Giving nutrition advice for cancer care to others and herself

There was good reason for that: During her undergraduate years, Alison’s mother and godmother (who is also her mother’s cousin) were diagnosed with breast cancer and her grandfather was diagnosed with liver cancer. She also had an earlier family history of breast and uterine cancer for one grandmother and lung cancer for the other. “As more of those diagnoses started to hit our family, my interest shifted to oncology nutrition,” Alison says.

She went back to school for degrees in dietetics and nutrition, then became a registered dietitian and board-certified oncology nutrition specialist, working at three cancer centers. Alison then opened Wholesome LLC, her own telehealth cancer dietetics practice in suburban Milwaukee, advising people about evidence-based nutritional approaches to help ease cancer side effects, tolerate treatments better, improve quality of life, and potentially reduce risk of recurrence.

In April 2022, shortly after Alison had stopped breastfeeding her second child, her OB/GYN found a lump during a breast exam. Because it was so soon after breastfeeding had ended, the lump could have been a clogged milk duct, so she went home to monitor it.

Alison remained concerned about the lump and reached out to her doctor a few weeks later. She was given an ultrasound, mammogram, and biopsy for what was thought to be DCIS, a stage 0 noninvasive breast cancer found in the lining of the milk ducts. In July 2022, she had a double mastectomy, with DIEP flap reconstruction. She was 33 years old and had two young children, a 14-month-old and a four-year-old.

The pathology test results from surgery changed Alison’s diagnosis to stage I invasive ductal carcinoma. Her breast cancer was positive for estrogen and progesterone receptors and HER2 (human epidural growth factor 2). Genetic testing showed Alison also had a CHEK2 genetic mutation, which can increase breast cancer risk.

“With my extensive family history, I knew that I was not invincible from this disease, but I always said that if I’m ever diagnosed, I want to be able to look back and say I did what I could,” she says.

Self-care

After surgery, Alison had chemotherapy, immunotherapy, and hormonal therapy. Throughout treatment, she used her knowledge of nutrition in cancer care to help herself.

She changed some aspects of her diet to ease GI symptoms, chiefly constipation and nausea. For constipation (which can worsen nausea), she focused daily on using ground flaxseed, eating foods that had plenty of fiber, drinking adequate water and having regular physical activity. When she felt nauseated, she ate ginger and peppermint, which enabled her to eat other foods. She avoided greasy, fatty, fried and spicy foods because they can contribute to nausea. Alison also increased her consumption of cruciferous vegetables such as broccoli sprouts and cauliflower, along with dark green leafy greens to strengthen her immune system.

"Nutrition played a huge role in how well I got through chemo and immunotherapy," she says.

Overall, she followed a plant-based diet, eating mostly fruits, vegetables, whole grains, beans, nuts, and seeds. She stayed physically active by walking her daughter to school, taking part in cycling classes when she felt able to, and yoga.

With a therapist’s help, Alison also focused on her mental and emotional health to better manage stress and develop healthy boundaries in her work and personal life. “That journey has informed my nutrition choices with the focus of controlling the controllable. That’s my motto to this day.”

Alison gives that same advice to her clients. By understanding what’s controllable, her clients learn how they can use nutrition to help support them during treatment and beyond, lessen side effects, and potentially reduce the risk of recurrence as best they can, she says.

Although she knew a lot about the needs of people with cancer before her breast cancer diagnosis, Alison says her experience as a patient changed her work dramatically. Clients tell her how much it helps to talk with someone who’s been through the same journey, who hears what they are saying, and validates their emotions.

“It’s not that I didn’t do those things before,” she says. “It’s just a different perspective that I can bring to it, and a different level of empathy than I was able to bring before.”

Individual choices

Alison’s personal nutrition choices are part of her growth too. Nine years ago, after reading research on cancer and nutrition, she started eating more plant-based foods because studies showed they reduce inflammation, which can cause disease.

She wanted to see if dietary changes could help with difficulties she and her husband were having while trying for a pregnancy. Soon she cut out animal products entirely, hoping to get past infertility and the hormonal condition PCOS (polycystic ovary syndrome), which she had. Alison believes that change helped her become pregnant with the couple’s first child, who is now eight years old.

When giving professional nutrition guidance, Alison encourages clients to increase the plant foods they eat, but she doesn’t pressure them to give up meat, dairy, eggs, or other animal products.

“The current recommendations from international and national agencies are to make plant-based foods a predominant part of your daily diet. That doesn’t mean getting rid of all animal products like some people might choose to do,” Alison says.

“That was a very personal choice for me, but it doesn’t mean that it’s appropriate for everybody.”

Tips from a cancer dietitian

Nutritional approaches can help before, during, and after breast cancer treatment or while living with cancer. Alison offers these suggestions:

Tip #1: When looking to improve your diet, try adding foods before removing others. Is your lunch usually a processed meat sandwich with a bag of chips? Alison suggests adding lettuce, tomato, or onion to the sandwich and enjoying a piece of fresh fruit with your meal to increase healthful fiber and phytonutrients. Regularly including vegetables and fruit in your meals may also gradually reduce foods you might want to minimize.

Tip #2: Know yourself as an individual. Most people do better by making slow and steady changes, which are more sustainable than an all-or-nothing change. “Know what motivates and inspires you,” says Alison. “What motivates me isn’t necessarily going to motivate somebody else.”

Tip #3: Work towards increasing the predominance of whole, plant-based foods in your diet. Add greens to pasta or a sandwich, or adapt a meat sauce by making it with half ground meat and half beans. “This is a recommendation for anybody that’s looking to reduce their risk of developing cancer in the first place, but also to reduce their risk of recurrence,” Alison says.

Tip #4: Focus on your lifestyle as a whole. It takes more than changing one factor, such as nutrition, if other lifestyle elements such as emotional health or physical activity need attention as well.

“Nutrition is essentially one of the bridges to help us get to do what we want to do…living the life that we seek to live during treatment and definitely into survivorship,” says Alison.