Maintaining good oral health by reducing sugar intake supports optimal cancer treatment.

“The oral cavity is highly susceptible to direct and indirect toxic effects of cancer chemotherapy and ionizing radiation.” Lalla RV, et al: Oral complications of cancer therapy. In (Pharmacology and Therapeutics for Dentistry. 6th ed. Mosby Elsevier, 2011, pp 782-98).

Oral function has a direct impact on quality of life and an indirect impact through its effects on metabolism and nutrition. Oral health issues are integral to the survivorship of cancer patients. While cancer treatment continues to evolve and improve survivorship, cancer treatments including radiation and chemotherapy can cause direct harm to the oral tissues and their systemic toxicity can give rise to indirect oral complications. These consequences may be acute or chronic and may arise throughout and after cancer treatment. Apart from hygiene protocols, diet plays an important role in addressing these oral complications. This blog focuses on sugar in diet and how it can alter patient outcomes. 

Research shows that a diet high in added sugars can lead to cavities and gum disease.

Dietary sugars include sugars, both naturally present in foods and those added to foods. The term ‘added sugars’ includes sugars that are added during the processing of foods, foods packaged as sweeteners (such as table sugar), sugars from honey, syrups (e.g., high-fructose corn syrups, maple syrup), and molasses. Natural sugars include sugars physically located in the cellular structure of grains, fruits, and vegetables plus those naturally present in milk and milk products. Evidence suggests that sugars naturally present in grains, whole fruits, and vegetables and also in milk do not make an important contribution to the development of dental decay. This is because of their innate characteristics such as fiber content, water content, and other protective factors such as polyphenolic compounds and calcium.

The impact of fruit, vegetables, and grains on mechanical stimulation of salivary flow helps reduce the potential risk of the sugars. Added sugars plus those sugars naturally present in honey, syrups, and fruit juices and concentrates should be restricted for optimal health. Both the amount of sugars and the frequency with which they are consumed is a risk factor for development of dental decay.

When we eat or drink added sugars, the sugar interacts with the plaque bacteria in our mouth to produce acids. The acid then dissolves our enamel slowly which can lead to cavities and tooth decay. The Dietary Guidelines for Americans 2020-2025 recommends limiting calories from added sugars to no more than 10% of calories. For someone who consumes 2000 calories per day that’s a max of ~12 teaspoons per day. According to these same guidelines, the average American consumes 17 teaspoons of added sugars per day!

While it is not realistic to cut out all sugar from your diet, it’s a good idea to focus on whole, unprocessed foods rather than highly processed/packaged foods to control your sugar intake. Limiting added sugar is not only important for oral health but diets high in added sugar are also linked to many chronic diseases including several types of cancer. There is an incredible amount of misinformation when it comes to sugars and cancer. All of our healthy cells need glucose to function, and there is no way for our bodies to let healthy cells have the glucose they need, but not give it to the cancer cells. Without the proper amount of carbohydrate intake from foods we eat, both healthy as well as cancer cells will make glucose from other sources, including protein and fat. To date, there are no randomized controlled trials showing sugar causes cancer. There is, however, an indirect link between sugar and cancer.

Eating a lot of high sugar foods such as cakes, cookies, and sweetened beverages can contribute to excess caloric intake. This can lead to weight gain and excess body fat. Research has shown that being overweight or obese increases the risk of 11 types of cancers including colorectal, postmenopausal breast, ovarian, and pancreatic cancer. While it is not necessary to completely avoid sugar, reducing added sugars and consuming nutrient-dense, high fiber carbohydrates may be most effective to maintaining good oral health and decreasing your cancer risk.

While your cancer care team and your oncologist will guide you on how to cut down on sugar in your diet, here are 6 practical tips for cutting back on added sugars on your own.

• Out of sight is out of mind. Don’t keep sweets like candy, cookies and sugary drinks in your cupboards and fridge. If you need to drive somewhere to get your sweet fix, you’re less likely to indulge.
• Be label savvy. Added sugars show up on the ingredient list in the label as glucose, corn syrup, brown sugar, dextrose, maltose, sucrose, cane sugar, agave nectar, etc. Avoid products that have these listed as one of the first ingredients.
• Beware of reduced fat products. When a company reduces fat in their food product, it almost always adds sugar to compensate for the lack in taste. These products, including reduced-fat muffins, baked goods, salad dressings and sauces, are likely to have just as many calories as their higher fat alternatives. Compare labels to make sure you are not overdoing the sugar.
• Skip sugary drinks. Regular soda, fruit juice, energy drinks and flavored coffee drinks are likely to have added sugars that quickly work up to a higher sugar intake. Even seemingly healthy drinks like store-bought smoothies can be loaded with sugar.
• Buy unsweetened versions of foods. Look for ‘no added sugar’ or ‘unsweetened’ versions of packaged food such as applesauce, nut butters, canned fruit and milk alternatives like almond or soy milk. The regular or flavored versions of the same often have added sugars.
• Balance your plate at every meal. 50 % of your plate should be high fiber vegetables and fruit. 25% of your plate should be protein-rich foods and the other 25% should be whole grain carbohydrates or starchy vegetables such as peas, or potatoes.