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Supplementation of Plant-Based Diet in Post-Radiation Patients

A recent study has found that radiation therapy in breast cancer patients considerably increases their risk of developing ischemic heart disease. It shows that the focus of the treatment on maximising survivorship is short-sighted, with an urgent need to address the cardiovascular health issues of the patient after radiation. When it comes to lifestyle and diet approaches, it raises concerns about the suitability of the commonly advocated plant-based diets for securing remission and requires that vegans and/or vegetarians supplement their diet with essential nutrients during and after the radiation therapy.

Breast cancer happens to be the most common form of cancer in women, with one million females diagnosed each year worldwide. As a result of continued medical advances, mortality rates are declining year on year, with the overall five year survival rate now being around 90%. For many survivors radiotherapy represents a vital part of the treatment. The latest research shows that women who receive radiation therapy experience a substantial increase in ischemic heart disease risk later in their lives.

The study in question was a population-based case control study of major coronary events such as myocardial infarction, coronary revascularization (procedures performed to increase coronary artery blood flow) and death from ischemic heart disease. Although suspicions have already existed, this study is of significant importance, finally contributing tangible evidence that is of clinical relevance. Firstly, the results suggest that for each gray of radiation exposure there is a 7.4% increase in the occurrence of subsequent major coronary events. In fact, the risk may be even higher than that as many cardiac conditions that have formerly being linked with radiation treatment were not included in this analysis. Secondly, it was observed that the increased risk occurs within the first five years and does not dissipate over time. Thirdly, we now know that there is no such thing as a safe radiation dose, with exposure of any level increasing the risk. And lastly, the authors report that the risk is markedly higher for those who already have existing risk factors for heart disease. This point is the one that we can, to certain extent, influence ourselves. Evidence shows that for patients undergoing radiation therapy the focus should not be merely on achieving remission but it should also encompass a strategy that assesses and actively manages cardiovascular risk factors from the time of deciding to undergo radiation therapy and continuing throughout survivorship.

In practice it means that a lifestyle regimen undertaken in order to ensure that cancer does not reoccur must be holistic and heart healthy. Fortunately, with the exception of moderate alcohol intake, this does not present a contradiction in how we need to live, with risks of cancer and cardiovascular disease reduced in tandem by a generally healthy lifestyle, including physical activity, smoking cessation, reduced sugar intake, plenty of phytonutrients, etc. However, this research questions one issue which is the highly prevalent recommendation for breast cancer patients to adopt plant-based vegan diets to improve their survivorship. There is no question, though, that an abundant plant intake is heart healthy. But a sole reliance on plant-based products presents serious concern. Those who consume meat-free diets can easily find themselves short of vitamin B12. Vitamin B12 can only be sourced naturally from animal products, also including dairy and eggs. Deficiency in this essential nutrient raises levels of homocysteine, a toxic by-product in the blood stream, involved in causing heart disease. If you eat a strictly plant-based diet, the only solution to this particular issue is the consumption of fortified foods, such as fortified rice or soy beverages, fortified cereals, fortified meat substitutes or B12 fortified nutritional yeast, or take it as a supplement.

When it comes to necessary dietary changes, the second issue is the likelihood of an insufficient omega-3 intake. The long chain omega-3 fats EPA and DHA are present almost exclusively in oily fish. They are not found in plant foods, yet they happen to be critical in the maintenance of cardiovascular health, particularly in the prevention of atherosclerosis, the major driver of ischemic heart disease. It is true, though, that we can get omega-3s in the form of alpha linolenic acid, rich in rapeseed, flaxseeds and walnuts, however, this seems an inferior version of omega-3, lacking the clear health benefits of EPA and DHA. While the body can convert alpha linolenic acid into the more desirable EPA and DHA, the problem is that it is not very efficient at doing it. The conversion of alpha linolenic acid to EPA is about 8-20 percent while to DHA is only 0.5-9 percent. Hence, it is not surprising that that vegans and vegetarians have considerably lower amounts of EPA and DHA compared to meat eaters. In addition to that, a plant-based diet is abundant in omega 6s, which when consumed in excess compared to plant omega 3s, promotes a pro-inflammatory environment, which is yet another driver of atherosclerosis. Therefore, plant-based diet followers should consume a supplement of DHA enriched microalgae. In the body, DHA can be converted to EPA, helping to raise our EPA levels.