Ask-the-Expert Online Conference: Food for Cancer Recovery

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Ask-the-Expert Online Conference

The Ask-the-Expert Online Conference called Food for Cancer Recovery featured Ronda Gates, M.S., R.Ph. and moderator Marisa Weiss, M.D. answering your questions about nutrition and how it relates to cancer recovery.

Editor's Note: This conference took place in July 2000.

Foods to help boost immune system?

Question from NancyB: Are there foods that can help boost your immune system?
Answers - Ronda Gates, M.S., R.Ph. The research on immune system and foods has been done on seniors, and seniors who eat well and supplement responsibly can stimulate their immune activities. In all the studies, there were people who took placebos, or had a more placebo-like diet, so they know that good nutrition helped. We are talking about foods like broccoli, spinach and oranges, and the ones with beta carotene, carrots and apricots.
Marisa Weiss, M.D. The main idea here is that good nutrition contributes to your general good health. And when your whole system is feeling strong, it can do its best job of fighting off illness.
Ronda Gates, M.S., R.Ph. I have a couple of snacks I suggest for people who want to boost their immune system. Fresh strawberries, blueberries, and blackberries are really good and available now. Stir any fresh fruits into non-fat yogurt. Put unsweetened fruit juice in ice cube trays, and suck on those. Honeydew melons filled with yogurt, smoothies with non-fat milk and fresh fruit. Carrots are really good, so carrots even dunked in peanut butter.

Organic foods vs. non-organic foods?

Question from lucy: Are organic foods a better choice than non organic foods?
Answers - Marisa Weiss, M.D. The word "organic" can mean so many different things. When I shop for organic foods, what I am looking for is foods free of preservatives, hormones, pesticides, and other additives.
Ronda Gates, M.S., R.Ph. The word "organic" doesn't guarantee anything, because the industry is poorly regulated. If you buy organic, be sure to look for the words "certified organic" to insure there is no fraud. That's the only regulation that guarantees that the foods are grown without pesticides, antibiotics, or any other medications that are added to the feed. Since the industry is growing so rapidly, there is a proposed law right now that includes Marisa's concerns, and two others that aren't of concern to me and most health promotion people. That is that organic food can't be genetically modified or irradiated, because genetically modified foods allow us to have foods that have more vitamins, proteins and minerals and there is no proof that irradiation harms or changes foods because the food is no longer living. In fact, this regulation will actually fly in the face of plant breeding and the hybridization of food, and actually deter pests and methods that can kill the bugs that harm us. I think that it can make food less safe. For example, I can cook a strawberry to kill the bacteria, but it would look horrible. If I irradiate it, it wouldn't, and it wouldn't produce cancer causing substances. It is endorsed by World Health Organizations and the United Nations. So although these laws that are coming are good because they will standardize what is now state regulation, a lot of it may be political.
Marisa Weiss, M.D. I think for women who have had breast cancer, it is particularly important to avoid purchasing meat or chicken that has been hormone fed.
Ronda Gates, M.S., R.Ph. The new law will cover that.

Hidden hormones in food?

Question from Ludy: Are there specific words that could mean hormones in foods?
Answers - Marisa Weiss, M.D. I think it's very important to know that food that is given to the animals is not considered an "ingredient" that they must reveal to you.

Does red wine help to prevent cancer?

Question from Anne: I have heard that moderate amounts of red wine can actually aid in the prevention of some cancers. Is breast cancer included in this? Does red wine really help? Or is this another myth?
Answers - Ronda Gates, M.S., R.Ph. The research on red wine has been done in relation to heart disease and cholesterol. The original studies came from France where there is a less stress-filled life, and newer studies support that people who have a less stress-filled life and drink wine have less heart disease. It may be the stress issue versus the wine issue.
Marisa Weiss, M.D. We could easily fill a whole night talking about stress! People believe that reservatrol and ellagic acid, both in red wine, may produce anti-cancer effects. Studies show you should limit your alcohol intake to three or fewer drinks per week to reduce breast cancer risk.
Ronda Gates, M.S., R.Ph. And don't drink even one glass of wine and drive, especially if you are on medication.

Is nutrition during or after cancer different?

Question from shawksie: How is nutrition during or after cancer therapy different from good nutrition in general? I'm confused.
Answers - Ronda Gates, M.S., R.Ph. It isn't. When we are eager to be well, we heighten our interest in good nutrition.
Marisa Weiss, M.D. It's a wake-up call.
Ronda Gates, M.S., R.Ph. All studies about preventing cancer come back to the simple rule of eating more vitamin and mineral enriched foods; what are called "nutrient dense" foods.
Marisa Weiss, M.D. And my point is that good nutrition is also tied very closely to weight control. And weight control has been shown to be important for breast cancer prevention.
Ronda Gates, M.S., R.Ph. Don't forget exercise. The two are partners.

Confused about soy and estrogen?

Question from butterfly: I'm confused about soy. As a BC survivor, I'm supposed to avoid estrogen. I read that soy mimics estrogen, yet the popular media says all women my age could benefit from soy. What gives?
Answers - Marisa Weiss, M.D. Soy proteins contain isoflavones that can mimic a weak estrogen effect. It's not "high test" estrogen like your own body would make. It is 1,000 times weaker than your own body's estrogen. I think that soy protein is a healthy source of protein in your diet, as a substitute for other less healthy sources of protein, like red meat, and chicken. I feel uncomfortable with the use of soy supplements, like powders and pills, because it is hard to know how much of the active ingredient that you are getting.
Ronda Gates, M.S., R.Ph. Don't forget, too, that these foods also may help with hot flashes.
Marisa Weiss, M.D. And they lower cholesterol.
Ronda Gates, M.S., R.Ph. And they help you with strong bones. The other active substance, or dietary estrogen-like substance, in these foods, is lignans.
Marisa Weiss, M.D. There are other foods and plants that contain estrogen-like substances, besides soy.

Bottled water better than tap water?

Question from Sternchen: Is bottled water better than tap water to drink?
Answers - Ronda Gates, M.S., R.Ph. This should interest Marisa, because you live in Philly, where the tap water used to be terrible! I'm going to start by saying we've become a little paranoid about our water, bottling and distilling it, but it comes from us wanting to be healthy. And bottled water is not always cleaner than tap water, so don't automatically assume it to be cleaner or safer. Basically, the EPA regulates tap water with really stringent guidelines; whereas the FDA regulates bottled water, where the regulations aren't that stringent, and the FDA doesn't test for contaminants. But water is always better than soda. I don't recommend distilled water because distilling takes all the minerals out, and that's where most of us get the minerals in our diet. If you or your children drink bottled water, don't forget about dental health--supplement the fluoride. So don't buy a filter for your sink that removes minerals, and don't forget to change your filters. If you buy water, there is an association called the Bottled Water Association. Their website lists all the companies that belong to it, and which are well-tested.

Should well water be filtered?

Question from Pearl: I have well water! Should I be filtering it? I live on a farm!
Answers - Ronda Gates, M.S., R.Ph. You should definitely filter well water because it is often highly contaminated with bacteria, including E. coli, giardia, and other bacteria that specifically cause intestinal diseases. The upside of well water is that it's really high in minerals.

Total recovery possible with new lifestyle?

Question from sweety: With the right diet, exercise and so on after treatment, is it possible to recover totally?
Answers - Ronda Gates, M.S., R.Ph. I have many people in my fitness classes who are totally recovered, back to 100 percent plus more, because their appreciation for life is heightened, and their lifestyle approach is enhanced and exemplary. These people are living life better than other friends who haven't been challenged by breast cancer.
Marisa Weiss, M.D. Be aware that recovery takes time. Some days you'll make great progress, and other days you may feel like you are drifting backwards.
Ronda Gates, M.S., R.Ph. And a bad day can come out of the blue, the same way it does for people who have had any physical or emotional challenge.

Suggestions for foods that energize?

Question from Pearl: Just had recurrence. Start radiation on Monday. Got any suggestions for energy food for me? Will then have 4 rounds of Taxol. Any suggestions?
Answers - Ronda Gates, M.S., R.Ph. Focus on nutrient dense food that hasn't been processed.
Marisa Weiss, M.D. Some people say that sometimes bland foods are kinder on your system during the chemo. Now there are many fresh fruits and vegetables available.
Ronda Gates, M.S., R.Ph. Or juices.

What does calcium gluconate do?

Question from rge: Can you tell me about calcium d-glucarate...what it does?
Answers - Ronda Gates, M.S., R.Ph. I bet you mean calcium gluconate. It's one of the more popular calcium supplements, but it's not really the best choice. It may be better absorbed, but it doesn't contain as much elemental calcium as calcium carbonate, which is really concentrated, and very inexpensive. So you only need a couple of tablets to meet RDA's for calcium. You can only absorb 500 mg. of calcium at a time, so if your pill has more, it is really wasted. Take it in separate doses, one in the morning and one at night. Don't forget, the best place to get calcium is from foods in the milk group.
Marisa Weiss, M.D. And stick to low- or non-fat dairy products. Tums is a nice way to get your calcium.
Ronda Gates, M.S., R.Ph. The whole thing with Tums is it is a non-aluminum, non-magnesium calcium. So you should take six a day. It is 200 mg per tablet, and don't take it with food. I keep Tums in my car and pop it when I have to drive somewhere, but I also drink a lot of milk and low-fat yogurt.

Are aspartame and saccharine products safe?

Question from Sandra: Is it OK to use aspartame or saccharine products for sweetener?
Answers - Ronda Gates, M.S., R.Ph. Like everything, moderation in all things. I did an extensive review of the literature on aspartame, and could see no harm in using it when it's part of a balanced and varied diet. If you are using it to lose weight, it has not been shown to make a difference. When you are baking, you can use fruit juices in place of sugar, like apple juice or prune extract, instead of a sugar substitute.

Why avoid dairy products?

Question from susie: Why should you avoid dairy products?
Answers - Marisa Weiss, M.D. Dairy products may have a significant amount of dairy fat, which is animal fat. Any pesticides, hormones, or other unhealthy things that may be given to animals tend to be concentrated in their fat.
Ronda Gates, M.S., R.Ph. That's why we encourage non-fat. We have to be clear that we are not discouraging milk products.

Tips to avoid junk food temptation?

Question from Maritza: I know cookies, chips and all the other junk foods are bad for me. Do you have any tips so that I'm less tempted to buy that stuff when I shop?
Answers - Ronda Gates, M.S., R.Ph. First of all, there are no good or bad foods; there are just wiser choices. The best shopping tip I suggest is to go with a list and stick to the list.
Marisa Weiss, M.D. Don't shop when you are hungry!
Ronda Gates, M.S., R.Ph. If possible, don't take your children with you if they nag you about buying those kinds of things. Cookies, chips and other foods are a normal part of a healthy diet. Don't moralize on food. Even Twinkies could save lives in poor countries. Don't give up foods that nurture you; just watch your food portions. A great strategy is to eat a healthy meal, and to then treat yourself using good judgement. I always say, how much would I feed to a young baby, and then feed myself that amount.

Choosing healthy foods when dining out?

Question from margaret: Do you have any suggestions for eating out? How to choose healthy foods?
Answers - Ronda Gates, M.S., R.Ph. The great thing about eating out today is that restaurants are willing to negotiate about what they will serve. When you are eating out for business, stick to the healthiest choices on the menu. When you are eating for pleasure, choose foods you don't normally fix at home that you will really enjoy, and watch food portions. Even the fast food restaurants now provide healthy choices.
Marisa Weiss, M.D. Avoid deep fried foods.
Ronda Gates, M.S., R.Ph. Go for broiled, baked, braised. Avoid creamed, deep fried.
Marisa Weiss, M.D. Put the wonderful salad dressing on the side, and dip your fork in it before you stab your salad.

Thoughts on juicing foods for soft diets?

Question from susie: What do you think about juicing foods for patients who are on a soft diet due to swallowing difficulties?
Answers - Ronda Gates, M.S., R.Ph. Absolutely!
Marisa Weiss, M.D. For women who have mouth sores due to treatment effects, stay away from any foods that are acidic, spicy, or hot in temperature. Acidic foods include tomato sauce, orange juice, grapefruit juice. I think the easiest consistency of food to swallow is applesauce, not of water consistency. Milk products can soothe a sore throat.

How to find calorie intake after menopause?

Question from peach: Now that I am in my 40's and have had surgical menopause I know I need fewer calories. Is there a simple formula to use to determine how many calories I need to eat to prevent any further weight gain?
Answers - Ronda Gates, M.S., R.Ph. First of all, the best prevention for weight gain is regular exercise. Basically, you can take your weight goal and multiply it by 12 to get your minimum calorie needs.
Marisa Weiss, M.D. I heard that a woman needs one third fewer calories once she is beyond menopause.
Ronda Gates, M.S., R.Ph. That is not true. Your needs are based on your weight goal and your activity. It has nothing to do with your age. You can email me at, and if you tell me what your realistic weight goal is, I will email you back an appropriate calorie level.

Foods to avoid on chemotherapy?

Question from margaret: What foods, if any, should you avoid while on chemotherapy?
Answers - Marisa Weiss, M.D. One medical oncologist I work with says to avoid your favorite foods, because you may lose your interest in them, because they become associated with the chemotherapy. Stick to a simple diet. I think soups are popular. Keep crackers by your side.
Ronda Gates, M.S., R.Ph. Keep whole grain crackers.
Marisa Weiss, M.D. A bland diet is helpful.
Ronda Gates, M.S., R.Ph. One of the great quick to fix ways to get some nutrition is to mix various cans of soups together. For instance, I mixed Progresso Green Pea or Lentil with a Minestrone. Instant, easy to swallow meal in three minutes or less.

How can partners help with nutrition?

Question from quaker: What can husbands do to help with nutrition during treatment? How can we make suggestions without seeming like an "enforcer"?
Answers - Marisa Weiss, M.D. Simple. Do all the shopping, the cooking, clean the house from top to bottom, and light some candles. It's hard to force someone to eat when they are not hungry. Try small and more frequent meals. It's common to fight over nutrition. You want her to be healthy again, and it's hard for her to force herself to eat. It's great that you are there for her, and trying to be helpful. Be encouraging whenever you can without being pushy.

Thoughts on vegetable/fruit rinses?

Question from Peppie: What do you think of this new rinse available to rinse fruits and vegetables?
Answers - Ronda Gates, M.S., R.Ph. I don't think that it's any more effective than water. But there is a new product out that can make you feel more confident about eating pesticide-free foods. It is called Fit.
Marisa Weiss, M.D. I heard Meryl Streep say that she washes all of her fruits and vegetables with soapy water and then rinses for a long time.
Ronda Gates, M.S., R.Ph. There is no reason to use soap.
Marisa Weiss, M.D. What about the wax on apples?
Ronda Gates, M.S., R.Ph. Peel them.

Does weight influence breast cancer risk?

Question from hidden: How much influence does being overweight have with being at risk for breast cancer? And why?
Answers - Marisa Weiss, M.D. There have been some studies that show that women who are shaped more like an apple than a pear (bigger in the middle) may have a higher risk of breast cancer. This has been attributed to two factors. First, the extra fat, as well as your normal muscle, help convert androgens into active estrogens. This is the main source of estrogen in the body of a woman who is beyond the menopause. Recent studies also show that high insulin levels may stimulate breast cell growth, acting like growth factors. For women who are overweight, and for women who may be binge eaters, your insulin levels tend to be higher than other women. If you are eating a lot of simple carbohydrates in order to lose weight, you may have a higher blood insulin level.

Vitamins, minerals better from foods?

Question from shawksie: Is getting the appropriate vitamins and minerals from the food we eat a reasonable solution, or are supplements advised, given the unpredictable nature and sources of the food we eat?
Answers - Ronda Gates, M.S., R.Ph. Food is always a prime choice for getting the vitamins and minerals your body needs to function optimally.
Marisa Weiss, M.D. Vitamins within whole and unprocessed foods are nestled in there with lots of other important food compounds. When you process out a particular vitamin, you lose some of its helpful partners, and they can't be replaced with supplements. But if you are having a hard time eating very much?
Ronda Gates, M.S., R.Ph. That is a good time to use a good multi-vitamin and mineral supplement.
Marisa Weiss, M.D. If you are undergoing radiation therapy as well as some chemotherapies, you may want to avoid taking supplemental anti-oxidant vitamins which includes Vitamin C and E, and sometimes Vitamin D and A. Also the minerals selenium and zinc. This is because these vitamins may prevent the creation of the free radicals that the radiation is supposed to cause in tumor cells. So, during the course of radiation, which is usually less than two months, it may be best to limit these vitamins by supplement. I think these vitamins within foods are OK.

Flaxseed okay to use while in treatment?

Question from nadine: I am still in treatment. Is it OK to use flaxseed and flaxseed oil in the hopes it will ease the flashes?
Answers - Marisa Weiss, M.D. The plant-like estrogen in flaxseed, the lignans, lives in the hull of the seed. If you are using an oil, use one that includes the ground up hulls, and buy it fresh in a light-proof bottle that is refrigerated (it goes rancid pretty fast). The amount of plant-like estrogen in flaxseed that your body can absorb is relatively limited, and there is no study and scant personal stories to suggest that flaxseed alone could reduce hot flashes.
Ronda Gates, M.S., R.Ph. If you are using flaxseed oil, use it in salads, not for cooking. It has a nutty taste to it.
Marisa Weiss, M.D. So if you feel like you are living on the edge, you may not want that "nutty" taste! :-)
Ronda Gates, M.S., R.Ph. I have somebody who takes the flaxseed and grinds it with a little bit of cinnamon powder, and puts it on toast. Others use it with chili powder in beans, and it can also be used instead of sesame seeds.

Any harm in Slim Fast?

Question from Kelly: I don't seem to have any appetite, but I can tolerate the taste of fruit-based Slim Fast. Is there any harm in this?
Answers - Ronda Gates, M.S., R.Ph. No. It's important to keep your caloric intake up when you are getting treatment for any disease state. If Slim Fast works, go for it.

Instant Breakfasts a good idea for vitamins?

Question from Pearl: Are Instant Breakfasts a good idea? Last chemo, my husband would put Instant Breakfast powder in pancake mix so I had more vitamins with less pancake.
Answers - Ronda Gates, M.S., R.Ph. That's fine. There is often a lot of sugar in it, but it won't hurt you. I don't think it's going to have very many vitamins in it.
Marisa Weiss, M.D. Ronda, are you contradicting what you said before?
Ronda Gates, M.S., R.Ph. No, because the amount used would be negligible in the total sugar picture.

How harmful is coffee?

Question from Maritza: I love coffee and have switched to decaf. How harmful is coffee, caffeinated or decaf?
Answers - Marisa Weiss, M.D. Coffee is a natural ingredient that many of us, particularly ME, need to think straight!
Ronda Gates, M.S., R.Ph. You think it's a natural ingredient, but it's a drug. If that's what you need to think straight, then you are addicted to it, and that's why you need it.
Marisa Weiss, M.D. I think that there is no harm to coffee in moderation, but it can keep you up at night.
Ronda Gates, M.S., R.Ph. Don't drink coffee after twelve noon. Three cups a day is considered max.
Marisa Weiss, M.D. It can also bring on hot flashes in some women.
Ronda Gates, M.S., R.Ph. If caffeine were introduced on the market today, it wouldn't get past the FDA. But I drink a Diet Coke every morning--I'm a southern girl.
Marisa Weiss, M.D. Mountain Dew, Surge, and Jolt, are full of caffeine. Coke also has caffeine. Coffee has 115 milligrams of caffeine, and Coke has only 46.
Ronda Gates, M.S., R.Ph. Don't forget there is caffeine if you are taking Excedrin--it has 65 milligrams per tablet. And if you are taking Empirin and Anacin, it's 32 milligrams per tablet. Tea has about 40 milligrams per five ounce cup.
Marisa Weiss, M.D. Ok, that's fine, so what about green tea--is that the healthiest tea to drink?
Ronda Gates, M.S., R.Ph. Green tea is turning out to be a great health tonic. One of the compounds in green tea prevents the growth of new blood vessels in animals, and since tumors must form new blood vessels to grow, green tea may turn out to be an anti-angiogenic agent. That's about two to three cups a day. The thing with green tea is you have to drink it for a while before you start to get its effects. Green tea has caffeine, but less than coffee. It also has fluoride in it.
Marisa Weiss, M.D. Is there such a thing as a "bad tea"?
Ronda Gates, M.S., R.Ph. I'm not in favor of tea concoctions. I'm not a proponent of drinking a lot of tea with stimulants, whether it is caffeine or any other added drug. But there is nothing more soothing than a cup of tea, especially some of the new flavored teas, especially in the company of friends. Ginger tea would be great if you are nauseous. I recommend a lemon ginger tea made by Tazo to my friends, available hot or cold.
Marisa Weiss, M.D. Watch out for all the sugar in ice tea mixes, or in bottled ice teas.

Hard to digest veggies, grains, beans?

Question from rae: I sometimes have a hard time digesting all the vegetables, grains and beans that are recommended.  How can I still eat these foods?
Answers - Marisa Weiss, M.D. There is a very important product you need to know about, it's called Beano. Keep your windows open, ladies!
Ronda Gates, M.S., R.Ph. Never eat beans or high fiber foods without Beano.
Marisa Weiss, M.D. If you think you may be having sex that night, that may not be the best night to have a big bean dinner.

Biotin, spirulina okay for hair loss?

Question from butterfly: A doctor who was at my hairdresser's shop getting her hair done suggested I take biotin to restore hair loss due to chemo. Someone else suggested spirulina. What do you think?
Answers - Ronda Gates, M.S., R.Ph. My first question is, are they selling it? There is nothing to support that any supplement will prevent hair loss or make it grow back faster.

Nutritious lunch at a sandwich shop?

Question from KT: When you are beyond chemo and onto radiation, what would you recommend as a good, nutritious lunch that you could get at a sandwich shop?
Answers - Ronda Gates, M.S., R.Ph. I would go for a veggie sandwich on whole grain bread.
Marisa Weiss, M.D. What about turkey?
Ronda Gates, M.S., R.Ph. That's another option, the tryptophan may relax you.
Marisa Weiss, M.D. Ask for the lettuce and tomatoes.
Ronda Gates, M.S., R.Ph. Go for non-pressed meats, so your turkey should be lean and not smoked. Make food wet, I always say, when you are going to the deli--sprouts, cucumbers, lettuce, tomatoes, onions....
Marisa Weiss, M.D. Ask for mustard and not mayonnaise. Some nice chicken breast and tuna salads can be had.
Ronda Gates, M.S., R.Ph. Some of the roll-up sandwiches are real appealing.
Marisa Weiss, M.D. You are making me hungry! One reason for having this conference on this topic is that many women who've had breast cancer blame themselves for getting the cancer. Seventy percent of women who have breast cancer believe that they got it as a result of bad eating habits, or a stressful event in their life, like the loss of a child, or a divorce. Ronda and I hope that all of this information will help you become as healthy as you can, moving forward.
Ronda Gates, M.S., R.Ph. Your worst enemy is probably yourself. When your "itty-bitty-pity-committee" starts to hold a meeting in your head, tell them to get off your back.
Marisa Weiss, M.D. Don't blame yourself for what has happened. It's not your fault! Your cancer is not your fault.
Ronda Gates, M.S., R.Ph. Use the experience as a stepping stone to a new way of life. A year ago today my sister was getting chemo, and she sat there and said "Next year I am going to be doing something different," and she went on a cruise.
Marisa Weiss, M.D. Great! Maybe we can all go on a cruise together!
Ronda Gates, M.S., R.Ph. No beans allowed!

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