Battling Cancer Through Diet
Here's a shocking statistic: Even when the right conventional medical treatment is usedwhether it's surgery, chemotherapy, or radiation, or some combination-half of all people with cancer will eventually die from their disease. To our way of thinking, that cold fact is reason enough to make us want to explore all avenues for helping our patients get well.
But there are plenty of other reasons. For example, studies show that in women who had surgery for breast cancer who were less than 30 years old, chemotherapy added only an extra ten months of life compared with women who did not receive chemotherapy. For women over 50, the added survival is about seven months. That's not a lot, especially when that precious extra time is often spoiled by the toxic side effects of therapy. We know many people who opted not to undergo treatment because they were afraid of side effects. For them, the cure semed worse than the disease. But we counsel them that natural therapies are known to lessen the impact of side effects, while at the same time allowing conventional treatment to work. In most cases, natural therapies can actually increase the benefits from other therapies, working synergistically to improve the outcome. When given that perspective, many patients are more willing to undergo conventional treatments and thus improve their chances of getting better.
In our clinical practice, we have met people who had tried all the conventional treatments for their cancer, but nothing worked. Told their discase was terminal, they figured they had nothing to lose by exploring a broader, more integrated approach to care. They heard about our philosophy and came to talk to us about their options. A few years later, many of these people were disease-free.
It's worth remembering the flip side of the statistic we used earlier: Fifty percent of cancer patients survive their disease, and many are completely cured. No one can predict exactly who will recover completely from cancer. And no physician can guarantee a cure. But we believe that you'll increase your odds of survival and have a higher quality of life if you take advantage of the whole spectrum of therapies, including those that harness the healing power of nature.
In this chapter we describe some of the general strategies that offer benefit to just about everyone who is coping with cancer.
Diet and Nutrition
The importance of high-quality nutrition in the battle against cancer cannot be overstated. Cancer patients who have higher nutritional status are not only more likely to fight off infections and recover from their illness, they're also better able to tolerate therapy and its side effects. In previous chapters we offered some general dietary guidelines that help protect your body against the onset of cancer. Many of those same principles apply to people who are undergoing treatment for the disease. Following are some additional dietary steps that cancer patients can take to minimize the negative effects of their condition, especially if they are on any chemotherapy drugs.
For someone with good energy levels, appetite, and nutritional status following the recommendations given in the daily plan provided in Appendix A may be all that is necessary to provide them optimal nutrition. But many people with advanced cancers and most people going through chemotherapy will usually be challenged with such things as low energy levels, loss of appetite, and nausea (and possibly even vomiting).
Nausea and vomiting are among the most troubling complications of cancer. The problem sometimes results from the cancer itself, but often it's an adverse effect of chemotherapy or radiation. If nothing is done to control nausea and vomiting, patients may lose their appetite. (The technical term for this condition is anorexia.) When they stop eating a healthy balanced diet, patients may gradually lose a severe amount of weight. This wasting away, called cachexia, is a sign that the body has started to use up all of its energy reserves. After it burns all the energy stored in fat cells, it begins using the muscle cells. Rapid weight loss is one of the most serious signs of trouble for a cancer patient.
Often anorexia and cachexia are two sides of the same coin: If you don't eat, your body may waste away. Cachexia, however, can also occur in people who are eating enough-their bodies are so ravaged by disease that they cannot properly absorb the nutrients. In some cases, tumors produce large amounts of cell proteins called cytokines. (The word means "cell activators.") Cytokines act on the body by revving up the metabolism, thus burning more cells, accelerating tissue breakdown, and speeding up the wasting process of cachexia. By some estimates, approximately 40 percent of cancer fatalities result not from the disease itself but from malnutrition.
Patients with anorexia or cachexia may find it necessary to suspend healthy eating habits and focus on eating the things that appeal to them. That is fine for the short term, but we cannot stress enough the importance of high-quality nutrition to effectively fight cancer. You will find dietary suggestions that can help improve nutritional status in cancer patients experiencing anorexia or cachexia in Appendix B on page 308.
Sometimes it just may not be possible for cancer patients to get the nutrition and fluids they need through eating and drinking. They may
need addition measures, such as enteral nutrition (feeding via a tube into the stomach) or parenteral nutrition (infusion through a vein). These methods are helpful when
- upper gastrointestinal blockage prevents cating or drinking
- side effects of treatment limit eating or drinking (e.g., burns or irritation to the throat resulting from radiation therapy to the esophagus)
- anorexia or other problems such as severe depression, confusion, or disorientation keep the patient from eating or drinking sufficiently
- pain makes it difficult to chew or swallow
- surgery has involved removal of part of the gastrointestinal tract
- the patient has difficulty maintaining adequate body weight and muscle mass
Often we find that cancer patients need to increase their intake of protein, especially if they are showing signs of cachexia or they are on chemotherapy. Protein is especially important for many of the functions necessary for your recovery. It helps maintain muscle mass, nourishes the lining of the gastrointestinal tract, boosts blood counts, heals tissues, and boosts the immune system to help fight cancer and prevent infections. On the other hand, inadequate protein intake slows recovery from illness and decreases resistance to infection. Undergoing conventional cancer therapy may require as much as 50 percent more protein than usual.
Smoothies are an idealand deliciousway for people with cancer to consume lots of high-quality protein. There are plenty of great-tasting protein powders on the market. You can mix them with water, juice, nonfat milk, or soymilk to make your own great-tasting smoothie. Several delicious recipes are given in Appendix B.
Not only is the protein quality higher in these powders, but these smoothies are much easier and more palatable for the cancer patient to consume than fish, chicken, or red meat.
The highest-quality protein powder comes from whey, a natural byproduct of the cheesemaking process. Cow's milk has about 6.25 percent protein. Of that, 80 percent is casein and the remaining 20 percent is whey. Cheese uses the casein molecules and leaves the whey. During processing, the lactose, fats, and minerals are filtered out. What' left behind is pure whey protein.
Whey is called a complete protein because it contains all essential and nonessential amino acids. (Amino acids are the building blocks of protein that are released during digestion and later used to make thousands of different kinds of protein your body needs.) Whey protein, when processed properly, also has the highest biological value (BV) of all proteins. BV is a measure that indicates how much of the protein you eat is actually absorbed, retained, and used in the body (as opposed to the amount that passes out of the body unused). One reason the BV of whey protein is so high is that it has the highest concentrations of glutamine (an amino acid) and branched-chain amino acids (BCAAs) found in nature. Glutamine and branched-chain amino acids are critical to cellular health and protein synthesis.
Glutamine, the most abundant amino acid in the body, is involved in more metabolic processes than any other amino acid. Glutamine is especially important as a source of fuel for white blood cells, and for cells that divide rapidly, such as those that line the intestine. It has become an important component of intravenous feeding mixes in hospitals, since double-blind studies have shown that it dramatically increases survival in critically ill subjects.Glutamine also prevents the mouth ulcers (stomatitis) and suppression of the immune system in cancer patients receiving chemotherapy. It also heals peptic ulcers, enhances energy levels, boosts immune functions, and fights infections.
We recommend that patients obtain their glutamine by taking daily doses of 20 to 30 g of whey protein concentrate twice a day. We believe that acquiring glutamine from whey protein provides additional benefit over simply taking glutamine. Whey protein is more beneficial because it contains other compounds (called fractions and peptides) that are known to improve immune function and boost glutathione concentrations. If for some reason (e.g.,allergy) you cannot take whey protein, then you can take glutamine supplements, 3 to 10 g daily.
Whey protein and/or glutamine can be used to support recovery from surgery, radiation therapy, and chemotherapy. If you have trouble keeping your weight up, then we would recommend using one of the whey-based weight-gain products on the marketplace.
Whey protein comes in premeasured individual serving packets and bulk canisters and is available in many different flavors-chocolate, vanilla, strawberry, pina colada, orange, and so on--from many different manufacturers. For many of the products, just mixing the whey prorein with 8 to 12 ounces of water, juice, nonfat milk, or soymilk and a few ice cubes is all that is needed to make a delicious shake. You can also add some frozen or fresh fruit, 1/2 to 1 cup, to make it even more nutritious and higher in calories. Smoothies are also a great way to add flaxseed oil or ground flaxseed to your diet. We provide a few smoothie recipes to try in Appendix B, Daily Plan for Beating Cancer.
Reducing Tumor Cell Glutathione Levels with Whey Protein
Glutathione is a powerful antioxidant that also helps enzymes rid the body of toxic substances. Ironically, some studies show that the concentration of glutathione is higher in tumor cells than in neighboring normal cells. This difference in glutathione status might explain why some cancer cells are resistant to chemotherapy--they've "recruited" glutathione to protect them.
If that's true, then it would make therapeutic sense to try to reduce the levels of glutathione in tumor cells. Whey protein might be the answer. Studies indicate that whey protein selectively depletes cancer cells of their glutathione, thus making them more susceptible to cancer treatment, and inhibits cancer cell growth, thus reducing the tumor burden. At the same time, it increases glutathione in normal cells and increases their growth. These benefits were not seen with other proteins. The researchers concluded: "Selective depletion of tumor cell glutathione may infact render cancer cells more vulnerable to the action of chemotherapy and eventually protect normal tissue against the deleterious effects of chemotherapy."
How does whey accomplish this neat trick? Scientists aren't sure. We do know that glutathione production is self-regulated--that is, when levels are high enough, the cell switches off production. Perhaps whey protein "fixes this feedback mechanism in tumor cells, causing them to shut down their overproduction of glutathione.
For optimal health, it's important for everyone to take in adequate fluid. For people with cancer especially those undergoing chemotherapy it's absolutely essential to maintain good hydration. Without adequate water your body cannot detoxify the drugs and remove them from your system. The buildup of these toxins will lead to further symptoms and discomfort. You also need fluid to remove the metabolic by-products of your fight against cancer, including the debris from dead cells.
Lack of adequate water can cause a range of medical complications including cystitis, excess calcium buildup, electrolyte disturbances, fatigue, muscle spasms, and irregular heartbeat. The risk of dehydration is higher if chemotherapy causes vomiting and diarrhea.
Here are some tips to maintain good hydration:
Suggestions for Dealing with Dehydration
- Drink bottled, filtered, or purified water.
- Prepare herbal ice teas and keep a glass at your side throughout the day. If you sip just 4 to 6 ounces every hour, you'll reach your daily quota for fluids.
- Avoid caffeine and alcohol. These act as diuretics, which means they draw water from your cells and cause you to urinate more fluid than you are consuming.
- Eat more soups, stews, and other "watery" foods. These are often easier to digest. They're also easy to reheat when you are tired, and they increase your total water intake with each serving.
- Freeze ice pops made with weak fruit juice and water or seltzer and suck on them when your mouth is sore.
- Drink most of your fluids between meals to leave more room to take in nutritious food when you eat.
- void drinking large amounts of fluids all at once, since that can cause nausea and perhaps aggravate the dehydration. Instead sip several ounces, wait about 15 minutes, and sip some more.
- Eat more fresh fruits, especially juicy ones. Watermelon is a particularly good choice.
- Choose sorbets and ices for dessert.
If you are extremely tired, keep an ice chest by your chair or bed side to make it easier to reach fluids throughout the day.
Electrolytes (such as potassium, calcium, and sodium) are chemicals your cells need to function. Dehydration can cause an electrolyte imbalance. If you are dehydrated because of vomiting or diarrhea, it is important to drink fluids that replenish electrolytes, such as Gatorade or other sports drinks. You can make your own electrolyte drink by combining 1 quart water, 4 tablespoons honey, 1 teaspoon salt, and 1 tea spoon baking soda. For milder dehydration, fruit juices and teas are adequate (and they taste better).
For severe dehydration, intravenous fluid replacement may be necessary. This can be done at your doctor's office or with the assistance of a visiting home nurse. Replacement of fluids can often lead to an immediate return of well-being and reduction of nausea. Be sure to notify your doctor if you are unable to drink fluids, if you have severe diarrhea or vomiting, or if you experience a rapid weight loss within several days. Other signs of dehydration include dry lips, dark urine, or getting dizzy or lightheaded upon standing.
Get a Juicer!
Juicing provides an easy and effective way to meet many needs of the cancer patient. It is a great way to get pure, clean water into your system, and it is a very efficient way to dramatically increase your intake of cancer-fighting phytochemicals.
One of the most consistent experiences of cancer patients who start drinking fresh fruit juice and vegetable juice is a tremendous increase in energy levels. Juicing helps the body's digestive process and allows for quick absorption of high-quality nutrition. The result: increased energy levels.
Of course, you will need a juice extractor to prepare the juice yourself. Any department store or store that sells small kitchen appliances should have juicers for sale. The Juiceman models from Salton are the most popular and are very affordable ($59 to $189, depending on the model).
We recommend that you drink 18 to 24 ounces of fresh fruit or vegetable juice daily, but don't drink your allotment of fresh juice all at once; break it up into 8-to 12-ounce dosages throughout the day. Note that if you do not want to invest in a juice extractor, you will need to double up on your green drinks (see Chapter 3, page 63) to provide your body with higher levels of phytochemicals. Take two servings of the green drinks daily.
Carrot juice is perhaps the most popular juice prepared on home juice extractors. Its flavor and sweetness blend well with other vegetables, Juicing four carrots along with one apple can mask many of the stronger vegetables such as broccoli or kale. Carrots should be fresh looking, firm, smooth, and vibrantly colored. Avoid carrots that have cracks, are bruised, or have mold growing on them and be sure to wash and scrub with a vegetable brush before juicing. The same guidelines apply to any of the other produce that you use.
Pineapple juice also makes a good juice base for the cancer patient. Believe it or not, juicing kale, spinach, or other greens with pineapple juice is delicious, as is mixing a green drink mix. If your juicer can handle it, you can juice pineapple skin and all (be sure to wash and scrub thoroughly with a biodegradable produce wash before juicing). For a delicious treat, juice 12 pineapple along with 1 cup fresh blueberries. raspberries, or cherries (remove pits before juicing).
With juicing, the best recommendation is to let your taste be your guide. It is pretty much anything goes. We provide several recipes in Appendix B, Daily Plan for Beating Cancer, to help you get started.
Ginger for Loss of Appetite, Nausea, and Vomiting
Ginger is an extremely valuable ally for the cancer patient as it exerts significant benefits in alleviating nausea. Ginger acts directly on the gastrointestinal system as well as areas in the brain that control nausea. In addition to studies in preventing motion sickness and nausea and vomiting during pregnancy, several double-blind studies have shown that ginger reduces nausea after surgery and the nausea caused by chemotherapy.
Ginger is available in dried ginger, freeze-dried, and tincture--and in various extracts, mostly in capsule or tablet form. Although most studies have used powdered gingerroot, fresh (or possibly freeze-dried) gingerroot or extracts might yield even better results, because they might deliver higher levels of active components.
The typical dosage used in studies has been 1 to 2 g of powdered dried ginger. This dosage would be equivalent to approximately 10 g, or 1/3ounce of fresh gingerroot, roughly a 1/4-inch slice of an average-sizedroot It you have a juicer, fresh ginger can be added to any fresh juice to give it a litde zing as well as greater health benefit. Here is a recipe that is quite soothing to the stomach and intestinal tract:
Juice the following:
- 1/4 slice ginger
- 1/2 handful fresh peppermint or spearmint
- 1/2 small fennel
- 2 apples, cut into wedges
Ginger tea can be made by adding slices of fresh ginger to hot water and steeping for 6 to 8 minutes. The longer it is steeped, the stronger the flavor. A squeeze of fresh lemon and a spoonful of honey can be added if desired
Ginger rice can also be eaten to try to reduce nausea. It also provides some good nutrition. Cook either brown or white rice as you normally would, but add 1 piece peeled fresh ginger (1 inch long by about 1 inch in diameter), and cut into thin slices for each 1-cup serving of rice.
Homemade ginger ale can be made with your juice extractor. Juice a 1/4-inch slice of an average size root, 1 lemon wedge, and 1 green apple and add it to 4 ounces sparkling mineral water. Stevia, a natural sweetener available at your local health food store, can be used to sweeten, if needed.
Soy in Cancer Treatment
Increasing the intake of soy foods appears to be helpful in most cancers. The possible exception is in women who have estrogen-sensitive breast tumors. While studies in test tubes and in animals show that the 1801lavone genistein stimulates the growth of estrogen-receptor positive tumors, it inhibits growth of breast cancer cells that lack estrogen receptors as well as most other cancer cells. It appears that for most can 18, especially prostate and lung cancers, there is some benefit to increasing the consumption of the soy foods, such as tofu, tempeh, and miso, and "second-generation" soy foods that simulate traditional meat and dairy products, such as soymilk, soy hot dogs, soy sausage, Soul cheese, and soy frozen desserts, found at the grocery store.
Soy isoflavonoids prevent the formation of new blood vessels, the preventing tumors from obtaining a blood supply necessary for continued growth. They also prevent tumor cells from dividing and growing by inhibiting enzymes involved in cell replication.
We encourage you to consume at least one serving of soy per day unless you have a history of estrogen-positive breast cancer, in which case we encourage you to limit soy consumption to no more than four servings per week. Remember that you can use soymilk as the base for your whey-protein smoothies.
Basic Nutritional Supplementation for the Cancer Patient
Nutritional supplementation is absolutely essential in order to give the body the tools that it needs to fight cancer. While the five key dietary supplement recommendations given in Chapter 3 would still offer some benefit to the cancer patient, more intensive support is needed. Here is the supplement program that we recommend for basic support to the cancer patient (NOTE: additional recommendations are given in Chapter 8. The Super Eight, and Appendix B, Daily Plan for Beating Cancer):
- Use a high-potency multiple vitamin and mineral formula according to the guidelines given on page 312.
- Take extra vitamin C-a total of 500 to 1000 mg three times a day.
- Make sure that your vitamin E intake is in the 400-to-800 mg range.
- Take green tea extract-enough to provide 300 to 400 mg of polyphenols daily.
- Consume one to two servings of a green drink daily (see page 63 for description).
Take a probiotic supplement that provides 5 to 10 billion live lactobacillus species, bifidobacteria species, and/or propionibacterium freudenrichi daily.
- Use fish oil supplements at a dosage to provide 700 to 1200 mg of EPA and 400 to 800 mg of DHA per day.
If you have cancer, then green tea extract definitely becomes your apropriate flavonoid-rich extract, Green tea polyphenols not only exert significant protective action against cancer, but according to preliminary studies they exert significant therapeutic effects as well and can be safely used with conventional chemotherapy.
If you have breast or prostate cancer, we would also add the following:
- Ground flaxseed or fax meal-2 tablespoons daily
- Indole-3 carbinol- 300 to 400 mg daily
- Lycopene-30 mg daily
- Calcium d-glucarate 100 mg daily
These supplements were discussed in Chapter 4. Special Steps for Preventing Lung, Breast, Prostate, and Colon Cancers. These supplements appear to be particularly important for hormone-sensitive cancers like breast and prostate, but they might be shown to be of benefit in other forms of cancer as well. In addition to a protective effect against breast and prostate cancers, these natural compounds have shown some therapeutic benefits as well. For example, in a study of 30 women with precancerous lesions of the cervix (CIN stages II and III), indole-3 carbinol (13C) at a dosage of 200 or 400 mg daily showed impressive results.20 While no subject in the placebo group had complete regression of CIN, about 50 percent of the women (4 of 8 patients in the 200 mg/day arm and 4 of 9 patients in the 400 mg/day arm) had complete regression of their precancerous lesions based on their 12-week biopsy.
13C may have benefit in nonhormone-related cancers as well. The basis for this statement is the result in the treatment of 18 patients prone to recurrent respiratory papillomas-precancerous lesions of the lungs and airways.21 Thirty-three percent (6 of 18) of the study patients had a cessation of their papilloma growth, six patients had reduced papilloma growth rate, and six (33 percent) patients showed no clinical response to indole-3-carbinol. No side effects were noted in any of the trials with 13C.
Anxiety About Antioxidants During Chemotherapy and Radiation
One of the main areas of controversy about natural medicine and cancer involves the role of antioxidants during chemotherapy and radiation. The concern is that the antioxidants will protect the tumor cells and negate the benefits of treatment, but just the opposite appears to happen. It seems that when cancerous cells are exposed to the appropriate levels of antioxidants that we are recommending, they increase the rate which they destroy themselves through apoptosis (cellular suicide) and become less able to switch on the gene that tells them to grow.
As we've noted elsewhere, the big drawback of cancer therapy is that while treatment destroys the bad cells, it also destroys many healthy cells and normal tissues. Use of appropriate antioxidant therapy, fortunately, can protect healthy cells from damage and so reduce the severity of side effects from chemotherapy and radiation.
An inappropriate use of an antioxidant would be taking enormous dosages far beyond the levels that we recommend. When animals have been given huge dosages of an antioxidant that far exceed the amount corresponding to normal human use, as well as in vitro (test tube) studies that used concentrations of antioxidants not achievable in living systems, antioxidants have been shown to inhibit the cancer-killing effects of radiation and chemotherapy. For example, when vitamin E is given to mice at dosages equivalent to greater than 35,000 IU in humans, it can definitely reduce the effectiveness of radiation therapy.26 Other studies have shown that lower amounts of vitamin E given before, during, and after radiation actually increased the effectiveness of the radiation in killing cancer cells while blocking the effect in normal cells.22-25 Of course, 35,000 IU of vitamin E is a dosage not easily obtained through supplementation and is certainly well beyond the 400 to 800 IU that we recommend to cancer patients.
The bottom line in the whole discussion about antioxidants with conventional therapies is that there is considerable evidence in animal studies showing benefit, and emerging evidence suggests that people who use antioxidants at appropriate levels during chemotherapy survive longer. For example, in one study involving people with small-cell lung
Vitamin C and Cancer
Perhaps the most controversial use of vitamin C supplementation is in the treatment of cancer. In 1976, Linus Pauling, a two-time Nobel Prize winner (1954 Chemistry; 1962 Peace), brought vitamin Cinto the limelight by reporting the results of a groundbreaking study. Pauling and his colleague Ewan Cameron gave 100 terminally ill cancer patients 10 g of vitamin C per day. Sixteen of these patients survived more than one year. Such results may not seem significant-until you realize that in the control group (1,000 terminally ill patients who did not receive vitamin C), only three survived at least a year. Thus the survival rate with vitamin C was 16 percent among treated patients, compared with just 0.3 percent of those who did not get treatment. Another way of stating the results is that the survival rate was 53 times higher among the vitamin C group.
Cameron conducted another study and reported similarly impressive results. The study included 1.826 "incurable" patients. Of these patients, 294 received high doses (10 g per day) of vitamin C. The remaining 1,532 patients served as controls. In analyzing the data, the researchers found that the treated patients had an overall survival time almost double that of the controls (343 days compared with 180 days). 30 Japanese researchers also published similar results from two uncontrolled trials conducted at two different hospitals in Japan during the 1970s.
These studies had some flaws. They were not double-blind (that is, they were not set up so as to prevent the researchers and the patients from knowing who was getting vitamin C). Since the patients knew the purpose of the experiment, a placebo response might have affected the results. Other scientists who later conducted double-blind studies to test (some say disprove) Pauling's contentions have not found that vitamin C is better than a placebo.
In our opinion, while vitamin C alone may not be a strong enough intervention in the treatment of most active cancers, we believe that vitamin C is appropriate for cancer patients (who typically have very low vitamin C levels anyway). because it appears to enhance their immune function, improve quality of life, and extend survival time.2 Our dosage recommendation is 500 to 1000 mg three times daily.
cancer who used several chemotherapy drugs and underwent radiation therapy, the group that used supplements (antioxidants, vitamins, trace elements, and fatty acids) lived longer compared with most published combination chemotherapy treatment regimens alone.
The Importance of Fish Oil Supplements (Again)
We cannot stress enough the importance of utilizing fish oil supplements rich in the omega-3 fatty acids EPA and DHA in cancer patients. Fish oil supplements not only address many of the underlying biochemical features of cancer but also have been shown to address quite effectively the underlying features that contribute to cancer cachexia. This benefit has now been documented by several clinical studies, including studies of patients with cancers associated with severe cachexia. Fish oil supplementation along with vitamin E has also been shown to produce favorable effects on immune status and the survival of cancer patients.
Fish oil supplementation is very much indicated in anyone taking chemotherapy, especially anyone receiving the drug doxorubicin. Not only has it increased survival time in humans and animals taking the drug, but there is considerable evidence in test tube studies that fish oils (especially DHA) increase the effectiveness of the drug.
Use fish oil supplements at a daily dosage of 700 to 1000 mg of EPA and 400 to 800 mg of DHA.