Fueling Survival: The Power of Nutrition in Breast and Prostate Cancer With Jasmin Hundal, MD, MS, MPH, and Stephen Freedland, MD
Expert Perspectives · Keira Smith · 2026-03-18
The intersection of nutrition and oncology is a rapidly evolving pillar of comprehensive cancer care. In this discussion, Dr. Stephen Freedland, Urologist at Cedars-Sinai Medical Center, and Dr. Jasmin Hundal, Hematology/Oncology Fellow at the Cleveland Clinic, explore how nutritional interventions and new metabolic therapies are reshaping outcomes in breast and prostate cancer. Their conversation highlights a critical shift in patient-centered care: treating the patient’s metabolic environment is as vital as treating the tumor itself.
The Shift Toward Metabolic Survivorship
The primary focus of cancer treatment is often on cancer-specific mortality; however, Dr. Freedland points out a sobering reality in the prostate cancer space that mirrors trends in other malignancies: "The vast majority of prostate cancer patients don’t die of their prostate cancer; actually, the number one cause of death among people with prostate cancer is heart disease.” This underscores the necessity of managing the chronic disease burden—diabetes, metabolic syndrome, and cardiovascular disease—which can often limit a patient’s ability to tolerate full treatment regimens. Dr. Hundal emphasizes that while we lack a universal "diet prescription," the goal during both active treatment and survivorship is to mitigate these comorbidities through healthy nutrition.
Navigating the "Diet Wars”
While national guidelines from the National Comprehensive Cancer Network (NCCN) and American Cancer Society (ACS) consistently recommend a diet rich in fruits, vegetables, and unprocessed foods, patients are increasingly asking about more restrictive protocols like the ketogenic diet. Dr. Hundal expresses caution regarding keto in breast cancer, noting the potential loss of fiber and its subsequent impact on the microbiome and estrobolome—the collection of bacteria capable of metabolizing estrogens. "Although it might be beneficial for a short amount of time, I worry about the relation of the microbiome to chemotherapy or targeted therapy,” she notes. “But I’m happy to see more studies that are investigating the underlying effects of ketogenic diet.”
Conversely, Dr. Freedland is investigating the ketogenic diet’s potential to "blunt" the metabolic side effects of androgen deprivation therapy (ADT), such as weight gain and muscle loss. He shares promising preliminary data from a phase 2 trial in glioblastoma (GBM), where reducing glucose supply may slow tumor progression. "For patients who are well-informed, I’m very comfortable with them going on this diet and being open with their physicians’ monitoring," he says, though both experts agree that more randomized controlled trials (RCTs) are needed to move beyond observational data.
Intermittent Fasting and Circadian Rhythms
The discussion also touched on time-restricted eating, with Dr. Hundal advocating for a "circadian rhythm–aligned" approach—eating during daylight hours to avoid "fooling" the insulin and insulin-like growth factor (IGF) pathways. However, she warns clinicians to be vigilant about the risk of undereating. In advanced stages, where cachexia and sarcopenia are prevalent, restrictive windows can be counterproductive. Dr. Freedland agrees, noting that "patients’ needs will evolve during the cancer journey," shifting from weight loss in early-stage survivorship to energy maintenance in metastatic disease.
A New Frontier: GLP-1 Agonists in Oncology
Perhaps the most "exciting new era" discussed is the emergence of glucagon-like peptide-1 (GLP-1) receptor agonists. While these drugs were not originally studied in cancer populations, their profound impact on weight loss and cardiovascular health is undeniable. Dr. Freedland posits that inducing a 10% to 20% body weight loss could fundamentally improve cancer biology and slow progression. However, he cautions that "if you’re taking in less food, you really have to make sure the food you’re taking in is high-quality." Clinicians must also emphasize exercise alongside these medications to prevent sarcopenia during rapid weight loss.
Empowering the Patient
Ultimately, the integration of nutrition into oncology provides a unique psychological benefit. "What I love about nutrition is it’s something that the patient actively can do on their own," Dr. Freedland concludes. "Too often, we’re prescribing the medicines and the patient’s passively going along this journey. This allows them to actively be participating."
Key Takeaways
Prioritize Cardiovascular Health: In many cancers, particularly prostate, cardiovascular disease is a leading cause of death; metabolic health is a survival priority.
Focus on Food Quality: Regardless of the specific diet (keto, Mediterranean, or plant-based), the emphasis should remain on whole, unprocessed foods and limiting simple sugars.
Monitor the Microbiome: Be mindful of how restrictive diets (like keto) might affect fiber intake and the gut microbiome, which plays a role in treatment response.
Adapt to the Stage: Nutritional goals must shift from weight loss in early-stage patients to preventing sarcopenia and cachexia in advanced-stage patients.
Integrate GLP-1s with Lifestyle: If using GLP-1 agonists, ensure patients prioritize high-nutrient density and resistance exercise to maintain muscle mass.
About the Speakers
Stephen Freedland, MD, is a Professor of Urology and the Warschaw Robertson Law Families Chair in Prostate Cancer at Samuel Oschin Comprehensive Cancer Institute, Cedars-Sinai Medical Center. He is also the Director of the Center for Integrated Research in Cancer and Lifestyle and the Associate Director for Education and Training at Samuel Oschin, and he holds a Staff Physician appointment at the Durham VA Medical Center in Durham, North Carolina. Dr. Freedland has published over 700 articles and served on numerous AUA and ASCO guideline panels for prostate cancer. His research interests include cancer health disparities, risk stratification, and the role of diet, lifestyle, and obesity in cancer.
Jasmin Hundal, MD, MS, MPH, is a third-year Hematology/Oncology Fellow at the Cleveland Clinic in Cleveland, Ohio. Previously, she completed her Internal Medicine Residency at the University of Connecticut. Dr. Hundal’s main area of interest is the overlap between cardiometabolic health and cancer, particularly for breast cancer patients and survivors. Outside of work, she enjoys traveling, cooking, and hiking.