Facebook Chat recap: Lifestyle changes to improve well-being and reduce recurrence


On Thursday, Jan. 24, CURE hosted a Facebook Chat on lifestyle changes after a cancer diagnosis. We thought this would be a good topic for those new year resolutions. We invited Stacy Kennedy, a certified specialist in oncology nutrition, and Russell Kennedy, a behavioral specialist, to answer questions for on improving diet and physical activity.

You can view the full chat here with a Facebook account.

This topic struck a nerve with our readers. It was one of the most fast-paced and involved chats we've had to date. I'm sure Stacy had finger cramps by the time the hour was up, but she answered most of the questions posed to her during the chat and a few that were emailed and posted ahead of the chat.

Here are a few of the questions Stacy answered during the chat:

Amy: After chemo/radiation treatment how do I get my energy back?
Stacy: Hi Amy after treatment getting your energy back can take a while. Drinking plenty of water, eating small frequent meals with protein, fruits and veggies and walking can be helpful. But extra rest is important too.

Christi: Are organic products truly better for you? Do conventionally grown products really offer less nutrients than organic? I also heard conventionally grown produce is worthless - can this be true?
Stacy: Hi Christi, organic foods can be tricky to figure out. Have you seen the Dirty Dozen list? for the 12 fruits and veggies most likely to carry a lot of pesticides you may want to choose organic. Eating what's in season and local is most important for overall health. Conventional fruits and veggies are not worthless at all! In fact most of the research showing that fruits and veggies promote survivorship are in people eating conventional produce. Wash everything well and get local when you can.

Julie: I was diagnosed with E+ breast cancer 2 years ago. Are soy and flax seed beneficial or harmful?
Stacy: Hi Julie, with E+ breast cancer it's suggested to consume flax in moderation and avoid processed soy products that use soy protein isolate like nutrition bars, protein powders and fake meats. Natural soy foods in moderation are OK but we suggest organic or non GMO.
CURE: We also wrote about soy in 2009: Soy Story.

Tammy: I have heard that I shouldn't eat fresh fruit or veggies because of possible I guess pesticides on them. Is this a problem that can be fixed I wash it but is that enough?
Stacy: Hi Tammy, washing produce with running water or a home remedy of lemon, baking soda, vinegar and water can be very helpful for removing pesticides. Remember eating fruits/veggies is more important for health than avoiding them due to concern over pesticides. Look into a CSA for local produce at

Amy: I cannot exercise other than walk because I get out of breath too easily from the damage done to my lungs during radiation. I am 90% vegetarian ( I eat chicken breast) and water is probably an issue for me since I don't like it...I do drink unsweetened green tea quite a bit.
Stacy: Hi Amy, walking counts as exercise!!! Aim for at least 3-5 hours a week

Terri: I am in-between reconstruction surgeries. It seems like I just start getting back to the health club and I have another surgery that sets me back. Any advice on what I can do for fitness between surgeries until I am finished with them all?
Stacy: Hi Terri - walking is probably your best bet between surgeries. Also, you can find a personal trainer or instructor who is certified to work with cancer survivors. Go to or look for the Pink Program or Livestrong programs at the Y for more specific recommendations

Nancy: Re: vitamin d3. Can you OD on it? (It being fat soluable) I'm not due for blood work till May and am concerned with that.
Stacy: Hi Nancy - yes you can get too much Vitamin D! 5,000 is considered the daily upper limit but this is generally too high of a daily dose for most people. 1000-2000 IU is generally safe. How much are you taking now? What was your last blood test?

Connie: I have CML and have absorption issues, what foods or practice can assist me.
Stacy: Hi Connie, for absorption issues try cooked veggies like roasted or in soups, smoothies using fruits without seeds and juicing are all ways to get more fruits and veggies in. Also, eat small meals often throughout the day to help boost absorption - a big meal is a big trigger for malabsorption or diarrhea in your case.

Candace: Is it true that most fruits and vegetables provide more nutrients when eaten raw except for tomatoes which are more nutritious cooked?
Stacy: Hi Candace, both cooked and raw veggies offer benefit. The lycopene in tomato is more available to the body when cooked and the Vitamin C is more available when raw. There are others though - like Vitamin K or iron content which can be higher when a veggie is cooked. So eat both cooked and raw for maximum benefit and when cooking steam, stir fry or roast over boiling and of course frying.


The challenges of a gastrectomy and how it helped me win my battle with stomach cancer


In July 2007, just two months after my 50th birthday, I was diagnosed with stage 2 stomach cancer--a very aggressive, fast-growing, signet ring cell type. Shocked and frightened, I quickly made appointments with surgeons and oncologists.

As anyone having a cancer diagnosis knows, your initial reaction is "cut it out as soon as possible!" But not everyone is a surgical candidate. I met with the doctors, got second opinions and the consensus was to perform a gastrectomy--hopefully a partial because the cancer appeared to be contained to a localized area. If there was any evidence the cancer had spread, surgery would be followed by chemotherapy and radiation.

Now I had to decide which surgeon was going to perform this very scary surgery. As much as I wanted it "out," I was scared to death about having my stomach removed. What would eating be like? What kind of complications could arise? In the face of a cancer diagnosis though, this really wasn't elective surgery, and I would have to deal with any after effects of the surgery. The more pressing issue was who was going to perform this surgery. Both surgeons were equally skilled and came highly recommended, but the one who could do it sooner, didn't give me the "warm fuzzies." I decided to go with my gut. I'm a person who needs the "warm fuzzies," so my instincts were that I would have a better outcome if I felt cared for emotionally as well as physically.

It seemed like an eternity, but just one month after diagnosis, I had my surgery. The surgeon was able to perform a partial gastrectomy, removing two-thirds of my stomach with clear margins. Thankfully, there was no evidence of spread to any other organs, but 3 of 11 lymph nodes were positive, so chemotherapy and radiation would still be necessary after I recovered.

After a five-day hospital stay, I went home to recover and learned to eat a whole new way. Rather than three large meals, I ate six small meals with no liquids at meal time. At first the meals were very small, maybe just a few bites at a time. The key was to listen to my body--eat when I was hungry and more importantly, stop when I was full.

Chewing well and eating slowly were also key to avoiding any discomfort or nausea. The nutritionist I met with recommended starting out with bland, easy-to-digest foods and then slowly introduced other foods to see what I could tolerate. Trust me, you quickly find out what you can't tolerate. Everyone's different, but for me it was sweets, fried foods and creamy, rich foods. If I had any of those, if I ate too fast, or if I ate too much, I became extremely nauseous. I would begin to sweat, my heart would race, and inevitably, I'd vomit. Not fun, but you learn by trial and error.

One of the biggest challenges though, was getting adequate nutrition during chemotherapy and radiation. The treatments themselves made me very nauseous and took away my appetite. Eating became an even bigger challenge since just about any food I ate would not stay down. It was a very trying time, to say the least. Over the course of six months, I lost 60 pounds, and often felt as though I'd never be "normal" again. But the human body has amazing healing powers. Once my treatments ended in February 2008, I slowly, but surely, got my appetite back, kept foods down, gained my strength back and began to heal.

My husband never left my side and wouldn't let me quit. My teenage sons kept brave faces, kept things light and made me laugh. Friends and family from all over the country took turns coming to stay with us and help out.

It's now been more than five years after my initial diagnosis. I'm cancer-free, feel great, eat normally and am grateful for the experience. Cancer taught me to live in the moment and be grateful for every day I'm given.

For that reason, I committed myself to helping others facing stomach cancer and to help them find information and support that I didn't have when I was facing my surgery and treatment. At the time of my diagnosis, no such organization existed. There was plenty of cancer support, but none specific to stomach cancer.

I am now a resource contact for the Patient Resource Education Program (PREP) of Can't Stomach Cancer and founder of the Maryland chapter. I am honored to be part of such a wonderful organization and able to offer support and hope for survival to other stomach cancer patients and their families.

Gae Rogers is a stage 2 stomach cancer survivor and advocate with Can't Stomach Cancer: The Foundation of Debbie's Dream (CSC), an organization founded by Debbie Zelman, a stage 4 stomach cancer survivor. CSC is a non-profit organization dedicated to raising awareness about stomach cancer, advancing funding for research, and providing education and support internationally to patients, families and caregivers. CSC seeks as its ultimate goal to make the cure for stomach cancer a reality. If you or someone you know is battling stomach cancer, you can find more resources at or by calling its toll-free hotline at 855-475-1201.


New guidelines state nutrition and exercise can reduce recurrence


The American Cancer Society released new guidelines that recommend good nutrition and exercise for survivors to reduce the chance of recurrence and increase the possibility of disease-free survival. The ACS formulated these recommendations after convening a group of researchers and thought leaders in nutrition, exercise and cancer survivorship to evaluate current evidence and best practices on these topics. Among the committee's recommendations:

 Minimizing weight gain during treatment may be important for survivors who are overweight and also for those of normal weight.

 Evidence suggests that exercise is not only safe during cancer treatment but can also improve physical functioning, quality of life, fatigue and may even increase the rate of completion of chemotherapy.

 Exercise after cancer diagnosis is associated with a reduced risk of recurrence and improved mortality in many cancer survivor groups, including breast, colorectal, ovarian and prostate.

 Results of observational studies suggest diet and nutrition may affect risk of recurrence, cancer progression and overall survival in those treated for cancer.

This report also specifies nutrition and exercise advice by cancer types including breast, colorectal, endometrial, ovarian, lung, prostate, head and neck, and hematologic cancers. It also includes a helpful section on common questions and answers about nutrition, exercise and cancer survivorship. Some questions covered are:

 Should alcohol be avoided during treatment? (Generally yes, or kept to a minimum, based on type and stage of disease.)

 Are organic foods recommended for cancer survivors? (At present it is not known if organic foods are more effective in reducing recurrence than foods produced by other farming methods.)

 Does sugar feed cancer? (No, however products high in added sugar may add substantial calories, resulting in weight gain, which may affect cancer outcomes.)

 Can dietary supplements reduce the risk of recurrence? (No evidence at this time suggests supplements will reduce the chances of recurrence.)

 Should I exercise during cancer treatment? (Evidence suggests that exercise is safe and can improve physical functioning and quality of life, however, intensity and duration may need to be adjusted during treatment and special precautions taken for those with anemia, weak immunity, bone disease, skin sensitivity, neuropathy and other side effects of therapy.)

"While we've published previous reports outlining the evidence on the impact of nutrition and physical activity on cancer recurrence and survival, this is the first time the evidence has been strong enough to release formal guidelines for survivorship, as we've done for cancer prevention. Living a physically active lifestyle and eating a healthy diet should absolutely be top of mind for anyone who's been diagnosed with cancer," Colleen Doyle, MS, RD, ACS director of nutrition and physical activity and co-author of the guidelines, said in a press release.

To read the full report, click here.


Dr. Bill's ultimate marathon


I recently joined CURE as managing editor of books and special projects. While I have been in journalism for many years now, this is my first foray, as an editor, into the complex world of cancer. But as a daughter--well, that's a different story.

During one of my first staff meetings here, someone brought up the often-used analogies to describe the cancer experience: a battle, a journey, a roller coaster. But when I think of cancer, I always envision it as a marathon, admittedly, another well-worn metaphor. Perhaps that's because my father was an avid runner. He finished seven marathons in his lifetime, counted Chariots of Fire as one of his favorite movies (the theme song was one of his favorite songs), and he even founded a nine-mile running race in our hometown.

But in April 2000, my father's real marathon began when he was diagnosed with metastatic melanoma. The doctors figured it was from a large malignant mole he had removed from his leg 15 years prior, but that was only a guess. Melanoma can lie dormant for years before it resurfaces in places like lymph nodes, which is where my father's recurred. A small, seemingly innocuous lump on his groin.

My father was a doctor himself--an ophthalmologist--so he knew that his prognosis would not be good. And it wasn't; it was of the "get-your-affairs-in-order" variety. But, being a stubborn man, a first-generation Italian from Newark and the son of a steeplejack, Dr. Bill, as his patients called him, was just warming up. He had only begun preparing for what was going to be a grueling six-year run filled with fatigue, dehydration, pain and emotional exhaustion.

There were runner's highs, like when a limb perfusion appeared to work, followed by extreme lows, when the brain mets appeared. And then there were the second, third and fourth winds when promising new studies came out. On he went, plodding from surgery to chemo to radiation. From clinical trial to clinical trial. Along the course, family and friend had lined up to cheer him on, give him water and food or tend to his injuries. In June 2006, my father hit the wall. His melanoma could no longer be controlled. He was spent, and he wanted to enjoy the final leg of the race at a slow amble, absorbing the sights and sounds of the course and the gathering crowd. On November 11, 2006, he crossed the finish line at peace--surrounded by his biggest fans.


Vitamin D and folate may reduce cancer risk


Two separate studies recently linked vitamin D and folate intake to a reduction in colorectal cancer risk.

In the vitamin D study, published in the Journal of Clinical Oncology, researchers found that people with higher blood levels of vitamin D had as much as a 33 percent reduction in colorectal cancer risk compared with those with the lowest levels. The group also found a 12 percent lower colorectal cancer risk for those with a high intake of supplemental vitamin D compared with those with the lowest intake.

While scientists are unsure about the exact connection between vitamin D and cancer, it is suggested that it may decrease the risk of cancer through cell proliferation or inhibiting angiogenesis (blood vessel growth to the tumor). The recommended daily allowance for vitamin D is 600 IU for most people, with 800 IU recommended for those above age 70. Vitamin D is found in salmon, tuna, fortified juices and milk.

The study results came from a meta-analysis that reviewed 18 studies that included over 10,000 people. Of the studies, which spanned three continents, nine looked at vitamin D intake and nine examined blood levels of vitamin D in the blood. Researchers noted this lack of uniform criteria, however, meta-analysis are used to study trends in similar data that may not been seen in a single study. They suggested the results be confirmed in large, randomized clinical trials of vitamin D supplementation.

In the folate study, published in the American Journal of Clinical Nutrition, researchers found that people with a higher folate intake per day were 30 percent less likely to get colorectal cancer than those who consumed less. For these results, researchers interviewed almost 6500 participants from the NIH-AARP Diet and Health Study who were diagnosed with colorectal cancer.

In the 1990s, folate supplementation was added to grain products in order to prevent birth defects. The recommended daily allowance of folate is 400 micrograms for most adults and 600 micrograms for pregnant women. Folate can be found in many fortified cereals as well as vegetables and beans.

The lead investigator of the study, Todd Gibson from the National Cancer Institute, told Reuters that "people don't need to change their current activities [with respect to folate]. Most people are getting what is considered an adequate amount."


Organic choices may minimize cancer risks


Victoria Maizes, MD, executive director of the Arizona Center for Integrative Medicine and professor of Medicine, Family Medicine and Public Health at University of Arizona, shares her knowledge on organic products.

One of the most common questions I receive from people with a cancer diagnosis relates to the value of organic food. Simply put, my patients want to know, "How important is it to eat an organic diet?" Unfortunately, there is no easy answer, but here is the advice I give to those who are interested in learning more about organic food and beverages.

Clearly, organic produce, dairy, chicken and meat cost more. At the same time, we know that choosing organic could reduce your exposure to pesticides, which may increase the risk of cancer directly or indirectly through endocrine-disrupting actions. It also may reduce exposure to antibiotic byproducts, arsenic and genetically modified foods. Here are some strategies I give my patients to help make wise organic choices.

The Environmental Working Group ( publishes a list each year ranking the amount of pesticides in the 53 most commonly eaten fruits and vegetables. Choosing organic for the most contaminated fruits and vegetables at the top of the list, the so-called "dirty dozen," and buying conventional for those with the least contamination, the "clean fifteen," can lessen your exposure to pesticides and save money on purchasing organics. EWG has calculated that if you choose five servings of fruits and vegetables a day from the clean fifteen instead of the dirty dozen, you will reduce your daily consumption of pesticide by 92 percent.

Organic dairy protects you from a different set of problems. While outlawed in Canada, Australia, New Zealand, Japan and the European Union, the U.S. allows use of recombinant Bovine Growth Hormone (rBGH) in dairy production. Two problems emerge: While cattle treated with rBGH produce 10 to15 percent more milk, they also have a higher incidence of mastitis, necessitating more frequent treatment with antibiotics. Cows treated with rBGH also have elevated levels of insulin-like growth factor-1 (IGF-1) in their meat and their milk. In people, higher IGF-1 levels may be associated with an increased risk of colon, breast and prostate cancers. A useful website that rates the quality and ethical issues around organic dairies is

Purchasing organic chicken is important for yet another set of reasons. Chickens are not treated with hormones. Instead, many are given Roxarsone, an FDA-approved form of arsenic. Roxarsone is used to promote growth of the animals, feed efficiency and to improve pigmentation. In the chicken's digestive track it is metabolized into arsenite and arsenate – inorganic forms of arsenic, which are carcinogens. It is also widely found in chicken manure used as fertilizer on many of our crops. In July 2011, Pfizer subsidiary, Alpharma, agreed to voluntarily suspend sales of Roxarsone. This may not fully solve the problem however, because there are other arsenic-based products on the market besides Roxarsone.

The term organic is sometimes also used with regard to fish, but its meaning is murkier. Wild fish are not in a controlled situation where only organic feed is given. The organic label for fish also addresses sustainability – which is great for our environment. Farmed fish are raised very differently if they are vegetarians like tilapia (easy to feed organic feed) or carnivorous like most salmon (must be fed wild fish.) The standards are still being created. One useful resource is the Seafood Watch from the Monterey Aquarium (

Two final points about organic: One, the organic designation is expensive to achieve. Some of your local farmers may be following organic practices and avoiding the use of most synthetic pesticides, rBGH, antibiotics and other dangerous farming practices to your health and the environment. If you get to know your local farmers at a farmer's market or by visiting their farms, you may feel really good about supporting locally produced vegetables, fruits and meats even without an organic designation. Second, consider becoming an activist for organic. With some regularity, the designation is threatened. Let your local, state and federal officials know that you value these high standards as a means to protect your health and that of your family.

Victoria Maizes, MD, is the executive director of the Arizona Center for Integrative Medicine and professor of Medicine, Family Medicine and Public Health at University of Arizona. Maizes will co-facilitate the "Courageous Women, Fearless Living Retreat for Women Touched by Cancer" at Shambhala Mountain Center, Aug. 23-28 in Red Feather Lakes, Colo. For information about this retreat, visit


Some bitter pills


The September issue of Consumer Reports features an article called "The 12 Most Dangerous Supplements" that lists the dangerous dozen as aconite, bitter orange, chaparral, colloidal silver, coltsfoot, comfrey, country mallow, germanium, greater celandine, kava, lobelia, and yohimbe.

While these supplements aren't common, it is important to note the potential harm they may cause. The article tells of a consumer who took colloidal silver, which turned her skin a permanent bluish tint. In another story, a consumer took a weight-loss supplement and developed hepatitis within weeks.

My purpose in mentioning this article is to promote education on this topic, not fear. Some of the supplements on this list are touted as simple remedies for common maladies, such as congestion or a cough, but they can cause serious problems, like liver and heart damage.

This issue also has a review of multivitamins and passes on some good advice, like checking your supplements for the "USP Verified" mark, a sign that the product was voluntarily reviewed by U.S. Pharmacopeia, a nonprofit organization that independently verifies the quality and purity of supplements and their ingredients.

The article says we spent about $26.7 billion on dietary supplements in 2009, according to the trade publication Nutrition Business News. While many supplements are safe to take and are beneficial, cancer patients and survivors must be careful about drug interactions as some can interfere with chemo or have other effects, see our article "Mixing It Up."

Finally, while we seek the simplicity of taking a pill to solve health or wellness issues, it is important to understand fact from fiction, so make sure you ask your doctor or nurse before adding any supplement to your diet.


When the “new normal” doesn’t feel normal at all


I came across a recent blog on how the after-treatment phase (or re-entry if you want to compare it with a NASA moon landing) can actually be more complicated and fraught with more emotional issues than the actual treatment phase.

"Broken," a post from ChemoBabe, detailed what so many other survivors have felt once treatment ends.

"Maybe it's self-pity talking, but I feel like everybody is sick of my cancer and is ready for me to move on," she writes. "When people see me these days, they say two things. First: 'Wow! Look at all your hair! You look great.' And, 'How are you feeling? Are you getting back to normal?'"

After nine months, she says she didn't just put her life on hold during that time, she's changed and things aren't going to go back to the way they were.

The comments that appeared almost as soon as the blog was posted last night speak to the magnitude of the issue. Unfortunately, it's an issue that doesn't get mentioned a lot to newly congratulated survivors. They celebrate their last treatment and end of cancer and are expected to go along their merry way. When they get home, they discover that everything is not fine and are left struggling with these emotions--often at a time when the support network that rallied during diagnosis and treatment have packed up its bags and left.

We covered the psychosocial issues of the after-treatment phase back in 2008 with "Back to Normal." It may be time to revisit the topic again since it's such an important subject for new survivors.

Some things to remember:

1. The feelings of loneliness, sadness, and fear are normal and common among new survivors, but it doesn't make it any less serious. Just know that there are other people who have dealt with these emotions too and they would love to help you through this time in your cancer journey.

2. Just because you're no longer seeing your oncology team for treatment, it doesn't mean you can't use the social services they offered. Talk to your nurse who may be able to recommend resources, people to talk with, and advice. Survivorship clinics, which are popping up in several cancer centers across the country, may also have support programs for those out of treatment.

3. And this is for friends and family: When you're diagnosed and going through treatment, a patient may see a support network pouring out of the woodwork--friends, colleagues, parents of your kids' friends, your boss's sister, your medical team--all people who want to be there for the patient and help him or her get through treatment. Unfortunately, once the cake and balloons are gone after that final treatment, that support group may disappear when the patient, now a survivor, needs it the most. Don't think that everything is going to go back to normal once treatment ends. Continue to let them know that you're there for them.

How did you deal with the re-entry phase? Were you prepared for it emotionally? And if you have a few minutes, go to ChemoBabe's blog and share your advice on getting through this phase in her cancer journey. I think she would appreciate it right now.


Two thumbs up


Although thyroid cancer stole film critic Roger Ebert's ability to speak, this Pulitzer prize winning writer has not lost his voice--or his sense of taste. Ebert announced he has written a cookbook that will be released in September.

"The Pot and How to Use It. The Mystery and Romance of the Rice Cooker" pays homage to this modest kitchen appliance. In an interview with the Associated Press, Ebert says the inspiration for the cookbook came from a 2008 blog he wrote about rice cookers. Hundreds of readers commented on the blog with recipes and anecdotes of their own. Ebert decided to compile those comments and some of his favorite recipes into a cookbook.

During his battle with cancer, Ebert had numerous surgeries, including having his lower jaw removed, and now uses a feeding tube. Even though he cannot eat, Ebert says in the interview that he still loves to cook, and the cookbook is a way for him to "live vicariously."

Bravo for Ebert. I'm inspired by his story and his desire to write whatever he wants to write despite physical limitation. I also look forward to reading this cookbook as I hope some of the recipes will help our readers who may have side effects, like mouth sores, and who may seek foods that are easier to eat.

I have to confess, though, I grew up with rice cookers, love to cook with them (they are so convenient), and still cook with the one my parents bought me in Japan some 20 years ago, so I may be just a little bias.

To learn more about Ebert's journey with thyroid cancer, read his blog for the Chicago Sun-Times. And for another perspective, Esquire's Chris Jones recently wrote a powerful glimpse into Ebert's life.


TED talks about Angiogenesis


In February, the TED2010 conference featured a series of "big ideas," ranging from how much money a person needs to make to be happy to how the ukelele can stop wars. One of the ideas featured was from William Li, president and medical director of The Angiogenesis Foundation.

Li's talk ("Can we eat to starve cancer?") focuses on how a lot of foods and beverages could help prevent cancer through the substances they offer, which are the same substances in the 11 FDA-approved anti-angiogenesis drugs. (Anti-angiogenesis is a type of targeted therapy, which stops tumors from making new blood vessels, keeping them from growing or causing tumors to shrink.) On the TED blog, they offer a list of some of these foods and beverages.

TED (standing for Technology, Entertainment, Design) is a nonprofit organization dedicated to "ideas worth spreading." And while angiogenesis, and the importance of good nutrition, are ideas definitely worth spreading, we should all be wary of putting too much stock in the research Li shares.

Yes, many of these foods and beverages contain substances that have anti-angiogenesis capabilities. And yes, one day we possibly could "eat to starve cancer." But a lot of this research is still very preliminary – either observational or they're animal studies. There has yet to be any substantial research showing these food and beverages are beneficial for humans with cancer.

Plus, we can't exactly directly compare green tea, berries and dark chocolate to anti-angiogenesis drugs, like Avastin, Nexavar, or Sutent, the way Li does.


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