My relationship to living changed. A person diagnosed with cancer is regularly inundated with imagery of battles and fighting, and admonished to create a strong will to survive. All of these things equate living with success, and living happening when the cancer is beaten. My strategy was this: Radical acceptance. To experience everything with an open heart. Yes, everything. This evolved into the awareness that cancer isn’t a fight, it’s a surrender. The more adept I became at giving up and letting go, the more room I made for the joy and peace I was having now. Ultimately, our destination is death, but until that moment we are alive. Live.
—Brandi Chase
FOOD AS MEDICINE
Food, glorious food! Foods come in every color of the rainbow and provide a cornucopia of beauty. Food brings us together daily and for special occasions. Its aromas can stimulate our appetites and perhaps take us back to significant points in our lives. Every culture on earth has daily meal rituals and customary foods that are important to communing.
Food can serve as medicine too. It provides nutrients involved in healing. In fact, food is probably the most commonly consumed “drug” available to all without a prescription. Certain foods can act as anti-inflammatory agents, antidepressants, diuretics, digestives, antibiotics, and anticoagulants, without the side effects that so commonly accompany conventional drugs. Except in cases of allergic reactions, food is rarely harmful.
However, the Standard American Diet is deficient in a number of nutrients, including fiber, magnesium, potassium, and calcium. These nutrients are involved in several important processes in our bodies, and lacking them can result in diseases such as hypertension, constipation, heart palpitations, fatigue, insomnia, osteopenia, and osteoporosis. During conventional cancer treatment, you need these nutrients even more, because they also repair and restore damaged tissues. You can address deficiencies with the selective intake of food.
Specific foods can be used successfully to decrease symptoms and improve quality of life during conventional cancer treatments without decreasing the effects of surgery, radiation, chemotherapy, or hormone therapy. Many foods contain antioxidants and other nutrients such as folate. If these nutrients were given as supplements they could potentially interfere with the effectiveness of, say, chemotherapy and radiation. But because foods only contain small dosages of these nutrients—unless we overindulge—we do not have to worry about this. They provide enough to help keep the normal tissues healthy and the immune system active, but not enough to interfere with the effectiveness of the conventional drug.
For Every Stage of Cancer Therapy
Importance of Protein
Of all nutrients, protein is one of the most essential during cancer treatment. Protein is found in every cell of our body and plays many important roles in cellular function. Chemotherapy and radiation destroy cancer cells, but they can affect healthy cells as well, depleting protein in the process and increasing our protein needs. Dead cells need to be replaced and damaged cells need to be repaired. This high turnover of protein can create a shortage of the amino acids that are the building blocks needed to replace and repair tissues, neurotransmitters, and hormones.
Protein also provides direct fuel for immune, gut, and kidney cells, all of which tend to be depressed by chemotherapy, radiation, and prolonged stress.
Protein is needed for proper metabolism, and when we find ourselves short of this nutrient we are more prone to developing fatigue, foggy memory, sleep problems, and anemia, among other issues. Proper protein absorption from the gut also allows adequate water absorption to take place, allowing better overall hydration. Being hydrated through chemotherapy and radiation is extremely important to long- and short-term recovery.
We recommend that your diet be heavy on plant-based protein and fish, with red meat restricted to three times a week or less. Scientific studies have shown that red and processed meats increase colorectal cancer risk and inflammation whereas intake of fish decreases these risks.
Protein needs when not undergoing cancer treatment is calculated by:
1. Taking your weight in pounds and dividing by 2.2 (which is your weight in kilograms).
2. Taking that number and multiplying by 0.8.
3. The result gives the grams of protein normally needed daily.
During cancer treatment, this will be the minimum amount of protein you will need daily. And it is important to spread the protein out during the day, including it in all meals and snacks. This will help keep your energy level stable. You can eat more plant-based protein and eggs if you want.
In general, approximately 50 to 80 grams of protein from your diet is needed while going through treatment, but you should always check with your health care provider for your specific requirements. People with conditions such as diabetes and kidney disease may have different requirements.
Recipes in this book, particularly those for breakfast, lunch, and dinner, contain adequate amounts of protein and, in combination with other daily meals, meet the requirements given above. Each recipe in this book lists its provided amount of protein in grams near the top of the page. Rest assured that each recipe is planned to complement our daily recommendation for protein and other nutrients we discuss.
For cancer prevention and throughout treatment, adequate amounts of protein are important in maintaining proper blood glucose levels. Why is your blood sugar level so important? For over 30 years the association between diabetes type 2 and increased cancer risk has been known (there seems to be no association between diabetes type 1 and cancer). In diabetes type 2 we find an insulin-resistant condition. In other words, insulin secretion is high and glucose levels are high because the glucose can’t get into the cells. So, is the problem the glucose? Is this “feeding” the cancer? Well, based on emerging research the answer is not so simple. It appears the insulin is the culprit. High insulin levels, the kind found in prediabetics and people with diabetes type 2, is associated with a higher risk for developing certain types of cancers. The take-home message is that your best bet is to maintain proper levels of blood glucose so as not to give cancer an advantage. This is where protein comes into play as a fuel that provides long-term energy stores, helping to maintain energy levels and proper blood glucose levels.
Carbohydrates
Carbohydrates are the body’s main source of quick energy. Most ingested carbohydrates are used as fuel, and the rest are stored as fat. There are two categories of carbohydrates: simple and complex. The two primarily differ in fiber and nutrient content.
Simple carbohydrates come from fruits, sweeteners, and processed grains. Fruits provide nutrients that help the body fight disease and infection, and usually only a smaller amount of fiber compared to vegetables. Refined products such as white bread, cookies, and cakes mainly serve as quick fuel, even when they may be fortified with vitamins and minerals. The American Heart Association recommends no more than 25 grams of simple carbohydrates per day for women and 35 grams per day for men.
The best carbohydrates are complex. And the best sources of these include vegetables and whole grains, which also supply vitamins, minerals, fiber, and phytonutrients to the body’s cells and contain both soluble and insoluble fiber. Soluble fiber is important to helping maintain proper gut flora, which may be disrupted by ingestion of antibiotics or pain medication. Insoluble fiber helps bulking in the colon and thus proper formation of stool. Based on findings from the European Prospective Investigation into Cancer and Nutrition (EPIC) study, diets high in fiber reduce colorectal cancer risk. Fiber is protective.
Both types of fiber are helpful for healing the digestive tract as well as helping with the elimination of toxins, including hormones and drugs. Fiber also slows down the absorption of carbohydrates, and this means you feel fuller longer and are less likely to overeat—which can happen if you are on steroids during chemotherapy. Fiber also helps decrease nausea and constipation, and it is beneficial for a healthy cardiovascular system and proper blood pressure levels.
It’s recommended that a balanced diet include 20 to 35 grams of dietary fiber per day. Our recipes contain almost all complex carbohydrates and meet or exceed these daily recommended fiber levels. However, some people will need to alter their daily fiber intake. This applies to people who have undergone gastrointestinal surgeries such as those for colon and rectal cancers. We’ve noted recipes that should be avoided if you are on a low-fiber diet.
Good Fats
Fats are a vital building block in our bodies. They are important in storage of fuel, making hormones, blood clotting, managing inflammation, and providing insulation for body temperature. They are integral to cell membranes and keep our skin healthy. Dietary fat helps absorb the fat-soluble vitamins A, E, D, and K, and even some fat-soluble antioxidants from vegetables. All of these vitamins are important in normal growth, development, and proper immune function. For example, vitamin D deficiency has a correlation to increased risk of cancer. People living in the northern hemisphere have a tendency to be deficient due to the angle of the sun not activating vitamin D in the skin sufficiently. The USDA dietary guidelines recommend adults consume about 20% to 30% of their calories from fats. The Standard American Diet contains about 34% to 40%.
Like carbohydrates, there are two categories of fats: saturated and unsaturated. Saturated fats come mostly from animal products. These should be limited.
Unsaturated fats come mostly from vegetable oils and nuts. These fats have been shown to lower cholesterol and cardiovascular disease. Unsaturated fats contain omega-3 fatty acids that are particularly important during cancer treatment and in prevention. Although they provide no antioxidant properties, they have anti-inflammatory capabilities. The dietary intake for unsaturated fats should be 65 to 70 grams. Our recipes contain a complement of good fats and the daily recommended intake. The exact amounts are listed on each recipe.
Counting Nutrients
During cancer treatment the goal is to maintain a stable weight, and replenish healthful amounts of nutrients that help to regenerate damaged tissues. The focus should move from counting calories to counting nutrients. There are common, specific foods that contain particular targeted nutrients that are helpful in reducing or preventing side effects. For example, oysters and leafy greens such as kale contain good amounts of magnesium, which, when deficient, can cause a number of conditions, including constipation, muscle cramping, and hypertension. We provide an index of common foods found in our recipes and the nutrients they contain. This should help you choose foods rich in the nutrients you need most, select from our recipes, and create your own. We’ve also identified recipes that are high in certain key nutrients (providing over 10% of the daily value) or are a good source of them (providing at least 10%).
For Specific Stages of Cancer Therapy
In the last several years, conventional therapy has moved from simply prolonging cancer patients’ lives to actually saving them. Conventional therapies, which are constantly changing according to developments in science and in technology, aim to locate, locally remove, and reduce the number of tumor cells. These therapies are vital to the survival of most patients, but they have side effects and long-term potential health risks, and each therapy increases the need for specific dietary nutrients. Let’s take a brief look at these therapies and how nutrition can play a role in decreasing side effects.
Surgery
Surgery is the oldest method used to treat cancer and offers the greatest chance for a cure. Different cancer types require different surgery.
Types of surgery include:
1. Curative surgery is recommended when cancer cells are localized and may be removed almost entirely by surgery.
2. Debulking surgery removes only part of a tumor, leaving radiation or chemotherapy to kill the remaining cells.
3. Diagnostic and staging surgeries help your doctor evaluate how far cancer cells have spread.
Patients’ physical health and nutritional status can affect the outcome and the side effects after surgery. Patients deficient in zinc and vitamin E, for example, may take longer to heal.
Pain at the site of surgery is the most common side effect. To treat pain, patients are often given medication that results in constipation. This slow bowel activity can sometimes become a very serious problem of gastrointestinal blockage. If the blockage is severe, surgery will be required and will often require the removal of a section of the bowel. Side effects of this surgery can be diarrhea, constipation, or both. Surgery can also pose a risk of infection, which would require treatment with antibiotics.
You can select nutrition prior to and after surgery that will enable you to recover quicker, decrease the need for or frequency of antibiotics, and help to restore proper bowel function.
Before surgery you should opt for a diet rich in nutrients. As a reminder, nutrients are minerals such as calcium and magnesium, and vitamins such as folate and thiamine, which your body needs to properly function. Nutrients also include the three major food groups: proteins, complex carbohydrates, and good fats.
Your diet should include plenty of both raw and cooked vegetables, plenty of protein, and plenty of whole grains containing fiber. Broths and soups packed with nutrients will help with anxiety and insomnia. Being well-hydrated will help you tolerate and recover from anesthesia.
Pineapple and papaya are two fruits that contain digestive enzymes. These are helpful for reducing inflammation and for decreasing scarring. Melons, nectarines, and other fruits high in soluble fiber can help in keeping the bowels moving after surgery. Foods high in vitamin D, the sunshine vitamin, will help skin repair and immunity. Foods containing good amounts of vitamin D include cold-water fish.
Recipe recommendations include berries high in phytonutrient content, broths with mushrooms, the high antioxidant–containing spice turmeric, and the antimicrobial spice garlic. Foods in our recipes identified for surgery are selected for their vitamin E, C, and D levels as well as a high fiber content to help prevent constipation. A particular focus is placed on protein, which will be needed to repair and restore tissues. Our salad and vegetable selections contain bitters that will help to stimulate digestive juices, another way to help with digestion and elimination.
Chemotherapy
Chemotherapy is a chemical agent or drug administered to the body in order to destroy the cancer cells that linger after surgery. It also may be administered before surgery as what is called neoadjuvant therapy, to shrink the size of the tumor. Treatment usually consists of a combination of therapies. For example, docetaxel and cyclophosphomide may be used together, or a combination of 5-fluorouracil and methotrexate. Chemotherapy can be taken orally or it may be infused or injected. It is administered over time, usually in cycles of once a week or once every two to three weeks, depending on the therapy, type, and stage of the cancer. Chemotherapy is often administered with steroids to decrease the chance of an allergic reaction. Patients are often also given antacids and antinausea drugs. Sometimes they may still be on pain medications or antibiotics from surgery.
Different chemotherapies work in different ways. Some work to generate free radicals that aim to damage the DNA of the rapidly dividing tumor cells. Some work by mimicking natural factors needed to make DNA. Others work by preventing cell division, growth, and the cell’s ability to make energy.
However, chemotherapy is not selective between cancer cells and normally dividing cells. This is why most of the side effects happen. All cells that replicate are affected: hair, nails, bone marrow, and cells in the digestive tract.
Interestingly enough, patients experience most of the side effects most strongly at three to four days after administration of the drugs. With each cycle the side effects tend to be more noticeable. Being well-rested with eight hours or more of sleep, well-hydrated with 64 ounces or more of clear water, and well-nourished, all seem to be a great help with side effects and your ability to rebound.
Chemotherapy can take an incredible toll, both physically and emotionally. Common side effects of chemotherapy and the drugs that are often administered with them include anemia, brain fog, indigestion or acid reflux, stomach upset and gas, mouth sores, constipation, fatigue, nausea, loss of appetite, loss or alteration of taste, peripheral neuropathy, and anal irritation. These symptoms are associated with the type of chemotherapy given.
Nutrient focus during chemotherapy should aim to aid digestion and absorption and decrease acid reflux. Addressing these will serve to decrease most of the side effects mentioned earlier. Tasty meals containing complex carbohydrates and a protein complement are helpful. Foods with adequate B vitamins, magnesium, zinc, and calcium top the list as well.
It’s recommended that foods be cooked or steamed lightly, not raw. Raw foods pose increased risk of infection because sometimes the immune system has been lowered as a result of chemotherapy. Ability to digest is often lowered during chemotherapy. Cooking food helps to break down fiber and aid your body’s digestive ability. Bitters (such as collard greens and arugula), foods high in glutamine (such as eggs), and foods high in electrolytes (such as broths), are a good bet during this time. Calcium and tryptophan/glycine-containing foods, for example turkey and kale, help to induce sleep and prevent insomnia and anxiety, and in turn help to avoid depression of the immune system.
Sometimes chemotherapy causes low red blood cell counts (anemia) or low white blood cell counts (leukopenia). Foods such as apricots and molasses, high in iron, can help build the blood back up. Fish is an excellent protein source at this time because of its omega-3 fatty acid content; it reduces inflammation and also contains vitamin D. During chemotherapy, try to avoid eating raw cruciferous vegetables such as broccoli and cabbage. They are very high in nutrients but can produce a lot of gas and gastrointestinal discomfort. Reducing beans (unless soaked to decrease gas) is also helpful—we use lentils and split peas instead. Asparagus, if it’s in season, is a sure bet, given its culinary dose of glutathione.
Chemotherapy can also cause a disruption in taste sensation for many people. Strong-tasting foods can help with this problem. The use of salt, sweeteners, and even some condiments such as mustard can help improve food’s taste. As mentioned earlier, foods containing magnesium, copper, and zinc are helpful for maintaining and restoring taste. Foods high in these nutrients include nuts, kale, collards, and cilantro.
Radiation
Radiation uses high-energy x-rays to destroy rapidly growing cancer cells. It is recommended for all kinds of solid tumors. The goal of radiation is to eliminate an entire tumor while it still occupies a confined space, or radiate an area where a tumor once occupied a space. About half of the people diagnosed with cancer undergo radiation as part of their treatment process.
A common side effect is skin irritation at the site of treatment. Radiation can cause permanent discoloration or scarring in certain patients, and sometimes hair loss at the site of treatment.
Some patients battle fatigue, which affects the patient’s ability to remain active and alert throughout the day. If lymph nodes are irradiated, swelling, also known as lymphedema, can result; this condition involves fluid retention in the limbs and needs medical attention.
Foods containing adequate protein, electrolytes, good fats, micronutrients (minerals that our body requires in small amounts, but are vital to health), minerals, vitamin E, and omega-3 fatty acids can help. If white blood cell counts have returned to normal, patients may begin to eat raw foods again. This can provide quite a boost in energy and also in mood. Foods high in vitamin C such as berries and Brussels sprouts can also be useful as long as they are not overconsumed. Pineapple, papaya, and avocado can reduce scarring and promote healing. Broths and asparagus help to restore healthful immune cells and boost energy.
Hormone Therapy
Hormone therapy prevents cancer cells from using hormones like estrogen and testosterone, which they need to grow and divide. This treatment, used for certain types of breast and prostate cancers, may include the use of drugs that stop the production of certain hormones or that change the way hormones are made.
Hormones serve a very important function in the body. For example, estrogen protects against bone loss and is slightly anti-inflammatory. Estrogen prevents calcium from leaking out of bone tissue and therefore helps to keep the body strong. Testosterone serves to maintain muscle mass. Their withdrawal from the system can result in some short- and long-term side effects such as increased risk of blood clotting, changes in appetite, fluid retention, hot flashes and night sweats, tiredness, weight gain, and muscle and joint pain.
During hormone therapy, we can start reintroducing fresh fruits and salads because, in most cases, digestive complaints and issues with low white blood cell counts have been resolved.
During this period of time we are wise to be careful with phytoestrogenic foods and caffeine. Phytoestrogens are naturally occurring chemicals in plants that can act like our own estrogens with certain types of cancers. They are contained in a number of foods but occur at highest concentrations in soy and tofu products. Research has shown that foods containing phytoestrogens and other hormone mimics from plants can have both positive and negative effects on cancer.
Foods high in calcium and micronutrients, such as magnesium, boron, and manganese, combat estrogen withdrawal symptoms such as bone loss, hot flashes, night sweats, joint aches, and osteoporosis. Foods high in omega-3 fatty acids also help with hormonal withdrawal symptoms.
Withdrawal of hormones can also result in decreased stamina and fatigue. Recipes high in protein, low in simple sugars, and moderate in whole grains help in recapturing stamina and building muscle mass. Foods high in antioxidants such as CoQ10, turmeric, garlic, and rosemary repair damage from chemotherapy and radiation. They will also begin to build your body’s defenses against developing cancer again.
High nutrient content and moderate calorie-containing foods will combat weight gain from steroids in chemotherapy. Foods containing vitamins B and C can combat adrenal disturbances from mental and physical trauma.
Recovery and Prevention
While recovering from treatment, focus on foods that increase energy and stamina, build muscles, and maintain bone mass. Bone mass maintenance will be particularly important for patients on hormone therapy. During this period of time it will also be imperative to eat foods that promote good sleep, optimal bowel function, and absorption. Our recipes identified for this phase are specially designed to meet these goals.
With most conventional drugs and their potential side effects out of the way, we can begin to introduce a wider array of foods and preparations, as well as spices.
Some nutrients particularly helpful during recovery and prevention will include foods and spices such as broccoli, turmeric, and garlic, which are high in micronutrients such as magnesium, calcium, manganese, and selenium as well as rich sources of vitamins A, C, and E and bioactive constituents that have been shown to have anticancer effects.
Additional Therapies Supporting Conventional Treatment
You may also be using some alternative, also known as complementary, therapies during conventional treatment. Complementary therapies are rational, evidence-based practices, delivered or taught by trained and licensed practitioners such as naturopathic physicians and integrative oncologists. They are often used by cancer patients in concert or synergy with conventional medicine and conventional cancer treatment. These therapies may include lifestyle counseling, nutrition advice, acupuncture, and massage therapy. The objective of all these therapies is to decrease the side effects of conventional treatment while increasing the quality of life for patients. Most importantly, all do this without decreasing the effectiveness of conventional therapies.
A naturopathic physician providing complementary cancer care often works in very close association with the conventional cancer care team. Most have specialized training in their fields, which can include many years of research training in immunology and/or oncology. Because medical doctors are not trained to use specific nutrition and supplement therapies, patients turn to naturopaths for this information. The benefit is a progressive, holistic team approach to health care.
Therapies used by naturopathic doctors depend on the stage and nature of the cancer, the conventional therapy being used, and the symptoms experienced by the patient. Vitamin and mineral supplements, diet, and nutrition are most frequently prescribed, and tend to be very effective. Herbal therapies are less often prescribed because there are often problems with quality control and contamination of the herbs. Some herbals therapies can also pose a risk of undermining conventional treatments. If you do seek a complementary practitioner to work with during conventional treatment, make sure he or she has received proper training, licensing, and accreditations and has established rapport with a medical oncologist.
None of the recommendations in this book should interfere with alternative or complementary therapies, but always discuss changes to your diet with your health care provider.
Final tips for getting through treatment:
Hydration
Make sure you drink at least 64 ounces (eight glasses) of water starting at least two days before chemotherapy treatment and continuing for at least three days after treatment. Dehydration can lead to exacerbation of nausea and fatigue. If water just doesn’t taste right during treatment, you can try to add some lemon juice to your water, or use carbonated water.
Sleep/rest
We’ve observed that patients who are well rested bounce back from all treatment phases more quickly. It can be tough to sleep through pain and the steroid treatment. Consult with your health care provider if you need assistance with sleep. It will be worth it.
Exercise
According to the EPIC study, the top factor corresponding to positive effects on cancer prevention and remission is exercise. In addition, other positive effects include sustained stamina, energy, bowel regularity, and mood stabilization.
Support
This is a period of time to ask for help and to rely on those family and friends who want to assist. It is hoped that this period of treatment will be a blink of time in your life. Be smart, and don’t go through it alone or without asking for help.
In 2004, Dan Buettner, CEO of the Blue Zones Project, partnered with researchers from National Geographic to study the places around the world that enjoy the greatest longevity. They found that what distinguishes places like Ikaria, Greece, and Okinawa, Japan, are environments and cultural attributes that foster community, family life, and physical activity.