My trip to the cancer nutritionist. Applying The China Study to real life


Recently, I went to see a nutritionist with expertise in cancer-fighting diets. And then consulted another cancer nutritionist by phone.

I have to admit, I was skeptical before I spoke to these experts. The last time I encountered a nutritionist/dietician, back in high school, the information she presented was so basic — pretty much common sense — that I had difficulty maintaining consciousness during her talk. So when my integrative medicine physician at the cancer center where I go for treatment recommended consultation with a nutritionist, I wasn’t exactly eager to comply. It has been my experience, reading around on nutrition and diet, that everybody has their own point of view. Nutritional opinions have become sort of like a political party — and we all know how discussions of politics go in polite society.

But I’m a good patient, so I made the appointment.

I was pleasantly surprised. I found the nutritionist’s approach refreshing and perceptive. Rather than rattle off an agenda for me, she spent the better part of the first hour sitting back and finding out how I eat and why. (No nutritional consultation is going to help if this listening — on the part of the nutritionist — isn’t an integral part of it.) And when I mentioned that I had recently read The China Study and had been convinced by its arguments for a plant-based diet, she simply nodded and smiled. If you aren’t familiar with this study (also a book), it’s the largest and most comprehensive study of nutrition and human health ever conducted, a joint project of Cornell University, Oxford University, and the Chinese Academy of Preventive Medicine. No rinky dink establishments, these three institutions.

It’s called the China Study, not surprisingly, because it was conducted in China. The 20-year study analyzed death rates from 48 forms of cancer and other chronic diseases, as well as diet and bloodwork, among 6,500 people. The study was made possible by the fact that the Chinese counties involved were populated by genetically similar people who tended to live in the same place for a long time, with few changes to their diets. For more on the China Study, click here.

The China Study found that the people who ate a plant-based diet (avoiding animal products such as beef, pork, poultry, fish, eggs, cheese, and milk, and reducing their intake of processed foods and refined carbohydrates) escaped, reduced or reversed the development of chronic diseases, including cancer. I suggest you explore the China Study in some depth. I think its findings will intrigue you.

But back to my trip to the nutritionist. After I mentioned the China Study, I was expecting a debate on its merits. Instead, the nutritionist calmly noted that she had read the China Study, too, and largely agreed with its findings. Over the years since the study was first published (2005), however, she has filled in some of the blurriness around its edges.

The experts behind the China Study weren’t clinical nutritionists, you see. They were, for the most part, biochemists and epidemiologists. To apply the study’s findings to a specific person’s diet requires some finesse — and my nutritionist has finesse in spades. This blog post relates some of the advice she offered, as well as later advice I received from a separate cancer nutritionist, all of which I found to be extremely valuable.

Adequate protein is a must for cancer patients

Since I altered my diet at the beginning of the year, I have been besieged by comments from other people about the lack of protein in a vegan diet. Most of these people know very little about veganism, yet they are convinced the diet is inferior when it comes to protein. It isn’t really. The surprising truth is that people on “regular” diets probably get way too much protein, and people on vegan diets get plenty from plant-based sources. But if you’re a cancer patient, and particularly if you are undergoing rigorous treatment such as surgery, radiation, or chemotherapy, it’s important to up your intake of protein.

The nutritionist reassured me that this can be done, but you have to plan carefully. For example, after hearing that my lunch consists primarily (often only) of green juice or a green smoothie (vegetable based drinks), she offered tips on how to bump up the protein content with hemp, a product of the cannabis plant (yes, that cannabis plant, but non-psychotropic varieties). (Not to worry, hemp won’t alter your mind.)

Most hemp-based foods start with the seeds, which can be eaten whole, ground, made into milk, sprouted, smoothed into butter, or steeped in teas. Hemp leaves can be eaten as well.

When it comes to protein, hemp is essentially “complete” — meaning it contains all 21 amino acids (although we now know you don’t have to eat complete proteins to reap their benefit). Hemp is also loaded with essential fatty acids, including the very important omega 3s, which reduce and help prevent inflammation. The nutritionist suggested that I add hemp milk or butter to my smoothies to boost their protein level.

For protein, she also recommended nut butters such as almond and cashew. (Little known fact: Peanuts are not nuts, but legumes.)

Some grains, such as quinoa and millet, are high in protein and can be combined with fruit to create a tasty morning porridge. (I try to avoid eating much wheat because of concerns about its inflammatory nature.)

And, of course, beans (including soybeans and products, such as tofu, derived from them) are other good sources of protein.

Eat across the color spectrum

Once you ensure you are getting adequate protein for your needs, focus on plants. Vegetables are anticancer powerhouses. Green vegetables such as broccoli, brussel sprouts, spinach, kale, and collards, for example, are packed with nutrients, antioxidants, enzymes, and other allies in your fight against cancer. Leafy salads also are good — and not just because they contain a lot of green, but also because they are consumed raw, preserving many important enzymes. Other colors are equally important — the vibrant orange of carrots and sweet potatoes, the crimson shades of red peppers and cabbage, the deep yellow of squash. By eating across the color spectrum, you can ensure that you take in the full range of nutrition nature has to offer. And by processing vegetables as little as possible (eating them raw or lightly steamed or sauteed), you preserve as much of their healthy power as possible.

In the interest of space, I will stop here. I hope this post has provided “food for thought” and that you will explore the China Study, as well as another useful book on cancer nutrition, Life Over Cancer, by Keith Block, MD, an integrative oncologist.

Here’s one last tidbit for your to munch on: A short video of cancer thriver Kris Carr discussing how she turned to veganism (partly as a result of the China Study).

The bottom line: Many oncologists are not well versed in nutrition, so it can pay dividends to seek out someone with expertise in nutrition for cancer patients. One oncologist I consulted told me to avoid all antioxidants during chemotherapy — a blatant untruth. I don’t want to encourage you to disregard your oncologist’s advice — just to take it with a grain of salt and continue researching on your own or through other reputable sources. Your quality of life — and, possibly, your life itself — may be on the line.

Updated February 21, 2015.


Wisdom from a five-time cancer survivor

“It’s all about your mentality,” she says brightly. This vibrant, articulate 29-year-old has been battling cancer for much of her young life. Hear what she has to say about continuing to live before, during and after treatment.

Aerobic exercise can reduce chronic inflammation and protect against cancer


In our quest to understand what causes and drives cancer, a couple of facts are givens:

  • Inflammation can facilitate or feed cancer.
  • Cancer can increase inflammation.

It can be a vicious cycle.

That said, the link between cancer and inflammation is not a simple association and cannot be boiled down to a single theory. Genetic predisposition plays a critical role in the development of malignancy, but so do environmental factors such as exposure to carcinogens and immune system compromise.

But rather than get lost in the scientific explanation of carcinogenesis, let’s focus on one intervention that has proven effective in preventing, forestalling, or even reversing cancer: regular aerobic exercise. Consider a 2006 study by Kohut and colleagues, in which 64-year-old adults were randomly assigned to aerobic exercise 3 days per week, 45 minutes per day, for 10 months, or to flexibility and strength training at the same frequency. Over the course of the study, researchers measured blood markers of inflammation: C-reactive protein (CRP), tumor necrosis factor-alpha (TNF-alpha), and interleukin-6 (IL-6) and interleukin-18 (IL-18). They also evaluated participants for depression, perceived stress, optimism, social support, and other psychosocial factors.

At the end of 10 weeks, CRP, IL-6, and IL-18 declined significantly in the group allocated to aerobic exercise, but not in the flexibility/strength training group. TNF-alpha, depression, and optimism improved in both groups. The researchers concluded that aerobic exercise can significantly reduce blood markers of inflammation.

We do not understand completely how aerobic exercise achieves these improvements, but it is likely that it boosts immune function, increases resistance to stress, lowers body weight (particularly the risky layer of fat around the waist and midsection), lowers blood pressure, improves lipids, and reduces insulin resistance.

The bottom line: Increase your heart rate. Exercise becomes aerobic when you move briskly enough to increase your intake of oxygen. A simple formula for determining whether you are exercising aerobically involves checking your pulse periodically during exercise. Let’s say you are walking briskly or running on a treadmill. Every 5 minutes or so, stop and measure your pulse for 6 seconds and multiply the number of beats by 10 to achieve a pulse rate for an entire minute (60 seconds). Let’s say you count 12 beats in 6 seconds. Then 12 x 10 = 120 beats per minute.

Now, to figure out your target pulse rate during aerobic exercise, subtract your age from 220. Let’s say you are 35. Then 220 – 35 = 185. You would multiply the result by 0.70 to determine what your pulse rate should be at 70% of your maximum effort. In this case, you would multiply 185 x 0.70 to get a pulse rate of 129.5. So, if you want to exercise aerobically at 70% of your maximum effort (a reasonable target), your pulse rate over 60 seconds should be 129.5.

How often should you exercise this way? At least three times a week for about 30 minutes, most experts say. Even more frequent is better. However, be aware that you can overdo it. Long stretches of high-intensity aerobic exercise on a regular basis can tax your body more than they help. As in all other things, moderation is key.

It’s been demonstrated that regular aerobic exercise can reduce the risk of breast cancer and its recurrence. That’s just one example of the real benefits of brisk movement. An anti-inflammatory diet also helps. More on that topic will be posted in the near future.

Here’s a short video on the benefits of exercise in the prevention of cancer and even during treatment.

Some thoughts on losing a friend to cancer


I have always been afraid of lung cancer. A former smoker, I know it is a very real possibility. So I was stunned when a healthier (than me) friend received a diagnosis of non-small cell lung cancer with metastasis to the brain. Chilled to the bone is more like it. My vibrant, life-loving pal, who had inspired me on so many levels, was now almost certainly facing the end of her remarkable life. Four months later, she was gone.

In the months since her death, I have made several realizations I’d like to share with you. Let me just mention that I am a cancer survivor myself, so I speak with some awareness of what it is like to endure a life-threatening disease.

1. Don’t be jaded about changes to your health. In the relatively brief time I knew my friend before her diagnosis, she had mentioned on numerous occasions not feeling completely well. She had difficulty sleeping. She felt nauseous sometimes for no reason. Her appetite wasn’t what it used to be. She had a dry, nagging cough. But she also had a high-deductible health insurance policy and hated to spend money unnecessarily, so she put off consulting a doctor until things got very bad—and by then it was too late. What I learned: Keep your priorities in perspective. Good health should be at the top of your list. Money is only money, but your good health is the key to life itself.

2. Get second (and third) opinions at the time of diagnosis. It was very late in the course of her cancer that my friend was diagnosed, and unlikely that she could expect to survive over the long term. Although she did drive several states away to consult a major cancer center, where I am not sure what she was told, she returned home and settled for cancer care that seemed, to my eye, somewhat erratic and unconsidered. For example, the brain metastasis was surgically removed first (as it probably should have been), but her oncologists failed to convey to her the importance of a speedy recovery to ensure timely treatment of the malignancy in her lung. So valuable time was wasted that could have prolonged her survival or enhanced her quality of life. What I learned: Get a cancer team, not just an oncologist. Make sure your treatment is well coordinated between all the specialists involved, and also require your doctors to explain things to you in a way you can understand—and to include you in the decision-making.

3. Enter hospice care sooner rather than later. Because she didn’t want to feel that the end was imminent, my friend put off hospice care as long as possible, leaving her caregivers frazzled and, as a result, not as effective or supportive as they might have been. Many hospice care programs require a doctor to certify that the patient has less than 6 months of survival ahead of her. My friend didn’t enter hospice until she had less than 2 weeks left. What I believe: She would have been more comfortable, and happier, and less traumatized, if she had asked for hospice care much sooner.

4. A calm environment is vital. Near the end of her life, when I arrived to sit with her in the hospital, my friend commented that my presence provided a calming effect, and she said it meant a lot to her. I tended to let her sleep when she was tired, and to divert her attention when she seemed anxious or upset. After she lost the ability to articulate her feelings, and her breathing grew labored, I read aloud to her in a low voice for several hours, until her breaths began to even out and come easier. And I noticed that, when the person scheduled to relieve me arrived, the noise level increased by about 50%, and the awareness of my friend’s fragility seemed to decline almost as much. No surprise, then, that she began to appear to be in some physical distress until I managed to quiet the new arrival down to some extent (and request a tranquilizing agent for my friend). What I learned: The dying are much more sensitive to their environment than they at first appear, and lack the resilience (to loud noises, jarring movements, etc) they once had. So it’s important to pay attention to subtle clues to their true state and to keep things calm.

5. Human connection is critical, even when someone is unresponsive. I made it a point to touch my friend regularly, and to talk to her about what was going on in the larger world. I would rub her (bald) head gently, or paint her toenails, or read or talk softly to her. She could no longer sit up or speak and rarely opened her eyes. But I remain convinced that she could feel and hear me and, at least on some level, understood what I was saying. This is where the golden rule comes into play: Do unto others as you would have them do unto you. I would not want my family and friends to treat my unresponsive body as an object rather than a human creature, so I made continuous efforts to communicate.

My friend has been gone for more than a year. As time passes, one regret I don’t have is the way our friendship ended. I regret her illness, the physical loss of her, and the suffering I know she endured. I also regret not taking her physical complaints more seriously in the weeks leading up to her diagnosis. But I feel satisfied that I was there for her in her dying to the fullest extent I could be. And that is no small thing.

Consumption of dairy products may increase your risk of hormone-sensitive cancers

Dairy 1

I mentioned last week that I would return to the subject of dairy products and cancer. Is there a link?

We already know that high-fat dairy products are linked to breast cancer (see my post of March 23). What other information do we have?

According to the Physicians Committee for Responsible Medicine, recent research suggests that the consumption of dairy products may increase a man’s risk of developing prostate cancer and testicular cancer. There is also some evidence of a link between dairy products and breast and ovarian cancer.

Prostate cancer

The Physicians’ Health Study (published in 2001 and conducted at Harvard University) involved more than 20,000 men. Those who consumed more than 2.5 servings of dairy foods per day had an elevated risk of prostate cancer (34% higher), compared with men who ate 0.5 serving or less of dairy products per day. Other studies have produced similar findings.

One reason for the link between dairy product consumption and prostate cancer may be that dairy foods contain the hormone insulin-like growth factor 1, which stimulates cancer cell growth. And high levels of insulin-like growth factor 1 have been linked to prostate and breast cancer — two hormone-sensitive malignancies.

Another reason may be that moderate to high daily dairy consumption increases the level of calcium in the blood, which simultaneously depresses the level of vitamin D. Vitamin D is believed to be protective against prostate cancer (and other cancers). In the Physicians’ Health Study, for example, men who consumed more than 600 mg of calcium daily from dairy products had lower plasma levels of vitamin D, compared with men who consumed less than 150 mg of calcium daily (from dairy products).

Testicular cancer

A study that explored the role of diet in cancer development in 42 countries found a strong link between milk and cheese consumption and testicular cancer among men 20 to 39 years old. The rate of testicular cancer was highest in countries where milk and cheese are ubiquitous, such as Switzerland and Denmark, and it was lowest in countries where dairy consumption is rare.

Like prostate and breast cancers, testicular cancer is hormone-sensitive. The natural estrogens present in milk and cheese derived from cows (especially pregnant cows) may fuel hormone-dependent malignancies.

Ovarian cancer

Milk contains the sugar “lactose,” and one component of lactose is galactose, which may play a role in ovarian cancer. One analysis of multiple studies found an increase in the risk of ovarian cancer of 13% for every 10 grams of lactose consumed. (One glass of milk contains about 10 grams of lactose.)

Breast cancer

The data on the link between dairy products and breast cancer are mixed. Some studies indicate an increased risk of breast cancer in women who consume dairy, and some do not.

Anecdotal evidence suggests that consumption of dairy products increases the risk of breast cancer. For example, in Asian countries where dairy products are rarely consumed, the rate of breast cancer is substantially lower, compared with Western countries where dairy consumption is pervasive. And as the rate of dairy consumption rises in Asia as the Western diet spreads across the world, so does the rate of breast cancer.

Among the experts who believe there is a definite link between dairy consumption and breast cancer is British geochemist Jane Plant. Dr. Plant experienced multiple recurrences of breast cancer and, at one point, was given only a few weeks to live. When she and her husband hypothesized that dairy may be linked to breast cancer, she immediately stopped consuming dairy products. Shortly thereafter, her cancer went into remission and has never returned.

Dr. Plant authored a book on the subject called Your Life in Your Hands: Understanding and Overcoming Breast Cancer. For more information about Dr. Plant, click here.

What’s the bottom line?

If you have an elevated risk of prostate, testicular, ovarian, or breast cancer—or if you have a personal history of one of these malignancies—you may want to consider curtailing consumption of dairy products. They aren’t necessary as a source of calcium, as that nutrient is present in significant quantities in leafy green vegetables, dried beans, almonds, figs, soybeans, and other foods.

Watch Andrew Weil, MD, discuss the link between cow’s milk and breast cancer in this short video:


Is screening for prostate cancer really necessary?

Prostate cancer

Last May, a prominent health-care panel (the US Preventive Services Task Force, or USPSTF) recommended against a common blood test used to detect prostate cancer — the prostate-specific antigen, or PSA, test — unless a man has been thoroughly counseled about it and specifically requests screening. (To read the USPSTF recommendation, click here.)

PSA is a protein found in the cells of the prostate gland. The PSA level is elevated when prostate cancer is present. However, it also is elevated in a number of non-cancerous conditions, such as benign prostatic hyperplasia (enlargement of the prostate gland) and prostatitis (inflammation of the gland). The USPSTF objected to widespread screening with the PSA blood test because, even when it detects cancer, the malignancy often is slow-growing and unlikely to lead to death. So the USPSTF reasoned that less screening would reduce the number of men who are treated unnecessarily for prostate cancer.

Not all experts agree with the USPSTF recommendation, however. Take urologist Peter T. Scardino, MD, who leads the Department of Surgery at Memorial Sloan-Kettering Cancer Center in New York — the cream of the crop in cancer centers. Dr. Scardino worries that a reduction in PSA screening could increase prostate cancer deaths. In a question-and-answer session at Memorial Sloan-Kettering, Dr. Scardino proposed “smarter screening,” which would consist of:

  • screening only men at high risk of developing prostate cancer that is life-threatening. Men who have a high risk of prostate cancer include those who have a family history of the malignancy and men of African-American heritage.
  • discontinuing screening among men 76 years of age and older, who are unlikely to benefit from the findings.

The new approach would involve screening all men for the first time at age 45 to determine their risk of life-threatening prostate cancer. Those who are found to be high-risk would then be screened every 2 years, while men at low or average risk would be screened every 5 years until the age of 76, when screening would end.

What if a PSA level is elevated?

Dr. Scardino notes that most men who have an elevated PSA level do not have cancer. In fact, PSA levels can go up and down over time. For this reason, Memorial Sloan-Kettering recommends against undergoing a biopsy on the basis of a single elevated PSA level. Rather, when the PSA is elevated, it should be re-measured 6 to 12 weeks later. If it is still elevated at that time, a biopsy may be appropriate.

If cancer is found, where should you get treated?

Dr. Scardino points out that outcomes are better when men with prostate cancer are treated by physicians who see a high volume of prostate cancer patients, or when men are treated at centers that see a high volume of prostate cancer patients (Memorial Sloan-Kettering is one of those centers).

To see the guidelines from Memorial Sloan-Kettering on PSA screening, click here.

Pay attention to your mouth: The link between gum disease and cancer

Teeth 1

We have known for some time that gum disease can increase your risk of heart disease, stroke, and diabetes.

Now it seems highly likely that gum disease can also increase your risk of cancer. The increased risk is small — but why take unnecessary chances with your health? Making sure your teeth and gums are healthy seems wise for a number of reasons, including keeping cancer at bay. And if you already have cancer, keeping your mouth healthy is one of the best strategies you can implement to make treatment successful, with as few side effects as possible.

Gum disease and the risk for cancer

A 2008 study from the prestigious journal Lancet Oncology explored the link between gum disease and cancer in more than 50,000 American men 40 to 75 years old. Men who had periodontal disease when they joined the study had a slightly increased risk of cancer. Even after researchers adjusted for other variables that can contribute to the risk of cancer, such as smoking and diet, the men who had periodontal disease still had a slightly increased risk of cancer. The five most common cancers in this study were colorectal cancer, melanoma of the skin, and lung, bladder, and advanced prostate cancers. It seems possible — if not likely — that if women had been included in the study, other cancers, such as breast malignancy, may have been linked to gum disease as well. For a summary of the study in Lancet Oncology, click here.

Oral health and cancer treatment

According to the National Institute of Dental and Craniofacial Research (NIDCR), more than 33% of patients undergoing cancer treatment experience complications related to the mouth. All the more reason to ensure that your dental health is intact before starting treatment, to minimize oral side effects and reduce the chance that a local infection can threaten your whole system. The NIDCR recommends that you see a dentist before starting treatment. Once treatment has begun, you should:

  • Keep your mouth moist by drinking lots of water, sucking on ice chips, and, if necessary, using a saliva substitute (if treatment causes dry mouth)
  • Use meticulous oral hygiene. Brush after every meal using a brush with soft bristles, floss regularly, and avoid mouthwashes that contain alcohol, which can irritate the lining of your mouth. Rinse your mouth several times a day with a solution of 1/4 teaspoon of salt and 1/4 teaspoon of baking soda in 1 quart of warm water. Some physicians also prescribe something called “magic mouthwash” to ease the discomfort associated with chemotherapy-related mouth sores.
  • Make sure your dentures and bridgework fit well. If they don’t, address the problem before treatment.
  • Avoid irritants like spicy foods, “sharp” foods like tostada chips that can cut your tender gums, smoking, and alcohol
  • Report any bothersome mouth problems to your oncologist right away, before they get out of hand.

When I started chemotherapy, a previously undetected low-grade gum infection quickly raged out of control — and it was extremely painful. My treatment had to be interrupted so that the gum disease could be cured. That in itself was stressful. I wish now I had consulted a dentist before that first dose of chemo.

For another article on gum disease and cancer, click here.