Dr. Fuhrman's New Year's Resolution: Fight Breast Cancer in 2012

Happy New Year! Flickr: Laura M Bailey

The Women’s Healthy Eating and Living (WHEL) Study was a randomized controlled trial that was designed to test whether adhering to a diet high in vegetables, fruits, and fiber would reduce the risk of recurrence in breast cancer survivors. The study was conducted from 1995-2006, and the subjects were 3,088 women who had been treated for early stage breast cancer. Women were either in a control group or an intervention group.

The daily dietary goals given for the intervention group in the WHEL study were as follows:

  • 5 servings of vegetables
  • 16 ounces of vegetable juice
  • 3 servings of fruit
  • 30 g of fiber
  • 15-20% of calories from fat.1

The overall results of the WHEL study were published in 2007 and were disappointing. Women in the intervention group on average increased their vegetable intake by 65%, their fruit intake by 25%, and their fiber intake by 30%; they also decreased their energy percentage from fat by 13%. However, there were no significant differences in the number of breast cancer recurrences or deaths between the control and intervention groups.2

Why did this intervention fail?

There were likely many contributing factors. This dietary intervention was started after the women had already been diagnosed and treated for breast cancer; after eating the Standard American Diet for decades and developing cancer; moderate dietary improvements at that point may be too late to prevent recurrence. The dietary advice was likely not specific enough or rigorous enough to have a significant effect. For example, vegetables with breast cancer preventive properties, such as cruciferous vegetables and mushrooms, were not emphasized over starchy vegetables – women were simply advised to eat 5 servings of vegetables daily. Plus, 75% of the women were already consuming 5 servings of vegetables daily before being randomized to control or intervention groups. 2

Women were not instructed to eat less of anything except fat or to decrease their caloric intake – so it is unsurprising that there was no significant change in body weight in the intervention group. 2 This is an important issue, since excess weight is strongly linked to breast cancer risk.3-7 Plus, these women were also consuming significant amounts of animal protein, which increases cancer risk by increasing IGF-1. 8-11

Another potential issue was the advice to reduce percentage of calories from fat, but no advice on limiting refined carbohydrates. Advising women to decrease their calories from fat without direction on what to replace those calories with likely resulted in the women choosing more pasta, rice, white potatoes, bread, and low fat processed foods. These women received no guidance on limiting refined carbohydrates, which is an important point here. Refined carbohydrates are higher in glycemic index and contain less fiber and more starch compared to natural carbohydrate foods. High dietary glycemic index is known to be associated with increased breast cancer risk.12 In contrast, consuming high-fiber foods increases the excretion of estrogen and decreases breast cancer risk.13-15  Research coming out of the original WHEL data suggests that starch intake may play a role in breast cancer risk as well.

Starch intake and breast cancer recurrence

In research presented at the San Antonio Breast Cancer Symposium in December 2011, data from the WHEL Study were re-analyzed with respect to changes in carbohydrate intake. Women from both the control and intervention groups were included in the analysis.

The subjects were arranged into four groups based on how much their starch intake changed over the first year of the study: in the group who had the greatest decreases in starch intake, the likelihood of recurrence was 9.7%; in the group with the greatest increases in starch intake the likelihood of recurrence was 14.2%.16,17 The women who increased their starch intake were at greater risk of recurrence.

Although this particular study did not investigate specific foods, we know that white rice, white flour products, and white potatoes are some of the highest starch foods – these are also low nutrient, high glycemic foods and staples in the Standard American Diet. Breast cancer survivors and all women who want to prevent breast cancer must focus on protective foods (GOMBBS) such as mushrooms, green vegetables, beans, and onions; and avoid low-nutrient disease-causing foods, like refined starches and sugars, animal products, and oils. Too often, researchers do not study dietary patterns with the best anti-cancer potential.



1. Pierce JP, Faerber S, Wright FA, et al: A randomized trial of the effect of a plant-based dietary pattern on additional breast cancer events and survival: the Women's Healthy Eating and Living (WHEL) Study. Control Clin Trials 2002;23:728-756.
2. Pierce JP, Natarajan L, Caan BJ, et al: Influence of a diet very high in vegetables, fruit, and fiber and low in fat on prognosis following treatment for breast cancer: the Women's Healthy Eating and Living (WHEL) randomized trial. JAMA 2007;298:289-298.
3. American Institute for Cancer Research. New Estimate: Excess Body Fat Alone Causes over 100,000 Cancers in US Each Year [http://www.aicr.org/site/News2/153571380?abbr=pr_&page=NewsArticle&id=17333&news_iv_ctrl=1102]
4. Trentham-Dietz A, Newcomb PA, Storer BE, et al: Body size and risk of breast cancer. Am J Epidemiol 1997;145:1011-1019.
5. Ballard-Barbash R, Schatzkin A, Taylor PR, et al: Association of change in body mass with breast cancer. Cancer Res 1990;50:2152-2155.
6. Vrieling A, Buck K, Kaaks R, et al: Adult weight gain in relation to breast cancer risk by estrogen and progesterone receptor status: a meta-analysis. Breast Cancer Res Treat 2010;123:641-649.
7. Parker ED, Folsom AR: Intentional weight loss and incidence of obesity-related cancers: the Iowa Women's Health Study. Int J Obes Relat Metab Disord 2003;27:1447-1452.
8. Rinaldi S, Peeters PH, Berrino F, et al: IGF-I, IGFBP-3 and breast cancer risk in women: The European Prospective Investigation into Cancer and Nutrition (EPIC). Endocr Relat Cancer 2006;13:593-605.
9. Hankinson SE, Willett WC, Colditz GA, et al: Circulating concentrations of insulin-like growth factor-I and risk of breast cancer. Lancet 1998;351:1393-1396.
10. Sugumar A, Liu YC, Xia Q, et al: Insulin-like growth factor (IGF)-I and IGF-binding protein 3 and the risk of premenopausal breast cancer: a meta-analysis of literature. Int J Cancer 2004;111:293-297.
11. Shi R, Yu H, McLarty J, et al: IGF-I and breast cancer: a meta-analysis. Int J Cancer 2004;111:418-423.
12. Dong JY, Qin LQ: Dietary glycemic index, glycemic load, and risk of breast cancer: meta-analysis of prospective cohort studies. Breast Cancer Res Treat 2011;126:287-294.
13. Goldin BR, Adlercreutz H, Gorbach SL, et al: Estrogen excretion patterns and plasma levels in vegetarian and omnivorous women. N Engl J Med 1982;307:1542-1547.
14. Zhou Y, Zhuang W, Hu W, et al: Consumption of large amounts of Allium vegetables reduces risk for gastric cancer in a meta-analysis. Gastroenterology 2011;141:80-89.
15. Park Y, Brinton LA, Subar AF, et al: Dietary fiber intake and risk of breast cancer in postmenopausal women: the National Institutes of Health-AARP Diet and Health Study. Am J Clin Nutr 2009;90:664-671.
16. Emond JA, Patterson RE, Pierce JP: Change in Carbohydrate Intake and Breast Cancer Prognosis. In San Antonio Breast Cancer Symposium, vol. Presentation #P3-09-01; 2011.
17. Starch Intake May Influence Risk for Breast Cancer Recurrence. 2011. AACR in the News. http://www.aacr.org/home/public--media/aacr-in-the-news.aspx?d=2654. Accessed December 29, 2011.


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Comments (10) Read through and enter the discussion with the form at the end
Judith Shaw - January 1, 2012 5:57 PM

Joel, are you Evelyn and Sy's son?


Ginger - January 1, 2012 7:49 PM

Thank you for this clarification. At first glance, the study seemed to nullify your research. With your explanations, I can clearly see that we must not only eat lots of the right vegetables (green leaves), we must also eliminate animal products, eliminate refined carbohydrates and oils, and limit starchy vegetables, whole grains, and fatty plant foods like avocados, nuts, and seeds. Your ideas have changed my food culture about 100% in the last few years. Thank you!

Mike Rubino - January 2, 2012 5:25 PM

The world really needs a fresh look at cancer, it causes, and its treatment . Right now to me the medical profession/ health care industry look like the barbarians advancing on Rome looking to cure Roman excess by butchering the men, raping the women and pillaging the villages.

My belief is that few care , and that those who do are looked on as kooks. The entrenched medical system just cant get by their training to see that there just might be a much better way . Dr F is a voice in the wilderness and Im hoping somehow his message get out to the mass and connects with them.

Pat - January 2, 2012 7:39 PM

I am on board with the program, although it has been very difficult to give up my food addictions. I have read about oxalates in many of the plant foods. Green beans, carrots, spinach, kale, blueberries, kiwi, and many more, that have oxalates and can form kidney stones. Low oxalates are in dairy and meats-which i dont want to eat anyway. I have read in several places on the web, one being "Livestrong.com" under "oxalate free diet". What are the facts on this from your position?

Joel Fuhrman, M.D. - January 3, 2012 9:38 AM

Another clarification - I am not advising limiting avocados, nuts, and seeds. In fact, it is eating more seeds and nuts which will help reduce exposure to many carbs and lower the glycemic index of your plant-based diet.

Sarah - January 3, 2012 9:43 AM

Thank you Dr. Fuhrman for this post. I was with Ginger at first...I wasn't sure why you were posting a failed study but reading further shed some light on that. I really appreciate all your research and dedication to healthy living, especially living Cancer Free.

I represent the Cancer Solution Center, which is dedicated to providing medical foods to Cancer patients. These are all natural medical foods that eliminate the side effects of Cancer, however we also have our flagship product , PhytoFusion, which is a daily shake that contains that most important phytonutrients for health.

The Cancer Solution Center and I are big fans of your books, blogs and posts. Thank you for this enlightening study.

Eat more greens !


Steve - January 3, 2012 6:07 PM

I enjoy reading your perspectives, Dr. Fuhrman, although I think you overly malign the white potato. But we'll see how you duke it out with Dr. McDougall on this topic next month.

Donna Crebbin - January 4, 2012 4:27 AM

Wow!!! Thanks for all of that information! To me it makes perfect sense. I am a Breast Cancer surviver.

I would like to add that I think you guys just may have hit the nail on the head.

I was diagnosed June 24, 2010. I was a very fit 44 year old mother of 2 teenage boys. For the previous 5 years prior to being diagnosed I thought I was doing all of the right things... I started running outdoors, I ran a distance of 6.7 km's 5 days per week + lifted weights 2-3 days per week. Was very fit for my age. My only down fall I guess was the fact that all of my life I have enjoyed White Potatoes, Pasta, White Rice & White bread!!! Big mistake guys!! Although over that period of running I did introduce wholemeal producst as in Rice & Bread. I only then started to enjoy Avocados as well.
I guess what I am trying to say is that these foods were a regular part of my diet. I still did include as often 5 serves of veg & 2 serves of fruit every day into my diet along with red meat & a stack of Chicken.
However I am still eating the same way. I will now be trying to eliminate Carbs as much as possible. I am trying to stick to 50% Protein, 25% Carbs % 25% Good fats(Such as nuts & avocados.
I continued to run whilst going through 6 cycyles of Chemotherapy, 4 weeks after surgieries I was back into the running & ran all the way through my Radiation.
Please, if you have any further information on how to prevent my Cancer coming back I would be most greatful if you could pass this on to me in an Email.
Obviously I need to change a lot.

Thank you so much for this information.

Donna - Australia :)

Peter - January 4, 2012 7:35 PM

Once again, we see the healing powers of a vegetable-based, low-carbohydrate lifestyle.

You don't need meat or animal products to get the essential fatty acids, essential amino acids, vitamins or minerals. Every nutrient with the exception of vitamin B12 can be found in sufficient bioavailable forms from a vegetable based diet supplemented by fatty plant foods.

Vitamin B12 is made by several strains of bacteria, and the current environment is too clean to sustain these bacteria. People need to take a vitamin B12 supplement in the form of methylcobalamin not because eating a vegan diet is unnatural, but because the modern environment is too clean for bacteria that produce vitamin B12 to survive.

You can eat as much as your stomach can handle on a vegetable-based, low-carbohydrate lifestyle and you won't get fat or diseased. If you are more active then it is okay to increase your carbohydrate intake as your body will burn it away and there will be no extras left for cancer cells to eat.

Thank you Dr. Fuhrman.

cynthia wohl - June 14, 2012 12:02 PM

does eating this way get rid of candida?

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