrointestinal tract where whole flaxseeds are not absorbed.  Add ground flaxseeds to a Greek yogurt bowl, smoothies, and oatmeal and flaxseed oil to salad dressings and sauces.   References   Rodríguez-García C, Sánchez-Quesada C, Toledo E, Delgado-Rodríguez M, Gaforio JJ. Naturally Lignan-Rich Foods: A Dietary Tool for Health Promotion? Molecules. 2019 Mar 6;24(5):917. doi: 10.3390/molecules24050917. PMID: 30845651; PMCID: PMC6429205. Calado A, Neves PM, Santos T, Ravasco P. The Effect of Flaxseed in Breast Cancer: A Literature Review. Front Nutr. 2018 Feb 7;5:4. doi: 10.3389/fnut.2018.00004. PMID: 29468163; PMCID: PMC5808339. Landete J.M. Plant, mammalian lignans: A review of source, intake, metabolism, intestinal bacteria, health. Food Res. Int. 2012;46:410–424. doi: 10.1016/j.foodres.2011.12.023. Tanwar AK, Dhiman N, Kumar A, Jaitak V. Engagement of phytoestrogens in breast cancer suppression: Structural classification and mechanistic approach. Eur J Med Chem. 2021;213:113037. doi:10.1016/j.ejmech.2020.113037 McCann SE, Hootman KC, Weaver AM, et al. Dietary intakes of total and specific lignans are associated with clinical breast tumor characteristics. J Nutr. 2012;142(1):91-98. doi:10.3945/jn.111.147264 Ma Y, Wang J, Li Q, Cao B. The Effect of Omega-3 Polyunsaturated Fatty Acid Supplementations on anti-Tumor Drugs in Triple Negative Breast Cancer. Nutr Cancer. 2021;73(2):196-205. doi:10.1080/01635581.2020.1743873 Farvid MS, Spence ND, Holmes MD, Barnett JB. Fiber consumption and breast cancer incidence: A systematic review and meta-analysis of prospective studies. Cancer. 2020;126(13):3061-3075. doi:10.1002/cncr.32816 https://www.oncologynutrition.org/erfc/healthy-nutrition-now/foods/flaxseeds-and-breast-cancer