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.


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."


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.


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.


Putting your health first


To support women in putting their health first in the battle against cancer, today the American Cancer Society kicked off a new program called "Choose You." This program hopes to encourage women to make healthier choices in areas that may affect cancer risk.

The Choose You program uses technology from stickK, a free Internet service that encourages participants to reach personal goals through "commitment contracts" that, if broken, result in a payout to a person or charity of their choice. We mentioned stickK in an article in CURE's 2008 summer issue. In Choose You, participants commit to eating better, exercising, quitting smoking, getting regular health checks, or protecting their skin, and then make a monetary pledge to the ACS.

If the goal is achieved, the pledge is returned. If the goal is missed, then the pledge is a donation to the ACS. So either way, you are a winner! A referee is assigned to help you toward your goal, and you can add a virtual cheerleading squad of family and friends to support you along the way.

The Choose You website also has many tools to help you achieve your goals. There is a virtual dietitian, videos on subjects such as making healthy choices on vacation, articles on eating healthy at restaurants, and nutrition and activity quizzes.

Being a working mother of two children, I know it is easy to put everyone first in your life, and many times, you have no choice. But if you don't stay healthy, how can you be there for your family, friends, and work? So do something for yourself--"Choose You" and pick one thing you would like to change to put yourself on the path to a healthier you.


Still eat your fruits and veggies


Recently there were lots of news stories rising from on a review in the Journal of the National Cancer Institute that said eating fruits and vegetables has a minimal effect on preventing cancer. USA Today headlined "Eating veggies doesn't stop cancer," and CNN said "Fruits and vegetables are no miracles in cancer prevention."

The American Cancer Society countered with this statement: "The results from this large, multi-country European study support the American Cancer Society Nutrition Guidelines in that participants who ate the most vegetables and fruit had up to a ten percent lower risk of being diagnosed with any cancer than those who ate the least. The results were consistent across countries, and cancer risk was lower in never and former smokers, as well as in those who smoked," said ACS vice president emeritus Michael J. Thun, MD. "The American Cancer Society recommends a diet that includes a variety of healthful foods with an emphasis on plant sources such as vegetables, fruits, and whole grains."

Studies can be confusing, and I'm glad the ACS gave us its take on this one before people started throwing out their fruit bowls to replace them with cookie jars. What is important to everyone, especially cancer patients who may lose nutrients during treatment, is to get the most nutrition out of the foods we eat, which is why fruits and vegetables are crucial to our daily diet. Fruits and veggies are low in calories, are packed with vitamins and minerals, and are an excellent source for fiber--claims that many processed foods cannot make.

Also, other research has shown that diets high in vegetables and fruits can have a preventive effect against obesity and cardiovascular disease. And we do know that obesity can increase your risk of getting certain cancers.

The ACS has some basic recommendations on diet: • Eat a healthy diet, with an emphasis on plant sources. • Choose foods and drinks in amounts that help achieve and maintain a healthy weight. • Eat five or more servings of a variety of vegetables and fruits every day. • Choose whole grains over processed (refined) grains. • Limit intake of processed and red meats. • If you drink alcoholic beverages, limit your intake. Drink no more than one drink per day for women or two per day for men.

For more information, check out the ACS's guidelines for nutrition and physical activity for cancer prevention.


Vitamin D may lower colon cancer risk


People with higher levels of vitamin D in their blood may have a reduced risk of developing colorectal cancer, says research published this week online from the British Medical Journal.

The study, part of the European Prospective Investigation into Cancer and Nutrition (EPIC), followed 1248 patients who developed colorectal cancer and compared them to 1248 patients who did not develop the cancer. Researchers found that patients who had the highest pre-cancer concentrations of vitamin D in their blood had about a 40 percent lower risk of developing colorectal cancer.

In an interview with Reuters, EPIC investigator Mazda Jenab, PhD, said although the findings showed lower risk, "... this has to be balanced with caution regarding the potential toxic effects of too much vitamin D and the fact that very little is known about the association of vitamin D with either increased or reduced risk of other cancers."

Jenab added, "the key take home message for colorectal cancer prevention is: stop smoking, increase physical activity, reduce obesity and abdominal fatness, and limit intakes of alcohol and red and processed meats."

The EPIC study is one of the largest studies on how diet and health can impact the incidence of cancer. From 1992 to 1999, the EPIC study recruited over a half a million people in ten European countries to participate. Many findings have emerged from the study including research showing an increased risk of breast cancer in obese adults and research showing an increased risk of colon cancer in people who consume larger quantities of red and/or processed meats. For more information on the EPIC study, click here.


Help for New Year's resolutions


Did you make any New Year's resolutions? I polled some of my friends and most of their resolutions involved eating better and/or exercise. I'm in there as well, always trying to focus more on nutrition and sticking to my exercise routine.

But not even two weeks into the year, and I'm already whining. It's been colder than usual here in Dallas, so in the morning the last thing I want to do is leave my warm bed for a freezing cold drive to an overcrowded gym.

So in looking for some inspiration, I noticed our federal government sponsors many online tools and offers information that can help toward the goal of a healthier lifestyle. And to top it off, they are all free. Here are some:

At, you can read about the President's Council on Physical Fitness and Sports, learn about the Council's guidelines on physical activity, and find tools and programs to help you start your own exercise routine.

The website covers the new food pyramid and can create a personalized nutrition plan. The MyPyramid Tracker helps you to track your nutrition and fitness goals. And parents, this website also has information on nutrition for children.

To increase our intake of fruits and vegetables, government organizations along with many nonprofits created This website has a tool to tell you how much fruit and vegetables you need based on your weight and exercise level. It also has recipes and nutritional information.

I'm supposed to eat two cups of fruit and two and a half cups of vegetables a day. One way to do that is to get into the locavore movement. Locavores are people who eat foods grown locally for a variety of reasons, such as having fresher food with better nutritional value, not supporting shipped and processed foods which burn fuel in production and transportation, and helping local farmers as well as sustaining local economies. You can find out more about your local farmer at this government website. You can also search for a farmer's market close to you with this tool.

The website aggregates nutrition and food information across federal agencies, so there is a range of information from nutrition and weight management to the latest government nutrition news (like did you know January 4-10 is folic acid awareness week?).

Happy New Year and I hope these tools and information help you on the path of a healthier you, resolution or not!


Curry and cancer


I often get calls or e-mails from friends wondering about natural cures for cancer that they have read in the news or heard about from other friends or family. And while some are hoaxes, there are also some that are backed by exciting research. Many natural ingredients are the basis for chemotherapies that we use today.

The call I got recently was about curry, more specifically turmeric, a spice in curry that provides that vibrant yellow color. Last week the British Journal of Cancer published a study that showed curcumin (a molecule in turmeric) began to kill esophageal cancer cells within 24 hours after exposure in lab tests.

Although these findings are based only on laboratory results and not human trials, they are part of a growing body of research on curcumin's effect on cancer cells. Other in vitro and animal studies have shown similar cancer-fighting properties, including effects on colon cancer and promyelocytic leukemia cells. Currently, there are over a dozen clinical trials examining curcumin as a treatment alone or combined with other therapies.

However, like other antioxidants, turmeric seems to counteract the effects of some chemotherapies. Patients on Cytoxan (cyclophosphamide) are advised to limit their intake of turmeric due to the possibility of interference. Also, there are questions regarding the dosage of curcumin, as well as its weakened effect after ingestion.

So before you load up on curry, ask your doctor or nurse if it hinders any medications you are on. And if you get a green light, enjoy this tasty, versatile spice, and hopefully we'll hear more about its cancer-fighting abilities through these latest clinical trials. It may not be a cure for cancer, but it is certainly a wonderful addition to any pantry.


I'll have pineapple with that


A couple of months ago, I wrote a blog about the importance of drinking water, especially for cancer patients. One of our readers asked a question that I thought was important as it could help people increase their water intake. "Adrienne" asked if adding fresh mint, ginger or honey to purified water makes a difference.

This is a question I've wanted to know the answer to so I contacted Milton Stokes, MPH, CDN, who is a registered dietitian and owner of One Source Nutrition, a nutritional consulting and counseling firm. Milton also sits on the board of CURE magazine.

Here's what Milton said if you missed it: "As a Registered Dietitian, I always counsel my clients to tweak/alter beverages (and foods) to fit their individual preferences. So if you like mint and ginger in your water--I certainly do!--then go for it. Whatever gets you to your goal. And your add-ins may help digestion, which is another bonus! If you need some sweetness, honey is fine. Just hone in on what "a little" really means. Is it a lengthy squirt from the bear-shaped container? Or are we talking a teaspoon? While honey provides antioxidants, it also delivers calories. So if you're trying to lose weight, you may wish to minimize or skip the honey. Another option: sliced oranges or berries in the water. That's your call. Just glad you're focused on hydration."

I've put citrus in my water before, but I hadn't tried berries so I sliced up a few strawberries today in my water, and it was yummy! Thanks, Milton, for the great input. I'm sure other fruits can be just as tasty. I think I'll try pineapple tonight.


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