A Dietitian's Cancer Story Newsletter: Spring 2005

Spring 2005 Greetings from Diana Dyer, MS, RD, author of A Dietitian's Cancer Story.

On April 8, 1997, The Detroit Free Press published an article in which I was interviewed about the impact of nutrition on cancer recovery. It was the first time I had spoken to a reporter, and I thought it would a little article buried in a big newspaper. In a nutshell, I never could have foreseen the multiple opportunities that would subsequently come my way to help other people with their cancer recovery journey after that article was published.

From that “little article”, I recently had the opportunity to speak at The American Society of Breast Surgeons’ annual meeting in Los Angeles. It was an awesome opportunity (in the true sense of the word) to be able to speak to and potentially influence the practice of 1000+ breast surgeons in this country about the importance of nutrition for their patients.

I recently came across this meaningful quotation:
  No one could make a greater mistake than he who
did nothing because he could do only a little.
• Edmund Burke (1729 - 1797)

We never know how far the ripples of our small actions will spread, but spread they will, just like the ripples that result from throwing a pebble into a lake.

I urge you all to do something “little”, not knowing where it will lead, hoping only that your actions will help someone else with some aspect of their life.

Diana Dyer


Newsletter Contents:

I. Autographed books now available
II. Past newsletters now available
III. Action Alert – legislation needs your support now
IV. Research Update
V. New Books to Suggest
VI. New Clinical Trial for Cancer Survivors
VII. Tidbits of Helpful Information
VIII. Book Ordering Information
IX. Newsletter forwarding guidelines
X. Newsletter sign-up instructions
XI. Newsletter removal Instructions



I. Autographed books now available! Many of you have written to me asking how to obtain a personally autographed book either for yourself or to send to someone you care about. There is now any easy way to do this. By going to the web site for Nicola’s Books in Ann Arbor, Michigan, you may order my book through that web site indicating how you would like the book signed. They will call me, I drive to the store to sign the book as soon as I am available, and they mail the book to the address specified.

I am very pleased to provide this new personalized service. They have already shipped a book to Australia! (Special note: sometimes I am out of town and cannot accommodate rush requests. Please allow at least a week for me to sign the book and Nicola’s Books to ship it out.)


II. All previous newsletters are now archived on my web site. Again, so many of you wrote me asking for access to these older newsletters. They are now all posted up on my web site; just click the Newsletter button on the Homepage to find them. Of special interest, all the information contained in these newsletters is also searchable with the search function available to use on my web site. I have enjoyed re-reading them myself!


III. Action Alert – since I developed this web site in 1998, the most frequently asked question I have received each year has been “Why isn’t nutrition included with my cancer care?” I have responded to this question in the past but have recently updated the answer on my web site to include information about a new bill that has been introduced into Congress this year called The Medical Nutrition Therapy Act of 2005. www.CancerRD.com/faqs/faq74.htm

In a nutshell, this bill would ultimately permit Medical Nutrition Therapy (MNT or professional services of a Registered Dietitian) to be a covered expense by Medicare for disease conditions like cancer when scientific evidence shows the intervention to be both beneficial and cost effective (private insurance companies usually follow Medicare guidelines).

For this bill to be passed (either alone or as an amendment onto another bill), your Senators and Representative in Washington, DC, need to hear from you now so they know this bill is important to patient care, particularly so that nutrition can become a component of comprehensive cancer care for all people diagnosed with cancer.

I have put a copy of the letter I wrote to my Senators and Representative on my web site at www.CancerRD.com/faqs/faq74.htm . Feel free to copy it, inserting your own comments, and send it off by Email or fax to your Senators and Representative.

Most people I meet who have not had personal experience with cancer are astounded to hear that nutrition services from Registered Dietitians is often not included as a component of comprehensive cancer care. Please write or call your Senators and Representative soon. You will be helping yourself and those millions of patients still coming to have better cancer care.


IV. Research Updates – New cancer drug side effects noted

(A) Bisphosphonates linked to osteonecrosis of the jaw.

Although causality has not yet been established, research reports have recently shown an increased incidence of a serious condition known as osteonecrosis of the jaw (ONJ) in some people receiving the bisphosphonate drugs zolendronic acid injection (Zometa) and pamidronate sodium injection (Aredia), both made by Novartis.

Symptoms include the following:

  Pain, swelling, or infection of the gums
Loosening of teeth
Poor healing of the gums
Poor healing after dental procedures
Numbness or the feeling of heaviness in the jaw

The drugs' labels now advise doctors who prescribe these drugs to consider having patients undergo dental evaluation and necessary preventive and noninvasive dental care before they start receiving Zometa or Aredia treatment.

Novartis is recommending that while receiving these drugs, patients should avoid invasive dental procedures if possible. If patients do develop osteonecrosis of the jaw while receiving bisphosphonate therapy, they should avoid dental surgery.

According to the FDA: "If patients on bisphosphonates do require dental procedures, there are no data available on whether stopping the drugs reduces the risk of osteonecrosis of the jaw. The clinical judgment of the physician should guide each patient's management, based on an assessment of benefits and risks."

Take home message: If you are already receiving either of these medications, maintain excellent oral hygiene. If you experience any symptoms or any dental procedures are needed, make sure that your dentist or oral surgeon knows of your increased risk for development of ONJ so that all symptoms and/or risks and benefits of a procedure can be evaluated taking this potentially very serious condition into consideration.

Additional information can be found at the following web sites:

(B) Tamoxifen may show decreased efficacy when prescribed along with SSRI anti-depressant medications such as Paxil in some women

A recent article in the January 2005 issue of The Journal of the National Cancer Institute reported that, depending on their genotype, women receiving tamoxifen may have a decreased level of one of tamoxifen’s most effective metabolites (endoxifen) if also taking an SSRI antidepressant drug.

This research showed two main outcomes: (1) individual genes and variants were identified and demonstrated to have an effect on how tamoxifen is metabolized, and (2) different antidepressant drugs in combination with those various genes result in varying levels of tamoxifen metabolites.

Without genotype analysis for each woman, it is not known if one has the genes that produce the enzymes to promote maximum or reduced response when taking tamoxifen. However the study did show that certain SSRI drugs were more potent at reducing the level of the desired tamoxifen metabolites. The authors point out that the most potent inhibitor of the enzymes that optimize tamoxifen metabolism was paroxetine (Paxil), followed by fluoxetine (Prozac), sertraline (Zoloft), and citalopram (Celexa). Venlafaxine (Effexor) was the least potent inhibitor. In fact, the authors found that venlafaxine had very little effect on plasma endoxifen concentration, the important metabolite of tamoxifen produced by the genes being measured in this study.

The lead author of this study, Dr. David Flockhart at Indiana University in Indianapolis, notes, "Patients should NOT stop taking tamoxifen or their anti-depressant medications, but they might want to talk about the research with their doctor. These data suggest that women taking tamoxifen should avoid potent inhibitors of this enzyme, including paroxetine and fluoxetine."

“Before his group can make wider recommendations regarding genotype analysis or measurement of metabolite levels, they must await results of ongoing studies analyzing mortality outcomes and breast cancer recurrence rates,” Dr. Flockhart added.

Full article citation:
Jin Y, Desta Z, Stearns V, Ward B, et al. CYP2D6 Genotype, Antidepressant Use, and Tamoxifen Metabolism During Adjuvant Breast Cancer Treatment .J Natl Cancer Inst 2005; 97: 30-39.

Additional information:


V. New Books

I have two new books to suggest purchasing. They are both beautiful books with recipes focusing on healthy ingredients to optimize either cancer prevention (The New American Plate) or recovering from a cancer diagnosis (One Bite at a Time). I love them both and am working my way through their delicious recipes.

A. The New American Plate Cookbook: Recipes for a Healthy Weight and a Healthy Life, The American Institute for Cancer Research, University of California Press, 2005.

B. One Bite at a Time: Nourishing Recipes for People with Cancer, Survivors, and their Caregivers, Rebecca Katz, Celestial Arts, Berkeley, CA, 2004.


VI. New Clinical Trial for Cancer Survivors

Calling all long-term survivors of colorectal, prostate, and breast cancers to participate in the RENEW Study (Reach out to Enhance Wellness in Older Survivors)!

What: A diet and exercise program for long-term cancer survivors funded by National Institutes of Health – led by Dr. Wendy Demark-Wahnefried
1. At Duke University, Durham, NC
2. You do not need to have had cancer treatment at Duke
3. You will not need to travel to Duke
4. All materials will be mailed to you
5. Health counseling will be done by telephone

Eligibility requirements:
1. Anyone with a diagnosis of colorectal, prostate, or breast cancer at least five (5) or more years ago.
2. At least age 65
3. Must be overweight

Contact Information:
1. Call Denise Synder at 1-877-239-1054 (toll-free) or,
2. Send Email to RENEW@geri.duke.edu

This will be a popular study. Call soon. The pilot study conducted earlier in the year filled up almost immediately.


VII. Tidbits of helpful information

A. New TV show on Public Television

A new TV series called Zonya’s Health Bites, featuring Zonya Foco, RD, is available nationally on PBS starting in April. In a country plagued with heart disease, cancer and obesity, Zonya offers realistic lifestyle solutions for the whole family. Each show features segments in the grocery store, kitchen and fitness area. Zonya uses her dynamic motivational keynote presentations to begin and end each show, which carry the theme of her health message. By watching Zonya’s Health Bites, you’ll learn quick and easy ways to keep you motivated and on the right track for staying high energy and healthy!

B. New web sites:

1. http://ncilistens.cancer.gov/ - NCI Listens and Learns is a pilot forum for NCI. This pilot program is structured to facilitate dialogue between NCI and two distinct segments of the community: registered cancer advocacy organizations and members of the general public. The pilot forum was designed, and is being overseen, by the NCI's Director's Consumer Liaison Group (DCLG). One area of input being requested is how to prioritize the recommendations of the President’s Cancer Panel issued in 2004. Take a look and send in your ideas.

2. Web site www.plwc.org (ASCO’s People Living With Cancer) The American Society of Clinical Oncology (ASCO) is increasing its focus on cancer survivorship issues with its new Survivorship Task Force, which will manage initiatives designed to improve the lives of cancer survivors from long-term physical, emotional, and practical perspectives.

The ASCO task force will operate in several spheres including education, research, and advocacy. They aim to enhance oncologists’ confidence in their own ability to provide appropriate long-term survivor care by making survivorship a key component in the Society’s updated Core Curriculum for medical oncology.

ASCO will also develop clinical practice guidelines on topics like late effects of cancer treatments, secondary malignancy, and the psychosocial issues of survivorship.

The will start by looking at the most promising prevention strategies among those survivors at high risk of second cancers such as female survivors of Hodgkins’ disease who received radiation therapy to the chest and now have a 35% cumulative incidence of breast cancer 20-25 years after treatment.

C. New restaurant

If you are lucky enough to live in Maine or Massachusetts, give this new restaurant chain a try and let me know how you liked the menu and the food. O’Naturals, now with four locations, was founded by the folks that also started Stonyfield Farm, a producer of organic yogurt. Menu items range from Asian soups to sandwiches with wild Alaskan salmon. It also has a kid’s menu to appeal to the entire family. www.onaturals.com/


VIII - Book Ordering Information

Both editions of A Dietitian's Cancer Story, the updated and revised 2002 edition (ISBN 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.

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 Navarette. 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.


IX – Newsletter forwarding guidelines

This e-mail newsletter may be reproduced, printed, or otherwise redistributed as
long as it is provided in full and without any modification. Requests to do otherwise must be approved in writing by Diana Dyer. Please email that request to Newsletter1@CancerRD.com with “Reprint Request” in the subject line.


X – New subscriptions to this newsletter

You may have received this newsletter because a friend forwarded it to you. To sign up for your own free subscription, please visit my web site at www.CancerRD.com, click on Newsletter and follow the directions.


XI - 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 (changed email address), 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: http://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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