A Dietitian's Cancer Story Newsletter: Winter 2006
Winter 2006 Greetings from Diana Dyer, MS, RD, author of A Dietitian's Cancer Story
I want to extend greetings and best wishes to my readers for the upcoming year.
During the last several weeks in December, I had been thinking about including the Quaker saying “Let your life speak” within my first greeting of the year, not really knowing how I would use it. However, an event occurred shortly after the new year began, which not only brought life and deeper understanding to this expression, but also brought this expression *home*.
Jill Carroll, the 28-year old journalist kidnapped in Iraq on January 7, 2006, grew up in the neighborhood where I live. Jill’s respected reporting has been her voice as she has let her life speak from Iraq. She has my deepest respect and admiration for the character and courage she has to be this voice while seeking both information and truth. (As of the date I am writing this, there has been no resolution to her kidnapping. I hope you will join me in saying a prayer or sending a care to the universe for her immediate and safe release, along with a prayer for all others being held hostage.)
Jill’s compassion for suffering, willingness to take on personal risk while learning something new, her quest for truth and courage to share her observations with the world will long be a role model for me.
No matter where you are on your cancer journey, I send my best wishes to you for health, healing, and hope, with an additional hope that you will find one aspect of your life that can “speak” as 2006 unfolds for you.
Diana Dyer, MS, RD
I. Survivorship Info
I. Survivorship Info
I have written in past newsletters and on my website about the importance of the pending legislation called The Medical Nutrition Therapy Act of 2005 (Senate Bill 604 and House Bill 1582), which has bipartisan support in both chambers of Congress. (http://cancerrd.com/faqs/faq74.htm) However, this bill was not moved out of committees to be voted on last year, and will need to be re-introduced in this new legislative year.
I will be attending the Public Policy Workshop in Washington, DC in mid-March 2006 that is sponsored by The American Dietetic Association (ADA) as a representative from the Oncology Nutrition Dietetic Practice Group of ADA. I will be learning about ADA’s priority nutrition issues and the development and implementation of public policy. My objective will be to bring to the attention of our lawmakers (from the viewpoints of both Registered Dietitians and cancer survivors) the need for inclusion of proactive and individualized medical nutrition therapy into true comprehensive cancer care.
Many of you have already sent me a short comment describing a situation in which professional services from an RD helped with the outcome of your cancer treatment (or that of a family member), recovery, or how you believe such professional expertise would have been of benefit if received after a cancer diagnosis.
I am still gathering comments such as these. If you would like to share your experience with me, I will have more information to convey to our senators and representatives. Please send me a short email message at newsletter2@CancerRD.com with “MNT in Cancer Centers” in the subject line. Thanks for your help.
II. New Clinical Trials for Cancer Survivors
A. MEAL Study (Men’s Eating and Living Study)
The MEAL Study is investigating whether an innovative telephone-counseling program can help men with localized, low-risk prostate cancer adopt a cancer-preventive diet. The MEAL Study is currently enrolling men 50-80 years of age who have been diagnosed with prostate cancer within the previous 48 months; who have completed initial treatment or have elected active surveillance or watchful waiting; and who are without a medical condition that would prevent adopting a high-fiber diet.
This study is recruiting subjects in the following locations:
For more information, please send an email message to firstname.lastname@example.org or visit their web site at http://www.healthyeating.ucsd.edu/pages/mealStudy.htm .
B. American Ginseng for Cancer-Related Fatigue
Researchers want to enroll 280 patients aged 18 & over diagnosed with cancer who are experiencing cancer-related fatigue.
See the list of eligibility criteria at http://cancer.gov/clinicaltrials/NCCTG-N03CA
C. Randomized Pilot Study of Low-Residue Diet for the Treatment of Diarrhea in Patients With Uterine, Cervical, or Prostate Cancer Who Are Undergoing Pelvic Radiotherapy
RATIONALE: Eating a diet low in residue (foods high in fiber and fat, and certain milk or vegetable products) may help prevent or reduce diarrhea caused by pelvic radiation therapy.
PURPOSE: This randomized clinical trial is studying a low-residue diet to see how well it works compared to no dietary intervention in treating diarrhea in patients who are undergoing radiation therapy to the pelvis for uterine, cervical, or prostate cancer.
Twenty (20) patients are being recruited for this pilot study at Case Comprehensive Cancer Center in Cleveland, OH.
D. Phase III Randomized Study of Levocarnitine (L-carnitine) for the Management of Fatigue in Cancer Patients
Low levels of the nutrient carnitine may contribute to feelings of fatigue in cancer patients. Carnitine plays an important role in cellular energy production by helping in the metabolism of fatty acids, which represent a major fuel source for tissues such as the heart and skeletal muscle. Levocarnitine (L-carnitine) is a nutritional supplement that may help alleviate fatigue by increasing the level of carnitine in the body.
In this trial, researchers will assess the prevalence of carnitine deficiencies in cancer patients and examine the effect of carnitine supplementation in patients experiencing moderate to severe fatigue. Patients will be randomly assigned to receive levocarnitine or a placebo.
More information about eligibility, study sites accepting patients throughout the country, and contact information can be viewed at the following web site:
III. New Web Sites:
A. www.lotsahelpinghands.com - Lotsa Helping Hands is a web site that provides a simple and immediate way for friends, family, colleagues, and neighbors to assist loved ones in need. It's an easy-to-use, private group calendar, specifically designed for organizing helpers, where everyone can pitch in with meals delivery, rides, and other tasks necessary for life to run smoothly during a crisis.
B. www.redtoenail.org - RedToeNail.org is an online community designed to help people whose lives have been touched by cancer. Whether you are the one with cancer or it’s a friend or family member who you are caring for, RedToeNail.org offers a supportive online environment where you can share your experiences via an online journal (blog), learn from others and find support for the challenges you are facing. Why is it named redtoenail.org? You’ll have to go the site to read about that!
C. The National Center for Complementary and Alternative Medicine (NCCAM) web site now links to a free database of info about herbs & dietary supplements.
IV. New Books to Suggest
A. When Life Hands You Lemons, Make Lemon Meringue Pie, Joanna M. Lund, Perigree Books, New York City, 2005. Joanna is the prolific author of the Healthy Exchange cookbooks. Now diagnosed with inflammatory breast cancer, she has written a delightful and thoughtful book about the lessons of her cancer experience, from healing to hope. Yes, she even includes her famous recipe for Luscious Lemon Meringue Pie.
B. Eating for Lower Cholesterol, Catherine Jones and Elaine Trujillo, MS, RD, CNSD, Marlowe and Co. New York 2005. Many people with cancer also have high cholesterol levels. This cookbook combines all the best anti-cancer foods into recipes that will also help you optimize the dietary approach to reducing cholesterol and triglyceride levels. I have little sticky notes all over the place marking recipes I want to try! Another strength of this book is the accurate and easy to understand nutrition information interspersed among the recipes. More info can be found at the authors’ web site www.staybalanceddiet.com
C. 12 Best Foods Cookbook, Dana Jacobi, Rodale Press, 2005. Here they are: blueberries, black beans, sweet potatoes, oatmeal, salmon, spinach, broccoli tomatoes, walnuts, soy, onions and yea! chocolate. I won’t have any trouble finding a recipe to take to the Super Bowl party. I only rarely eat desserts, but the recipes in this book look too tempting to pass up. Here are two that sound delicious: Sweet Potato Pudding and Spinach Strudel.
V. Tidbits of helpful information
A. Disaster preparedness: The Healthy Hurricane/Disaster Cookbook
B. Breast cancer exercise DVD – Developed through Brigham and Women’s™ Hospital and Reebok University, this DVD will help you understand your treatment options and will give you the tools to regain your quality of life after breast surgery and treatment. All proceeds donated to breast cancer research. More information about the contents of the DVD and how to order it can be obtained at the following link:
C. Over the years, I have received several inquiries from people asking my opinion about the cancer-fighting benefit from drinking wheat grass juice. I have looked and looked but never found much information available to back up the popularity of this juice. I have tried it several times, but I am simply unable to tolerate the taste of it.
Here is a web site that has analyzed the nutritional content of wheat grass juice and compared it to spinach juice. It makes for interesting reading. Scroll down to the bottom to read the article about wheat grass.
D. Confused about the new white wheat flour that is called a whole grain? Here is a web site that explains that seeming oxymoron and guides you through the nutritional maze about this new flour and its food products.
E. The University of California – San Diego has launched their innovative Healthy Eating Program, a personalized counseling program designed to help you adopt a diet that will promote health and fight disease. Based on research conducted at UCSD, their dietary counseling program has been proven successful with over 2,000 participants.
This program is personalized and convenient, with counseling done by telephone to fit your schedule. More information can be obtained at the following web site:
VI. Research Updates
A. Dietary soy isoflavones inhibit estrogen effects in the postmenopausal breast. Wood CE, Register TC, Franke AA, Anthony MS, Cline JM, Cancer Res. 2006 Jan 15;66(2):1241-9.
Recent research in post-menopausal monkeys (from which results are more comparable to humans than research in rats or test tubes) suggests that the dietary intake of the natural plant estrogens (phytoestrogens or isoflavones) found in soy foods does not increase markers of breast cancer risk. In fact, the results suggest that there may even be a protective effect in some women from intake of the isoflavones in soy foods, particularly in post-menopausal women who are exposed to higher levels of estrogen compounds. (Estrogen exposure in post-menopausal women can come from either hormone replacement therapy or endogenous estrogen production from fat cells, also called adipose tissue.)
Isoflavone doses given were equivalent to the following human levels: no isoflavones, 60 milligrams (comparable to the typical Asian diet), 120 milligrams (the highest levels that can be consumed through diet alone), or 240 milligrams (levels obtained through supplements). Estrogen doses were designed to mimic either a low or high-estrogen environment found in postmenopausal women.
Interestingly, the most protective effects observed from the intake of the soy compound were found in monkeys who had the highest intake of isoflavones and the highest estrogen levels, with no evidence of stimulation of breast cell growth or other biomarkers for cancer risk in breast tissue in this group. In addition, during the low-estrogen environment, no evidence of increased breast cell proliferation was seen at any level of isoflavone exposure, even at isoflavone doses several times higher than in a typical Asian diet.
My comments: This is a well designed study that has added new and important information toward resolving the current conflicting and confusing information regarding both the safety and potential benefit of soy food consumption for cancer prevention in post-menopausal women. However, it does not provide information about potential safety or benefit in either pre-menopausal women or women who use a combined estrogen-progestin hormone replacement therapy.
More research needs to be done to fully resolve the concerns of oncologists, ER+ breast cancer survivors, and those women at high risk of breast cancer regarding the safety of soy and/or isoflavone consumption. One conclusion of a recently held workshop entitled "Soy and Breast Cancer: Resolving the Controversy" was to conduct a year-long intervention study in women at high risk of breast cancer. The design of the study would allow for both potential benefits and adverse effects to be identified.
B. Genistein, a Dietary Isoflavone, Down-Regulates the MDM2 Oncogene at Both Transcriptional and Posttranslational Levels, Mao Li, et al, Cancer Research 65: 8200-8208, 2005.
This is an in vitro (“test tube”) type of research study, in which the scientists were able to determine mechanisms of action of the isoflavone called genistein found in soy foods that may explain the observed associations between regular intake of soy foods and reduced risk of several human cancers, such as breast, prostate, and colon.
In a dose and time dependent manner, genistein down-regulated (inhibited) the expression and activity of an important oncogene (a cancer-promoting gene) called MDM2. Genistein also induced apoptosis (programmed cell death) and inhibited cell growth of a variety of human cancer cell lines.
In an additional in vivo (animal) study, genistein inhibited the expression of this oncogene and tumor growth in animals implanted with prostate cancer cells.
My comments: This interesting new research is yet another small piece to a large puzzle as biology needs to be understood in order to make sense of observations in populations related to diet’s effect on cancer prevention and treatment. As tools for doing research involving genes and the molecules they produce continue to advance, look for much more research of this type.
^*^*^*^*^*^ Take Home Message ^*^*^*^*^*^
I continue to use 1-3 servings of soy foods in my daily diet, as I have done for the past 10+ years without a recurrence of my ER+ breast cancer. I consume primarily the traditional (the least processed) soy foods such as tofu, tempeh, miso, soy nuts, soy flour, and unsweetened soymilk, with occasional use of a processed food such as a soy-based veggie burger as part of my overall healthy diet.
C. Two recent studies about ovarian cancer
A prospective study in a large population of women in Sweden found an association between increased consumption of tea and decreased risk of invasive epithelial ovarian cancer.
Compared with women who never or seldom (less than monthly) consumed tea, the relative risks for those who consumed less than 1 cup per day, 1 cup per day, and 2 or more cups per day were 0.82, 0.76, and 0.54, respectively. Each additional cup of tea per day was associated with an 18% lower risk of ovarian cancer.
These results suggest that tea consumption is associated with a reduced risk of epithelial ovarian cancer in a dose-response manner.
(2) Possible Chemoprevention of Ovarian Cancer by the Herbal, Ginkgo Biloba - Abstract #3654 presented by Drs. Bin Ye and Daniel Cramer at the American Association of Cancer Research’s annual meeting in Baltimore, MD, October 31,2005 http://www.aacr.org/default.aspx?p=1275&d=553
A case control study matching 600 ovarian cancer patients with 640 healthy women as controls observed that women who had consumed ginkgo biloba supplements for six months or longer had a 60% lower risk of developing ovarian cancer. The protective effect was highest for non-mucinous ovarian cancers. (See the following web site for a discussion of various types of ovarian cancers http://www.ovariancancer.org/index.cfm?fuseaction=page.viewPage&PageID=511&D:%5CCFusionMX7%5Cverity%5CData%5Cdummy.txt)
Compounds found in ginkgo called ginkgolides did cause ovarian cancer cells to stop growing in cell cultures and were most effective in the non-mucinous type of ovarian cancer cells.
Both of these studies clearly fall in the category of early or preliminary research. The first study has been published but is a case-control study, not the stronger type of study called an intervention study where one group receives a treatment and the other does not (preferably a randomized, blinded, placebo controlled trial). The second study showing an association of a decreased risk of ovarian cancer with consumption of the dietary supplement ginkgo biloba has not yet been subjected to the peer review process necessary for publication.
^*^*^*^*^*^ Take Home Message ^*^*^*^*^*^
If you are at high risk of ovarian cancer, it does seem prudent to increase the amount of tea (green or black) in your diet. However, if you are interested in consuming ginkgo biloba to potentially decrease your risk of this cancer, I recommend first consulting with your physician as ginkgo may interact with other medications (anticoagulants, antiseizure, insulin as a few examples).
VII - Book Ordering Information
Both editions of A Dietitian's Cancer Story (English version ISBN 096672383X) and the Spanish version (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 AICR’s 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 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.
Personally autographed copies of A Dietitian's Cancer Story are now readily available through Nicola's Books in Ann Arbor, Michigan. It's easy to order the book directly from this full service independent bookstore at their web site, http://www.nicolasbooks.com , which has a space to indicate how you would like the book inscribed. They will happily mail the book anywhere in the world.
VIII - Newsletter forwarding guidelines
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