Abstract: After you have read all the 10 books reviewed above, you will realise that your doctor’s / oncologist’s advice – Eat anything you like – is definitely not right. There are many, many more books written by medical doctors, cancer researchers, cancer survivors, professors of nutrition etc. explaining the link between diet, nutrition and cancer.
Yeong Sek Yee & Khadijah Shaari
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6) THE CANCER RECOVERY EATING PLAN by Dr Daniel W. Nixon, MD
Dr Nixon is a Professor of Experimental Oncology and director of Cancer Prevention and Control at the Hollings Cancer Centre at the Medical University of South Carolina. He was a Consultant and former Vice President, Detection and Treatment at the American Cancer Society and former associate director of the Cancer Prevention Research Program of the National Cancer Institute. He was also a former Professor of Medicine at Emory University and head of its clinical medical oncology unit.
From a doctor of such impeccable credentials, Dr Nixon cuts through the media hype and explains the most recent scientific findings on the connection between food and cancer. Summarized below are the main points on the role of diet in the development and progression of cancer:
a) Diet can play a role not only in the development of certain cancers, but also in the growth and progression of cancers after they have developed. The role of diet in cancer is most likely that is stimulates cells with genes that have already been altered to grow into a tumor. In other words, poor diet is most likely a promoter of cancer, not an initiator.
b) Nutritional changes will benefit the person who already has cancer, the person recuperating from cancer, and persons who are at risk for cancer. The types of foods you choose may have an important impact on your future outlook. Your goal is to eat adequately without feeding the cancer.
c) Researchers at the Oxford University estimated that up to 70%of cancer may be due to diet. The American Cancer Society and the National Cancer Institute have recognized the diet-cancer connection and have issued dietary guidelines to help people reduce their cancer risk.
d) Dietary fats may provide energy for the body and assist in the metabolism of vitamins A, D, E and K, but dietary fats also have a dual role in cancer. It may act both as a promoter of cancer and as a modulator of the growth of an existing cancer. Fats harbor certain fatty acids that have been shown to stimulate cancer cell growth. Here Dr Nixon recommends that saturated fats, which are primarily found in foods from animal sources, should be avoided.
e) Total dietary fiber, both soluble and non-soluble (mainly from fruits, vegetables, legumes, grains) works against cancer by binding with carcinogens in the gut, rendering them harmless or it may alter gut bacteria and acidity so that fewer carcinogens are produced.
f) The body uses carbohydrates mainly for fuel. A number of studies have shown that a high intake of carbohydrate-rich foods especially vegetables and fruits has a cancer-protective effect. This may be due to the vitamins and chemo-preventive compounds contained in these foods and the fact that high-carbohydrate diets are high in fiber and low in fat.
g) High-protein diets are generally also high in fat and low in fiber. You do not need to eat meat for health reasons. You can obtain adequate protein by eating legumes (beans) and grains, nuts and seeds. What’s important is to eat a variety of vegetable protein sources.
h) There are several reasons for a person with cancer to limit sodium intake:
- Excess salt intake can aggravate high blood pressure, which increases the risk of heart attack, stroke, and kidney disease.
- If you are on hormonal therapy, your body may tend to accumulate fluids and your blood pressure may rise.
- Certain chemotherapeutic agents can damage the heart and kidneys. Salt and fluid may exacerbate such damage.
i) The American Cancer Society recommends that everyone limit or avoid the consumption of salt-cured, smoked and nitrate-preserved foods (such as ham, sausage, bacon, fish, etc.). During the smoking process, the tars contain numerous carcinogens that are similar chemically to the carcinogenic tars in tobacco smoke.
j) For those with BREAST CANCER, take note that dietary fats in your diet can do at least 3 bad things:
- Fat is full of calories and calories can stimulate cancer cells to grow.
- Fat accumulates in the body and fat cells create estrogen, which may stimulate cancer cells to grow.
- Fat contains certain fatty acids that may stimulate cancer cells to grow.
k) For those with COLORECTAL CANCER, take note that animal protein is involved in colon cancer. A diet high in fat is a diet high in calories. Fats contribute to cancer by the increased production of the bile acids. These can be converted to toxic “secondary” bile acids in the colon wall, stimulate cell division and promote tumors.
l) For men with PROSTATE CANCER, take note that studies have linked prostate cancer to high consumption of total protein, especially beef products. The high-fat low-fiber diet may stimulate “latent” prostate cancer cells to grow.
In summary, studies of eating patterns in various countries have suggested that the ideal diet for prevention of cancer appears to be a low-calorie, low-fat, high-fiber diet, with fruits and vegetables, similar to what our remote ancestors ate with the addition of a proper balance of needed trace elements, vitamins and minerals.
7) CANCER FREE by Dr Sidney Winawer, MD & Dr Moshe Shike, MD.
Dr. Winawer is the chief of gastroenterology and nutrition service at Memorial Sloan-Kettering Cancer Centre and also Professor of Medicine at Cornell University Medical College. Dr. Shike is Memorial Sloan-Kettering’s director of clinical nutrition and Professor Medicine at Cornell UniversityMedical College.
The authors offer a practical and comprehensive approach by giving readers tools to assess their overall cancer risks. General prevention methods, including lifestyle changes such as smoking cessation, exercise, and diet are discussed in detail.
Chapter 5 of the book is devoted to Diet and Nutrition and we shall examine some of the main points in this chapter:
a) Scientists estimate that as many as 40% of men’s cancers and 60% of women’s are linked to diet. That should be enough to make anyone take a second look at what is on his or her plate!
b) A high-fat diet may increase the risk for many cancers, including those of colon, breast, prostate, ovary, uterus and skin. Some of the mechanisms by which fats might instigate or assist in the growth of tumors:
- In the process of using fats, the body produces free radicals, which can damage the DNA.
- Increasing the secretion of bile into the intestines. Bile acids, produced by the liver to help the body digest fats, might then be converted into carcinogenic compounds in the colon.
- Interfering with the body’s signals to cells to stop dividing.
- Interfering with the immune system, which can destroy some cancer cells.
- Making cells less able to defend against invaders.
c) We need to cut down on meat and poultry. Besides the fat, meat is one of the greatest sources of dioxin, a toxic chemical.
d) Butter, cheese, sour cream and gravies can be high in fat. So are commercially or deli-prepared salads such as tuna, chicken, egg, potato and coleslaw, snack foods and desserts, potato chips, etc.
e) Higher calorie consumption coincides with higher rates of cancers of the breast, colorectal, uterus and kidney. A high-calorie diet adds extra body fat. Excess body fat increases a woman’s risk of breast, uterine and possibly ovarian cancer because it metabolizes the hormone estrogen, which stimulates cell growth in those organs.
f) In summary, the authors’ advice for cancer prevention consists of:
- Eating five to nine servings of fruits and vegetables daily
- Eating foods rich in vitamin A, C and E.
- Increase your dietary fiber intake.
- Lower your dietary fat intake.
- Use beans, lentils, peas, tofu and other legumes as meat substitutes.
- Add brown rice, barley, buckwheat and bulgur to your diet for variety.
- Choose whole-grain varieties of breads, rolls, and pasta.
Adjusting your diet will require effort. When you begin to change your eating habits, remember that you are in control of your diet and your life. Food does not control you.
8) THE ANSWER TO CANCER by Dr Carolyn Runowicz, MD, & Dr Sheldon Cherry, MD.
Dr. Runowicz is a gynecologist and a past president of the Society of Gynecologic Oncologists while Dr. Cherry is a Clinical Professor of Obstetrics and Gynecology at Mount Sinai School of Medicine inNew York.
In this book, the authors – husband and wife, believe that the “answer to cancer” lies not in early detection, but in preventing cancer in the first place. They review how cancer develops, explaining risk factors beyond our control (e.g. genetics, age) and controllable risk factors (e.g. smoking, diet, etc.). They examine specific prevention strategies, including chemo-prevention for nine common cancers. Finally, their cancer prevention plan outlines steps patients should take, such as maintaining a healthy weight, eating fruits and vegetables and exercising.
In the chapter on Prevention, the following are the authors’ main statements:
a) Your diet, your exposure to the environment and your habits play pivotal roles in the initiation and promotion phases of cancer development. As much as 40% of all cases of cancer may be preventable by feasible and appropriate diets and by physical activity and maintenance of appropriate body weight.
b) Nutrient-rich, high-fiber, low-fat foods and a low-calorie diet reduce the risk of most cancers.
c) The components of fruits and vegetables are protective – probably due to the vitamins, minerals, phytochemicals, fiber or 2,000 plant pigments found in fruits and vegetables.
d) Grains, too, seem to be protective.
e) Meat is a mix of nutritional benefits and hazards. Although it provides protein and minerals, it also contains a lot of saturated fat and cholesterol. Saturated fat is associated with cancer. We do know that people who consume a lot of fat are more likely to develop certain cancers, such as breast cancer and colorectal cancer. Dietary fat contributes to colorectal cancer by triggering the secretion of larger-than-normal amounts of bile acid from the gall bladder into the intestine.
f) The way meat is cooked can pose a cancer risk too. When protein is cooked at a high temperature, carcinogenic compounds called heterocyclic amines are formed. The longer the meat is cooked at high temperatures, the more of these substances are formed. According to the Physicians’ Committee for Responsible Medicine, grilled chicken is an especially potent source of heterocyclic amines, it contains 15 times more of these carcinogens than roast beef or a hamburger.
g) Cooking meat at high temperature, as with grilling or barbecuing, also is a source of carcinogens known as polycyclic aromatic hydrocarbons (PAHs).
h) Why you need fruits and vegetables:
- They contain a lot of water
- They are good sources of fiber
- They supply an abundance of cancer-preventing nutrients
- They are rich in phytochemicals
A final advice from Drs. Runowicz and Cherry – “Eat plenty of fruits and vegetables in a variety of colors every day. You will get a generous mix of phytochemicals in adequate amounts to boost your cancer defenses.”
9) LIVING TIME (FAITH AND FACTS TO TRANSFORM YOUR CANCER JOURNEY) by Dr Bernadine Healy, MD.
She is one of America’s best known cardiologist and is the former head of the National Institute of Health and a Professor of Medicine at John Hopkins University Hospital.
After being diagnosed with a brain tumour in early 1999, Dr Healy was surprised by some of the awkward comments and gestures from those who discovered she was a cancer patient. People who meant well would do inappropriate things like grabbing her hair to see if she was wearing a wig. One woman told her: It’s amazing how good you can look when you’re dying. Dr Healy has written a book which includes useful advice for people wondering what to say – or not say – to a friend or family member recently diagnosed with cancer.
In Chapter 7 – Making an Everyday Difference, Dr Healy offer some advice on nutrition for cancer patients. These are summarized as follows:
a) The old English saying that we dig our grave with our spoon applies to our health in general and cancer in particular. A diet rich in saturated fat is linked to an increased risk of cancer of the colon, prostate, uterine lining, and possibly breast and pancreas. High-salt diets and one with lots of salt – preserved or nitrite foods are linked to stomach cancer.
b) The Western Countries, where diets are heavy with red meats, saturated fats, and refined sugars, suffer more breast, prostate and colon cancer than those countries whose typical diets are low in saturated fats and higher in complex carbohydrates such as rice or pasta.
c) A low fat diet reduced recurrence rates of breast cancer by 24% over 5 years in more than 2,400 women with similar lifestyles.
e) The monounsaturated fats of olive oil and the omega 3s of fish oil seems to bring positive health benefits not seen with other forms of unsaturated fats.
f) One intriguing health discovery is the protective value of very low calorie diets. Fewer calories mean low oxidation is going on and therefore fewer destructive free radicals are floating around and doing damage to the DNA. Consuming fewer calorie overall results in fewer and less severe sugar spikes– the sudden jolt of sugar that call insulin into play. Cutting back on the glucose spikes should also cut back on blood levels of insulin like growth factors (IGF). These are factors in your body that stimulate cell proliferation and block apoptosis. High levels of these growth factors have been associated with breast, prostate, and colon cancer.
g) When given the choice, choose a glass of fruit or vegetable juice rather than a soda pop. Think apple or a handful of baby carrots rather than a chocolate chip cookie or donut.
h) The bulk of the diet should come from plants, not animals. Thus a simple principle of cancer prevention is to have a diet rich in fruits and vegetables. Fruits and vegetables are little factories pumping out all sorts of phytochemicals, not just the well- known micronutrients such as vitamins and minerals. What’s clear is that Mother Nature offers us a means of protecting our genes through the natural chemicals of the garden.
As we wait for more complete data, the common sense formula still holds: go easy on saturated fats and increase your intake of fruits and vegetables. A critical dietary goal would be, VARIETY.
10) HEPATITIS and LIVER DISEASE by Dr Melissa Palmer, MD.
She is a nationally renowned hepatologist. She received her medical degree and training in liver disease from Mount Sinai Medical School. Dr Palmer is also on the nutrition education committee of the American Liver foundation.
Chapter 23 of her book, Nutrition and Exercise, Dr Palmer offers the following advice:
a) Most people with liver disease need to restrict some foods from their diet. Eat primarily complex carbohydrates (such as whole grain breads, pasta), mainly vegetable protein, drink 8-12 glasses of water per day, restrict sodium intake, no alcohol, avoid processed foods, avoid caffeine consumption, avoid excessive amounts of vitamins and minerals (especially iron).
b) Although adequate protein intake is important, many people mistakenly believe that the more protein they consume, the better. Not only is this belief misguided, but for someone with liver damage such an approach can actually be downright dangerous. The trouble is that a damaged liver cannot process as much protein as a healthy liver. And when a damaged liver gets unduly overloaded with protein, encephalopathy (a state of mental confusion that can lead to coma) may occur.
c) Dr Palmer further stressed certain dietary recommendations for protein:
1) Remember that protein has vegetable sources as well as animal sources. People with unstable liver disease need to lower the percentage of protein content in their diets to between 10 and 15% and they need to eat protein from vegetable sources only.
2) Vegetarian diets have a low ammonia content and have been shown to be much less likely to induce encephalopathy than animal protein diets. A diet high in animal protein (which contains a lot of ammonia) may precipitate an episode of encephalopathy among these people.
3) Vegetable fiber plays a role in helping to eliminate harmful waste substances such as ammonia, from the body. Also, a high-fiber, vegetable protein diet may reduce sugar levels.
4) Even the leanest cuts of red meat are high in fat content and approx 50 to 75% of calories from most red meats actually come from fat! A diet high in fat may contribute to such a person’s liver–related abnormalities.
5) It is very easy for people with liver disease to consume too much protein. The ingestion ofprotein supplements can be dangerous to people with a liver condition. Protein supplements force the liver and kidneys to work overtime in order to get rid of the excess protein ingested. Under no circumstances should any form of amino acid supplement be added to the diet of a person with liver disease.
d) Gram for gram, fats contain more than double the amount of calories of other nutrients. It is important for people with liver disease to minimize their fat intake by avoiding foods that are high in fat.
e) People with liver disease should strive for a diet consisting of approximately 60-70% carbohydrates, with high complex carbohydrates predominating. If there are too few carbohydrates in a person’s diet, this will likely result in excessive protein and fat intake. If too much protein is consumed and not enough carbohydrates, the liver will be forced to use protein as an energy source. This is an inefficient use of protein, as protein will be diverted from its primary job of building cells and tissues. Furthermore, this will put undue stress on the liver, as it is more taxing for the liver to convert protein into energy than it is to convert carbohydrates into energy. Converting foods other than complex carbohydrates into energy is stressful even to a normal liver. By eating an unbalanced diet that is low in complex carbohydrates (such as simple carbohydrates – mainly simple sugars), a person with liver disease will add to the stress that the disease has already caused the liver.
f) Just like foods and medications, vitamins must pass through the liver to be metabolized. If taken in excess, any vitamin has the potential to cause serious health problems for people with liver disease, the potential for damage is much greater. Of special mention is IRON (Fe). People with liver disease often assume that when they feel weak and tired, they need to take iron supplements. But taking iron supplements may be dangerous – iron is toxic to the liver, even mildly increased amounts of iron may cause or enhance the amount of injury to the liver in the presence of other liver diseases.
(Take note: A lot of iron (Fe) is found in animal products, SUCH AS RED MEAT. We, at CACARE, recommends that all cancer patients avoid meat / animal products).
g) Sodium can create problems for a person with advanced liver disease. People with ascites must be placed on a severely salt–restricted diet. Table salt and salt used for cooking should be totally eliminated from the diet.
(Take note: Meats, especially red meats, have a high sodium content. Consequently, adherence to a vegetarian diet may become necessary for people who develop severe ascites).
Dr Palmer’s final tips on diet and nutrition – most people with liver disease find that eating multiple small meals throughout the day is the best approach, as it maximizes energy levels and the ability to digest and absorb food.
After you have read all the 10 books reviewed above, you will realise that your doctor’s / oncologist’s advice – Eat anything you like – is definitely not right. There are many, many more books written by medical doctors, cancer researchers, cancer survivors, professors of nutrition etc. explaining the link between diet, nutrition and cancer.
So please be more enlightened by reading more! You don’t have to be misled by your doctors / oncologists who advise you to eat more meat or super tok foods to build up your blood counts, platelets, etc. (Well, so that you can go for your next session of chemotherapy, really). What happens to you after chemotherapy is not their concern or responsibility at all. Remember, your life is in your hands, not your doctor’s/
In conclusion, we leave you with this quotation to ponder upon: One-quarter of what you eat keeps you alive. The other three-quarters keep your doctor alive.
ACKNOWLEDGMENTS: WE WOULD LIKE TO THANK OUR NEPHEW ARIFF AZRAEI AND NEICE BIBI NURSHUHADA FOR TYPING THE ABOVE NOTES.