Cancer Nutritionists: Things to Know Before Choosing One

February 18, 2024

By Angie N Choi, EdD, Author of Whole New Me: Healing From Cancer in Body, Mind, and Spirit

There are different types of cancer nutritionists such as functional medicine practitioners, orthomolecular medicine practitioners, ketogenic nutritionists, and oncology nutritionists. Each one views cancer nutrition through a different lens with some overlap and recommends different diets and supplements, but all consider each cancer patient’s nutritional needs individually. In this blog, we’ll discuss four main types of nutritionists or practitioners, the diets they emphasize, where to find them near you, and how much services cost. I’ll also include a case study on my personal experience with cancer nutrition using nutrition services.

Types of Cancer Nutritionists and Dietary Emphasis

Functional Medicine Practitioners

Focus: Functional medicine practitioners (naturopathic doctors or NDs and integrative doctors or MDs) approach cancer through a holistic approach. They aim to find the root cause of cancer rather than simply manage its symptoms. They utilize lifestyle medicine (diet/nutrition, exercise, sleep, social interaction, relaxation, etc.), genetics, supplements, and detailed testing to determine the cause of disease.
Role: They are like private detectives who perform detailed client health histories, review prior lab work, and order other necessary tests to determine the root cause of the problem and create a comprehensive, personalized treatment plan. Testing is more thorough than in conventional medicine, and they take time to discuss health conditions with clients.
Dietary Emphasis: Nutrition is used to enhance overall health and restore balance in bodily functions. Dietary plans include eating whole foods, eliminating inflammatory foods, taking supplements, detoxification, healing the gut microbiome (as needed), and lifestyle changes.

Orthomolecular Medicine Practitioners

Focus: Orthomolecular medicine practitioners approach cancer through therapeutic doses (mega doses) of vitamins, minerals, and other nutrients (amino acids, enzymes). They view disease as a result of longstanding nutritional deficiencies arising from unnatural, refined, and highly processed foods, toxin overload, and environmental chemicals. They believe that by providing the body with the nutrients it needs, the body will heal itself, but mega dosing is necessary to address these deficiencies. Recommended daily allowances (RDAs) of vitamins are too low to have a therapeutic effect in already deficient individuals, and dietary intake of food is not sufficient to replenish nutrition. Thus, high dose supplementation is necessary.
Role: They primarily recommend using high dose vitamins and minerals to help the body replenish nutrients from which the body is naturally comprised. They work with patients individually, and treatment plans are tailored to the deficiencies presented by the patient.
Dietary Emphasis: Practitioners will recommend foods, vitamins, and minerals that are high in the nutritional deficiencies that are presented. The emphasis is on natural, whole food in the diet with a tendency toward a plant-based diet (though not exclusively). Eating the amount of whole food that would be required to address deficiencies is not possible in almost all cases so therapeutic doses of nutrients are recommended.

Ketogenic Diet Nutritionists

Focus: Ketogenic Diet Nutritionists specialize in creating dietary plans for cancer patients that are high in fat and low in carbohydrates. The approach is metabolic meaning it exploits how cancer cells produce energy to deprive them of fuel for growth. Cancer cells require enormous amounts of energy to grow quickly, but when this energy is drastically reduced, cancerous cells are unable to sustain their growth and become susceptible to cellular death. Cancer cells are unable to utilize fat for energy unlike healthy cells, so the ketogenic diet is an effective diet for cancer patients. It allows the body to receive nutrition to function while depriving cancer of its preferred fuel.
Role: Ketogenic nutritionists provide therapeutic ketogenic dietary plans for cancer patients. A therapeutic ketogenic diet is more rigorous than those used popularly for weight loss. Ketogenic nutritionists help patients stay in ketosis, where the body shifts over to burning fat for fuel instead of glucose.
Dietary Emphasis: Therapeutic ketogenic diets for cancer emphasize healthy fats (not processed fats like vegetable oils or margarine), moderate protein intake (as protein can serve as a secondary compensatory fuel for cancer cells), and very low carbohydrate intake (low-carb vegetables).

Oncology Dietitians

Focus: Oncology Dietitians focus on managing nutritional challenges in cancer patients who have undergone standard treatments like surgery, chemotherapy, and radiation. They use nutrition to address the side effects due to standard treatment and for overall healing.
Role: Oncology Dietitians will identify patients at risk for malnutrition and work with them to prevent weight loss and malnourishment during and after treatment. They are part of the healthcare team and serve as a liaison to medical professionals. They will also collaborate with caregivers to help provide nutritional support to patients.
Dietary Emphasis: The emphasis is on nutrient-dense foods that individual patients like. After treatment, side effects can affect the desire to eat, so the aim is to encourage patients to eat by providing their favorite foods (unless otherwise harmful) more than restricting their diets. For patients experiencing nausea, eating bland foods in small amounts more frequently may be recommended. For patients experiencing diarrhea, the BRAT (bananas, rice, applesauce, and toast) diet may be recommended. For those experiencing diarrhea, limiting high-fiber foods is recommended. Conversely, high-fiber diets are recommended for constipation.

Where to Find Cancer Nutritionists Near You

Functional medicine practitioners may be found at the Institute for Functional Medicine’s website, at integrative health centers, teaching hospitals, and medical centers and clinics.
Orthomolecular medicine practitioners may be found through orthomolecular medicine associations like the International Society for Orthomolecular Medicine. Holistic health centers may also have nutritionists who practice orthomolecular medicine. Orthomolecular medicine and functional medicine align closely, so you may be able to find them through functional medicine associations as well. Some functional medicine practitioners also offer orthomolecular medicine services.
Ketogenic Dietitians may be found at the Charlie Foundation and clinics and hospitals specializing in ketogenic diets or metabolic therapies and epilepsy.
Oncological Dietitians may be found at cancer treatment centers with integrated, multidisciplinary teams. Many large cancer centers have nutritionists and dietitians who specialize in oncology. Ask your oncologist for a referral.

How Much Cancer Nutrition Services Cost

Functional Medicine Practitioners: The cost varies between approximately $200 and $500 for initial appointments which includes a detailed health history, comprehensive assessment, and a personalized treatment plan. Additional costs such as laboratory testing, supplements, and follow-up appointments may drive the cost up from several hundreds to thousands of dollars. Most costs will be paid out-of-pocket. Practitioners typically require payment (partial or in full) before services are provided. They do not file reimbursement claims with private insurance companies, but they may provide the necessary paperwork to file your own. Flexible Spending Accounts (FSAs) may cover appointment fees and laboratory testing, but supplements will not be covered. Check with your insurance or Medicare provider beforehand to see what services are covered by insurance plans.
Orthomolecular Medicine Practitioners: The cost of initial appointments varies between approximately $150 to $500 depending upon the services needed for cancer. Initial costs will be similar to those of functional medicine practitioners, but follow-up costs will depend on the therapies recommended such as high dose IVC and the number of treatments. Other costs include supplements (vitamins and minerals) which do not have to be expensive ones but can add up.
Ketogenic Diet Nutritionists: The initial cost varies between approximately $100 to $350 dollars with follow-up appointment fees being slightly less. Ketogenic dietitians focus on creating meal plans and educating patients of food choices to stay in ketosis. The main cost beyond appointment fees is the food itself. Typically, the focus is on food instead of supplements, so supplement costs will not be high, but buying high-quality, whole food that is organic (if affordable) will drive grocery costs up. Other costs include a glucometer, blood ketone meter (some meters take both ketone and glucose measurements), and testing strips. Some nutritionists may charge at an hourly rate and others may have packaged deals. The overall cost is less than other practitioners because ketogenic nutritionists do not order laboratory tests, and patients may not need so many follow-up visits as they learn more about staying in therapeutic ketosis. Combining these services with a functional medicine or orthomolecular practitioner would be ideal for cancer.
Oncology Dietitians: Many insurance plans will cover services with registered dietitians, but some may not pay for oncology dietitians. Cancer centers may include oncology dietitian services as part of their cancer care especially those that offer integrated services with a multidisciplinary approach. Check with your insurance provider to see if medical oncology nutrition services are covered.

Case Study on Cancer Nutrition

I was diagnosed with ovarian cancer and had surgery (complete hysterectomy with 17 lymph nodes) to remove a tumor the size of a cantaloupe. Because there was spillage during the excision, my gynecological oncologist recommended six rounds of chemotherapy. After deep reflection and research, I declined chemotherapy and began an empowering journey toward healing from cancer by working with cancer nutritionists.

Working with a Ketogenic Nutritionist

I knew that nutrition needed to be the foundation of my fight against cancer, so I started working with a ketogenic nutritionist and shifted from a high carb diet to one that was high fat and extremely low carb. This was a significant change for me, but I was highly motivated because it kept me from having to put toxic chemo into my body and still provide nutrition for healthy cells. I wrote another post on keto cancer recipes if you’d like some ideas and a book that provides an in-depth explanation of my healing process using a therapeutic ketogenic diet or metabolic approach to cancer.

Working with a Naturopath (Functional Medicine)

I also worked with a naturopath who helped me test for toxins, bacteria, parasites, inflammation, dysbiosis, and nutritional deficiencies. I had an H.pylori infection that compromised my microbiome and hindered proper digestion of food thus affecting the breakdown of nutrients into their constituent parts. I could see that my food wasn’t fully digested in my stools. It’s not how much you eat but how much you digest, and of course, the nutritional quality of food. I wrote another post on how long it takes for H.pylori to cause cancer if you’d like to read more.

My naturopath helped me to heal my microbiome over the course of a year and this was while I was also on a therapeutic ketogenic diet. So, I was working with two practitioners at the same time (three counting my conventional doctors). Though costly, I wanted to support healing and wellness in the right way (at the root cause) rather than manage symptoms. I was aiming for good health of the body and mind.

Using Orthomolecular Medicine

Let me set the stage for the conditions that allowed cancer to thrive. I had been nutritionally deficient for decades. At the time of my diagnosis for ovarian cancer, the nutrients I knew I was deficient in were B12 and vitamin D. Even if you eat the highest-quality, whole food, organic diet however, it would still be unlikely to replenish nutritional deficiencies because you just can’t eat the amounts of food on a daily basis (and consistently throughout the day) that would be required to correct deficiencies.

For example, could you eat a bunch of sweet potatoes, carrots, and pumpkins to get beta carotene (precursor to vitamin A) each day? That’s just one vitamin. Imagine how much food you would have to consume to address all the other vitamins. I’m not saying you shouldn’t eat an organic, whole food diet (you should if possible), but just making a point that diet alone is not enough. That’s why it is necessary to use supplements.

I began reading Abram Hoffer and Andrew Saul’s book on Orthomolecular Medicine which led me to further research mega dosing vitamins. I had suffered from chronic fatigue where even walking down the stairs was exhausting. I’d have to lie down right after for 30 minutes before I had energy to get up! It was like having the flu without actually having the flu. After getting a micronutrient assay, I learned that I was deficient in several vitamins, minerals, and amino acids. After mega dosing at therapeutic levels, I started to feel much better. My energy returned gradually as it can take several months to address deficiencies, but even after the first few days, I could tell the difference. I realized that if you provide the body with the nutrients that it needs, it knows how to heal itself. After all, the body is made up of these nutrients. It is not made up of drugs or medications, so while drugs can help as a temporary response, they cannot build the body up.

Cancer Remission

After focusing on deep nutrition for the body and working with cancer nutritionists, the cancer went into remission. I am doing fine now and see my oncologist semi-annually for blood work for monitoring. My energy levels have improved, but it’s still a work in progress. Although not perfect, I am probably in the best health of my life except of course when I was young and deficiencies hadn’t accumulated and led to severe illness.

Benefits of Working with a Cancer Nutritionist

Working with a cancer nutritionist is important because you need to provide the body with the nutrients it needs to heal. Trying to do this alone can be daunting (though not impossible) because there is a steep learning curve, so it is highly recommended that you work with a nutritionist who understands nutritional therapy for cancer. You need to ask because not all nutritionists or dietitians may have experience with cancer. If you don’t have the energy to do this, cancer nutritionists can work with your loved ones with meal plans, recipes, and supplements to provide you with support at home.

Conclusion

Also, remember, you don’t have to go through it alone. It’s an act of self-love to ask for help, and a cancer nutritionist can be your main ally in healing cancer at the root. A cancer nutritionist can open the door to a lifelong path of education, healing, and self-esteem. When you start feeling better (greater energy, mobility, strength, and less pain) and seeing results, wellness begins to overtake illness. A deep sense of empowerment arises when you realize you are healing due to better nutrition through the choices you made. After all, food is medicine.