# WHEL (Women's Healthy Eating and Living)

Source: https://onco.cc/trials/whel/  
OnCo record `whel` (Trial). Data CC BY-NC 4.0, attribute "Data from OnCo (onco.cc)"; commercial use needs a licence.

## TL;DR

Three thousand breast cancer survivors were coached for years to eat far more vegetables, fruit and fibre. They did, and it made no difference to recurrence or survival.

## Summary

WHEL randomised 3,088 women (1995-2000) and followed them for a mean 7.3 years. The intervention group substantially and durably changed their diet (vegetables +65%, fruit +25%, fibre +30%, fat -13% at four years, confirmed by plasma carotenoids). Invasive breast cancer events (16.7% vs 16.9%) and deaths (10.1% vs 10.3%) did not differ. Secondary analyses generated hypotheses later explored elsewhere: women with both high vegetable-fruit intake and high physical activity had lower mortality; a nightly fast under 13 hours was associated with recurrence. WHEL and WINS (low-fat diet, marginal effect confined to HR-negative disease) are the reason the field moved from diet alone to energy balance, weight loss and exercise, and they are a standing caution against assuming observational diet associations are causal.

## Fields

- Kind: Trial
- Status: negative
- Last checked: 2026-09-08
- Registry id: NCT00003787
- Phase: 3
- Setting: Early-stage breast cancer survivors within 4 years of diagnosis: intensive telephone counselling for a diet very high in vegetables, fruit and fibre and low in fat vs printed dietary guidelines
- Sponsor: University of California San Diego / NCI
- Enrolled: 3088
- Result: Breast cancer events 16.7% vs 16.9%; no effect on recurrence or mortality despite large dietary change.
- Outcomes: Invasive breast cancer event (recurrence or new primary): Dietary intervention 16.7% vs Comparison 16.9%, HR 0.96
- Replication: WINS (2,437 women, low-fat diet) showed a marginal reduction in relapse driven by weight loss and HR-negative disease; no diet-only trial has shown a recurrence benefit in breast cancer.

## Sources

- ClinicalTrials.gov NCT00003787: https://clinicaltrials.gov/study/NCT00003787
- Pierce et al. (JAMA 2007): https://doi.org/10.1001/jama.298.3.289

## Connected records

- cancers: [HR-positive / HER2-negative breast cancer](https://onco.cc/cancers/breast-hr-positive/), [Triple-negative breast cancer (TNBC)](https://onco.cc/cancers/tnbc/)
- fronts: [Diet, Exercise & Lifestyle](https://onco.cc/fronts/nutrition-lifestyle/)
- technologies: [Dietitian-led weight-loss programmes in HR-positive breast cancer](https://onco.cc/technologies/dietitian-led-weight-loss-breast/), [Mediterranean and plant-forward dietary patterns](https://onco.cc/technologies/mediterranean-plant-forward-diet/), [Time-restricted eating in cancer prevention and survivorship](https://onco.cc/technologies/time-restricted-eating/)
- terms: [Dietary pattern scores (Mediterranean, HEI, AHEI, DASH, WCRF/AICR)](https://onco.cc/terms/dietary-pattern-scores/), [Energy balance](https://onco.cc/terms/energy-balance/)
- bottlenecks: [Failures are hidden](https://onco.cc/bottlenecks/b-negative-results/), [Survivorship and late effects are neglected](https://onco.cc/bottlenecks/b-survivorship/)
- key papers: [Influence of a diet very high in vegetables, fruit, and fiber and low in fat on prognosis following treatment for breast cancer: the Women's Healthy Eating and Living (WHEL) randomized trial](https://onco.cc/key-papers/paper-whel-jama-2007/)
- roadmaps: [Diet, exercise and lifestyle roadmap: causes established → interventions that disappointed → exercise proven as treatment](https://onco.cc/roadmaps/nutrition-lifestyle-roadmap/)

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