vegetables and fruits sources healthful compounds

Cancer-Fighting Compounds and Immune-Boosting Foods

As you plan your menu, be generous with a variety of vegetables and fruits, because they are the main sources of these healthful compounds.

As you push your grocery cart down the aisle, you’ll want to keep a lookout for foods that have special cancer-fighting properties. In this chapter, we’ll focus on foods rich in protective compounds called antioxidants and phytochemicals, as well as foods that can help boost your immune system.

As you plan your menu, you’ll want to be generous with a variety of vegetables and fruits, because they are the main sources of these healthful compounds. Studies have amply demonstrated the ability of diets rich in vegetables and fruits to reduce the likelihood that cancer will develop in the first place. Although fewer studies have investigated their effect on survival after diagnosis, some have suggested that cancer survivors who consume more vegetables and fruits do indeed live longer. As you’ll see, researchers have begun to tease out reasons why produce is so powerful.

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.’

A WORD ON ORGANIC and MEAT WARS

A WORD ON ORGANIC

‘Organic’ is a recent buzzword in South Africa, with retailers like
Woolworths climbing onboard as the demand for transparent food practices
becomes more prevalent. A number of local organic shops and restaurants
have also popped up, offering consumers access to organic foods. But what
does ‘organic’ really mean and is it really beneficial, especially when it comes
to meat?

Organic, according to Wolhuter, refers to the way farmers grow and
process agricultural products such as fruits, vegetables, grains, dairy products
and meat. ‘Organic farming practices are designed to encourage soil and
water conservation and reduce pollution. Farmers who grow organic produce
and meat don’t use conventional methods to fertilise, control weeds or
prevent livestock disease. For example, rather than using weed killers, organic
farmers conduct sophisticated crop rotations and spread mulch or manure to
keep weeds at bay.’

In terms of meat, conventional farmers give animals antibiotics, growth
hormones and medications to prevent disease and spur growth. Organic
farmers, on the other hand, give animals organic feed and allow them to
access the outdoors. They also use preventative measures such as rational
grazing, a balanced diet and clean housing to help minimise disease.

For Wolhuter, not enough research has been done yet on the effects of
hormones, steroids and antibiotics and the role they play in the South African
meat industry to fairly judge the benefits of organic over conventional
produce. However, she says, ‘the question everyone wants to know is if
organic is safer or better for you than conventional foods. Organic may have
higher nutritional value than conventional foods, according to some research.

For conventional foods, the amount of pesticides acquired has raised
concerns, but many experts maintain that the levels of pesticides in
conventional foods are safe for most healthy adults.’

But health factors are not the only ones to consider; there are the
emotional and ethical ones too. This is where organisations like Compassion
in World Farming come in. South African representative Louise van der
Merwe says, ‘Compassion in World Farming is an international NGO that
lobbies for an end to factory farming of animals … We believe that treating
farmed animals as units of production and with a callous disregard for their
sentience and their suffering, demeans us as humans.’

According to Compassion in World Farming South Africa, twenty-sixmillion
laying hens are trapped in cages that give them a space allowance each
of 75 per cent of an A4 sheet of paper. ‘They are unable to exercise even one of
their natural behaviours. Breeding pigs live their lives in metal “straightjackets”
unable to move backwards, forwards or sideways. Boy calves born
into the dairy industry are “surplus” because they will never produce milk.

They land up at auctions with their umbilical cords still dripping wet and
their legs still wobbly. Broiler chickens spend the last third of their short lives
in chronic pain because, through selective breeding, their bodies are too heavy
for their legs. And we are talking huge numbers here. The scale of suffering is
beyond our comprehension,’ Van der Merwe says.

In 1968, broilers (chickens bred and raised for meat production) were
slaughtered at sixty-two days weighing 1.2 kilograms. Today they are
slaughtered at forty-two days and weigh 1.9 kilograms. According to a
Health24 article written by Birgit Ottermann in March 2011, ‘The birds grow
so rapidly that their hearts and lungs are not developed well enough to
support the remainder of the body, resulting in heart failure and tremendous
death losses. The chickens also become crippled because their legs can’t
support the weight of their bodies. About one-third of them suffer agonising
ammonia burns on their feet as a result of spending their short six-week lives
on faeces-saturated litter.’60

These are all examples of factory farming, where, according to
Compassion in World Farming, only about 3 per cent of laying hens in South
Africa are free-range, around eighteen-million birds are slaughtered for their
meat each week and two-million broilers are slaughtered daily.61
‘Our vision is for farmed animals to be given lives worth living, like the
ability to range freely, to exercise most of their natural behaviours, to be free
of mutilations like de-beaking and tail-docking and castration for pigs, and to
be assured of a humane death,’ explains Van der Merwe.

A point she raises is that organic applies almost exclusively to the fact that
the food fed to the animals is free of pesticide residue and has been grown
without artificial fertilisers and other chemicals, and not to whether the
animal is free-range or factory-farmed. In the same token, a free-range animal
may not necessarily be organic as the food it eats may include artificial
additives.

In terms of South African legislation, Van der Merwe says that the Animal
Protection Act of 1962 is meant to protect all animals against acts of cruelty.

However, in reality, farmed animals are not covered and are subject to gross
brutality and suffering. ‘We need a nation of informed, educated consumers
who know enough to be able to make informed choices.’

What is more is that local legislation, or the lack thereof, makes it difficult
for consumers to identify what is free-range and organic because there are no
real laws covering these issues. According to Health24, at the moment there
are only drafted laws when it comes to governing organic farming and, while
there are local certifying bodies, their regulations are largely based on
European Union requirements.

If you are concerned about the type of meat you are eating, it is important
to first check the practices of the outlets where you buy your meat. The
Supreme Poultry frozen chicken scandal in December 2010, when Rapport
broke the story that employees were repacking old chicken to be sold to
consumers, is a perfect reason to do so. The old chicken had reportedly been
injected with brine and sold with a new expiry date. Check where your meat
comes from and whether your preferred outlets have regulations in place or
sell meat that is organic, free of antibiotics and hormones, free-range and
grass-fed rather than grain-fed. Van der Merwe also suggests trying to source
meat directly from a local farmer who you know treats his or her animals
well.

In terms of nutrition and health, Wolhuter warns that ‘even if food is
certified organic, it doesn’t claim that these products are safer or more
nutritious’. She does, however, cite a 2006 study published in the Journal of
Dairy Science comparing organic and conventional dairy farms. The results
‘showed that milk from organic farms had higher levels of polyunsaturated
fatty acids [the ‘good’ fats] than conventionally produced milk. Other studies
suggest that this may be because organic cows eat more fresh grass and
clover.’

Another point she makes is that organic foods meet the same quality and
safety standards as conventional foods, but the difference lies in how the food
is produced, processed and handled. You may sometimes find that organic
foods look less than perfect compared to conventional foods, but, in most
cases, they look very similar. If you do want to limit your exposure to
pesticides, buying organic can be an option.

A noteworthy problem with organic foods is that they usually cost much
more than conventional food products. Wolhuter explains: ‘Higher prices are
due to more expensive farming practices, tighter government regulations and
lower crop yields. Because organic farmers don’t use herbicides or pesticides,
many management tools that control weeds and pests are labour intensive and
you may end up paying more for these vegetables.’

She recommends buying fresh fruits and vegetables that are in season, to
read food labels carefully and to wash all fruits and vegetables thoroughly. In
terms of meat, she advises buying ‘smaller pieces of organic meats and round
out meals with vegetables and whole grains’.

MEAT WARS

Whether you eat only organic, are a vegan or have never considered such
meaty issues before, it is important to draw your own conclusions and decide
what works for you. There are many local resources, books and dietitians
available to help you figure it out. At the end of the day, you need to structure
your own beliefs and diet in a way that promotes optimal health and that
keeps you fighting fit for either the prevention or treatment of cancer, as well
as a life rich in quality.

MEAT MATTERS and THE SOUTH AFRICAN CONTEXT

MEAT MATTERS and THE SOUTH AFRICAN CONTEXT

While Campbell’s views might be considered quite extreme, South Africa’s
experts paint a more moderate picture. Nicolette Hall explains that South
African consumers are becoming increasingly focused on the quality and
nutritional characteristics of meat and meat products. For this reason, an
ongoing campaign to promote the consumption of South African lamb and
mutton among South African consumers, called Healthy Meat, was launched
in 2008 by Lamb and Mutton South Africa.

Their research shows that modern-day lean red meat contains less than 10
per cent fat per edible portion; can be included as part of a healthy, wellbalanced
diet; and is a significant source of many nutrients essential for health
and well-being, contributing significantly to an individual’s daily nutrient
requirements.

Hall asserts that the link between cancer and red meat is likely to be in
relation to obesity and low physical activity, increased consumption of
refined foods, alcohol and smoking, and a decreased consumption of
vegetables and fruits – in other words, the ‘westernised’ diet. She draws
attention to the fact that a moderate amount of red meat per week (up to 500
g cooked) is recommended by the WCRF, while, as we have already seen, the
South African Food-Based Dietary Guidelines recommends up to 560 g red
and white meat per week.

Johannesburg dietitian Tammy Wolhuter agrees that a westernised diet
can be problematic, explaining that over the past fifty years diet trends have
changed considerably. She says that a western diet is typically high in protein,
containing significant amounts of meat, particularly processed meat and fat,
and is generally low in fibre. ‘Together with other risk factors, this contributes
towards increased risk for cancer.’

She also points out that processed meats (smoked, salted or pickled)
provide carcinogenic nitrosamines and nitrosamides. ‘Cooking meat at high
temperatures, charring meat or smoking meat can cause the formation of
polycyclic aromatic hydrocarbons and heterocyclic amines, which are
carcinogenic. For this reason, it is now advised that people should be aware
of unhealthy cooking methods, avoid processed meats and consume meat in
moderation.’ According to Wolhuter, evidence reveals that one can eat a
maximum of 80 g of red meat daily, which translates to no more than 560 g
per week, without increasing the risk for cancer while still gaining the
nutritional benefits of red meat. She adds that it is also important to eliminate
the fat on meat in order to reduce one’s intake of saturated fat, further
reducing the risk of cancer.

In Red Meat in Nutrition and Health, Hall and co-author Hettie C.
Schönfeldt analyse the role of meat in South African society and look at how
possible health benefits of foods have introduced modern consumers to the
concept of food as medicine. They explain that a ‘double burden of nutritionrelated
diseases is prevalent in many households and communities in South
Africa, as both over- and under-nutrition occur due to rapid urbanisation and
acculturation. Numerous South Africans suffer from the health implications
of inappropriate diets.’56

With 24 per cent of deaths in Sub-Saharan Africa attributed to
noncommunicable diseases, and with obesity considered the most important
nutritional cause of many major non-communicable diseases, the authors
point out that data and recommendations from developed countries on
nutritional guidelines can overshadow what less-adequately fed populations
might need. ‘Red meat, including South African lamb and mutton, is a
valuable source of essential nutrients in the human diet required for optimal
nutrition and health. When trimmed, lean red meat contains less than 10 g fat
per 100 g product and can be included as part of a healthy and balanced
diet.’57

When talking about red meat and cancer specifically, Hall and Schönfeldt
point out that genes, hormones, immune conditions, metabolism mutations
and external factors like tobacco, chemicals, radiation and infectious
organisms all play a role in cancer. ‘Normally various factors act together or
in sequence to initiate or promote carcinogenesis and it should be
remembered that no single study can prove that any single factor is a cause of,
or is protective against, any specific type of cancer.’58

Another point they make is that while the ‘Colorectal Cancer Report
Summary concluded convincing evidence that red meat, processed meat and
ethanol from alcoholic drinks, body fatness and abdominal fatness, are causes
of colorectal cancer,’ the report also ‘recommends that people should
consume less than 500 g cooked meat per week to reduce risk of cancer from
red meat. This amount is in line with the South African Food-Based Dietary
Guidelines and all limited data available indicate that on average the South
African population consumes values well below this amount of red meat.’59
The point is that we should limit our red meat intake rather than eradicating it
completely. Moderation is key.

In a South African context, what Wolhuter and Hall both point to as
crucial is a balanced diet. Hall says that a balanced diet builds on a foundation
of healthy foods from a variety of food groups, including whole grains, fruit,
vegetables, dairy products and lean meats. ‘In order to promote a healthy
cancer-fighting diet, emphasis should be placed on a varied diet rich in
vegetables, fruit and other fibre-rich foods in combination with a moderate
intake of lean red meat. Caution should be placed on other westernised
lifestyle habits such as the consumption of refined sugars, processed foods,
alcohol and smoking.’

Wolhuter says that red meat does provide beneficial micronutrients and is
a good source of protein, which, if eaten in moderation, can contribute to an
improved nutritional status. However, ‘It is important to include a variety of
whole grains, fruits and vegetables in the diet to reap the benefits of the shortchain
fatty acids that these foods provide, which reduce the amount of fat
absorbed in the gut, together with the added benefit of antioxidant intake.’

Antioxidants are also very important when it comes to diet and nutrition.

Wolhuter explains that managing free-radical production that causes
oxidative stress in the body can prevent cancer. Oxidative stress is caused by
an imbalance between the production of free radicals and the body’s ability to
detoxify the damage. Factors that cause oxidative stress include eating large
quantities of food at once, abstaining from exercise, eating trans-fatty acids,
sugar and refined carbohydrates, smoking, drinking more than one alcoholic
drink a day for woman and two alcoholic drinks a day for men, and baking in
the sun. There are several ways to manage oxidative stress, including:

• taking part in regular physical activity (at least thirty to sixty minutes of cardiovascular activity on most days of the week);

• maintaining a healthy body weight; and

• following a diet low in inflammation-inducing molecules (a diet providing plenty of vitamins, minerals, phytonutrients and antioxidants found in fruit and vegetables).

Sources of anti-inflammatory molecules include five to nine servings of fruit
and vegetables each day, omega-3 fatty acids from fatty fish, and plant fibres
found in oats, legumes, fruit and vegetables.

In conclusion, Wolhuter says that nutrition contributes to approximately
35 per cent of causal factors for cancer, meaning that diet can most certainly
make a difference in preventing cancer, as can other lifestyle factors.
‘Nutrition can also improve immunity and thus assist the patient during
cancer treatment. During cancer treatment, diet can assist in preventing
excessive weight loss, help treat diarrhoea and constipation, and assist in
compromised energy levels. Nutrition forms a very important component in
the long-term survival plan for cancer survivors.’

MEAT MATTERS for Cancer

MEAT MATTERS

Although there are contradictory claims and experiences when it comes to
meat consumption – a reminder that each individual is unique and reacts in
their own way to certain foods – The China Study provides some important
insights. As scientists, the authors have dedicated a large portion of their lives
to examining nutrition. They set out to prove the link between diet and
twenty-first century illnesses, such as heart disease, diabetes and cancer, and
put an end to conflicting dietary messages, fad diets and unsubstantiated
claims made by special-interest groups and government entities among others.
Their findings could make you swear off meat for good.

Published in 2004, The China Study presents the results of a twenty-sevenyear
laboratory programme and field research conducted in rural China, and
funded by reputable agencies. The research found that by lowering intake of
animal products like meat, dairy and eggs, one’s health could be significantly
improved. The China Study goes so far as to claim these results ‘prove that
eating right can save your life’.50

Campbell Sr was not always an advocate for a vegan way of life – quite the
opposite in fact. In his early days as a researcher, he worked to promote the
American diet of more meat, milk and eggs for better health. It was during a
project in the Philippines examining malnourished children that he stumbled
onto something shocking. While tasked with investigating why so many of
these children were being diagnosed with liver cancer, ironically, the goal of
his project was to make sure that they were getting as much protein as
possible. Instead, he ‘uncovered a dark secret. Children who ate the highest
protein diets were the ones most likely to get liver cancer.’51

This discovery led him to years of research and investigation into not only
the idea that protein is not healthy, but also that it may cause cancer. In
laboratory tests on rats, he found that low protein diets inhibited the
initiation of cancer by aflatoxin regardless of how much carcinogen was given
to the rats, and that after cancer was initiated, low protein diets dramatically
blocked subsequent cancer growth. Aflatoxin, as described by the Oxford
Dictionary, is ‘any of a class of toxic compounds produced by certain moulds
found in food, which can cause liver damage and cancer’. Campbell writes:
‘In other words, the cancer-producing effects of this highly carcinogenic
chemical were rendered insignificant by a low protein diet. In fact, dietary
protein proved to be so powerful in its effect that we could turn on and turn
off cancer growth simply by changing the level consumed. Furthermore, the
amounts of protein being fed were those that we humans routinely consume.

We didn’t use extraordinary levels, as is so often the case in carcinogen
studies.’52

The research also revealed that casein, which makes up 87 per cent of
cow’s milk protein, promoted all stages of the cancer process. The types of
protein that did not promote cancer, even at high levels of intake, were
proteins from plants, like wheat and soy.

This initial research led to what the New York Times dubbed the ‘Grand
Prix of epidemiology’ – a survey of a vast range of diseases and diet and
lifestyle factors in rural China and Taiwan. The China study revealed over 8
000 statistically significant associations between various dietary factors and
disease.

Based on these findings, The China Study concludes the following:

Synthetic chemicals in the environment and in your food, as problematic
as they may be, are not the main cause of cancer.

The genes that you inherit from your parents are not the most important
factors in determining whether you fall prey to any of the ten leading
causes of death.

The hope that genetic research will eventually lead to drug cures for
diseases ignores more powerful solutions that can be employed today.

Obsessively controlling your intake of any one nutrient, such as
carbohydrates, fats, cholesterol or omega-3 fats, will not result in longterm
health.

Vitamin and nutrient supplements do not give you long-term protection
against disease.

Drugs and surgery do not cure the diseases that kill most Americans.

Your doctor probably does not know what you need to do to be the
healthiest you can be.

Referring to subsequent studies, Campbell writes: ‘These findings show that
heart disease, diabetes and obesity can be reversed by a healthy diet. Other
research shows that various cancers, autoimmune diseases, bone health,
kidney health, vision and brain disorders in old age are convincingly
influenced by diet. Most importantly, the diet that has time and again been
shown to reverse and/or prevent these diseases is the same whole foods, plantbased
diet that I had found to promote optimal health in my laboratory
research in the China study. The findings are consistent.’

Studies on the effect of animal protein on tumour development
particularly interested Campbell. Having grown up on a farm and being
convinced of the benefits of this type of protein, he was flummoxed. Further
research revealed that when a carcinogen entered a cell in the body and was
metabolised by an enzyme, a low protein diet could decrease this enzyme
activity and prevent dangerous carcinogens binding to DNA. He also found
that tumours were reduced by low protein diets in several ways:

less aflatoxin entered the cell;
cells multiplied more slowly;
multiple changes occurred within the enzyme complex to reduce its activity;
the quantity of critical components of the relevant enzymes was reduced;
and
less aflatoxin-DNA adducts (bonds) were formed.

‘Just like seeds in the soil, the initial cancer cells will not grow and multiply
unless the right conditions are met. The seeds in the soil, for example, need a
healthy amount of water, sunlight and other nutrients before they make a full
lawn. If any of these factors are denied or are missing, the seeds will not grow.

If any of these factors are missing after growth starts, the new seedlings will
become dormant, while awaiting further supply of the missing factors. This is
one of the most profound features of promotion. Promotion is reversible
depending on whether the early cancer growth is given the right conditions in
which to grow. This is where dietary factors become so important. These
dietary factors, called promoters, feed cancer growth. Other dietary factors,
called anti-promoters, slow cancer growth.’53

The studies showed that the consumption of animal protein promoted
cancer growth, feeding the illness. More revealing was that when the same
tests were done on plant proteins, they did not promote cancer growth, even
at high levels of consumption. And while the tests were done on rats,
Campbell explains that they are extremely important for humans for four
reasons: ‘First, rats and humans have an almost identical need for protein.
Second, protein operates in humans virtually the same way it does in rats.
Third, the level of protein intake causing tumour growth is the same level that
humans consume. And fourth, in both rodents and humans the initiation
stage is far less important than the promotion stage of cancer. This is because
we are very likely “dosed” with a certain amount of carcinogens in our
everyday lives, but whether they lead to full tumours depends on their
promotion, or lack thereof.’54

At this point, the challenge for Campbell was that even though he had
become convinced that increasing casein intake promoted cancer, he had to
be very careful about over-generalising. His ‘provocative’ studies ‘drew fierce
scepticism’. And then came the China study in the 1980s, when Campbell
travelled to the country to compare cancer rates between the US and China.

The study examined why cancer was so prevalent in some rural Chinese
communities but not others; why the differences were so large; and why,
overall, cancer was less common in China than in the US. By examining
diseases of poverty and affluence, blood cholesterol and disease, blood
cholesterol and diet, fat and breast cancer, fat and cancer in general, the
importance of fibre, antioxidants from plants, popular diets, carbohydrates
and weight, the study found that plant-based diets were linked to lower blood
cholesterol and lower rates of breast cancer while animal-based foods were
linked to higher blood cholesterol and higher rates of breast cancer. It also
found that fibre and antioxidants from plants are linked to a lower risk of
cancers of the digestive tract. Campbell says: ‘Plant-based diets and active
lifestyles result in a healthy weight, yet permit people to become big and
strong. Our study was comprehensive in design and comprehensive in its
findings.’55

The idea that a plant-based diet can not only lower the risk of getting
cancer and other life-threatening diseases, but can also improve illness once it
has already occurred, is worth taking note of. Campbell is adamant that while
the China study does not constitute absolute scientific proof, it does provide
enough information for some practical decision-making.

DOES MEAT MATTER? for Cancer

DOES MEAT MATTER? for Cancer

‘Red meat consumption increases risk of death from heart disease and cancer
up to twenty percent,’ reads the title of an article published in April 2012 on
Natural News.43

I bet you are not shocked. I also bet you will not now rush to your freezer
and throw out that leg of lamb and T-bone steak. Why? Because you have
probably heard it all before. There are simply too many headlines and too
many articles making similar or contradictory claims, begging us to look at
our diets. Today red meat is the problem, tomorrow dairy, and the next day
sugar. We cannot fight this tide of advice, this wave of information. Instead,
we let it wash over us and continue living the way that suits us best.

However, the fact that the ACS recommends limiting consumption of
processed meat and red meat is significant. In 2012 it reported: ‘Studies have
shown that individuals who eat more processed and red meat, potatoes,
refined grains and sugar-sweetened beverages and foods are at a higher risk of
developing or dying from a variety of cancers, and that consuming a diet that
contains a variety of fruits and vegetables, whole grains and fish or poultry
and fewer red and processed meats is associated with lower risk.’44

The question of the effects of the consumption of red meat and meat in
general cannot be overlooked in modern society. According to Natural News,
researchers at the Harvard School of Public Health have cast an alarming light
on red meat. Following a twenty-two-year study of red meat consumption, it
was found that ‘red meat consumption is associated with an increased risk of
total, cardiovascular and cancer mortality and the substituting of other
healthy protein sources, such as fish, poultry, nuts and legumes, was
associated with a lower risk of mortality’. The findings were based on two
studies of over 37 000 men and 83 000 women, all of whom had no signs of
cancer or cardiovascular disease at the beginning of the study. ‘For the
duration of the two studies, a total of 23 962 deaths were recorded with 5 910
from cardiovascular disease and 9 464 from cancer. From the results, regular
consumption of red meats, especially processed meats such as sausage, hot
dogs and luncheon meats was associated with a significant increased
mortality risk. A daily serving of unprocessed red meat (the size of a deck of
cards) was found to increase mortality by 13 per cent. Processed meat
consumption (the equivalent of one hot dog each day) increased death risk
from all causes by 20 per cent.’45 The researchers concluded that choosing
more healthy sources of protein, rather than consuming red meat, would
reduce chronic disease morbidity and mortality, and improve health.

These findings are not new or unusual. In September 2012, The Telegraph
ran a story that claimed halving meat consumption ‘would cut heart disease
and cancer rates’.46 The article was based on research done by Cambridge
University researchers and published in the journal BMJ Open. They
calculated that if men cut their daily intake of red or processed meat from an
average of 91 g to 53 g (the equivalent of a large burger to a small burger), it
would result in a 12 per cent reduction in bowel cancer cases. In addition,
there would be 12 per cent fewer cases of Type 2 diabetes and 10 per cent fewer
of coronary heart disease. They also found that if women ate 30 g of red or
processed meat a day, rather than the average of about 54 g, bowel cancer
cases would drop by nearly 8 per cent.

It is no longer simply about health either, as many are now making
arguments about the link between environmental sustainability, animal
cruelty and diet. Vegetarianism and veganism have become more common
trends, as people shift towards a ‘greener’ lifestyle and diet based on
vegetables, fruits, nuts and grains. Many testify to the benefits of these diets
and their own renewed health and vigour, as well as the fact that they are
contributing to a greener way of life. ‘Organic’, which will be explored later in
this chapter, is now the buzzword in South Africa as people search for cleaner
ways of eating and living in general.

On the other side of the fence, however, are those that argue that red meat
is still a valuable source of protein for the human body. Nicolette Hall, an
associate of the Institute of Food, Nutrition and Well-being at the University
of Pretoria and a research consultant at Lamb and Mutton South Africa, as
well as co-author of the book Red Meat in Nutrition and Health,47 says: ‘A
critical review of thousands of epidemiologic studies found the totality of the
available scientific evidence not supportive of an independent association
between red meat or processed meat and cancer. The link between cancer and
red meat consumption is likely to be in relation with other westernised
lifestyle factors, including obesity and lower physical activity, increased
consumption of refined foods, alcohol and smoking and a decreased
consumption of vegetables and fruits.’

Even the South African Food-Based Dietary Guidelines (FBDGs)
recommends up to 560 g of cooked red and white meat per week (80 g a day).
With other sources arguing that red meat consumption is a huge risk factor
when it comes to disease and illness, it can be a confusing and daunting topic.

The ACS sums it up thus: ‘The scientific study of nutrition and cancer is
highly complex, and many important questions remain unanswered. It is not
presently clear how single nutrients, combinations of nutrients, overnutrition,
and energy imbalance, or the amount and distribution of body fat
at particular stages of life affect a person’s risk of specific cancers. Until more
is known about the specific components of diet that influence cancer risk, the
best advice is to consume a mostly plant-based diet that limits red and
processed meats and emphasizes a variety of vegetables, fruits, and whole
grains. A special emphasis should be placed on controlling total caloric intake
to help achieve and maintain a healthy weight.’48

It is up to each and every one of us to look at the different arguments and
decide what feels right for us. While the information overload can be
overwhelming, it is important to educate ourselves so that we can adjust our
diet according to our own needs and preferences, using the knowledge at hand
to assist and guide us.

GOING RAW, THE RAW COST, and RAW FOOD EATS SICKNESS

GOING RAW

A raw food diet perhaps sounds cleaner and healthier, but how convenient is
it really? Leiman says that for her it was a largely instinctual journey, but at
the moment there is a lot of information out there that can help people make
their own decisions about their diet. ‘I think the best is just to try and
reconnect with one’s instinct and look at food, just allow yourself to look at
what you are eating. When you open a tin, think about what is in that tin.

How can food that has been sitting bottled up in a tin have any presence of life
in it?’ It is because of this that she believes many people are putting substance
and volume into their food, but none of it is providing the body with life
force.

Even for the Kentons, the idea of a high-raw food diet initially sounded
extraordinary – unusual, hard work and extreme. ‘But,’ they explain, ‘what
most people don’t realise is that by eating raw food you gradually come to feel
that the high-raw diet is not just what’s good for you, but what you like best.

Living foods vibrate with a special quality of energy. This energy, when
regularly taken into your body, changes you physically as well as mentally,
bringing you strength, clarity of mind, confidence and a sense of well-being
which makes you want to do what is best for your body.’39

Having coached a variety of people on raw food over the last six years,
Marten says that, while everybody is different, many are embracing the
thought of introducing more raw food into their diets. It can also be quite an
exciting change when it comes to preparing food.

Leiman says that while it does take a bit more time to prepare, it is worth
it. In fact, she argues that besides the food we are exposed to, it is the fast pace
of our lives, overpopulation and the need for convenience that are having an
adverse effect on our health. ‘The focus of life is to look after yourself and to
enjoy your life and make sure you do things in the day for yourself that you
want to do; I don’t know how many people honour that any more. And then
they wonder why they aren’t happy.’

Taking great pleasure in preparing her raw meals, as well as entertaining
others with raw food feasts, Leiman follows a diet that sees her completely full
and nourished throughout the day. She starts her day off with a cup of warm
water with either a slice of lemon or a piece of ginger. Then she makes herself
a green juice (you will find the recipe on page 151), which she says is very
important as it neutralises the acids in the body.

After a morning session of yoga, she has breakfast, which usually consists
of fruit in season and some chia seeds. She also has nut milk made from
almonds, which is very high in protein. She snacks on an apple mid-morning
and then makes a different type of salad for lunch each day. Avocado features
prominently in all of her dishes. In the middle of the afternoon she might
have a bit of seaweed blended with organic brown rice, kelp noodles, spinach
and avocado. For supper she makes sprout or nut patties with a salad and
maybe has a beetroot and carrot juice. She also makes her own chocolates
with raw cacao, honey or organic maple syrup and natural vanilla pod, which
she treats herself to as dessert. ‘If you spent a week with me, you would be full
and good full. When you’re good full, you don’t crave. You only crave
because your body is starving for nutrients and minerals. These are what our
body wants more than anything.’

Leiman works a lot with superfoods, believing in supplementing her body.
Juice cleansing also plays a role in her diet – a process whereby you drink
fresh fruit and vegetable juices throughout the day for one day a week. She is
very strict when it comes to the type of water she drinks, saying that the
chlorine in tap water ‘kills our antibodies and actually disempowers our
immune system’. She only drinks filtered water that she supplements with
mineral salts and trace minerals. ‘I make myself a two-litre bottle and I drink
that and you can feel it. Initially you hardly urinate because your body is
soaking up all of the water because it actually recognises the minerals and
salts.’

In South Africa, she admits, eating out at restaurants can be difficult.
‘There aren’t a lot of raw restaurants yet in this country so eating out has lost
its charm, but I’m fine with that. I prefer entertaining because I put on an
entire spread. For me, to have people over and really put a lot of time into a
beautiful meal where I know that everything that goes into their mouths is
going to do them good, I just find that so much more pleasurable.’

THE RAW COST

Organic and raw, with a couple of superfoods thrown in, can, however, be
intimidating for the average consumer when price is considered. Marten says
that eating in a clean and healthy way can be more expensive, but he has
found that he actually spends less money on food. He also eats less because his
body is getting the minerals it needs, reducing cravings. ‘If you walk into your
average supermarket and you spend R500 in the processed food and the meat
aisles or R500 on packaged and convenience food, you are probably going to
be able to carry that out in a few packets. But if you spend that in the fruit and
vegetable section, you are not going to be able to carry that out. If you actually
look at kilo per kilo the amount of food that you get, if you are buying fresh
fruit and vegetables as your main supply of foods, which we do, it actually
works out a lot cheaper.’ He adds that while superfoods may be quite
expensive, it does balance out. Moreover, it may save you thousands of rands
at the doctor at a later stage. ‘It’s a personal choice in life and everyone has to
decide what is important to him or her,’ he says.

RAW FOOD EATS SICKNESS

Modern diets packed with sugar, laced with preservatives and soaked in transfats
contribute significantly to diseases like cancer. The ACS has stated that
people who eat more processed meats, potatoes, refined grains and sugary
drinks and foods are at a higher risk of developing or dying from a variety of
cancers.

‘I think our modern model of eating has gone really, really horribly
wrong, particularly in the last sixty years, and I think it’s actually got quite a
lot worse quite recently,’ comments Marten, ‘I would personally class
probably a large portion of what people eat everyday as not even being food
any more. If you actually look at the definition of food, it is something that
provides energy and nutrients in various forms – macro and micro – to
sustain the body in an optimal health.’

For Leiman, diet has become completely warped, as has society in
general. ‘How can you give a chicken so many hormones that instead of
taking fourteen weeks to mature, it takes four weeks? The chicken can’t even
stand on its legs any more because of the presence of so many hormones that
are used to develop the breast because it is the most popular part. This is what
they are allowing human beings to do and eat – I think we’ve just totally lost
the plot.’

Having said that, as someone who often tries to guide cancer patients
through a cleaner and raw way of eating while they undergo treatment,
Leiman says she has noticed in the last few years that people are paying a lot
more attention to their diet. ‘People are getting scared because sickness is
going rampant, serious sickness. People are eager, and at the same time also
desperate, to make some changes because they don’t want to get diabetes or
cancer or any of those illnesses.’ She has noticed that people are starting to
realise that what is on the supermarket shelves is just so far from nature.
Adopting a more natural and raw way of life can bring one back to one’s self.

‘There is not a cell in my body that doesn’t believe diet contributes to
cancer. It’s the preservatives, it’s the metals, it’s the poisons, it’s food that is
so refined that there is nothing in it. It creates a tremendous acidic presence in
the human body. When the body creates that kind of acid, it enables the seed
of the disease to get a life,’ Leiman says.

Her view is that cancer already exists in our bodies. If you do not
encourage it by eating food that may trigger the cancer to grow, then there is
nothing for it to feed off. To cancer patients, she recommends a raw diet that
is specific to their type of cancer and their body. She encourages them to
drink a lot of green juice as it neutralises the acidity of the toxins from
chemotherapy. ‘You get so bilious when you are on chemo, and some say you
should eat whatever you like, but I recommend that they rather don’t eat and
if they can get anything in their body, they get green juice into it. And they
can feel the benefits.’

Leiman describes raw food as a blessing to people’s bodies, especially
when they are suffering with illness. ‘Very often, you get very desperate when
you are looking at yourself in the mirror and you are seeing that your days
could be numbered; there’s a mental shift that happens. The instinctual desire
to live becomes very, very strong in most people.’

Living in a way that is happy and wholesome extends to more than just
diet, however. Leiman, for example, makes sure that every single day she
gives herself time to do something purely for herself – be it walking on the
beach, painting a picture or doing some gardening. ‘I don’t know why people
don’t just put some more activities or vacant space in their day for
themselves, I don’t know why they just don’t do it. Who do you need to get
permission from? Don’t let something dictate your life to the point that you
are so wired you can’t even sleep at night. For what?’

UNDERSTANDING RAW FOOD and THE EFFECTS OF RAW FOOD

UNDERSTANDING RAW FOOD

For Barbara Leiman, a raw food chef, astrologist and health counsellor, the
journey to a raw food lifestyle was an instinctual one. ‘I have always been
healthy; in my little head at just five or six years old I had already made the
decision that I wasn’t going to eat any sweets because I had got a toothache.’

The connection between toffee and toothache stuck, and she stayed away
from anything processed or high in sugar. By the time she was in her midtwenties,
Leiman had stopped eating meat and would only eat wholewheat
bread, brown rice and less-refined foods.

‘I came across the more defined concept of raw eating because I was eating
60 per cent raw naturally. It was just getting more in touch with what is
available, which brought that journey into a more wonderful focus of what
foods and superfoods are available. So I went totally raw about five or six
years ago. I don’t eat any meat, dairy or cheese or any flesh at all. For me the
most important thing is that I don’t touch food that is refined or preserved,’
she explains.

This is an experience that many South Africans have shared, evident in
the rising popularity of outlets like Superfoods, which was the first company
in South Africa to import and distribute superfoods and promote raw diets.
Started by Peter and Berryn Daniel in 2006, Superfoods stocks a wide variety
of foods from around the world that enhance the raw food diet, including
Goji berries, raw cacao, maca powder, hemp seed powder, spirulina and
coconut oil. Their motto is ‘Eat as close to nature as possible’. They describe
superfoods as foods ‘that are exceptionally high in vitamins, minerals and
overall nutritional value. Eating superfoods helps to re-mineralise the body,
minimizing the desire for snacking on sugar rich foods, helping the body get
back on track with a healthy lifestyle.’33

As superfoods and raw food diets have become more common in South
Africa, some distributors have started making their own products. One of
these is Earthshine. Based in Cape Town, Earthshine offers raw food classes
as well as products that contribute to a raw way of eating. Noel Marten, who
owns Earthshine with Natalie Reid, says the company came about as a result
of increasing demand. ‘We realised that we could really have some fun with it
and I think we were at an advantage because we were stuck down here in
South Africa with no real influences. You couldn’t just go on a course to learn
how to make raw food so we just started doing our own thing and, as a result
of that, we’ve come up with a style that is potentially quite original,’ he
explains. At first it was just a hobby where they would run some classes in the
evenings, but soon they found that a class once a month turned into a class
three times a week due to growing demand and popularity. Shortly after, a
business plan was formulated and Earthshine was born over six years ago.

A raw food diet, however, was not one that Marten was initially drawn to.

He had explored it but found it too extreme: ‘I perceived vegetarianism and
veganism as sort of a declining extremist view of food right on the end of
extremism and I’m someone in general life who, by nature, is very moderate.

I tend to find that often the middle ground is where the good stuff really
happens, so I kind of ruled raw food out initially on that basis alone.’

Originally from the UK, Marten returned to his home country for a
wedding and was blown away by the raw food feast provided at the reception.

He stayed with his raw foodist friends for ten days following the wedding and
could not believe the breads, cakes, puddings and dishes that were served,
which seemed to be cooked but were in fact raw. They were also simple, quick
and easy. ‘Suddenly it didn’t seem that extreme, but the thing that really
grabbed me was that after eating raw food exclusively for about ten days, I felt
really electric. My energy was up and my mental focus was back. I didn’t
perceive that I had been feeling bad before that, but I felt a whole lot better and
that was something that was quite interesting.’ As someone who had always
had quite low energy levels and had struggled to get up and get going, Marten
says he could not believe how he felt – it was as if he was running on fuel.

When he returned to South Africa, he decided to find out more.

‘I also suddenly made the connection – and I don’t have anything against
vegans or vegetarians and my diet is largely now vegan but I don’t wear the
badge – but for me, vegetarianism and veganism by their nature are defined
by what you can’t do. You don’t eat meat or you don’t eat animal products.

Raw food is an interesting contrast, because it is defined by something that
you do do.’ It was because of this that a raw food way of life seemed more
accessible to Marten than a vegetarian or vegan one. ‘For me that just seemed
like a more realistic way of approaching food because I am a foodie, I love
my food. I look forward to my meal times with great relish. I like preparing
food and eating out, so for me food is where I derive an enormous amount of
pleasure.’

THE EFFECTS OF RAW FOOD

What Leiman and Marten both point out is that they did not feel like they ate
unhealthily or there was anything wrong with their lifestyles before going raw.
Their experiences are echoed in a book by mother and daughter Leslie and
Susannah Kenton. In Raw Energy, the Kentons set out to uncover and present
the facts about uncooked foods based on their own positive experiences. In
the introduction, they write: ‘Our fascination with uncooked foods could
seem very eccentric to anyone who knew nothing about the enormous
quantity of European research into the health-promoting effects that
uncooked foods have on the body or someone who had never experienced the
energising effects of a raw diet.’34

In terms of their experiences, the women write, ‘At first we thought that
the effects of the high-raw food diet were entirely personal – some kind of
genetic penchant we had both inherited from a long line of rabbit-like
ancestors, which made us biologically susceptible to what we had come to call
“the raw food effect”.’35 However, they soon realised their experience was a
shared one.

For Marten, the effect of eating raw food was transformative, even though
he had always tried to buy organic produce and was very aware of what he
ate. ‘I’ve always understood the value of high quality food,’ he explains.
‘When I started eating raw food, I immediately had more energy.’

As someone who had always suffered from Irritable Bowel Syndrome
(IBS), Marten was used to stomach discomfort and pain after a meal.

However, after eating more raw food, he says the symptoms abated quite
drastically, which encouraged him to eat even more raw food. ‘There are
many ways of eating raw food, but we really started putting a lot of mineral
rich food into our diets, a lot of wild foods, things like seaweeds, so quite
quickly I got to a point where I found that I was eating a lot less. I shed a few
kilos and came to a much healthier, more balanced weight, that [I’ve]
maintained over the last five years; I don’t gain or lose weight.’

Leiman, who has not suffered from even a cold in the last twenty-five
years, explains that a raw food diet allows a person’s immune system to be
rebuilt. ‘Preservatives pull the immune system down and refined foods have
not got an awful lot of value in them. I think this precipitates so many large
people because they are totally undernourished and in a constant mode of
craving because their hormones are always unbalanced. What satisfies the
hormones and puts the body in balance is mineral content, the body loves
minerals, it loves live food.’

I n Raw Energy, the Kentons talk about Swiss physician Maximillian
Bircher-Benner, the first doctor to really analyse raw food diets. He believed
that plants contain a special form of energy directly derived from the sun
during photosynthesis. ‘When we eat plants this special energy passes into us.

He sought theoretical support for his theory from physics, in particular from
the Second Law of Thermodynamics.’36 This law looks at how energy is
degraded. Bircher-Benner concluded that ‘since a very high order of the sun’s
energy is converted by plants through photosynthesis and then stored in them,
and since the quality of this energy is degraded by all kinds of physical and
chemical processes such as wilting, cooking or processing, when we eat the
fresh raw plants themselves we receive the very highest order of energy
possible direct from our food’.37

There are varying opinions on the benefits of raw food and the harmful
effects of cooking on the nutritional value of food, with some nutrition
experts claiming that cooking has no real effect and others claiming that it
obliterates all natural vitamins and nutrients in food. Another factor often
considered is the benefit of enzymes in food, which are destroyed in the
cooking process. The Kentons claim that enzymes in raw food have all kinds
of health benefits, including providing protection from dysbacteria, a
debilitating disease caused by antibiotics. Furthermore, many raw foods are
said to contain nitrilosides (vitamin B17), which may have cancer-fighting
properties. ‘[Nitrilosides] were first isolated by Californian physician Ernst T.
Krebs and his biochemist son Ernst T. Krebs Jr. The controversy over whether
or not nitrilosides can be used to treat cancer still rages, with many
biologically oriented physicians claiming that they cause remission and their
more orthodox colleagues dismissing such claims as absurd. Nevertheless it is
a fact that nitrilosides figure heavily in the diets of primitive people who
suffer not at all from cancer or degenerative diseases.’38

The proof, it seems, may be in the pudding. What all these foodies suggest
is that people simply try a raw food diet for a while to experience the effects
for themselves. With South Africa’s raw food industry growing slowly but
steadily, there are a number of restaurants and recipes that you can try to test
the benefits for yourself.

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

CLEAN EATING AND CANCER

CLEAN EATING AND CANCER

According to dietitian Jenny Meyer: ‘Nutrition may modify the
carcinogenesis process at any point and one-third of cancers can be prevented
through dietary changes, therefore it is important that we always make a
conscious effort to eat healthily and make good, high-quality food choices.’

Whether trying to prevent cancer or maintain a healthy diet and lifestyle
during the treatment of cancer, it is important to eat a range of different types
of food to ensure your body gets all of the vitamins, minerals, antioxidants
and phytonutrients it needs to function properly, keep the immune system up
and cope with any side effects.

Side effects of cancer treatment can include weight loss, appetite changes,
nausea, vomiting, diarrhoea, constipation, sore throat, sore mouth,
mucositis, thrush, fatigue, changes in taste and smell, and thickened saliva.
According to Meyer, diets should thus be modified to assist with managing
the relevant side effects.

‘Diet is also important to meet energy needs and requirements to maintain
weight and prevent weight loss and muscle wasting, and to keep strength up,’
she says. It is because of this that cancer patients should try to meet their
protein requirements – which increase during periods of stress and illness – to
repair and rebuild tissues affected by treatment and to ensure adequate
vitamin, mineral and antioxidant intake to maintain a healthy immune
system. Fluid intake is also important to ensure adequate hydration and
electrolyte balance and to prevent dehydration and hypovolemia. Meyer
advises meeting micronutrient requirements, such as antioxidants,
phytonutrients, vitamins and minerals, through food sources rather than
supplements:

• Include a variety of fresh fruits, salads and vegetables by choosing different types and different colours. Aim for five to nine servings per day (where one serving is 1⁄2 cup cooked vegetables, 1 cup raw vegetables or salads, 1 medium fruit or 30 g dried fruit). Include vitamin C-rich fruits and vegetables.
• Include a variety of high-fibre and whole-grain carbohydrates such as oats, mealies/corn, barley, quinoa, millet, rye, and health or seed breads.
• Incorporate legumes (beans, lentils, chickpeas).
• Avoid high-sugar foods and drinks, and adding extra sugar. Keep intake of refined carbohydrates to a minimum. Always give preference to highfibre, whole-grain carbohydrates over the more refined and high-sugar options.
• Give preference to fish, especially omega 3-rich fish such as salmon, pilchards, sardines, mackerel and trout.
• Give preference to skinless chicken (preferably the white meat) over red meat.
• Keep red meat intake down and always choose leaner cuts and trim off all visible fat. Avoid processed meats and meat that has been grilled or charred at very high temperatures, as these contain PAHs and heterocyclic amines, which are carcinogenic enhancers.
• Limit intake of smoked, salted and pickled foods, as they contain the carcinogenic enhancers, nitrosamines and nitrosamides.
• Drink alcohol in moderation by avoiding excessive alcohol consumption or binge-drinking behaviours. Moderation is defined as no more than twodrinks per occasion for men and no more than one drink for women.
• Manage overall energy intake to maintain a healthy weight, as obesity is a risk factor for cancer and overweight and obese cancer survivors are at an increased risk for recurrence and developing problems later on. It is also important to prevent excessive weight loss and muscle wasting, which can also occur.
• Keep fat intake down, especially saturated fat. Incorporate small to moderate amounts of healthier monounsaturated fats such as avocadoes, olives, olive and canola oils and unsalted nuts. Increase intake of foods rich in omega-3 fatty acids.
• Limit salt intake.
• Avoid undesirable behaviours such as smoking.

For cancer patients suffering with nausea, Meyer suggests the following:

• Sip on small amounts of cool liquids or liquids at room temperature.
• Separate liquids from solids.
• Avoid foods with strong flavours or odours.
• Avoid high-fat and greasy foods.
• Avoid very spicy or overly sweet foods; rather stick to bland, soft and easyto-digest foods such as dry crackers.
• Eat smaller, more frequent meals and snacks during the day.
• Drink herbal teas with honey, peppermint and chamomile.
• Ginger can help alleviate nausea.

What is also globally recommended for cancer patients is the adoption of
good food hygiene, especially as white cell counts may be low during
chemotherapy. By following food safety guidelines, like those outlined by the
Queensland Cancer Council,30 you can protect yourself:

• Choose freshly cooked and freshly prepared foods.
• Always thaw frozen food in the fridge or defrost in the microwave.
• Keep raw meat covered, and keep it separate from cooked food or readyto-eat foods.
• Thoroughly wash hands, knives and cutting boards between handling raw food and ready-to-eat foods.
• Keep hot foods hot and cold foods cold.
• Do not purchase pre-made sandwiches or salads, or food from hotboxes or buffets.
• Take care when eating out, as it can be difficult to know whether food safety guidelines are being followed.
• Avoid raw, rare or partially cooked fish, meats, poultry and eggs.

The Cancer Council also stresses the importance of fluids, recommending at
least eight to twelve glasses of fluid per day (this may vary depending on the
type of treatment). Fluids like coffee, tea and soft drinks contain caffeine and
may not contribute to hydration.

While these are all general guidelines that cancer patients can follow,
Meyer says that it is best to individualise a plan, as it will depend on the
person as well as the type of cancer that they are dealing with. ‘The total
energy and macronutrient requirements and the suitability of different types
of food will vary from person to person, depending on the type of cancer,
treatment type, symptoms and side effects, and appetite level. The degree to
which they are able to prepare and pre-prepare their own food and the help
and support systems that are available will also affect their meal choices, as
will the presence of any other underlying illnesses, allergies or medical
conditions,’ she explains.

To make it easier on yourself, Meyer suggests trying to incorporate foods
that you enjoy and taking advantage of the up times by maximising your
intake when you feel better. She also suggests planning in advance and
accepting help from family and friends. ‘Each day may be different in terms
of how you are feeling. You will have good days and bad days, so take each
day as it comes and do the best that you can each day.’

Clean foods are natural foods and often take the form of fresh fruits and vegetables, as well as seeds, nuts and legumes

EATING CLEAN

When I refer to ‘eating clean’, I am talking about eating in a way that lowers
exposure to toxins and increases the amount of ‘good’ food entering your
body. Clean food has a high nutritional value, is low in refined sugars and
trans-fats, and promotes vitality and health in the body. Clean foods are
natural foods and often take the form of fresh fruits and vegetables, as well as
seeds, nuts and legumes. These are ‘natural’ because they come directly from
nature, have had little tampering and thus contain fewer toxins. Less natural
foods are laden with sugar, salt, preservatives and pesticides, as well as
chemicals and toxins that are very bad for our bodies. These ‘unnatural’ foods
are the ones that in all likelihood contribute to illnesses like cancer.

Eating clean thus means putting healthy, nutritional and non-toxic food
into your body, which will in turn create a healthy and more nourished body
that is free of toxins.

Faced with so many choices, it can be challenging to know which options
are the cleanest. Moreover, after a busy day or in the rush of everyday life,
convenience meals often trump cooking from scratch. Because you have not
made the food yourself, you do not know how ‘clean’ it really is.

‘From a food perspective,’ explains dietitian Nathalie Mat, ‘we can
obviously reduce toxins that we are exposed to by choosing foods that are
closest to their natural form.’ She explains that one of the ways in which we
can move towards a cleaner way of eating is to eat organically, as this reduces
our exposure to pesticides, which contain chemicals and toxins. Mat says that
the safety of pesticides is normally tested on animals, where the single
pesticide is the single toxin the test animal receives. Humans, however, are
exposed to many different chemicals in combinations that have never been
tested. ‘So while the total dose of each chemical that we are exposed to may be
below the amount associated with side effects in the single chemical trials, we
have no idea how the vast number of chemicals we are exposed to affect our
health. There is simply no way of knowing whether or not it’s the chemicals
or the change in our modern-day diets or the lack of activity that is to blame
for our increase in disease.’

What Mat has learnt through her experience as a dietitian is that everyone
reacts differently and everyone has a different ability to process toxins. Thus,
her main recommendation for eating in a more ‘clean’ way would be to first
cover the most important behaviours associated with health. These include:
being physically active;
eating at least two to four servings of fruit a day;
eating at least three to five servings of vegetables a day;
avoiding a diet high in processed carbohydrates and animal fats; and
maintaining a healthy weight.

‘Once the aforementioned foundations of health have been implemented,
more attention can be given to the smaller components that may be affecting
one’s health, such as contaminants in the environment.’

There are a few tips that Mat recommends when it comes to avoiding such
contaminants, which she draws from a list released by the American
Environmental Working Group. 29 Known as the ‘dirty dozen and clean
fifteen’, it lists the twelve most contaminated fruits and vegetables, which
have the highest levels of pesticide contamination, and the fifteen fruits and
vegetables least contaminated with pesticides, which do not need to be bought
as organic produce. The dirty dozen are best bought from organic farms to
reduce the levels of pesticides consumed. There is no South African version of
this list, but Mat suggests using a similar logic when it comes to which fruits
and vegetables are best bought organic. ‘Produce with thick skins/rinds which
are normally not consumed, like watermelon or bananas, are less likely to
have the flesh contaminated with pesticides. Salad leaves, fresh herbs and
berries are consumed as they are packed. It is important that these types of
foods are either bought organically or are washed.’

Packaging, Mat explains, can also play a role, as the chemicals that make
plastic soft can act as endocrine disruptors in the body. When in direct
contact with food, these chemicals leach into the food. Because they tend to
leach into fatty foods and are transferred fastest when plastic is heated, one
should avoid heating fatty foods in soft plastic wraps and store high-fat foods
like cheese in containers, rather than wrapping them in cling wrap.

Food additives also need to be considered. ‘Food additives should not
receive a blanket ban as carcinogenic, but careful label reading can help to
reduce the amount of unnecessary chemicals one consumes. Highly processed
foods not only contain more additives, but are also likely to contain less
desirable ingredients, such as refined carbohydrates and trans-fats,’ Mat says.

Food that contains heavy metals like aluminium salts should be avoided, as
well as fish that eat other fish (like shark, sword fish or albacore tuna), as they
accumulate mercury.

While eating in a more natural way by incorporating fresh foods, fruits
and vegetables, as well as sprouts and herbs, may seem logical, unfortunately
many of us have become accustomed to an unhealthy lifestyle. The WHO has
found that more than half of South African women are overweight, which
means that the average woman is eating more than she needs and is
increasing her risk of developing certain cancers. It can also be deduced that
her fruit and vegetable intake is inadequate. ‘Generally South Africans are not
eating or living in a way that is congruent with long-term health,’ says Mat.

But why? Besides the amounts of chemicals, antibiotics, artificial
hormones and heavy metals that have made their way into the food chain,
Mat says that modernisation has introduced many readily available, ‘hyperpalatable’
and highly refined foods into our diets. We tend to eat these in
place of healthier foods. ‘Food is more readily available which makes eating
for reasons other than hunger that much more common too. I think it is a
great contributor to the increase in noncommunicable diseases of lifestyle such
as cancer and the huge increase in the average weight of the population.’

If you want to eat in a cleaner way, Mat suggests a diet high in vegetables
and low in animal products, to lower inflammation in the body. Eating at
least one vegetarian meal a week can reduce your carbon footprint too. Mat
recommends cruciferous vegetables, explaining, that they ‘may play an
important role in cancer prevention. These vegetables contain phytochemicals
known as isothiocyanates. These phytochemicals change the way oestrogen is
metabolised or broken down in the body. This in turn decreases the risk of
hormone or oestrogen-related cancers, such as breast and uterine cancer.

Chopping or chewing cruciferous vegetables results in the formation of these
bioactive products. Eating these vegetables either raw, lightly sautéed or
steamed is best to retain the full array of nutrients. Cruciferous vegetables are
also known as important sources of fibre, vitamins and minerals. Eating a
serving of these vegetables daily (particularly broccoli, kale and Brussels
sprouts) can help lower disease risk.’ The following vegetables are included in
the cruciferous family:

arugula (rocket) bok choy (Chinese cabbage) broccoli
Brussels sprouts cabbage cauliflower
daikon (white radish) kale kohlrabi
mustard greens radish rapini (broccoli rabé)
turnips watercress

While all these suggestions and tips are important, they can be
overwhelming. Start making changes to your diet and eating habits slowly, so
that they might be more sustainable. The most important thing is to first
adopt a clean way of eating that promotes behaviours associated with health.

Once this is achieved, the nittygritty can be tackled.

Understanding cancer in itself, as well as how nutrition affects cancer,
may also help you to gain a clearer understanding of why eating clean can
lead to much better health.

Essential oils that get from fish

Dietary Fat - Questions and Answers ABOUT FOODS AND CANCER PREVENTION AND SURVIVAL

QUESTION: Aren’t there essential oils that you need to get from fish? Can plant sources provide these essential oils?

ANSWER: Two essential fatty acids cannot be synthesized in the body and
must be included in the diet. Their names—linolenic and linoleic acid—will
never show up on a food label and are not important to remember. What
is important is that these basic fats are used to build specialized fats called
omega-3 and omega-6 fatty acids.

Omega-3 and omega-6 fatty acids are important in the normal functioning
of all tissues of the body. Deficiencies are responsible for a host of
symptoms and disorders including abnormalities in the liver and kidneys,
changes in the blood, reduced growth rates, decreased immune function,
and skin changes including dryness and scaliness. Adequate intake of the
essential fatty acids may protect against these health problems and may
also reduce the risk of atherosclerosis, heart disease, stroke, and symptoms
associated with ulcerative colitis, menstrual pain, and joint pain.

Alpha-linolenic acid, the primary omega-3 fatty acid, is found in
many vegetables, beans, and fruits. More concentrated sources include
flaxseeds, soybean products, walnuts, and wheat germ. Adding flaxseed
oil to your salad or grinding flaxseeds for your breakfast cereal are simple
ways to incorporate extra omega-3 fatty acids into your diet. Corn,
safflower, sunflower, and cottonseed oils are generally low in omega-3
and high in omega-6.

Gamma-linolenic acid, a healthful omega-6 oil, can be found in more rare
oils, including black currant, borage, evening primrose, and hempseed oils.

Some people eat fish and use fish oils to obtain their omega-3s.
However, plant-derived omegas-3s have none of the potential contaminants
that fish contain, nor do they have the fish odor that can be apparent in the
perspiration of people using fish oil. They also tend to be lower in saturated
fats. Between 15 and 30 percent of fish oil is saturated fat, which is about
double that of plant oils. Fish make their omega-3 oils from linolenic acid
in plankton, just as mammals—including humans—synthesize omega-3s
from land plants.17,18

Do the phytoestrogens in soy foods prevent cancer? Are they helpful or risky for cancer survivors? What about the estrogens in soy for men and boys?

Soy - Questions and Answers ABOUT FOODS AND CANCER PREVENTION AND SURVIVAL

QUESTION: Do the phytoestrogens in soy foods prevent cancer? Are they helpful or risky for cancer survivors? What about the estrogens in soy for men and boys?

ANSWER: Soy products, such as miso soup, tofu, and tempeh, contain very
weak plant estrogens called phytoestrogens, which block the body’s natural
estrogen from attaching to cells.27 (The prefix “phyto” simply means
“plant.”) Normally, estrogens hook onto tiny receptor proteins on your
cells that allow them to influence the cell’s chemistry.

Think of it this way: An estrogen molecule is like a jumbo jet that
attaches to the Jetway of an airport. It discharges passengers into the terminal,
which is suddenly a busy, noisy place. Phytoestrogens, being weak
estrogens, are like small, private planes with few passengers and no cargo,
yet they still occupy the Jetway after landing. When phytoestrogens occupy
the cellular receptors, normal estrogens cannot. So, while plant estrogens
do not eliminate all of estrogen’s effects, they do minimize them, apparently
reducing breast cancer risk and menstrual symptoms.28,29

Like all foods, soy products have advantages and disadvantages.
Soybeans are rich in essential omega-3 fatty acids, but they tend to be
higher in fat compared to other beans. Many soy products derive roughly
half their calories from fat, while black beans, pinto beans, or other varieties
are only about 4 percent fat. Also, soy extracts, such as genistein, may
not have the same beneficial effects as products made with the whole bean.

In Asia, where tofu, soymilk, and other soy products are commonly
consumed, not only is the population healthier overall, but cancer and
heart disease are much rarer than in North America and Europe and
longevity is greater. However, these populations differ in other ways, aside
from their use of soy products. Asians eat much less meat and dairy products
and generally exercise more compared to Americans; they also smoke
more cigarettes and eat more salt. It has therefore been difficult for
researchers to tease out the effects of soy itself.

Also, it is possible that soy products that go through more processing,
such as veggie burgers, veggie hot dogs, and particularly isolated soy protein
products, are not as beneficial as soy products with less processing,
such as whole soybeans, tofu, and tempeh, which are traditionally consumed
in Asia. Replacing processed soy products with more traditional,
less processed ones, or with other whole beans and lentils, may provide you
with a more health-promoting diet.

In human research studies, soy products have been shown to lower
blood cholesterol levels, in part due to their rich content of soluble fiber,
and their isoflavones also play a role in bone formation. Soy products have
been shown to reduce estrogen activity, at least in premenopausal women,
which, over the long run, reduces cancer risk. The evidence is not as definitive
for postmenopausal women.

Research findings are not clear on whether soy products are safe for
women who have had breast cancer. Some researchers believe that two
servings per day of soy products, such as soymilk, tofu, or tempeh, are fine
for these women, while others discourage soy consumption completely. It is
also not yet clear whether the effects of soy products differ for women with
estrogen receptor-positive breast cancer compared to those with estrogen
receptor-negative cancers.

For men and boys, the phytoestrogens in soy do not appear to have
any adverse effect on hormone levels and have not been shown to affect
sexual development or fertility.30 Research studies show that men consuming
soy have less prostate cancer and better prostate cancer survival.

However, it’s also important to remember that a vegan diet of beans,
vegetables, grains, and fruits does not have to include soy products to be
nutritionally complete. Soy products make convenient alternatives for meat
and other health-damaging foods that people, quite rightly, are looking to
avoid. However, the benefits of complete protein and soluble fiber can easily
be found in an array of plant foods.

Are macrobiotic diets helpful in cancer prevention and survival?

Macrobiotic Diets - Questions and Answers ABOUT FOODS AND CANCER PREVENTION AND SURVIVAL

QUESTION: Are macrobiotic diets helpful in cancer prevention and survival?

ANSWER: The word “macrobiotic” means “long life” and refers to a healthful
lifestyle, diet, and other recommendations related to eating that are
good for overall well-being and thus are also effective in cancer prevention
and survival. Macrobiotic diet guidelines are largely drawn from the principles
of traditional Chinese medicine and emphasize balance, with a
particular focus on grains, vegetables, beans, and bean products. The diet
generally excludes animal products, although some macrobiotic practitioners
include fish. People following macrobiotic diets who wish to include
higher-protein foods while avoiding fish can choose beans or tofu dishes.
Numerous epidemiological studies have shown that a low-fat, plantbased
diet is effective for cancer prevention and survival. There have been
a great many remarkable case reports of individuals whose bleak cancer
prognoses were dramatically improved though macrobiotics.23

How to ensure proper food safety when cooking for someone undergoing chemotherapy

Questions and Answers ABOUT FOODS AND CANCER PREVENTION AND SURVIVAL

QUESTION: How do you ensure proper food safety when cooking for someone undergoing chemotherapy?

ANSWER: A clean and safe food supply is important for everyone, but is
essential for people with compromised immune systems. Older persons and
individuals undergoing cancer treatment are especially at risk from bacteria,
viruses, or other foreign substances that can turn up in food. To keep
your meals safe and clean, follow these simple practices:

■ Wash your hands with soap and hot water before and after preparing
food and before eating.
■ Avoid preparing or eating all types of meat, eggs, and dairy products,
as these foods are commonly contaminated with bacteria. Poultry
products are especially likely to be contaminated. Raw milk and
home-prepared ice creams or mayonnaise, as well as cake and cookie
batter made with eggs, may easily contain infectious bacteria.
■ Keep cold foods cold (below 40 degrees F) and hot foods hot (above
165 degrees F).
■ Wash fruits and vegetables thoroughly under running water before
using them.
■ Wash the tops of cans before opening them.
■ During food preparation, if you need to taste the food you are making,
use a different utensil from the one used for stirring or serving.
■ Do not taste food that looks or smells strange.

evidence linking the consumption of eggs to cancer risk

linking the consumption of eggs to cancer risk  - Questions and Answers ABOUT FOODS AND CANCER PREVENTION AND SURVIVAL

QUESTION: Is there evidence linking the consumption of eggs to cancer risk?

ANSWER: While egg consumption has not been studied as thoroughly as the
consumption of meat and dairy products in relation to cancer risk, there is
still enough evidence to encourage dietary alternatives to both egg whites
and egg yolks. About 70 percent of the calories in eggs are from fat—a big
portion of which is saturated fat. They are also loaded with cholesterol—
about 213 milligrams for an average-sized egg. Eggs have no dietary fiber
and are devoid of cancer-fighting antioxidants.

The most convincing evidence points to egg consumption as increasing
risk for colorectal cancer and bladder cancer. The World Health Organiza -
tion analyzed data from thirty-four countries and determined that egg
consumption was significantly correlated with mortality from colon and
rectal cancers in both men and women.19 A study done in Argentina found
that people who consumed approximately one and a half eggs per week had
nearly five times more colorectal cancer risk than individuals consuming
fewer than eleven eggs per year.20 Moderate egg consumption also tripled
the risk of developing bladder cancer, as determined by a study of 130 newly
diagnosed bladder cancer patients published in the journal International
Urology and Nephrology.21

Eggs are often used in baked products because of their binding and
leavening properties. But smart cooks have found good substitutes.

Is it good to avoid using oils in cooking? And what about nuts?

Dietary Fat - Questions and Answers ABOUT FOODS AND CANCER PREVENTION AND SURVIVAL

QUESTION: Is it good to avoid using oils in cooking? And what about nuts?

ANSWER: By avoiding the use of added oil and minimizing your use of nuts,
you can greatly reduce the fat content of your diet. Although vegetable oils
and nuts generally contain less saturated fatty acids compared with animal
fats (with the exception of coconut and palm oil), when it comes to calories
and possibly even hormone production, total fat is what matters—
regardless of whether it’s a “good” or “bad” fat. There are many ways to
prepare foods without oil, such as using water or vegetable broth for stirfries
and substituting applesauce, banana, or soy yogurt for oil or butter in
baked goods and desserts.15,16

Doesn’t healthful eating cost more?

healthful eating cost  - Questions and Answers ABOUT FOODS AND CANCER PREVENTION AND SURVIVAL

QUESTION: Doesn’t healthful eating cost more?

ANSWER: Surprisingly, choosing health-promoting foods over high-fat and
processed foods is a much more economical way to eat. Below are the costs
comparing a chicken and cheese tortilla to a vegetarian tortilla. As you can
see, the more healthful vegetarian version costs about 40 percent less.

CHICKEN AND CHEESE TORTILLA (SERVES 4)

Nutrition facts: 690 calories, 56 grams protein, 44 grams fat, 17 grams carbohydrate
(per serving)
8 small corn tortillas: $1.29
1 pound Kraft shredded cheddar cheese: $3.29
1 pound chicken breast: $3.48
1 (4-ounce) jar salsa: $1.50
Total cost of chicken and cheese tortilla meal: $9.56 ($2.39 per serving)

VEGETARIAN TORTILLA (SERVES 4)

Nutrition facts: 485 calories, 12 grams protein, 7.6 grams fat, 93 grams carbohydrate
(per serving)
8 small corn tortillas: $1.29
1 pound brown rice: $1.19
1 (15-ounce) can vegetarian refried beans: $0.69
1 (4-ounce) jar salsa: $1.50
1⁄2 head shredded lettuce: $0.99
Total cost of vegetarian tortilla: $5.66 ($1.42 per serving)

Grocery Shopping, Revising Conventional Recipes, Restaurants and Fast Food

Grocery Shopping

What to look for in the grocery store

Shopping for healthful food doesn’t have to be overwhelming if you know
where to look. Use table 19 to help navigate your way to health-promoting
food in the different sections of the grocery store.

Revising Conventional Recipes

Replacing ingredients in conventional recipes

Deciding to choose more healthful foods doesn’t mean you can’t still enjoy
Grandma’s famous cream of mushroom soup. Most recipes can be easily
modified to be health-supporting and still remain delicious. Use the substitutions
in table 20 when you are revising recipes.

Restaurants and Fast Food

More and more of our meals are served at restaurants, and much of what’s
on the menu is far from healthful. But that doesn’t mean you have to forgo
dining out. If you’re a choosy about which restaurants you patronize and
about what you order when you arrive, you’ll still find plenty of great options.

For starters, it helps to think in terms of international foods. Restaurants
that feature the cuisine of other lands often have a broad range of healthful
menu items. For example, at an Italian restaurant you’ll find minestrone,
pasta and bean soup, pasta with marinara sauce, and green vegetables
sautéed with garlic. Chinese and Thai restaurants have plenty of savory
soups as well as vegetable-based main dishes featuring tofu, broccoli, green
beans, spinach, and other nutritious ingredients. You’ll also find a great
many rice and noodle dishes. Ask them to use their more traditional cooking
methods, without the added oil that may Westerners have come to
expect. Japanese restaurants serve miso soup, salads, tofu, and vegetable
sushi, all of which are usually very low in fat and delicately prepared.

Mexican restaurants serve hearty bean burritos, which, if prepared
without lard and not smothered in cheese and sour cream, are usually low
in fat and free of cholesterol. Indian restaurants always feature many delicious
vegetarian choices, from appetizers to desserts. Ask the waiter to skip
the dairy products and to be careful about the overzealous use of oil.

At generic restaurants and American steak houses, you’ll find salad
bars and vegetable plates. More and more fast-food and family-style restaurants
are featuring veggie burgers, salad bars, and baked potato bars.

If you find yourself at a restaurant that does not have any healthsupporting
options on the menu, ask your server if the chef can prepare
a vegetarian meal that does not include dairy products. Common examples
include spaghetti with marinara sauce, a vegetable stir-fry over rice,
or a baked potato with grilled vegetables. Chances are the kitchen has
plenty of ingredients to prepare a wonderful vegan dish. And, since restaurants
want their customers to leave happy, they should be more than
willing to oblige.