Food and diet as CANCER TRIGGERS

CANCER TRIGGERS IN DETAIL

The majority of individuals are aware of and often even clued up on health. Take away the distractions, the everyday rush and the amount of things we have on our plates, many of us do know what to do and what not to do in order to maintain a healthy lifestyle.

Yet, according to the WCRF and the AICR, chronic disease in South Africa accounts for 53.9 per cent of deaths, while infectious diseases, and maternal, perinatal and nutritional conditions account for 40.2 per cent. We are not a healthy country. And it is not just us. Although cancer patterns and trends vary in different parts of the world, every year there are more than ten million new cases of cancer recorded worldwide and nearly seven million cancer deaths. ‘By 2020 these figures are estimated to rise to over 16 million new cases with 10 million deaths.’14 We are not a healthy world.

Considering that the majority of cancers are caused by environmental factors rather than genetics, it is important to understand how each lifestyle factor contributes to health and risk of illness.

Food and diet

Understanding how food plays a role in cancer and how nutrition can affect or damage cells is not so clear-cut. Ernest Hawk, vice president and division head of Cancer Prevention and Population Sciences at the University of Texas MD Anderson Cancer Center explains that research efforts in the
ecological, observational, experimental and clinical realms involving the general population, those at risk for cancer, cancer patients and survivors is difficult because of challenges in assessing the complexity and heterogeneity of diets within and across individuals, especially in our time. The most compelling data, he says, is observational. When talking about his home country, Hawk says: ‘Approximately 30 to 40 per cent of cancer is believed to be related to the broad concept of energy imbalance in the American population – specifically, 20 per cent to overweight/obesity, which is by far the most important issue, 5 to 10 per cent to physical inactivity, 5 per cent to unhealthy diets.’

To make matters worse, there is no hard and fast rule when it comes to knowing exactly what you should be eating for your body type to avoid or treat cancer. People’s bodies react differently to certain things, which is what makes it so difficult to understand why some get cancer and others do not.

Moreover, different diets may apply to different cancers. What all of this really means is that the most crucial thing to understand is that the individual is key.

Scientific research into the food we eat and its contribution to cancer is something dietitian Catherine Boome has extensively investigated. ‘Cancer results from the interaction of genetic risks and environmental exposures.

Environmental factors include many aspects of how we live, from how active we are, our diet, our lifestyle habits such as smoking, alcohol consumption and our stress levels,’ she says.

According to Boome, modern society has a huge impact on how we eat, and often leads to obesity, which can enhance our cancer risk. She adds that obesity and excess weight have been linked to breast cancer among postmenopausal women. It could also influence cancer in the colon, endometrium, oesophagus, kidneys and possibly many other sites as well.

‘Nutrition can influence cancer risk, directly due to carcinogens in foods or indirectly by hormonal and metabolic responses to obesity,’ she explains. We will look at weight in more detail in the next section.

Another factor is what goes into our food. There is extensive research out there – if you know where to look – that can make understanding food constituents and their relationship to cancer risk a little easier. According to Boome: ‘Nutrient and toxicant exposures are important contributors to the risk of some cancers. The ACS has compiled research on many components of the human base of diet and its risk on cancer development.’

Boome herself addresses some of the common questions pertaining to the components in our food and their effects, if any, on cancer risk:

Nitrates and agents used in meat processed by methods involving smoking, salting and curing to enhance flavour and colour and to prevent bacterial overgrowth have been linked to certain cancers such as colorectal and stomach cancers. It is important to avoid exposure to these foods or eat them in limited quantities.

Food additives added to foods to preserve them and to enhance colour, flavour and texture must be cleared by the Department of Health before entering the food supply. Additives are usually present in very small quantities, however, and no convincing evidence has shown that any additive at these levels causes human cancers.

Aspartame is a low-calorie artificial sweetener that is about 200 times sweeter than sugar. Current evidence does not show any link between aspartame use and increased cancer risk.

Genetically modified foods are made by adding genes from other plants or organisms to crops to make them more resistant to pests and to slow spoilage. Some genes improve flavour and nutrient composition, or make food easier to transport. In theory, these added genes might create substances that could cause harmful reactions among sensitised or allergic individuals. But there is no evidence at this time that the substances found in bioengineered foods currently on the market are harmful or that they either increase or decrease cancer risk.

Pesticides can be toxic when used improperly in industrial, agricultural or other occupational settings. In South Africa, the departments of health and agriculture set maximum residue limits for the levels of pesticides used in food production, and these are usually way in excess of actual intakes.

Although vegetables and fruit sometimes contain low levels of these chemicals, overwhelming scientific evidence supports the overall health benefits and cancer-protective effects of eating vegetables and fruit. At present there is no evidence that residues of pesticides and herbicides at the low doses found in foods increase the risk of cancer, but fruit and vegetables should be washed thoroughly before eating.

The food you eat on a daily basis affects how you feel, as well as your energy levels. In terms of general health, another Johannesburg-based dietitian, Nathalie Mat, says the most important thing to remember is that if you do not eat balanced meals at regular intervals, you will not have consistently good energy levels. If you do not have good energy levels, you will not be able to operate at full capacity. ‘You do not need to completely make over your lifestyle – adopt small changes that will become habits. Concentrate on daily healthy eating behaviours like getting a minimum of three servings of vegetables a day, choosing unrefined starches instead of products made with refined flours, and on doing exercise when you can. These behaviours will become part of your daily routine, at which point you can create new health goals.’

THE ROLE OF DIET IN CANCER TREATMENT

For those diagnosed with cancer and undergoing treatment, diet and
nutrition play a pivotal role. Controlling your diet during cancer care may
not only assist with healing, but may also help you to feel more in control of
your disease. It is one way to take action and actually do something yourself
to help you feel better.

People Living With Cancer (PLWC) firmly believes there is a strong link
between diet and recovery. Having suffered with ovarian cancer over a decade
ago, co-founder Linda Greeff says she really battled with diet. One major
problem is the lack of resources and localised information and studies
available. Another is that oncologists do not place enough emphasis on how
diet can help with recovery and instead encourage patients to eat whatever
they want.

In an attempt to address this imbalance, PLWC is looking to develop a
handbook of sorts that gives valuable guidelines and information about diets
depending on the specific type of cancer the patient is dealing with. Those
with throat cancer require different diets to those with ovarian cancer, for
example. Greeff ’s ovarian cancer and subsequent hysterectomy left her
hormones way off balance. ‘I picked up a lot of weight and I really battled to
lose weight. Now only, after nearly fifteen years, I am starting to stabilise. It is
a very big problem for patients that have a hormone-sensitive kind of cancer.’

PLWC has found that diet is the one area in which cancer patients can be
truly empowered and that eating a good balance of proteins, vegetables and
fruit can help the healing process. Drinking a lot of fluids is also important, as
it assists with flushing out chemicals and dead cells during treatment.

EATING FOR THE DIFFERENT PHASES OF CANCER SURVIVAL

As South Africa does not yet have its own local model for diet, physical
activity, dietary supplements and nutritional complementary therapies for
cancer prevention and treatment, PLWC uses guidelines published by the
ACS, updated approximately every five years, as a frame of reference.62
This resource highlights that the different phases of cancer survival (see
below) have different nutritional requirements. However, there are some
basics that are important during all phases:

1. Choose foods mostly from plant sources.
Eat five or more servings of fruit or vegetables each day.63
Eat other foods from plant sources, such as breads, cereals, grain
products, rice, pasta or beans several times a day.

2. Limit your intake of high-fat foods, particularly from animal sources.
Choose foods low in fat.
Limit consumption of meats, especially high-fat meats.

3. Be physically active – achieve and maintain a healthy weight.
Be at least moderately active for thirty minutes or more on most days of
the week.
Stay within your healthy weight range.

4. Limit alcoholic beverages, if you drink at all.

Ensuring that the basics are in place, you are then in a position to tailor your
lifestyle and diet for the phase you are currently in. During cancer treatment,
because loss of appetite is so common, the most important goal is to maintain
a caloric balance through eating proteins, carbohydrates and fats. Try to
follow these guidelines:

• Eat when you are hungry, even if it is not a mealtime.

• Eat several small meals or snacks throughout the day rather than three large ones.

• Eat when you feel best.

• Keep simple meals in the fridge for when you become hungry, and keep healthy snacks close by for nibbling when you get the urge.

• If other people offer to cook for you, let them. Do not be shy about telling them what you would like to eat.

• If you are able to eat only small amounts of food, you can increase the calories per serving by:

1. adding butter or margarine;
2. mixing canned cream soups with milk rather than water;
3. drinking eggnog and milkshakes; and
4. adding cream sauce or melted cheese to your favourite vegetables.

• Some find they can drink large amounts of liquids even when they do not feel like eating solid foods. If this is the case, try to get the most from each glassful by making drinks enriched with powdered milk, yoghurt, honey or powdered supplements.

• Eat your favourite foods; if familiar foods no longer taste good, try new foods and use different methods of food preparation.

Regular, light physical activity is also recommended during treatment to
improve appetite and digestion, assist with constipation and increase energy
levels and muscle mass. Nutritional supplements and antioxidant vitamins are
not recommended in great quantities, because they may reduce the
effectiveness of cancer therapies.

In the second phase, recovery from treatment, patients are advised to
obtain a nutrition and physical-activity plan to rebuild muscle strength and to
help with anaemia or impaired organ function. It is most important for
survivors in this phase to consume a nutritionally balanced and varied diet
with adequate calories and micronutrients.

There has been little research into nutrition in the third phase, preventing
cancer recurrence, second primary cancers and nutrition-related disease.
The ACS thus recommends following guidelines for the prevention of cancer,
which include avoiding tobacco, consuming a moderate amount of alcohol,
being physically active and consuming a healthy diet with an emphasis on
plant sources (see Chapter 13 for more recommendations).

It is important in the fourth phase, living with advanced cancer, to
maintain a sense of well-being and quality of life. Food choices will need to be
adapted depending on nutritional needs, while symptoms and side effects will
need to be managed.

While dietary supplements including nutrients, vitamins and minerals are
essential, the ACS warns they should not replace whole foods and those that
have not been well studied should be taken in moderate doses.

Greeff would like to see these nutritional guidelines becoming more central
to cancer treatment, because they aid patients not just with adequate nutrition
for recovery, but also allow them to gain a sense of control over their
situation.

THE ROCKY ROAD OF TREATMENT

Cancer treatment has some unique and debilitating side effects. It is
important to understand that you are not alone and that your friends and
family are there to help you through the tough times and to ensure that you
receive an adequate and nutritional diet based on your particular needs.

Dietitian Nathalie Mat explains that eating is often an area of conflict for
those undergoing chemotherapy and their families. ‘The family will want the
cancer patient to eat and may get upset when the person has a poor appetite
or is unable to eat much. If an individual is battling with oral intake they
should see a dietitian who can recommend supplements or meal replacements
that are easier to consume.’

The Queensland Cancer Council says that loved ones should not shy away
from taking an active role in the patient’s diet during cancer treatment, and
provides advice on how to assist in an empathetic and unobtrusive manner:
Encouragement and support is important, but try not to push the patient
to eat or drink.

Be prepared for the patient to experience taste changes from day to day,
particularly during treatment periods.

Make sure the patient has food at home that is ready to eat when they feel
like eating. For example, tinned fruit in the cupboard or yoghurts in the
fridge, and a frozen meal in the freezer.

Be flexible and willing to try new ideas and recipes.

Eating is a social activity and effort spent on making it a pleasurable
experience will be worthwhile. Eat with the patient as often as possible, as
people often eat better with company.

A well-balanced diet may not be achievable, and the patient may only
want a small range of foods. This is not a problem, as it is likely to be for a
short period of time.64

Although the side effects of treatments can be terrible, they can be relieved
with the right diet and eating regime. ‘Dietitians can also provide strategies to
help cancer patients cope with the side effects of the chemotherapy,’ affirms
Mat.

PLWC has collected many resources to help those dealing with particular
side effects. One that they recommend is the Queensland Cancer Council’s
booklet, Understanding Nutrition.65 It outlines the various side effects of cancer
treatments and gives advice and guidelines on how to deal with them.

One of the most common side effects is loss of appetite.

Recommendations include trying to keep a regular eating pattern of small
meals every few hours during the day, taking advantage of times when you do
feel like eating, stocking a range of prepared foods and snacks, drinking fluids
after and between meals so that the fluids do not fill you up during meals,
partaking in gentle activity to stimulate appetite, enjoying meals with family
and friends where possible, and eating your favourite foods.

Another side effect, directly related to loss of appetite, is weight loss. Try
including more foods like meat, fish, poultry, milk, dairy products, eggs,
legumes and nuts in your diet to help you gain weight. And weigh yourself
often to check that you are maintaining your weight.

When it comes to hormonal cancers like breast cancer, side effects may
include weight gain resulting from a number of factors including steroids or
medications that cause the body to store excess fluid. If the latter is the case, it
is suggested that you talk to your doctor. Aim to keep your weight as stable as
possible during treatment with moderate, regular physical activity (always
check with your doctor before commencing an exercise programme). Once
treatment is finished, consult a dietitian about reducing your weight.

Nausea and vomiting are other common side effects, especially during
chemotherapy. Take a look at page 40 for what you can do to alleviate these.

Difficulty chewing and swallowing, a dry or coated mouth, taste changes,
indigestion and heartburn are also possible side effects of treatment. Some
could even be a direct result of your type of cancer. You may simply need to
alter your diet by including smaller meals and more fluids, moistening food
with things like gravy or sauces, or altering the flavour of foods.

Other side effects can include diarrhoea, constipation and bowel
obstruction. There is no need to feel embarrassed by any of these conditions.

In some cases, increasing or decreasing the amount of fibre in your diet may
help, along with including certain foods and drinking plenty of fluids.

TOWARDS RECOVERY

Understanding your type of cancer and the side effects will help you deal with
your illness head on. Consult organisations like PLWC and resources like the
ones offered by the Queensland Cancer Council, as well as your doctor
and/or a dietitian. The WCFR and AICR’s comprehensive Food, Nutrition,
Physical Activity, and the Prevention of Cancer: A Global Perspective details the
different types of cancers and gives nutritional advice for each. It is a very
good resource to work through if you want to understand how nutrition plays
a role in your specific type of cancer.

The New South Wales Cancer Council also offers detailed advice on what
to eat for the various types of cancers. For people dealing with brain cancer,
for example, they suggest having daily at least two servings of fruit, five
servings of vegetables, four to five servings of bread, cereals, rice and pasta,
two to four servings of milk and dairy foods, one to two servings of meat and
alternatives, one tablespoon of fats and oils, and six to eight glasses of fluid.66
And while the Internet is not the best resource for finding accurate
information, it can be a vast support group of sorts.

Once you are as well informed as possible, you can begin adopting the
habits and eating patterns that could ease you in treatment and see you into
recovery.

A word of caution though: examining health and the role it can play in
cancer is not intended to provoke you into questioning your diet, emotions
and habits leading up to your diagnosis. Leave the past in the past, and
instead use the information to aid treatment and recovery.

Adopting healthy behaviours will lead to an overall improvement in
quality of life whether you are undergoing treatment for cancer, are
recovering from cancer or have never been diagnosed with cancer. Having
this knowledge by your side will empower you to positively and actively
achieve good health.

BECOMING AN ACTIVE PARTICIPANT EATING CLEAN

BECOMING AN ACTIVE PARTICIPANT EATING CLEAN

One of the most important things you can do for yourself is to visit a dietitian
in person so that he or she can assist you with a specialised eating plan that
works for you and your type of cancer. The focus, however, should be on
variety and balance, and choosing nutrient-rich foods.

With little localised information in South Africa, you may also want to
speak to someone who has been through a similar process within the local
context for practical tips and advice. People Living With Cancer (PLWC),
founded by Carl Liebenberg and Linda Greeff, both of whom are cancer
survivors, has branches across South Africa. It is a volunteer counselling
organisation that offers a free buddy support network (Cancer Buddies),
where cancer patients can interact with and receive practical advice and
support from cancer survivors with a similar profile, disease and treatment
protocol. Patients are supplied with the Buddy Booklet, which provides them
with relevant information about cancer and available support systems. Greeff
explains: ‘When you get diagnosed, and I’m a cancer survivor myself, you
always think cancer is a death sentence. So when you are able to talk to
someone who has come through that diagnosis, it gives you hope. It makes
you feel that you can also achieve that. Buddies can also give practical tips on
how to deal with chemotherapy or radiation and the side effects of treatment.’

Greeff explains the benefit of PLWC in terms of knowing what route to go
when it comes to nutrition, as patients sometimes find it difficult to obtain
relevant information from doctors or local resources. What can be confusing,
she says, is the number of fad diets available that claim to cure cancer. ‘There
is no diet that is going to cure cancer. We need a balanced diet that is also
quite high in protein, because the body needs protein to help cells recover.

People think protein is only red meat, but you can eat legumes, which are also
proteins.’

Another factor that makes organisations like PLWC relevant is that while
there are general guidelines for healthy diets, like a balanced intake of fruit
and vegetables, Greeff points out that someone suffering from throat cancer,
for example, may not be able to eat such things. It is because of this that
understanding your particular cancer and how to get the best nutrition
possible for you is so important. PLWC has noted that one of the most
devastating effects of cancer is the different losses a patient is exposed to
during their journey with cancer, from loss of hair to loss of control. To
address this, PLWC adopts a patient-active approach, encouraging patients
to become active participants in their treatment and helping them regain
some control. This means engaging right from the start with their oncologists
and making treatment decisions, as well as planning all aspects of their
recovery, including diet, spirituality, emotion, family and support.31

Using Diet to Fight Recurrent Cancer in Foods and Prostate Cancer Survival - How Foods Fight Cancer

Using Diet to Fight Recurrent Cancer in Foods and Prostate Cancer Survival - How Foods Fight Cancer

Ornish’s approach is extremely promising for men with early prostate disease.
But what about advanced cancer? Evidence suggests that dietary
changes can still play a vital role. Two studies have used special diets in men
who had previously been operated on for prostate cancer but who had
experienced recurrences of their disease. Using a macrobiotic diet emphasizing
whole grains, vegetables, and legumes, while avoiding dairy products
and most meats, nine men with prostate cancer had an average survival of
228 months compared to 72 months for a matched group of men receiving
no special diet.5

A study at the University of Massachusetts tested the benefits of a dietary
change in ten men with prostate cancer that had recurred after surgery. The
diet was based on whole grains, legumes, green and yellow vegetables,
seeds, soy products, and fruit, and the men were also instructed in stressreduction
techniques. To measure the program’s effect, researchers tracked
how long it took for the patients’ PSA levels to double—the longer the PSA
doubling time, the slower the cancer is spreading. Before the study began,
the average PSA doubling time was 6.5 months. But after four months in
the program, it had slowed to 17.7 months, an encouraging finding. In three
of the men, PSA levels actually fell.6

Using a Vegan Diet

Using a Vegan Diet in Foods and Prostate Cancer Survival - How Foods Fight Cancer

Dean Ornish, founder and director of the Preventive Medicine Research
Institute and clinical professor of medicine at the University of California,
San Francisco, who had already demonstrated the benefits of a low-fat,
vegetarian diet for heart patients (finding that it reversed heart disease in
82 percent of research participants), decided to put a similar program to the
test for prostate cancer.4 The ninety-three volunteers were men with earlystage
cancer who were able to defer treatment, at least for the moment,
because they were keeping a careful watch on their prostate-specific antigen
(PSA, an index of cancer spread) levels, a strategy known as “watchful
waiting.” Typically, PSA levels slowly rise, and eventually treatment (such as
surgery) may be required. Ornish randomly assigned half of the men to follow
their usual habits (the control group), and the remaining half were to
follow a low-fat vegan diet along with moderate aerobic exercise and stress
management. In the experimental vegan group, PSA levels decreased by 4
percent after one year, while PSA levels rose by 6 percent in the control group.
Six of the men in the control group needed treatment during the one-year
study period because their prostate cancer was progressing, whereas no one
in the experimental group needed treatment during the study period.

Putting Diet to the Test

Putting Diet to the Test in Foods and Prostate Cancer Survival - How Foods Fight Cancer

The first prospective studies of diet’s potential benefits were purely observational.
In 1999, researchers in Québec City reported their findings after
following 384 men with prostate cancer over a five-year period. It turned
out that those who consumed the most saturated fat—the kind particularly
prevalent in meats and dairy products—had three times the risk of dying
from the disease compared to those with the lowest saturated fat intake.
Increased risk was also found with higher intakes of total and monounsaturated
fat, but these increases were not significant.2

The following year, researchers in Toronto and Vancouver reported the
results of a study of 263 men with prostate cancer. The study found that
the men who consumed the most monounsaturated fat (the type that is
abundant in olive and canola oils) lived the longest. Their risk of dying was
70 percent lower compared to those with the lowest intake of monounsaturates.
The study also found increased risk from animal fat and saturated
fat intake, although these latter findings were not strong enough to reach
statistical significance.3

Combined Diet Effects: The Women’s Healthy Eating and Living Study

Combined Diet Effects: The Women’s Healthy Eating and Living Study in Foods and Breast Cancer Survival - How Foods Fight Cancer

These dietary factors tend to work together: A diet that is higher in fruits
and vegetables will also tend to be high in fiber and low in fat. In turn,
women who eat such diets tend to be slimmer than other women, thus
avoiding the risks of overweight. One study suggested that there may be a
measurable benefit of these combined effects. Researchers at Mt. Sinai
Medical Center in New York found that women with breast cancer who
were slimmer tended to live longer, and those who had lower cholesterol
levels also lived longer. But the women at greatest risk of dying were those
who were overweight and had high cholesterol levels.20

The Women’s Healthy Eating and Living (WHEL) Study included more
than 3,000 pre- and postmenopausal women previously treated for breast
cancer in a test of two different diets rich in fruits and vegetables.21 Half
the participants (the intervention group) were asked to include in their daily
diets five vegetable servings, 2 cups of vegetable juice, three fruit servings,
30 grams of dietary fiber, and no more than 15–20 percent of calories from
fat. A comparison group was asked to consume at least five fruit and vegetable
servings per day.

In 291 of the study participants, changes in diet and hormone function
were compared between the two diet groups.22 The women who ate
less fat and more fiber found that the amount of estrogen in their blood fell
to safer levels, confirming that diet changes really do help get hormones
into better balance.

In the same study, the investigators tracked the experience of 1,551
women assigned to the comparison group, using blood tests for plasma
carotenoids as an indicator of vegetable and fruit intake.23 As in any large
group, their diets varied from one person to another. It turned out that
those with the highest carotenoid concentrations—indicating high vegetable
and fruit intake—had a 43 percent lower risk of either cancer
recurrence or a new primary breast cancer compared to women with lower
blood levels of carotenoids.

After approximately seven years of follow-up, those women in the
comparison group who followed the guideline of eating at least five fruit
and vegetable servings daily and who were also physically active had an
almost 50 percent reduction in mortality compared to women who did
not meet these healthful guidelines.24 However, the recommendations for
even greater vegetable and fruit intake made for the intervention group
did not extend benefits beyond those achieved by the five-a-day (comparison)
group.25
While the WHEL participants succeeded at emphasizing vegetable and
fruit intake, they did not maintain a low fat intake or a high fiber intake.
The intervention group did reduce fat intake to 21 percent of calories in the
first six months, but fat intake gradually climbed back to 29 percent by the
six-year point. Similarly, fiber intake was only slightly higher at six years
(24 grams per day) compared to the study’s onset (21 grams). As a result,
neither the intervention nor the comparison group succeeded at weight loss;
both groups were overweight at the beginning of the study and gained a small
amount of weight as the study progressed. A vegetarian or vegan regimen
may have been a better choice; the meat and dairy products that were permitted
in the WHEL guidelines contain significant amounts of fat and
contribute no fiber.

Nonetheless, the WHEL study demonstrated that women previously
treated for breast cancer who consume at least five vegetable and fruit servings
daily and are physically active have a large measure of protection
(nearly 50 percent reduction in mortality), and their protection is not
increased by pushing vegetable intake even higher. The study did not test
other potentially helpful dietary measures.

Reduced Fat Intake

Reduced Fat Intake in Foods and Breast Cancer Survival - How Foods Fight Cancer

Specific dietary factors appear to play key roles in cancer survival. First,
two studies of women diagnosed with breast cancer showed that those who
consumed less fat prior to diagnosis generally had smaller tumors with less
evidence of cancer spread compared to women whose diets had included
more fatty foods.4,5 One of these studies identified benefits among premenopausal
women and the other among postmenopausal women.

Studies that have followed women for several years after diagnosis
have generally found that those with less fatty diets prior to diagnosis live
longer than other women. In one of the first such studies, researchers at the
State University of New York in Buffalo found that women with advanced
cancer had a 40 percent increased risk of dying at any point in time for
every 1,000 grams of fat they consumed per month.6 Note that this does
not mean a person’s risk of dying is 40 percent. It means that if a person’s
diet contains an extra 1,000 grams of fat per month at the time of diagnosis,
that person’s risk of dying is 40 percent higher than it would otherwise
have been. There is, of course, tremendous variation from one woman to
another, so this figure is simply an overall observation drawn from the group
of participants. To make this more concrete, the difference between a typical
American diet and a low-fat vegan diet is approximately 1,000–1,500
grams of fat per month, which corresponds to a 40–60 percent difference
in mortality risk at any point in time.

Other studies found much the same thing—fatty diets are associated
with increased risk, and that is particularly true for saturated fat, the kind
that is common in meat, dairy products, eggs, and chocolate.7–10 Some
studies have failed to confirm the dangers of fatty diets.11–14 However, most
evidence indicates that women consuming less fat tend to do better after
diagnosis, including the Women’s Intervention Nutrition Study (WINS),
sponsored by the National Cancer Institute (NCI).15 This study followed
nearly 2,500 postmenopausal women with breast cancer for five years after
their standard surgery and cancer treatments. Researchers instructed some
of them to continue their regular diets while the rest were put on a low-fat
diet. The women continuing their usual diets consumed an average of 51.3
grams of fat per day, which is still lower than the average American’s fat,
while the low-fat group averaged 33.3 grams per day—slightly more than
in a typical vegetarian diet. After five years, 12.4 percent of the women eating
their usual diet had cancer recurrences compared to only 9.8 percent of
the low-fat diet group, a 24 percent reduction in recurrence.

Why does low fat intake improve survival? To begin with, low-fat diets
tend to be modest in calories, since fats and oils are the densest source of
calories of any food we consume. In fact, some investigators believe that the
main problem with fatty diets is simply their high calorie content. In addition,
women who eat less fat and more fiber tend to have less estrogen
(independent of the difference in their body weight). They may also have
stronger immune defenses that can help them fight cancer cells.

Evidence suggests that diet changes must be substantial to be effective.
The Women’s Health Initiative included 48,835 participants, aged fifty to
seventy-nine, who were free of breast cancer, and tested a diet that emphasized
vegetables, fruits, and grains.16 Fat intake fell from 38 percent of
calories at the beginning of the study to 24 percent at one year, but slipped
back up to 29 percent at six years. After 8.1 years of follow-up, overall
breast cancer risk fell 9 percent, but the difference was not statistically significant,
meaning that it could have occurred due to chance. However, risk
of one type of breast cancer—progesterone receptor-negative tumors—fell
by 24 percent. While the study was not a survival study—it assessed the
risk of cancer developing in the first place, rather than the course of the disease
after diagnosis—it suggests that modest dietary changes may bring
only modest results.

Meal Planning for Maintaining a Healthy Weight

Meal Planning for Maintaining a Healthy Weight  - How Foods Fight Cancer

If you’re aiming to knock off some pounds, this is a great time for a new
focus on high-fiber foods. They tend to be very low in fat, so they won’t add
many calories. And they will fill you up, so you’re less likely to overdo it.

If you were to include high-fiber foods at breakfast, lunch, and dinner,
what would they be? Here are a few ideas; think about the ones that are
most appealing to you:

Breakfast: Old-fashioned oatmeal is a natural choice. A bowl of strawberries,
half a cantaloupe, or any seasonal fruit will add fiber, too. And,
while it might sound a bit odd at first, a serving of chickpeas at breakfast
provides plenty of protein and fiber, with very little fat. Try it; you’ll like it.
Whole-grain breads and bran cereals with low-fat soymilk or rice milk will
also give you plenty of fiber.

Lunch: Start with salads loaded with fresh vegetables, beans, and lowfat
salad dressing. For a hearty lunch, baked beans, lentil soup, or bean
burritos are unbeatable. Or try hummus tucked into whole wheat pita
bread with grated carrots, sprouts, and cucumbers, or spread low-fat black
bean dip into a whole wheat tortilla and wrap it with peppers, tomatoes,
and lettuce. A side of steamed green vegetables is always a great addition.
And, if your tastes call for fresh fruit, a couple of pears or apples will give
you loads of fiber with very few calories.

Dinner: For dinner, there are endless choices: vegetable stir-fry over
brown rice, a chunky vegetable chili, lentil curry, vegetable fajitas loaded
with fat-free refried beans and sautéed vegetables, or vegetable lasagne layered
with tomato sauce, crumbled tofu, spinach, mushrooms, and cheesy-tasting
nutritional yeast in place of the usual fatty meat and cheese. Or keep it
simple and enjoy whole wheat pasta with a vegetable-rich marinara sauce.
For dessert, try fresh fruit or a fruit sorbet.

Recommended Recipes
Blueberry Smoothie
Rutabaga Mashed Potatoes
Lentil Artichoke Stew
Veggies in a Blanket

Weight-Loss Keys

Weight-Loss Keys - How Foods Fight Cancer

To summarize, here are the keys to healthy weight loss:

■ Build your diet from the New Four Food Groups: vegetables, fruits,
beans, and whole grains.
■ Avoid animal products and added vegetable oils.
■ Go high fiber, and enjoy plenty of vegetables, fruits, and bean dishes
in as natural and unprocessed a state as possible. Choose high-fiber
grains, such as brown rice instead of white rice and whole-grain bread
instead of white bread.
■ Add any common multiple vitamin as a source of vitamin B12.
■ There are not many fatty plant foods, but it is good to minimize the ones
there are—nuts, seeds, avocados, coconut, olives, and some soy products.
■ If your doctor gives you the green light for regular physical activity,
be sure to add exercise to your routine. Start slowly. Brisk walking
for a half hour daily or an hour three times a week is a good way to
begin. Then gradually increase your regimen.

Exercise - Maintaining a Healthy Weight

Exercise - Maintaining a Healthy Weight

Exercise burns calories, boosts metabolism, and helps reduce the stresses
that can lead to binge eating. But don’t jump into a vigorous regimen too
quickly. If you’re over forty, significantly overweight, or dealing with any
serious medical condition, you should check with your doctor before
greatly increasing your physical activity.

When you start an exercise program, it pays to begin slowly. For most
people, a brisk walk every day for half an hour—or three times per week
for an hour—is a good way to begin.

If you are unable to exercise because of joint problems, cardiac limitations,
or any other reason, you’ll be glad to know that a low-fat diet based
on the New Four Food Groups typically promotes weight loss even when
people do not exercise. Yes, exercise is a good practice for lifelong health,
but it is not essential for weight loss in particular.

Avoid Risky Diets - Maintaining a Healthy Weight

Avoid Risky Diets - Maintaining a Healthy Weight

Some fad diets have had on-again, off-again popularity but are very detrimental
over the long run. For example, low-carbohydrate, high-protein diets
eliminate bread, pasta, beans, rice, starchy vegetables, and other carbohydraterich
foods and focus instead on high consumption of meat and eggs. There
are several things wrong with such diets.

First, controlled tests show that, over the long run, these diets cause no
more weight loss than that associated with old-fashioned low-calorie diets
or with nutritious low-fat vegan diets.

Second, when people lose weight with high-protein diets, it is simply
because they are eliminating so many other foods that their overall calorie
intake drops. If overall calorie intake doesn’t drop, they don’t lose weight.
Third, and most important, high-protein diets are linked to significant
health problems.

Researchers have found that people on these diets lose large amounts
of calcium in their urine, and the loss is caused by the massive amounts of
protein they are consuming.8 Animal protein tends to leach calcium from
the bones and send it through the kidneys into the urine. Over the long run,
that can lead to osteoporosis.

As we saw, meaty diets are linked to higher risk of colon
cancer.9,10 And high-fat diets in general are linked to poorer survival in
individuals diagnosed with cancer.

For individuals battling serious illness—and for anyone else—it is a very
good idea to lose excess weight, and it is important to do so in as healthful a
way as possible.

Trimming Down the Healthy Way

Trimming Down the Healthy Way - How Foods Fight Cancer

Studies show that every 14 grams of fiber in our daily diet reduces our
calorie intake by about 10 percent.

So, how do we slim down? The first key is to focus not on how much you
eat, but on what you eat. It is natural for people seeking to lose weight to
skip meals and eat tiny portions. But doing so over even a few weeks tends
to slow down your body’s calorie-burning speed, making it harder and
harder to lose weight. And cutting back on portions can make hunger get
out of control, leading to binges and rebound weight gain.

Instead, focus on healthful foods that are naturally modest in calories.
The best advice is to build your menu from the New Four Food Groups
introduced in chapter 1. Vegetables, fruits, beans, and whole grains are
nearly always lower in calories than typical meats, dairy products, eggs, and
fried foods.

This is partly because they are usually very low in fat. Ounce for
ounce, fat has more than twice the calories of carbohydrate or protein. In
addition, plant-based foods are so high in fiber, they tend to fill you up
before you’ve taken in too many calories. Studies show that every 14 grams
of fiber in our daily diet reduces our calorie intake by about 10 percent.3

By building your diet from the New Four Food Groups you’ll avoid
animal products and keep vegetable oils to an absolute minimum. In the
process, you’ll eliminate all animal fat and fiber-depleted foods and dramatically
cut your fat intake.

Several studies by the research team at the Physicians Committee for Responsible Medicine have shown that simply using the New Four Food Groups while avoiding animal products and keeping oils to a
minimum leads to a weight loss of roughly one pound per week—week after week after week—
even if you don’t exercise. For example, in a study of fifty-nine postmenopausal women, the
diet change caused participants to lose an average of thirteen pounds in
fourteen weeks.4

The same effect was seen in young women.5 And in a study
of individuals with type 2 diabetes, participants lost an average of thirteen
pounds in just twenty-two weeks.6 A recent review of eighty-seven studies
on vegetarian or vegan diets and weight found that vegetarians were more
likely to be at a healthy weight and that vegetarian diets brought greater
weight loss than nonvegetarian diets.7

Many other research studies have reached similar conclusions. You can
focus on the type of food you eat—not the amount—and lose weight naturally
and safely.

Of course, a slimmer body is not the only benefit of this type of nutritious
menu. Low-fat vegetarian and vegan diets have been used to reverse
heart disease, bring diabetes under control, lower blood pressure, reduce menstrual
and premenstrual symptoms, and achieve many other health goals.4-9

Maintaining a Healthy Weight

Maintaining a Healthy Weight - How Foods Fight Cancer

Body fat is like an estrogen factory. Fat cells convert hormones into estrogens.

Many studies have shown that slimmer people are less likely to
develop cancer. Trimming excess weight may also improve survival
after cancer has been diagnosed. Among women with breast cancer,
at least seventeen different research studies have shown that those who
are thinner tend to live longer and have less risk of recurrence.1

Researchers have not had to look hard to find reasons to explain this
finding. It has long been known that body fat is like a factory producing
estrogens (female sex hormones). Hormones produced in the adrenal glands
(small organs above each kidney) travel through the bloodstream into
body fat. There, fat cells convert these hormones into estrogens.1 In turn,
estrogens fuel breast cancer growth.

That’s not all. Both women and men who have more body fat tend to
have less of a protein compound called sex hormone-binding globulin
(SHBG) in their blood. SHBG’s job is to bind estrogen and testosterone,
keeping these hormones inactive and unable to promote cancer. If overweight
people have less SHBG, it means that more of their hormones are
not reined in. They travel freely in the bloodstream, increasing the risk that
cancer will start or, if it has already started, will spread to other parts of
the body.

Excess weight may also reduce immune defenses. Researchers have
shown that overweight people are more likely to show other signs of flagging
immunity, such as recurrent infections. Poor immune defenses could
mean they are less able to combat cancer cells that may arise.2

Meal Planning for Cancer

Meal Planning for Cancer-Fighting Compounds and Immune-Boosting Foods 

Here are some simple tips that will help you build generous amounts of antioxidants, phytochemicals, and immune-boosting foods into your diet:

■ Include plenty of vegetables and fruits in your routine, emphasizing
the colorful varieties. Shoot for at least seven servings per day. One
serving of vegetables is one-half cup cooked or one cup raw. For fruit,
a serving is one small whole fruit or one-half cup chopped fruit.

■ Keep a bag of baby carrots (rich in beta-carotene) nearby. Try them
plain or dipped in hummus or a light vinaigrette.

■ Limit storage of fruits and vegetables. Once they are separated from
the plant, their carotenoids begin to break down.

■ Check out your local Asian or Latin American grocery store to discover
some new vegetables. For fresh seasonal produce, check out
your local farmers’ market.

■ Avoid overcooking vegetables. While you still get a substantial amount
of antioxidants in cooked vegetables, you will get much more if you
don’t cook them. A few exceptions, such as carrots and tomatoes,
actually release more carotenoids when they have been cooked. If
you don’t like cooked carrots, try finely chopping raw carrots to
release more of their carotenoids.

■ Have plenty of tomato products (rich in lycopene): Mix sun-dried
tomatoes into bread dough or add them to a veggie sandwich. Top
pasta with marinara sauce (and add frozen vegetables, such as chopped
spinach or kale, to the sauce as it cooks). Add canned tomatoes or
salsa to a bean burrito, or top a veggie burger with ketchup or salsa.
Reach for tomato juice to quench your thirst. Or make a quick
bruschetta by toasting baguette slices, and then topping them with
canned diced tomatoes and a sprinkling of basil.

■ Crush a Brazil nut (rich in selenium) on top of your vegetable salad.

■ Enjoy beans and whole grains for vitamin E and selenium.

■ Add blueberries (rich in vitamin E) to your cereal or fruit smoothie.

■ Add barley (rich in vitamin E and selenium) instead of pasta to vegetable
soups and stews.

■ Add broccoli, cauliflower, or any other of the other cruciferous veggies
to stir-fries, soups, stews, and sauces.

■ Boost any salad’s cancer-fighting potential by adding cabbage, collard
greens, kale, or watercress.

■ Use rutabagas or turnips in place of potatoes in your favorite potato dish.

■ Add fresh garlic to almost any meal.

■ Take a multiple vitamin each day.

■ Build your diet from plant foods and stay away from animal products.
By doing so, you’ll avoid most fat and all dietary cholesterol to help
keep your immune system operating at its best.

■ Avoid added oils and you’ll keep fat content very low and immunity
high.

Recommended Recipes :

Buckwheat Pasta with Seitan

Spinach Salad with Citrus Fruit

Zippy Yams and Collards

CHECK YOUR DIET WITH A THREE-DAY DIETARY RECORD

CHECK YOUR DIET WITH A THREE-DAY DIETARY RECORD - How Foods Fight Cancer

THREE-DAY DIETARY RECORD

You can get a good idea of the healthfulness of your overall diet with a
three-day dietary record. This is the same diet-tracking tool that researchers
use in clinical studies. It not only lets you see exactly what you’re eating
now, it also helps you see how to improve your diet over time. If, for example,
you’re getting a little too much fat or too little fiber, you’ll spot it right
away and can fix the problem.

To do your record, you simply take a sheet of paper and note down
everything you eat or drink (except water) for three days, including two
weekdays and one weekend day (most of us eat a bit differently on weekends
compared to weekdays).

Using the Diet Record form (photocopy it as many times as
needed), jot down each food, condiment, or beverage on a separate line.

For example, if you had a salad made of lettuce, tomatoes, chickpeas, and
dressing, use four lines, one for each ingredient. Or if you had a peanut butter
and jelly sandwich, along with a cola, use four lines so you can separate
out each part of the meal—bread, peanut butter, jelly, and the drink.

Write down everything you eat, including snacks and condiments. The
only item to omit from the list is your water consumption. Record the
amount of each food as accurately as you can. You can either weigh each
item using a food scale (available in stores that sell kitchenware) or measure
or estimate its volume (for example, one cup of orange juice, or perhaps
a small, medium, or large apple).

Record your foods as you go so you don’t forget. If it is more convenient,
you can keep notes in a small notebook and transfer them to the Diet
Record form later. Be thorough.

If you like, you can get a detailed nutrient analysis of your diet. Just
be sure to fill in the quantities carefully and use a food scale. A dietitian
can analyze the record for you, or you can simply log in to a nutrientanalysis
Web site, such as the University of Illinois Food Science and
Human Nutrition Department’s site www.nat.uiuc.edu/mainnat.html,
www.dietsite.com, or www.NutritionMD.org.

Please note that while the
nutrient analyses on these sites are generally accurate, some of their nutrition
guidelines are not necessarily optimal. Many commonly used guidelines
allow too much fat and cholesterol. Here is a better set of goals: For an
adult consuming 2,000 calories per day, a good fat-intake goal is about
25–35 grams each day. This works out to about 10–15 percent of calories.
Cholesterol intake should be zero. Your protein intake should be
roughly 50 grams per day. Resist the temptation to push protein intake
too high.

The risk of dying at any point in time increased by 40 percent for every 1,000 grams of fat the women consumed per month.

The risk of dying at any point in time increased by 40 percent for every 1,000 grams of fat the women
consumed per month.

There were some bright spots in the study. Risk of progesterone-negative
tumors fell by 30 percent. And those women who made the greatest reductions
in fat intake had a more significant drop in overall risk, up to 20
percent. Large studies of American women have shown that moderate variations
in fat intake made no difference in their breast cancer risk. The best
evidence suggests that, to be effective, dietary changes have to be sizable.

Nonetheless, research bears out a major effect of diet, not only on cancer
prevention, but also on cancer survival. Breast cancer patients who
follow lower-fat diets do tend to live substantially longer. Researchers at
the State University of New York in Buffalo tracked the diets of 953 women
who had been diagnosed with breast cancer. They then followed them to
see who did well and who did not. The results were striking. The risk of dying at any point in
time increased by 40 percent for every 1,000 grams of fat the women consumed per month.6

Let’s see what this means in practical terms:
If you were to add up all the fat in a typical American diet over the course of a month and
compare it to the amount of fat in a low-fat, pure vegetarian diet, the two
would differ by approximate 1,500 grams of fat each month. If the study’s
findings hold, that would correspond to a 60 percent increased risk of
dying at any point in time for patients following a typical American diet.

Several other studies have found much the same thing: Women with
breast cancer who eat fattier foods—meats, dairy products, and fried foods—
have greater rates of cancer recurrence and succumb more frequently than do
those whose diets are based on the lower-fat choices—vegetables, fruits,
whole grains, and beans.7 Frightening as this sort of finding may be, it shows
us a path toward reducing the need for further treatment and improves the
odds of living a life free of the tolls cancer can take.

Similar findings have emerged about prostate cancer. Men on more
health-promoting diets—that is, diets rich in vegetables, fruits, and other
low-fat foods from plant sources—are less likely to develop cancer in the
first place and, if cancer does strike, are more likely to survive it.8,9

Jump Right In Diet

Jump Right In diet - How Foods Fight Cancer

Many parts of the diet can help us stay healthy or regain health when we’re
dealing with illness. Vegetables, fruits, beans, whole grains, and many other
foods have been under study for some time. While we do not have all the
answers, we have more than enough information to get started with more
healthful ways of eating.

As we begin, let us encourage you not to simply dabble with dietary
changes. If you or a loved one have been diagnosed with a major illness, it
is time to take full advantage of what your diet can do for you. Much as
we might like to pretend that small dietary changes help, the fact is that
trimming a little fat here and adding a piece of fruit there does very little.

That has been proven true in studies using diet to control cholesterol,
diabetes, hypertension, osteoporosis, weight problems, and many other
conditions. So we will not sell you short with half-baked dietary suggestions.

Rather, we will encourage you to jump in and take full advantage of
what these foods can offer. Chances are, you will love where you’re headed.

An exploration of healthful eating may not only bring you better health; it
may also lead to new and interesting tastes, exotic restaurants, and some of
the most remarkable aisles in the grocery store.

Yes, you’ll have some challenges along the way. A new recipe might
turn out to be stunning, or it could also be a dud. Don’t worry. That’s what
experimenting is all about. As you get to know what works for you, you’ll
discover a new world of nutritious, powerful foods and delicious tastes,
and an entirely new way of thinking about food and health.

Maintaining a Healthy Weight

Maintaining a Healthy Weight - How Foods Fight Cancer

Healthy weight control is essential for warding off a variety of chronic diseases,
and studies have shown that slimmer people are less likely to develop
cancer. In addition, trimming excess weight may also improve survival
after cancer has been diagnosed

Diet: How Eating for Health Manages Dysglycemia

Diet: How Eating for Health Manages Dysglycemia

In the Eating for Health approach to managing dysglycemia, we recommend a diet
that contains approximately:

• 25 to 30 percent of calories from proteins
• 20 to 30 percent of calories from good-quality fats
• 40 to 50 percent of calories from complex carbohydrates

In short, the key to glycemic control is to minimize the amount of refined
carbohydrates consumed. As often as this is said, it is hard to hear and truly
understand, because breads, pasta, bagels, and pastries are so much a part of our
culture.

Reimagining Breakfast: The Power of Protein

Breakfast is the most important meal of the day; after all, you have fasted all
night long. And the most important macronutrient to include in your breakfast is
protein. That’s because:

• Protein is satiating and, in most people, stabilizes blood sugar for three to four hours.
• Protein stimulates the production of glucagon, the hormone that promotes the mobilization and utilization of fat for energy, not storage.

A high-glycemic bagel, a muffin and coffee, or a bowl of sugary cereal won’t
provide the protein you need to steady your blood-sugar level; you will find
yourself craving carbs again soon after eating such a breakfast, setting up a vicious
cycle. If you ignore your hunger and don’t eat, your blood sugar can drop too low,
setting you up for a wild ride of blood sugar crashes and spikes. You might have a
sense of these crashes from symptoms such as headaches, brain fog, irritability, or
cravings.

To maintain a balanced blood-sugar level—thereby giving yourself stable
energy throughout your day—try to make the time to prepare a balanced meal in the
morning. A balanced breakfast includes protein but also provides fat and complex
carbohydrates. This means eggs and greens; cottage cheese and fruit; or a proteinbased
smoothie (we suggest rice or whey protein powder) made with yogurt and
fruit, for example.