A Dietitian's Cancer Story Newsletter:Spring 2003

Greetings from Diana Dyer, MS, RD, author of A Dietitian's Cancer Story.

The first Sunday in June is National Cancer Survivors' Day.

Hopefully your cancer center is having a celebration for your cancer community's participation. I have regularly attended my local one and also several around the country during these past 8 years since my most recent cancer diagnosis in 1995. I have always been touched by the inspirational people I have met, the new friends I have made, and the joy I have felt, leaving each event quite energized.

Since I think of all of you receiving my Email newsletter as friends, whether I have met you in person or not, I would like share this traditional Irish friendship wish with you:


May there always be work for your hands to do;
May your purse always hold a coin or two;
May the sun always shine on your windowpane;
May a rainbow be certain to follow each rain;
May the hand of a friend always be near you;
May God fill your heart with gladness to cheer you.


Newsletter Contents:
I. Recipes
     (A) Tofu-Avocado Sandwich Filling
     (B) Chocolate-Peanut Butter Tofu Pudding
     (C) Spiced Coffee
II. Web sites of interest
III. ConsumerLab.com - new service
IV. Research Updates
     (A) Benefits of nutrition intervention in patients with
hormone-refractory prostate cancer and non-small cell lung
     (B) Impact of diabetes mellitus on outcomes in patients with
colon cancer
     (C) Lifestyle changes may halt progression of prostate cancer
V. 2003 American Society of Clinical Oncologist (ASCO) Update
VI. Clinical Trials
     (A) The Sister Study (breast cancer)
     (B) Bladder Cancer
VII. Book Ordering Information
VIII. Removal Instructions


I. Three Simple Recipes

(A) Easy Tofu-Avocado Sandwich
I often rummage through my refrigerator to develop new recipes, simply based on what I find in there. Here is a delicious, healthy, quick and easy sandwich filling. Amounts can easily be increased to accommodate the number of sandwiches you would like to make.

2 slices whole grain bread (I love Honey Whole Wheat sold by Great Harvest Bread Co.)
1/4 soft avocado (I buy these every time I go to the grocery so I always have one or two on hand ready to use.)
1/2 cup tofu (I used soft but firm would be ok too.)
dash Tabasco sauce (optional)
~ 1 teaspoon ground flaxseeds dash of herb seasoning (I used Mrs. Dash original)
hummus dark green lettuce (I used fresh spinach leaves)

Spread bread slices with hummus. Using fork, mash tofu and avocado together in a small bowl. Mix in Tabasco sauce if desired. Spread on 1 slice of bread. Sprinkle tofu-avocado mixture with flaxseeds and herb seasoning. Cover with lettuce, and then top with second slice of bread.

Serve with fresh fruit and iced green tea. Some of the filling will likely escape - just scoop it up with a spoon and enjoy. There are many ways to vary this recipe; add onions or tomato slices, use broccoli sprouts, use almond butter instead of hummus. Use your creativity, imagination, and what you have on hand. Enjoy!

(B) Chocolate-Peanut Butter Tofu Pudding
My husband has often called chocolate-peanut butter ice cream *the necessity* :-) This pudding is a delicious and healthy substitute. I modified a recipe by someone named Chris that I found on a recipe exchange web site.

2-12 ounce boxes of silken tofu (I used firm)
3/4 cup cocoa powder
3/4 cup maple syrup (I use the real thing)
1 Tbsp. pure vanilla extract
3-4 Tbsp. smooth peanut butter

Blend all ingredients together in a blender or food processor until smooth. Makes 6-8 servings. Chill. Yum, yum!

(C) Spiced Coffee
I am frequently asked if I ever drink coffee and black teas, or if I always stick to green tea. I do drink green tea every day, but I also love a good cup of full-bodied coffee. I usually reserve my coffee for weekends as a *treat*. Lately I have been experimenting with adding various spices to my coffee for fun and flavor when brewing it at home. I have added 1 scoop (~1 Tbsp.) ground cardamon seeds, cinnamon, or nutmeg to the coffee grounds when brewing 6 cups. In addition, I have added 1-2 scoops of pre-mixed chai to the coffee grounds and then mixed a small amount of unflavored soy milk and just a drop or two of honey with the brewed coffee/chai for a really robust drink that is not too sweet for me like all pre-mixed chai. All the spices in chai (cardamon, cinnamon, ginger, and cloves) have some anti-cancer activity, as does the black tea used in chai. I have bought a chai mix by Choice Organic Teas from Seattle, WA in my local natural food store. It is just teas, spices, and pepper; no sweetener is included.

If there is any left over, I never throw it out but pour it over ice for an afternoon treat that would cost big bucks at your local coffee shop. I do think about which foods and beverages optimize my goal of having everything going in my mouth enhance my efforts to remain cancer-free. However, food is both pleasure and biochemistry, and I enjoy the feeling of *double-dipping* when it serves both purposes. :-)


II. Web sites to browse and bookmark.

Web sites for recipes using dried beans and legumes:
American Dry Bean Board - http://www.americanbean.org/
BeanBible.com - http://www.beanbible.com/index.php
FatFree.com - http://www.fatfree.com/recipes/beans/
Idaho Bean Commission -
Just Crock Pot Recipes -
Michigan Bean Commission -
http://www.michiganbean.org/ (site not accessible on 04/05)
North-Harvest Bean Growers Commission -
Ontario White Bean Producers -
Suite101.com - http://www.suite101.com/welcome.cfm/5164
USA Dry Pea and Lentil Council -

I make sure I eat healthy fiber and folate-containing beans or legumes every day. These web sites will inspire you to do the same. My husband's recipe "Dr. Dick's Mean, Lean Kidney Bean Hash" (http://www.cancerrd.com/Recipes/drdick1.htm) is so good that www.BeanBible.com asked for permission to re-print it on their web site. He was thrilled and talks about working on a recipe for healthy creme brulé.

A new web site called Meatless Monday, http://www.meatlessmonday.com, has many healthy meatless recipes. This site is sponsored by the Johns Hopkins School of Public Health. (Be patient as the home page takes a long time to load.)


III. ConsumerLab.com Update

I get so many questions from my web site viewers about the various dietary supplements they consume. Questions generally revolve
around the two most important questions:
(1) "Is this product safe to take?", and
(2) "Is this product effective to take?"
Both questions then lead to the next most frequent question
(3) "Is this product worth my money?"

Each of those questions is very difficult for me to answer thoroughly for individuals. However, www.ConsumerLab.com has made the first and third questions a little easier for you to answer yourself. They will now be naming and reporting on products that not only pass their tests for purity of contents, but also listing those products that have failed to match contents stated on the label to what is actually in the analysis of these dietary supplements (and why these products failed). That way you will have full information to help you choose a product in a more informative manner. For an annual membership fee of $17.95, you have access to all the information on their web site.

You will still benefit from the the expertise of a Registered Dietitian (RD) at your cancer center to help you sort out which supplements help to answer question #2, i.e., which are effective, meaning which may give you the *most bang for the buck* toward your individual goals, and/ or which may potentially interfer with your type of cancer therapies.


IV. Research Updates

(A) Nutritional intervention improves patient tolerability of chemotherapy and/or radiation therapy by preventing symptomatic bone marrow depression while improving local control of disease and maintaining a patient's performance status during therapy. Abstract No:2868 (presented at the 2002 American Society of Clinical Oncology meeting) Category: Supportive Care Author(s): Kenneth R Hoffman, Totowa, NJ.

Abstract: In 1995, we began a trial where patients being treated for hormone resistant prostate cancer or stage III or IV non-small cell lung cancer receiving chemotherapy and/or radiation therapy would be given preventive nutritional counseling, supplementation and medical management which continued through and three months after treatment completion vs. intervention only if symptomatic during and after therapy. 64 male patients agreed to the study, 36 prostate patients and 28 lung cancer patients. Only patients within five percent of their pre-morbid weight and with an expected life-span of greater than six months were enrolled. Patients were randomized based on their disease, stage, performance status and treatment. Patients were treated through the summer of 2000, and the results analyzed.

When the two groups were compared, the patients who received active nutritional invention throughout their treatment had clinically and statistically significant fewer delays in therapy, were able to receive more dose intense treatment, had fewer hospitalizations for the complications of therapy including the need for transfusions, intravenous hydration, and the treatment of infection and sepsis. Patients with nutritional intervention maintained their weight 38% better than those patients who did not receive early nutritional intervention. Patients'performance status, pain management, and lower family stress levels were better preserved in the intervention group. Local control of tumor was enhanced and survival of Stage III and Stage IV HRPC patients was clinically and statistically significantly improved (at this time an eight month difference). Aggressive nutritional intervention made a clinical difference for the patients and their families.

My comments: This is a small study that has not yet been published in a peer-reviewed journal. However, it presents valuable preliminary information showing that pro-active, individualized, and in-depth nutritional intervention can enhance many important aspects of quality of life and also, in some cases, even help extend life for people diagnosed with cancer. In addition, it is likely that overall costs to the health care system are reduced with nutrition intervention being proactive instead of reactive. Many more studies like this will need to be done in other types of cancer and with larger patient groups, but it is information that can be used as a starting point for patients and health care professionals alike advocating for the inclusion of nutrition services as an expected component of comprehensive cancer care.

(B) Impact of Diabetes Mellitus on Outcomes in Patients With Colon Cancer, Jeffrey A. Meyerhardt, Paul J. Catalano, Daniel G. Haller, Robert J. Mayer, John S. Macdonald, Al B. Benson, III, Charles S. Fuchs Journal of Clinical Oncology, Vol 21, Issue 3 (February), 2003: 433-440. The full abstract is available on-line at: PubMed Conclusion: Patients with diabetes mellitus and high-risk stage II and stage III colon cancer experienced a significantly higher rate of overall mortality and cancer recurrence, even after adjustment for other predictors of colon cancer outcome. These results underscore the need for further research to understand the mechanism that underlies this relation.

My comments: Research has not yet evaluated if proactive, individualized nutrition intervention for patients with colon cancer and diabetes will improve their survival and disease-free intervals. However, that is certainly one aspect of the overall care that should be put to the test to see what interventions will help improve the odds for these people. In the meantime, my recommendation for people with colon cancer and diabetes would be to work closely with the Registered Dietitian at your cancer center as soon as possible after your diagnosis to obtain proactive and individualized help with diabetes control and symptom management during and after cancer therapy. If your cancer center does not have an RD, perhaps the doctor that manages your diabetes can refer you to one, or you may need to find an RD with a private practice in your area by typing in your zip code at the American Dietetic Association's web site (www.eatright.org).

(C) Lifestyle changes may halt progression of prostate cancer (info obtained from www.healthscout.com and www.medscape.com) A new study presented during the Moderated Posted Sessions at the American Urological Association annual meeting in Chicago on April 28, 2003 by Dean Ornish, M.D., President and Director of the Preventive Medicine Research Institute of the University of California, San Francisco, showed that lifestyle changes, including regular exercise, stress management techniques, and a very low-fat vegan (no animal products) diet, may slow, stop, or even reverse the progression of prostate cancer.

The study represents the first randomized, controlled clinical trial of the effect of lifestyle changes on the progression of prostate cancer, as measured by prostate-specific antigen (PSA) levels. 87 men with biopsy-documented early prostate cancer who chose watchful waiting over conventional treatment for reasons unrelated to the study were randomized into either an intervention group or a control group. The men had PSAs ranging from 4 to 10 and Gleason scores under 7.

The intervention group (41 men) included exercising (mostly walking) at least three hours a week for 30 minutes per session; a strict very low-fat vegetarian diet (<15% fat) emphasizing unprocessed whole foods; and stress-management techniques on a daily basis that consisted of meditation, gentle stretching, breathing techniques, guided imagery, and progressive relaxation.

After a year, PSA decreased 4 percent in the experimental group and rose 6 percent in the control group. There was a strong correlation between adherence to the program and changes in PSA across both groups in a dose-response relationship. The top one-third of the most compliant patients had 13% better PSA scores than the lowest third. Adherence to the lifestyle interventions also correlated with inhibition of LNCaP prostate cancer cell growth across both groups by a factor of 7 to 1. LNCaP cell growth was inhibited in 70 percent of patients in the experimental group versus 9 percent in the control group.

Dr. Ornish and his colleagues say their findings are clinically significant because prostate cancer is unlikely to metastasize in patients whose PSA levels are declining. During the study, six patients in the control group underwent conventional therapy for prostate cancer due to rising PSA levels. The UCSF researchers plan to continue to follow all the patients in their study to determine how many undergo conventionl treatment and the rates of metastasis and survival.

My comments: This a very small study that shows men can make and adhere to major lifestyle changes on a long-term basis! (My own sons pointed out to me that the vast majority of my clients were women when I had my private practice.)

Changes in laboratory tests (PSA and LNCaP cell growth) are interesting but the only data that oncologists (and patients) usually want to see are numbers that relate to increasing length of life. Patients also want to know if these major lifestyle changes will increase their odds for long-term survival but, additionally, are very interested in knowing if such changes will improve their quality of life (a worthy goal in its own right). This very interesting study needs to include more men and be carried out for many years along with measuring various parameters of quality of life (sleep, stress, energy level, etc). However, anyone who has read my book, visited my web site, or heard me speak can guess correctly that I would recommend implementing as many of these diet and lifestyle changes as possible right now! :-) Indeed many men with prostate cancer have written to tell me my book has been very helpful motivating and guiding them to a healthier diet and lifestyle.


V. 2003 ASCO Update

People Living With Cancer, the American Society of Clinical Oncology's (ASCO) patient information web site, is sponsoring an Advances in Cancer Research Live Chat: News from ASOC's 2003 Meeting, May 31-June 3 in Chicago. Dr. Frank Haluska, MD, PhD, Director of Melanoma Research at Massachusetts General Hospital, will answer questions about new developments in the treatment of breast, colorectal, lung, and head and neck cancers from information presented at the 2003 ASCO meeting. Date: Thursday, June 5, 2003 from 2:00 - 3:00 PM ET How: Go to the People Living With Cancer web site (www.plwc.org) up to 15 minutes before the scheduled start time, or any time during the chat, and follow instructions on the web site to join in. Pre-registration is not required. Only a username of your choice is required to view or join the chat.

Transcripts of previous live chats are available for viewing on that web site, also.


VI. Clinical Trials of Interest

(A) "The Sister Study" - This is not a nutrition intervention trial for cancer patients, but I still thought many people receiving this Email newsletter would find this trial of interest and wish to be involved.

Funding - National Institute of Environmental Health Science (NIEHS) Investigators - Dale Sandler, PhD (Acting Chief, Epidemiology Branch) and Claire Weinberg, PhD (Chief, Biostatistics Branch)

WHAT - a long-term (10 year), large (50,000 women) national study that will focus on determining risk factors in the cause of breast cancer, including the role that both heredity and environmental factors may play.

WHO - You are eligible to be in the study IF:
* You live in the United States
* You are a woman who has never had breast cancer
* You are currently 35 and 74 years old
* Your sister (living or deceased) was diagnosed with breast cancer.

WHERE - Currently women who live in the following metropolitan areas are being recruited: Phoenix, AZ, Providence, RI, St. Louis, MO, Tampa, FL. The study hopes to be recruiting women in all 50 states by the end of 2003.

BENEFIT - to help scientists learn how to potentially prevent breast cancer.

CONTACT INFO: Additional information and on-line sign up is available at the study's web site (http://www.sisterstudy.org) or you may call toll-free at 1-877-4Sister (1-877-474-7837) for additional information or to sign up.

(B) Bladder cancer clinical trial is comparing two different treatments regimes. The study then splits each of those two groups into two further groups (four groups all together) comparing outcome results when two different vitamin supplementation interventions are also given with the conventional therapies. Detailed information is on my web site, which includes entry criteria and contact information for the doctors and medical centers participating in this important study. Recently NIH and NCI have provided further funding to this study so that all participants have the option of completing detailed diet and lifestyle surveys that will be analyzed to determine if any of these factors play a role in the recurrence of bladder cancer.

Read more about this study on my web site at http://www.cancerrd.com/FAQs/FAQ50.htm.


VII - Book Ordering Information

Both editions of A Dietitian's Cancer Story, the updated and revised 2002 edition published in April 2002 (new ISBN is 096672383X) and the Spanish edition published in 2000 (ISBN 0966723821), can be ordered from any bookstore, library, Amazon.com, and directly from the American Institute for Cancer Research (AICR) by calling 1-800-843-8114 or going to their web site, http://www.aicr.org.

Discounts for orders of 10 or more copies are available for both editions by calling AICR at 1-800-843-8114 - asking to speak to Candis Navarrette. Many cancer centers, health care professional offices, and places of worship have ordered books in larger quantities to have available to give as educational and support information or to resell.

Bookstores and libraries may order directly from the book wholesalers Ingram or Baker & Taylor.


VIII - Removal from future Email updates from Diana Dyer

I know that life changes with time. Thus, if you are not interested in receiving future updates and announcements from me via Email or have other subscription requests, please Email that information to Newsletter1@CancerRD.com.

(Special Note - Please use this Email address only for subscription information. I do not check it regularly, and thus any personal messages to me may not be read or answered in a timely manner.)

For those of you who choose to remain on this list, be assured that I will never share or sell your name or Email address to anyone.

I send my best wishes to all of you for health, healing, and hope!

Diana Grant Dyer, MS, RD - Author
A Dietitian's Cancer Story (English and Spanish translation)
Available from AICR (call 1-800-843-8114)
My Website: www.CancerRD.com

"Information and inspiration for cancer survivors"

Proceeds donated to the Diana Dyer Cancer Survivors'
Nutrition and Cancer Research Endowment at the
American Institute for Cancer Research (AICR).


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