A Dietitian's Cancer Story Newsletter: Summer 2003

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

Question - "Diana, do you have a favorite cookbook?"

Answer - This is a very common question that I receive from cancer survivors and others simply interested in a anti-cancer cookbook to use. In fact, much to my surprise, the most frequently used search word that people use to find my web site is *recipe*.

I use a wide selection of cookbooks that I have been collecting for years. They are all vegetarian or *plant-based* cookbooks. I list some on my web site's page of suggested books (http://www.cancerrd.com/booksug.htm) and many in the resource section of my book. Most get regular use; some have fallen apart with use!

The book Diet for a Small Planet by Frances Moore Lappé ©1971, did nothing less than change my life when I found it in 1975 browsing the library stacks while taking a study break. In fact, finally getting my second copy of it autographed by the author last year was a life highlight for me (my first copy literally fell apart). I still use several recipes from that book and always get asked for my Tabouli recipe when I take it to a potluck (http://www.cancerrd.com/Recipes/tabouli1.htm), which is based on the recipe from this book.

I have used and loved many cookbooks in the meantime but have recently become a fan of cookbooks by Lorna Sass, in particular her Recipes from an Ecological Kitchen, William Morrow & Co., ©1992, Unfortunately, this book is out of print but my husband recently found a used copy for me. I knew I would love this cookbook when I read its dedication, which is very simply dedicated to Mother Earth. In addition, the author's first paragraph states "When I changed my diet a number of years ago, I discovered a beautiful symmetry: What is good for our health is also good for the health of our planet."

Diet for a Small Planet was my first introduction to thought and opinion that eating a vegetarian diet was healthful both for our body and our planet. It made sense to me as a biologist turned nutritionist. A long time ago now, I had first wanted to be an environmental biologist but followed the advice I received (yikes - can't be 30+ years ago!) to be *practical* and enter a profession that would have defined jobs and career-paths, leading me to a career as a Registered Dietitian (RD). My BS in Biology was considered unconventional as a platform for a career as an RD way back then (maybe even now) but I know it has given me many different perspectives, which have been valuable, and many of my colleagues have found helpful and even interesting. :-)

Recipes from an Ecological Kitchen includes frequent *eco-tips* and quotations by cookbook authors, organic food growers, philosophers, and spiritual leaders that remind us of the vital connections between the earth, food, eating, and life. One example: ....Food reveals our connection with the earth. Each bite contains the life of the sun and the earth. The extent to which our food reveals itself depends on us. We can see and taste the whole universe in the piece of bread! -- Thich N'hat Hanh, Peace is Every Step (New York: Bantam, 1991)

This book is good for my body and soul. It has made me realize that even as an RD, I have come full circle to my original goal. I have always been an environmental biologist, using a plant-based diet to optimize my personal internal environmental biochemistry along with my food choices optimizing the health of our planet. Thus, I urge you to try to find this book at a used book store or check it out at your local library. I don't feel that I could improve it in any way.

As a final note, when I first made Tabouli back in the mid-70's, not only had I never eaten it, I had never heard of it. I can still remember that night like it was yesterday. My husband and I ate the entire recipe - enough for 6 - it was that good! The experience on that evening was a *defining moment* for me; it opened my eyes by making me both aware of and wonder what other wonderful experiences I had been missing in life simply because I had not yet been exposed to them. Be adventurous - try something new. Not only might it be good for you, better yet, you might actually enjoy it! Life doesn't get any better than that :-)

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Newsletter Contents:

I. Recipe and Food Info
      (A) No-Guilt Potato Salad
      (B) Books
      (C) Food and Recipe websites
II. Newsletters and magazines of interest
III. Coral Calcium
IV. Dietary Supplements and Cancer - moving beyond "Buyer Beware"
V. Research Updates
      (A) How natural are 'natural herbal remedies'?
      (B) Associations of Energy, Fat, Calcium, and Vitamin D with Prostate Cancer Risk.
      (C) Long-term survival rates of cancer patients achieved by the end of the 20th
            century: a period analysis.
      (D) Flaxseed enhances the inhibitory effect of tamoxifen on the growth of estrogen
            receptor positive human breast cancer.
VI. Cancer Legislation
VII. Book Ordering Information
VIII. Removal Instructions

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I. Recipe and Food Info:
(A) No Guilt Potato Salad

My husband's potato salad has always reigned supreme in our family. This recipe has him worried about his ranking :-) I modified this recipe from one developed by the California Avocado Commission simply to fit ingredients that I had in the house. It is delicious, healthy, and perfect to take to a summer picnic or potluck all year long. Enjoy!

8 medium Yukon Gold potatoes, unpeeled and cut into 1 inch cubes
3 avocados, peeled, pitted and cubed (it helps to plan ahead for this recipe, buying the avocados a few days in advance so they are soft but not mushy)
2-3 Tbsp. fresh lime juice (I get ~2 Tbsp. per lime by hand squeezing them)
1/2 cup diced sweet onion
1/2 red sweet pepper, diced into small pieces that will still show up nicely for color
1/4 - 1/2 cup cup fresh cilantro/parsley leaves, chopped (cilantro is strongly flavored - I used ~2 Tbsp. cilantro, often called flat-leaf parsley, and the remainder as curly parsley so the cilantro flavor did not overpower the senses)

For Dressing:
1/4 cup fresh lime juice (2 limes)
2 cloves crushed fresh garlic
2 Tbsp. Dijon mustard
2 teaspoons sugar
1/2 teaspoon salt
1/2 teaspoon ground black pepper
1 Tbsp. olive oil
1/2 cup plain unflavored yogurt (I use Stoneyfield Farms)

1. Boil the diced potatoes in a large pot until just tender (about 10-15 minutes - keep trying one to not overcook)
2. White potatoes are boiling, cube the avocados and toss with the lime juice, setting aside.
3. Drain the potatoes and cool by placing in a bowl of cold water. Then drain very well and place into a large salad bowl.
4. To make dressing: Put all ingredients except yogurt into a blender or food processor. Blend thoroughly so garlic is finely diced. Gently mix in yogurt, either on low-speed or by hand. Taste. You may prefer to add more seasonings like salt, pepper, or sugar.
5. Pour dressing over potatoes and toss completely.
6. Carefully add cilantro/parley, avocados, onions, and peppers and gently toss. Great at room temperature or chilled.
Makes 8-10 cups of salad. Cut the recipe in half if you don't need this much.

If there is any left-over, be sure to chill and enjoy as a midnight snack. Or mix it with a bit of left-over salmon or tuna and then roll up in a wrap sandwich the next day. Yum, yum! Be sure to check out http://www.avocado.org for lots more healthy recipe using avocados.

(B) Books:

* This Can't Be Tofu! by Deborah Madison, Broadway Books ©2000 - my most recent acquisition that I am enjoying. Pick it up at your local bookstore, preferably an *indie* (i.e. your local independent bookstore).
* Recipes from an Ecological Kitchen by Lorna Sass, William Morrow & Co., ©1992 - out of print but worth checking on Amazon.com, used book stores, and also your local library. * Simply Soy Cookbook - organized both by soy food and recipe type - no longer available in print but all recipes are on the Internet at http://www.soyfoods.com/SimplySoy/

(C) Food and Recipe websites:

* http://www.avocado.org - great avocado recipes
* http://www.stonyfield.com (also free E-coupons for their organic yogurt products that are found in most regular grocery stores)
* http://www.soyohio.org - recipes for using various soy products
* http://www.fatfree.com/ - all kinds of interesting and basic recipes with no or very low fat - I am going to try the sweet potato pizza recipe!

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II. Email Newsletters and magazines of interest to cancer survivors (not an exclusive list - I am sure there are many more out there - but these are a few that I receive and like to read. Sign-up info will be on the web sites.)

* http://www.HealthJourneys.com - by Belleruth Naparstek - goddess of creative imagery for health and healing - includes research updates, information about her workshops, and healing tapes/CDs.

* http://www.CancerWise.org - CancerWise Consumer, the monthly e-mail alert from The University of Texas M. D. Anderson Cancer Center highlighting the latest cancer news and information.

* http://www.CancerPage.com - cancer news updates and "Ask an RN".

* http://www.CancerFit.com - research updates about the benefits of exercise during cancer treatment and recovery.

* http://www.CureToday.com - CURE Magazine (Cancer Updates Research and Education) - free print magazine to cancer survivors and caregivers, also available to read on-line. Terrific medical illustrations.

* http://www.plwc.org - People Living With Cancer - this web site will be sponsoring a live chat on Nutrition - Before, During, and After Cancer Treatment on August 13, 2003, from 2-3 pm Eastern time with David Alberts, MD and Cynthia Thomson, PhD, RD from the University of Arizona.

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III. Coral Calcium

I have lost count of the number of people who have sent me Email asking if Coral Calcium was really the cure for cancer. My answer has always been a short one: "No."

With no research to back up that amazing claim (and others), action has finally been taken against this product's main promoters. In June 2003, ConsumerLab.com found low levels of lead in Bob Barefoot's Coral Calcium Supreme, levels above which California requires a warning label that was not provided by this product. The Federal Trade Commission (http://www.ftc.gov/opa/2003/06/trudeau.htm) charged the marketers of the same dietary supplement with making false and unsubstantiated claims about the product's health benefits. Even the dietary supplement industry (http://www.crnusa.org/shellnr051603.html) had called for crackdown on the claims and sales of coral calcium. Quackwatch.com (http://www.quackwatch.org/01QuackeryRelatedTopics/DSH/coral.html) has summarized all of the related information about this waste of money and hope. Finally, Nutrition News Focus (http://www.nutritionnewsfocus.com) says that Coral Calcium's only real claim is that it is certainly the world's most expensive calcium supplement.

Has my answer to this question changed? In a word, "No! Don't waste your money and hope for a cancer cure on this product."

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IV. Dietary Supplements and Cancer or how to move beyond "Buyer Beware"

Having just highlighted the truth behind coral calcium, a very common question I receive is "Where can I find reliable free information on the Internet to help me sort out various claims about the purported benefits of various herbs and other dietary supplements on cancer?" One free source with reliable information that is updated often is from Memorial Sloan Kettering Cancer Center in New York City (http://www.mskcc.org/mskcc/html/11570.cfm). Information on their "AboutHerbs" web site is presented in two formats: one for consumers and one for health care professionals, with both being freely accessible. Topics covered in the more extensive monograph for each herb, vitamin, or other substance like shark cartilage include: Clinical summary, Also known as, Food sources, Purported uses, Mechanism of action, Pharmacokinetics, Warnings, Adverse reactions, Drug interactions, Literature summary and critique, and References cited.

The next time someone tells you about a dietary supplement that sounds *too good to be true*, check it out on this web site before spending your hard earned money and, even more importantly, your trust and hope. Make yourself into an informed, even savvy, consumer with this evidence-based information to guide you.

I have previously highlighted the web site http://www.ConsumerLab.com, which tests specific dietary supplements at one point in time for contents and contaminants. In addition, you may view products certified by NSF International (http://www.nsf.org/Certified/Dietary/) that NSFhas tested multiple times and Certified that they contain the identity and quantity of dietary ingredients declared on the product label and do not contain unacceptable quantities of unwanted contaminants.

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V. Research Updates:

(A) How natural are 'natural herbal remedies'? A Saudi perspective. Adverse Drug React Toxicol Rev 2002;21(4):219-29 Bogusz MJ, al Tufail M, Hassan H. Study results online at PubMed

RESULTS: 39 samples contained high concentrations of heavy metals. This was particularly striking in remedies used to treat leukemia (arsenic content of 522-161,600 ppm). Eight preparations contained synthetic drugs (e.g. benzodiazepines and tricyclic antidepressants in sedative preparations, cyproheptadine in a remedy to gain bodyweight, ibuprofen and dipyrone in herbal capsules used to treat rheumatism). 18 samples were contaminated with micro-organisms. 14 samples contained toxic substances of natural origin. Of the 247 examined preparations, 77 (i.e. over 30%) were disqualified due to high heavy metals content, bacterial contamination or presence of toxic organic substances.

This study is alarming to me because of the high frequency of contamination of these products or remedies, many of which are used to treat cancer. Think that can't happen here? Not true. There are no government regulations currently in place (Good Manufacturing Practices) to prevent the sale of adulterated and/or contaminated dietary supplements. Again, it's "buyer beware" unless you have tools to move beyond that (see above articles).

If you are a cancer patient and considering taking dietary supplements during or after your treatments, I strongly urge you to discuss any potential supplements with your Oncologist, Registered Dietitian, or Pharmacist for help evaluating the latest research regarding safety and benefit in your unique situation of type and stage of cancer, treatments, and full medical history. At the very least, everything you are consuming should be noted in your medical record so the right hand knows what the left hand is doing in regards to potential adverse reactions and also potential benefit.

(B) Associations of Energy, Fat, Calcium, and Vitamin D with Prostate Cancer Risk Cancer Epidemiol Biomarkers Prev. 2002 Aug;11(8):719-725, Kristal AR, Cohen JH, Qu P, Stanford JL, Study results online at PubMed

This population-based, case-control study in King County,Washington examined associations of energy, fat, vitamin D, and calcium with risk of prostate cancer in 605 incident cases (ages 40-64 years) identified from the Seattle-Puget Sound Surveillance Epidemiology and End Results registry and 592 controls. Self-administered food frequency questionnaires were used to assess diet over the 3-5-year period before diagnosis or interview date. The results suggest that high energy (caloric) intake is a risk factor for both localized and nonlocalized prostate cancer, whereas dietary fat (total, saturated and monounsaturated fats) and calcium increase the risk of regional/distant disease only.

This is preliminary observational research, and no study has yet evaluated if an intervention, i.e., changing the diet after a prostate cancer diagnosis, will help decrease the spread of early stage prostate cancer (from local to metastatic), but if you or a loved one has a prostate cancer diagnosis, I strongly suggest insisting on a consultation with the Registered Dietitian (RD) at your cancer treatment facility now (not waiting for more research that might take years to do and publish) to evaluate your diet's intake of calcium, fats intake, and calories. See the two FAQ's on my web site for further information on diet and prostate cancer.
(http://www.CancerRD.com/FAQs/FAQ21.htm and
http://www.CancerRD.com/FAQs/FAQ45.htm)

(Don't have a Registered Dietitian at your cancer treatment facility? You're not alone. See information below in section VI. on Legislation.)

(C) Long-term survival rates of cancer patients achieved by the end of the 20th century: a period analysis. Lancet. 2002 Oct 12;360(9340):1131-5. Brenner H. Study results online at PubMed.

Using a different way of analyzing cancer survival data, this author has determined that current long-term cancer survival rates are significantly higher than have been reported in the past, which he attributes primarily due to earlier detection and improved treatments. He shows some truly hopeful data with near 90% 20-year survival rates for testicular and thyroid cancer, but the over-all 20-year survival rate for cancer in general is only 51%.

It is clear from these data that cancer is not the automatic death sentence that the general public previously believed. I do believe in the power of beliefs, and as a patient, I would want to believe that I had a chance to be in that majority of 51% vs. the 49% for long-term survival. However, a 20 year survival rate of only ~50% is way too low.

Much more research needs to be done combining nutritional aspects with cancer therapies to see if these outcomes can be improved even more. As an example, read the following animal study.

(D) Flaxseed enhances the inhibitory effect of tamoxifen on the growth of estrogen receptor positive human breast cancer. Proceedings of the AACR, Volume 44, 2nd ed., July 2003. Jianmin Chen, Evon Hui, Lilian U. Thompson. Department of Nutritional Sciences, University of Toronto, Toronto, ON, Canada. http://aacr03.agora.com/planner/displayabstract.asp?presentationid=624 (site not accessible on 04/05).

In a nutshell, this yet unpublished research (so far only presented at the July 2003 AACR meeting just held in Washington, DC) showed that giving a dietary source of flaxseed with the anti-estrogen drug Tamoxifen to mice injected with estrogen-receptor positive breast cancer cells resulted in enhanced anti-cancer activity of the drug Tamoxifen in simulated pre- and post-menopausal situations.

Of additional interest, although this is a small and preliminary study that needs repeating, it is notable that at the end of this 6-week study, the low-estrogen group of mice given flaxseed without tamoxifen had a better rate of tumor regression than those given tamoxifen alone or those given tamoxifen + flaxseed. More of this type of research is urgently needed along with expanding this important animal research (critical for testing both safety and benefit) to humans. Enhancing current conventional therapies by modification of diet is potentially a safe, non-toxic, and low-cost way of improving those long-term cancer survival odds to be even better!

Patient advocates need to be pushing for greatly increased funding for this type of research. Who are advocates? We all are. Who do we push? Our Congress, the National Cancer Institute, the dietary supplement industry, all private granting organizations like the American Institute for Cancer Research, the Komen Foundation, for just a few examples of the multiple organizations out there that fund research.

In addition, let your voice be heard at the National Coalition of Cancer Survivors (NCCS). Ask them to advocate for this important research, too. They have a great new web site at http://www.CancerAdvocacy.org. Check it out.

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VI. Cancer Legislation

Advocacy must first begin on a personal level, extend to a local level, and then finally reach the larger national or global level. High school government and civics class is a long time ago for most of us, and many of us are not sure how we could really make a difference on a national level. In addition, I know that many of my readers are still in a stage of needing to concentrate on self-advocacy. However, I have recently begun thinking about what can be done at a national level to help effect change for the many many many people who have contacted me to express (1) their gratitude for the information on my web site along with their concurrent (2) frustration that there is no Registered Dietitian at their own cancer treatment facility.

I have recently added to my web site (Link to my new FAQ on Legislation here) a summary of my thoughts and a beginning action plan to address this gap whereby too many cancer treatment centers do not have Registered Dietitians (RD) on staff, or where the RDs are woefully understaffed and cannot begin to have the time to give people the pro-active, individualized, and in-depth nutrition information patients both need and desire during cancer treatment and recovery. You may read my answer and think "This is a beginning action plan???" Yes, it is. I could have written much more about additional strategies that will also need to be part of this effort to ensure that cancer patients ultimately receive the nutritional care they need as a component of true comprehensive cancer care.

I do urge you to read the legislative information on my web site. Briefly, legislation is currently pending before Congress that would help to improve the care of cancer patients by requiring that nutritional counseling be a covered expense in facilities that provide cancer therapy to Medicare patients.

The Senate and House Medicare reform bills currently being debated in Congress have some serious flaws regarding the reimbursement of chemotherapy for community-based oncologists. Thus another bill is also already working its way through both the House and Senate to "reform this reform" if an acceptable compromise for the original Medicare reform bill cannot be obtained.

This new bill is called The Quality Cancer Care Preservation Act, also known as HR 1622 in the House and S 1303 in the Senate. In addition to seeking a fair and balanced reform of reimbursement of chemotherapy administration, this bill also requires payment of chemotherapy support services, which includes nutritional counseling!

I support The Quality Cancer Care Preservation Act and urge you to do the same.

Recommended Action Plan:
1.) Contact your Senators and your Representative expressing your support of these bills. (HR 1622 and S 1303 are identical) and urge them to co-sponsor this legislation. Find their names and link to their web sites at:
* http://www.house.gov
* http://www.senate.gov
Contact info will be on their individual web sites: Phone, Email, or Fax is preferred.

2.) View the web site where all the current cancer legislation before Congress can be found (http://thomas.loc.gov/). Just type in the word cancer and 50 bills will currently come up (some are identical bills before the House or Senate). You may see additional legislation for a special concern of yours such as colon cancer, pancreatic cancer, cervical cancer, breast cancer, to name a few, that would benefit from your advocacy efforts.

These two quotes have been inspirational to me for a long time. I hope they will be meaningful to you as you decide when and where you are ready to put your advocacy efforts.

"If it is to be, it is up to me."
* Author unknown

"Never doubt that a small, group of thoughtful, committed citizens can change the world. Indeed, it is the only thing that ever has."
* Margaret Mead

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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 Angela Logan. Many cancer centers, support groups, health care professional offices, and places of worship have ordered books in larger quantities to have available to give as as educational and support information or to resell.

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

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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 Newsletter@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
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Diana Grant Dyer, MS, RD - Author
A Dietitian's Cancer Story (English and Spanish editions)
Available from AICR (1-800-843-8114)
Web site: 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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