Tonya Orchard and Anna Maria Bittoni wearing masks sitting at a desk and looking at a laptop computer

Tonya Orchard (right) and Anna Maria Bittoni discuss the results of a pilot study of patients from The Ohio State University Comprehensive Cancer Center — Arthur G. James Cancer Hospital and Richard J. Solove Research Institute to help cancer survivors combat chronic fatigue through improved diet quality.

Most of us think of leafy greens when we think of a “healthy” diet. But to reduce inflammation and for overall health, dietitians say filling our plates with a variety of whole, food-based, colorful foods and sources of rich omega-3 fatty acids is the best approach for overall health.

This best approach could especially be beneficial to cancer survivors struggling with chronic fatigue, the No. 1 lingering side effect of cancer treatment among all cancer survivors.

Chronic fatigue has been linked to depression, anxiety and overall lower quality of life.

With more than 18 million cancer survivors in the United States living well beyond a cancer diagnosis, addressing these quality-of-life issues has become a major focus of the medical community.

“Chronic fatigue is especially prevalent for lymphoma patients, where up to 60% of survivors specifically report fatigue that lasts beyond treatment completion,” said Tonya Orchard, lead author of a new study published in the journal Nutrition and Cancer.

Orchard is a member of The Ohio State University Comprehensive Cancer Center’s Cancer Control Research Program and an associate professor in the college’s Human Nutrition program.

“We believe that there are some foods rich in specific nutrients that may help reduce inflammation in the body and help improve fatigue.”

Battling chronic fatigue through focused nutrition

Orchard and her team recently conducted a pilot study to determine the feasibility of remotely delivered nutrition counseling in a small group of diffuse large B-cell lymphoma survivors. The study was specifically designed around food choices to reduce fatigue and improve overall diet quality.

Anna Maria Bittoni works at her desk as a registered dietitian
Registered dietitian Anna Maria Bittoni meets virtually with a cancer survivor to explain the benefits of different foods. The pilot study at The Ohio State University Comprehensive Cancer Center—Arthur G. James Cancer Hospital and Richard J. Solove Research Institute provides education, guidance and sample recipes to cancer survivors to help improve overall diet and reduce chronic fatigue.

Previously published data suggest that dietary interventions with a focus on increasing levels of lycopene and other carotenoids (naturally occurring pigments found in colorful foods and vegetables), as well as certain B vitamins and omega-3 fatty acids obtained from whole foods (meaning not from pills or dietary supplements), can result in meaningful change that increases quality of life.

In this study, patients received one-on-one nutrition counseling from a dietitian with special training in oncology. These sessions occurred weekly during the first four weeks, then moved to every other week until completion.

Participants were asked to incorporate whole grains, vegetables, fruits, fatty fish and plant-based foods with high levels of dietary omega-3 polyunsaturated fatty acid (n-3 PUFA) into their diets.

Participants were given goals and could choose whichever specific foods they like. Specific food goals included:

  • At least one high vitamin C fruit a day
  • One yellow or orange vegetable a day
  • One tomato serving a day
  • One leafy green serving a day
  • Three servings of whole grains a day
  • Two servings of omega-3 fatty acid rich foods a day, whether plant or seafood-based

Striving for long-term change to improve life for cancer survivors

“There is much we don’t understand about the process specifically, but it may be the synergistic effect of the nutrient-rich foods that create healthful changes in our bodies long term,” said Anna Maria Bittoni, a dietitian with the OSUCCC – James and coauthor of the study.

Study participant Angel Kowalski was no stranger to healthy eating when he was asked to participate. An avid cyclist with a healthy lifestyle, he knew he had to do even more to stay well as a cancer survivor.

Angel Kowalski standing in the ocean shore raising his bicycle in the air after a ride
Angel Kowalski had always led an active lifestyle. After going through chemotherapy for lymphoma, he made every effort to stay healthy to continue living the life he loves. He found benefits from learning how dietary modifications might help reduce chronic fatigue, the most common long-term symptom among cancer survivors.

Kowalski says the fatigue is very real, and he doesn’t want it interfere with living his life to the fullest. A self-proclaimed “A+ student” in the study — thoughtful about his food choices and open to input — even Kowalski says he found ways to fine-tune his nutrition that surprised him to support an overall better quality of life and health.

“Not only can I continue to do adventures, but I continue to stay healthy,” Kowalski says. “I was really good at eating green vegetables, but it turns out I wasn’t integrating a lot of orange foods in my diet. Now I'm a bigger fan of carrot and hummus. It is healthy and I like it. Win-win.”

Angel Kowalski and his wife cook dinner in their kitchen.
Angel Kowalski (left) prepares meals for the week with his wife. Angel is a cancer survivor and worked with a dietitian at The Ohio State University Comprehensive Cancer Center—Arthur G. James Cancer Hospital and Richard J. Solove Research Institute to learn about foods that combat chronic fatigue, the most common long-term side effect of cancer treatment.

Watch the video below for more details about this study.

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