When someone you love gets diagnosed with cancer,
it can be a very helpless feeling. You want to know what you can do to
make a difference, and what kind of lifestyle changes will help give that
person the best chance to survive. You want to know what caused the
cancer; maybe that will help you focus on certain areas. For some types
of cancer, the cause and effect may be obvious. If you’re a long time
smoker and get lung cancer, you know the reason. If you’ve been a regular
at the tanning booth for years and get skin cancer, you probably have an idea about
what might have caused it. But a lot of times, doctors will not be
able to tell you what caused a cancer to grow. That is often the case
with stomach cancer.
When Megan was diagnosed, the doctors weren’t very
concerned with figuring out the root cause. The focus was immediate
chemotherapy and killing the tumors. But I wanted to know. And
without any other information to go on, I correlated the location of her
primary tumor (the junction between the stomach and esophagus) with what passed
through that region – food.
I can’t remember the exact timing, but I’m pretty
sure it was the day that we got confirmation that it was stomach cancer that I
printed out this list of food guidelines for the Gerson
diet. A few people mentioned the Gerson Therapy to us after finding it
online or watching a documentary on it. It’s an alternative, non-toxic
approach to treating cancer. In their words, “The Gerson Therapy is a
natural treatment that activates the body’s extraordinary ability to heal
itself through an organic, vegetarian diet, raw juices, coffee enemas and
natural supplements.” But it’s super-intense (yes, you read that
correctly – coffee enemas), and although there are stories of people who have
done well, I doubt that any oncologist would recommend it as a first-line
therapy for someone with stage 4 cancer. It’s probably more realistic for
someone with very early stage cancer who is completely against
chemotherapy. I figured doing something
like that would be a last-resort type of option for Meg.
Their literature is also very clear that someone
should not attempt to do the intense therapy while undergoing
chemotherapy. But, I thought that the list of prohibited foods was a good
starting point for what we should not be eating. So Megan and I went to
Whole Foods that night with the list in our hand, and attempted to follow it
while still going home with food that we could actually form into edible meals.
It wasn’t easy. Even though we already ate a 99% vegetarian diet at home,
the Gerson list ruled out so many of the things that we normally bought at the
grocery store. That weekend, I cleaned out our refrigerator, throwing away anything
that wasn’t organic. Cutting down toxins and eating healthy was going to
be the new plan. I also went out with Meg’s mom and bought a Vitamix, so
we could make protein shakes with leafy vegetables. And I made a big pot
of Gerson’s Hippocrates Soup, which was notable for being
the first time I cooked with celery root, and also the first time I made soup
with no added seasonings. (It tasted exactly like you are imagining
it might taste like.)
This was all well intentioned on my part, but it
was not the right approach.
Megan could barely eat due to the pain she was in,
and she was starting chemotherapy – a treatment that can wreak havoc on your
appetite. In a situation like that, the focus should really just be on
getting calories and protein any way you can. The oncologist at
Georgetown told her that ice cream was a great thing to eat. I was a
little upset at that, but in retrospect he was right – it didn’t require
chewing, and it provided some protein and calories. She couldn’t eat
anything those first few days after getting chemo, but slowly she started being
able to eat and drink again. The first goal was 800 calories a day, and
it wasn’t easy, but Meg did her best to finish as much “Ensure” as she
could.
After several weeks of chemo, Meg was finally back to a somewhat normal
eating schedule and getting in a full load of calories. I had been doing a lot of research, and was getting overwhelmed
with all of the information available on the internet about what we should be
focusing her diet on, and what natural supplements might be complementary to
the primary chemo regimen that Meg was on. I wanted some help from a
professional who could help us decipher between what was real and what was a
gimmick, and wanted to get some real guidance and motivation on what Megan
should and should not be eating. I found
a nutritionist associated with the George Washington Center for Integrative
Medicine. I chose this nutritionist
because she was associated with a University, and because she was a cancer
survivor herself. I also noticed that
most of the big cancer hospitals had Integrative Medicine departments, so I
thought this sounded like a good approach.
As Sloan-Kettering’s website says, “Integrative medicine uses evidenced-based complementary
interventions to optimize the receipt of mainstream care by controlling the
serious physical and emotional symptoms often experienced by patients before,
during, and after therapy.”
We met with the nutritionist for 90 minutes, and she gave
us a lot of information. Here are some
of my notes from the session:
Disclaimer: these are recommendations for someone with cancer -
Megan specifically. So they don’t all
apply to healthy individuals. And we
needed to run everything by our oncologist, particularly the supplements. These appointments are expensive and not
usually covered by insurance, so I want to share the info. But be sure to read the rest of this blog
post before taking any advice presented here.
- Normally, she would put cancer survivors on a very strict diet. Low sugar, no grains, no gluten, etc... But she is not recommending that for Megan right now because it would eliminate too many food options. Most important for Meg is keeping weight up and getting enough calories/protein.
- She is recommending an anti-inflammatory, low-glycemic diet.
- No fruit juices. No Gatorade. Look for sugar-free drinks.
- But ok to mix a little fruit juice in with water to make water easier to drink.
- No cakes/cookies/cupcakes
- Eat small meals/snacks throughout the day instead of large meals.
- Read labels – the protein and fiber should make up half of the carbohydrate total.
- Avoid artificial sweeteners. But natural sweeteners like Stevia and Xylitol are ok.
- When it comes to organics, try to follow an 80/20 rule. Impossible to go completely organic, but do organic for everything that you can. If 80% is organic, then you are really limiting the pesticides.
- “Dirty dozen” attachment outlines which fruits and veggies need to be organic and which are ok to get conventional.
- Goal is 2000-2200 calories per day.
- Want to strive for 9-12 servings of fruits and veggies per day. Mostly veggies (75%), and as many greens as possible.
- This is very hard to achieve, so a good option is to use “Green foods”, a powder supplement that can provide 6 or 8 servings of veggies in a single serving.
- Berries are the best fruits but must be organic.
- Want to get a minimum of 65g of protein per day, shoot for 80g.
- Breakfast
- Eat cereals that are as plain as possible, without added sugar.
- Regular cheerios instead of honey nut.
- Kashi lean is good
- Try almond or rice milk
- Canadian bacon or turkey bacon is ok
- Oatmeal is good
- When eating fruit, don’t eat it alone. Eat with a protein.
- Chipotle / Panera are ok. They are GMO free.
- When making smoothies, make with 20g of protein per serving.
- Whey protein is best. Get organic, preferably pasture raised.
- Use organic greek yogurt. Would normally recommend non-fat, but normal yogurt is good for her now.
- Another option could be using coconut milk as the base.
- Things to avoid
- Flaxseed is not recommended as a primary source of omegas. It is an inflammatory, and we want an anti-inflammatory diet.
- Cut down on soy. No more than once a week.
- Clif bars – not low-glycemic.
- Ice cream – ok as a snack once every three weeks. But eat it with a protein.
- Supplements / vitamins
- Multivitamin with no Iron or Copper
- Vitamin D
- Omega 3
- Curcumin BCM95 (turmeric)
- Now Foods Pure AHCC (mushroom powder)
The main thing we took out of this was a reinforcement that we needed to
focus on a low-glycemic diet. We got the
list of supplements approved by Megan’s oncologist, and started trying to work
all of this stuff into our daily routine.
We did that for about two months, went for one follow-up appointment
with the nutritionist, and everything seemed to be going pretty well. That is, until we went for a second opinion
at Sloan Kettering in November. While we
were there, the oncologist asked why Megan was taking such a long list of
supplements. He expressed a concern
about overdoing it on anti-oxidants while undergoing chemotherapy, and asked if
we would like to make an appointment with a nutritionist in their Integrative
Medicine center. We said sure, and we
were able to have the appointment with their director of nutritional
counseling, Donald Garrity, over the phone the next week. He was a little more conservative than the
first nutritionist, but I really liked what he had to say. You could tell that he was associated with a
leading research hospital, because he really tried to have a reason for each
recommendation he made and often referred to nutritional trials and
research. Here are some of my notes from
that conversation:
- He said if we were in his office we would see a 3-foot stack of papers on studies about the role of vitamins and supplements as they relate to cancer prevention. At this point, opinions are split 50/50 as to whether or not they can really help prevent cancer.
- There is much less research on the role of supplements during active chemotherapy, maybe a 6 inch pile. So no one can really tell you what the right answer is. Because of that, he tends to be conservative about supplements during chemo.
- Supplements:
- Multi-vitamin is above and beyond what they would recommend.
- For multi-vitamin, during chemo stay at 100% DV. The one she is on seems too high.
- Cancer cells absorb more vitamin C than healthy cells. A subsequent study showed that it stabilized the cancer cell.
- Omega 3 – is a blood thinner. Many benefits, but as long as your platelets are normal.
- Vitamin D – should stay in the middle of the range. Get it checked, cut back if you hit 80.
- Curcumin – very promising. But acts like grapefruit juice. Interacts with many medications. Ok in-between chemo treatments. But could inhibit the ability of the chemo to clear the body.
- AHCC – good, but still questions about interactions with chemo. Try one of these, or alternate between them:
- Maitake Mushroom Extract D-Fraction: standard formula (not extra strength)
- From Grifron or Mushroom Wisdom
- Coriolus Versicolor
- Diet
- Avoid: white sugar, white flour, white fat
- Smaller meals
- Relaxed eating environments
- Favorite foods anytime of the day
- Eat extra calories when feeling well
- Soups, stews, casseroles (with added plant oils)
- Research
- Book: “Anti-cancer”
- Eugene Fine – sugar/cancer study. Atkins diet slowed cancer growth in 50% of patients.
- Dr Andrew Weil - head of Integrative Med at Univ Arizona
- raised a fear that if you raise anti-oxidants during chemo, you may protect the cancer cells as well as healthy cells
- still hotly debated
Donald was very clear about something – he wasn’t trying to tell us that the other nutritionist was wrong. In many areas, they both made very similar recommendations. But when it came to supplements, he didn’t want to recommend anything that had the possibility of a negative impact during chemotherapy. We agreed. We wanted to make sure we were doing everything we could to maximize the effectiveness of the chemotherapy while minimizing the side effects. If a study indicated that there was a chance this might not be the case for one of the supplements, we were going to play it safe. So Megan cut back a bit on the multi-vitamin and vitamin D, stopped the curcumin, and replaced the AHCC with Maitake.
2,000 words
later, what’s the lesson here? I’m not
completely sure. I think we did the
right things, and I’d like to believe that Meg’s effort to eat healthy and cut
most of the sugar out of her diet helped keep the cancer at bay for a little
while, while keeping her strong enough to remain relatively active while
undergoing chemo for 9 months. But the
reality is that we don’t know. Unlike
pharmaceuticals, there isn't big money in nutritional supplements and natural
approaches to treatment. Without large
companies sponsoring these trials and lobbying the government to give them
funding, they don’t get studied nearly enough.
You see so many articles about a fruit that can prevent cancer, or a
natural approach to beating cancer. But
it’s usually anecdotal evidence at best, and hearsay at worst.
So that’s
why I want to share the website that the nutritionist from Sloan pointed us
to. It’s one of the best sites I’ve
found on the internet.
That URL
will redirect you to a segment of the Sloan-Kettering Integrative Medicine
website. On it, you can look up many
herbs and supplements, and find (what seems to be) unbiased information about
them. There are two tabs for each
“herb”. The Healthcare Professional
tab provides a summary of clinical studies that have been performed, and
provides a list of references to actual research that has been conducted and
published to the National Institute of Health.
The Consumer tab provides a “Bottom Line” written for the lay
person, and addresses the purported uses and research evidence. I’ve found this site to be a fantastic
alternative to just looking things up on Wikipedia and hope I’m getting the
right information. The summaries are
generally conservative, but the information is right there – you can read the
studies and form your own opinions if you really want to. If someone recommends that I start taking a new daily supplement in the future, I am definitely going to take the time to do some research on this site before putting it in my body. In a world of unregulated supplement labels and unsubstantiated promises of
“miracle cures,” I appreciate having someone pulling all of this information
together. It's not the answer, but it's a start.
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