In today’s world, where information is readily available and social media platforms are flooded with health advice, myths and misinformation around diet and nutrition are more prevalent than ever. This is especially concerning when it comes to serious health conditions like childhood cancer, where families already face immense emotional and physical challenges. Many turn to the internet and social media for guidance, but not all sources are accurate or reliable, and misleading nutrition advice can create confusion, frustration, and even lead to harmful decisions.

 In this blog, we debunk five common myths that Cuddles nutritionists come across about pediatric cancer nutrition when counseling patients and their caregivers. We aim to fact check these myths and provide clarity and help families make informed choices that support their child’s well-being.

Myth 1: Red and Orange Fruits and Vegetables Increase Hemoglobin

Fact: Hemoglobin, the red component of blood cells, carries oxygen from the lungs to the rest of the body. Low hemoglobin levels, known as anemia, require attention to diet, especially foods rich in iron and protein. But do red fruits and vegetables like pomegranates, beetroot, apples, and carrots actually raise hemoglobin levels? 

While red and orange fruits and vegetables, such as carrots, tomatoes, and bell peppers, are rich in vitamins (like vitamin A) and antioxidants, they do not directly increase hemoglobin levels as they are not sources of iron. However, they do support blood health in other ways. Their benefits stem from nutrients like vitamin C, vitamin B, magnesium, copper, and antioxidants, which can stimulate red blood cell production¹. In children with cancer, anemia often results from altered blood cell production. Thus, consuming red and orange fruits can positively impact Complete Blood Count (CBC) reports, though they may not be sufficient for treating iron-deficiency anemia alone.

Myth 2: Milk or Dairy Products Do Not Contain Protein; Only Meat and Eggs Are Good Sources of Protein

Fact: This myth overlooks the fact that dairy products are excellent sources of protein. Milk, curd, and cheese contain high-quality protein that is essential for growth and recovery in children with cancer.

A 200ml glass of cow’s milk offers about 6.5g of protein, comparable to an egg or half a serving of chicken³. While the protein in meat and eggs may be slightly more bioavailable, dairy products provide a well-rounded balance of carbohydrates and essential micronutrients, including vitamins A, calcium, and phosphorus that help the child during this crucial growth period. Milk and milk products therefore are excellent sources of high-quality protein and essential nutrients that support health in areas like bone strength and muscle repair. For vegetarians especially, milk products serve as valuable sources of complete, high-quality protein. Plant-based proteins from legumes, nuts, and seeds can also contribute significantly to a child’s protein intake.

Myth 3: Egg Yolk Is Harmful for a Child with Deranged Liver Function Tests

Fact: Egg yolks are often mistakenly considered harmful due to their cholesterol content and are avoided. Recent studies have shown that moderate consumption of egg yolks are generally beneficial for children with certain types of liver issues. 

Egg yolks are often viewed with caution regarding liver health, but they are actually nutrient-dense, containing key vitamins and minerals such as vitamins A, D, E, K, B12, folate, iron, and selenium. They also provide choline, an important nutrient for liver health and fat metabolism². Though egg yolks contain saturated fat and cholesterol, which require the enzyme bile for digestion, the high-quality protein and broad array of micronutrients outweigh the small amount of fat in moderate consumption, such as one or two eggs.  A Joint Position Paper of the North American Society for Pediatric Gastroenterology, Hepatology, and Nutrition and the European Society for Pediatric Gastroenterology, Hepatology, and Nutrition do recommend egg yolks as part of the diet for children with cholestasis⁴. However, it is important to consult with a nutritionist regarding dietary restrictions based on liver function tests and the nature of liver function test derangement. Individual medical conditions may vary and require a customized approach.

Myth 4: Turmeric Should Not Be Given If Hepatitis or Icterus Is Present

Fact: Turmeric contains the yellow pigment curcumin, which has anti-inflammatory properties that may benefit liver health. While it’s true that excessive amounts through turmeric or curcumin supplements is not advisable not just during acute liver conditions but even in normal healthy individuals due to liver toxic effects, moderate use of turmeric as a spice in food is generally considered safe.⁵

The belief that turmeric should be avoided during hepatitis and jaundice is based more on myth than science. Turmeric is often unnecessarily restricted due to its yellow color, which some fear may interfere with monitoring changes in skin yellowing associated with jaundice. However, unless advised otherwise by a healthcare provider based on individual assessments turmeric as a spice and added to food can be part of a balanced diet.

Myth 5: Papaya Leaf Extract (Juice), Dragon Fruit, and Unboiled Goat Milk Are Effective in Increasing Platelet Count

Fact: There is limited scientific evidence supporting the claim that papaya leaf extract or dragon fruit or goat’s milk can significantly increase platelet counts in pediatric cancer patients. This advice should be approached with caution.

While some studies suggest that papaya leaf extract may have beneficial effects on platelet levels by stimulating the production of platelets, these findings are not universally accepted or robust enough to serve as a primary treatment method⁶. Papaya leaf extract, often consumed in the raw juice form without cooking, can also be a potential source of infection, particularly in cancer patients with compromised immunity and those experiencing neutropenia.

Limited studies have shown that dragon fruit and goat milk are rich in antioxidants that may help prevent the premature use of platelets, thereby maintaining blood levels^7,8,9.. However, these have not been well-established. But it is a no-brainer that consuming unpasteurized goat milk can pose a risk of infection, potentially worsening health and hence should be strictly avoided.

Conclusion

It is important for parents to know the facts about common pediatric cancer nutrition myths so that they can help care for their children during treatment. Adequate nutrition including diverse foods such as proteins from meat, legumes and fish, good fats, and fruits and vegetables to get vitamins can improve prognosis outcomes significantly. It is crucial that nutrition intervention be supported by scientific evidence and a qualified pediatric oncology nutritionist can help address these myths.

References:

1. Manthou E, Georgakouli K, Deli CK, Sotiropoulos A, Fatouros IG, Kouretas D, Haroutounian S, Matthaiou C, Koutedakis Y, Jamurtas AZ. Effect of pomegranate juice consumption on biochemical parameters and complete blood count. Exp Ther Med. 2017 Aug;14(2):1756-1762. doi: 10.3892/etm.2017.4690. Epub 2017 Jun 27. PMID: 28781633; PMCID: PMC5526177.
2. Mehedint MG, Zeisel SH. Choline’s role in maintaining liver function: new evidence for epigenetic mechanisms. Curr Opin Clin Nutr Metab Care. 2013 May;16(3):339-45. doi: 10.1097/MCO.0b013e3283600d46. PMID: 23493015; PMCID: PMC3729018.
3. Longvah, T., Ananthan, R., Bhaskarachary, K. and Venkaiah, K. (2017). Indian Food Composition Tables 2017, National Institute of Nutrition, Indian Council of Medical Research, Hyderabad, Telangana, India.
4. Mouzaki M, Bronsky J, Gupte G, Hojsak I, Jahnel J, Pai N, Quiros-Tejeira RE, Wieman R, Sundaram S. Nutrition Support of Children With Chronic Liver Diseases: A Joint Position Paper of the North American Society for Pediatric Gastroenterology, Hepatology, and Nutrition and the European Society for Pediatric Gastroenterology, Hepatology, and Nutrition. J Pediatr Gastroenterol Nutr. 2019 Oct;69(4):498-511. doi: 10.1097/MPG.0000000000002443. PMID: 31436707.
5. Halegoua-DeMarzio D, Navarro V, Ahmad J, Avula B, Barnhart H, Barritt AS, Bonkovsky HL, Fontana RJ, Ghabril MS, Hoofnagle JH, Khan IA, Kleiner DE, Phillips E, Stolz A, Vuppalanchi R. Liver Injury Associated with Turmeric-A Growing Problem: Ten Cases from the Drug-Induced Liver Injury Network [DILIN]. Am J Med. 2023 Feb;136(2):200-206. doi: 10.1016/j.amjmed.2022.09.026. Epub 2022 Oct 14. PMID: 36252717; PMCID: PMC9892270.
6. Nandini, C., Madhunapantula, S. V., Bovilla, V. R., Ali, M., Mruthunjaya, K., Santhepete, M. N., & Jayashree, K. (2021). Platelet enhancement by Carica papaya L. Leaf fractions in cyclophosphamide induced thrombocytopenic rats is due to elevated expression of CD110 receptor on megakaryocytes. Journal of Ethnopharmacology, 275, 114074. https://doi.org/10.1016/j.jep.2021.114074
7. Nangare DD, Taware PB, Singh Y, Kumar PS, Bal SK, Ali S and Pathak H (2020) Dragon Fruit: A Potential Crop for Abiotic Stressed Areas. Technical Bulletin No. 47. ICARNational Institute of Abiotic Stress Management, Baramati, Pune, Maharashtra, India, pp: 24
8. Salonen, J., Salonen, R., Seppänen, K., Rinta-Kiikka, S., Kuukka, M., Korpela, H., Alfthan, G., Kantola, M., & Schalch, W. (1991). Effects of antioxidant supplementation on platelet function: A randomized pair-matched, placebo-controlled, double-blind trial in men with low antioxidant status. The American Journal of Clinical Nutrition, 53(5), 1222-1229. https://doi.org/10.1093/ajcn/53.5.1222
9. Simos, Y., Metsios, A., Verginadis, I., D’Alessandro, A., Loiudice, P., Jirillo, E., Charalampidis, P., Kouimanis, V., Boulaka, A., Martemucci, G., & Karkabounas, S. (2011). Antioxidant and anti-platelet properties of milk from goat, donkey and cow: An in vitro, ex vivo and in vivo study. International Dairy Journal, 21(11), 901-906. https://doi.org/10.1016/j.idairyj.2011.05.007