Ask-the-Expert Online Conference
The Ask-the-Expert Online Conference called Buying Healthy Food and Drink featured Penny B. Block, M.A., David W. Grotto, R.D., L.D., and moderator Judith Sachs answering your questions about finding, buying, and preparing the healthiest food and drink for people with breast cancer and their families.
Editor's Note: This conference took place in July 2005.
- Question from shel: Other than water, what is the best to drink?
- Answers - David Grotto Besides water, there are a variety of fluids we recommend. We encourage people to drink a variety of herbal teas, preferably caffeine-free, diluted fruit juices (diluted with a non-sodium sparkling water, if you like). A variety of sodas are available that are fruit-juice sweetened. More likely health-food stores would have these, but you may be able to find them at your local grocery store as well.
- Judith Sachs Can you talk a bit about water? Should it be filtered, store bought, etc.?
- David Grotto We prefer our patients drink filtered water. There is a variety of different filters on the market. We encourage them to use filters that remove volatile organic chemicals, which are harmful contaminants that have been linked to increased risk for cancer. So beyond removing bad odor, taste, and chlorine, we think it's important to remove nitrates and also harmful organisms, such as cryptosporidium and giardia. As for well water, have it tested first to see what issues are with that water. There are companies that make filtration systems for well water. One of the big concerns we would have is high iron content of water.
- Penny Block Also check for lead levels in well water. David mentioned correctly that this testing needs to be done on an ongoing basis. Some people though, tend to use the plastic water bottles and reuse them. There is some evidence suggesting harmful effects from the plastic in the bottles. There is one kind, Nalgene, that does not leach the harmful properties of the plastic into the water.
- Question from jiri: My wife has a recurrent breast cancer which is related to a high level of estrogen in her body. What kind of food and drinks can lower the level of estrogen in a woman's body?
- Answers - David Grotto One of the things we do know that will increase risk for breast cancer is obesity, and we know especially if there's more fat that collects around the abdominal area, that can promote more circulating estrogens. There is an issue with weight management, because there's a concern with a diagnosis of breast cancer and being overweight at that diagnosis, having a poorer prognosis associated with that. Gaining weight during remission is also a concern.
- Penny Block Even during treatment, when people can’t spend a lot of energy trying to lose weight, it might be poorer prognostically to gain weight. This is always a whole dietary plan, and we try to individualize for each patient.
- David Grotto We know that whole grains, for example, have fibrous compounds that can block harmful estrogens and there is some good research showing the cultures that consume more whole grains, fresh fruits and vegetables, and legumes have lower rates of breast cancer not only because of the estrogen binding properties, but because of the general health benefits.
- Penny Block Crucifers, for example - broccoli and cauliflower, and the lowly cabbage, because people don't always think of what a gem of a food it is. So even coleslaw is good, because cabbage contains a compound that shifts the estrogen to a safer form of it. It's a property in cabbage that is very healthy. Sometimes we're looking for more exotic foods, but even cabbage, which is available in every supermarket, has tremendous benefits.
- David Grotto Out of all the vegetables—not that we're picking one over another, because vegetables in general are good for the diet—a doctor did some research into a phytochemical in cruciferous vegetables showing it blocked breast cancer growth. So besides the possible estrogen-blocking properties, there is a chance it affects programmed cell death.
- Penny Block Dave is mentioning an important point, that there is something potentially more beneficial about the whole food rather than just the isolated compounds in that food. Another University of Illinois researcher talked about the beneficial effect of eating broccoli three times a week in terms of reducing risk value of cancer.
- Judith Sachs Broccoli three times a week sounds difficult. Can you give us some tips on preparing it?
- David Grotto Broccoli ice cream…
- Penny Block I think we can get into such seriousness about all this, but having fun with food (and I'm glad you're asking what to do with broccoli!) but what to do with good food is important. If food is just a nasty prescription we swallow three times a day, it's no good. And there is evidence that if we have pleasure in eating, we absorb the nutrients more effectively.
- David Grotto Now for the broccoli tips! Again, we often come into this situation talking about an optimal diet, but how do you make it doable? Think of vegetables beyond a couple of cooked stalks of broccoli on a plate. It can be in a soup, a juice, frozen, fresh—there's a variety of ways to include it. And with broccoli or other vegetables that may be a challenge, that's been a dilemma we've addressed for years. We finally decided to produce an organic green vegetable drink that can be easily incorporated into a beverage, a juice, pesto, etc.
- Penny Block Getting back to what to do if you want to use broccoli? But quickly steam it so it's still a vibrant green, so it's still crisp. The green may actually be more vibrant at this point than when it's raw. Serve it with a dip, or slightly sauté it with a good quality extra virgin olive oil and garlic. You could certainly incorporate some of it in a pasta sauce. A creamed broccoli soup. It's easy to make creamed broccoli or mushroom soup, using oats cooked in water. If you puree it, it's quite creamy. So cook your broccoli with garlic, onions, oregano, etc. then put it in this creamy oatmeal liquid that's been seasoned to taste, and puree to make a nice creamy soup which is often more pleasing to the digestion.
- David Grotto Not to gloss over the importance of whole grains, but again, following Penny's great suggestion to add oats, there is also some bang for the buck in fighting cancer. Oats are rich in a substance found to enhance natural killer cell activity. It's like the game Pac Man, where these little guys go out and gobble up cancer cells. You want those cells in your body to have highest activity, and oats may enhance that.
- Penny Block There are some vegetables, particularly hearty green vegetables like kale, collards, etc. but even carrots, cooking them seems to break down the tough cellulose wall which makes it more difficult to absorb the nutrients if they're not cooked. This doesn't mean you can't eat raw vegetables, only that there is a benefit in cooking them. There are some people in my family that don't want crunchy cooked vegetables; they want them cooked more so they're softer. So cooking them until they're crunchy is not the only way to cook them.
- Judith Sachs When the transcript for this chat is posted, we'll include some of the recipes from Penny's cookbook.
And we have new recipes we post to our website, www.blockmd.com. We just did a presentation on TV where we talked about foods for fighting breast cancer specifically. Some of the recipes we features showed creative ways to eat dark greens. We actually had a roasted vegetable spinach wrap sandwich. Admittedly, the amount of spinach in the wrap was at low levels, but some is better than none!
One last comment about raw vegetables, because I know we're talking about reducing risk of breast cancer. But if you're undergoing treatment for breast cancer, especially treatments that can lower your white blood cell count, there can be increased risk of bacterial infection (food poisoning, if you will) when you have low white blood cell counts. So that's why we strongly encourage you to cook vegetables to kill bacteria that are on vegetables.
- Penny Block It doesn't mean you have to eliminate raw vegetables, because a cool fresh salad in summer is so refreshing. But maybe for a day or two, people need to be more cautious. One of the things that Dave and his team of dieticians do is to counsel our patients so they know what is appropriate for them at any given time. We use tests to determine their biochemical statuses. But when the while blood cell count is low, use a little caution for a day or so.
- Question from frolic: I saw an article in the paper a few days ago that said that green tea may help prevent breast cancer. I don't like the taste of it—can I mix it with something else and still get the benefits?
- Answers - David Grotto Yes, in fact, in my own home I like to drink green tea quite a bit but I'm not a fan of cold green tea. So I make a pitcher of it, and use a sweetener called agave, which is the same plant they make tequila from. So do NOT substitute Tequila if you can't find agave! :-) I may add some cherry juice with the green tea, which is a wonderful anti-inflammatory but more importantly, I can get my daughters to drink the tea if it has cherry juice in it. A lot of natural food stores carry agave.
- Penny Block Or you can find it online—do a web search for agave.
- David Grotto Besides green tea, that's not necessarily the only game in town although it is rich in polyphenols, the antioxidants that can help fight cancer. But also white tea is rich in these as well, and has a nice mild taste, there's also red tea.
White tea may actually be higher in polyphenols. We also have a supplement that provides the equivalent of 42 cups of decaffeinated green tea, for some patients who may not like green tea. But it's hard to get that high concentration if you're just going to sip 42 cups of green tea!
The research is so impressive about the benefits of green tea, so this is a great example of food supplementation that may help augment the diet and provide other ways of getting it in.
- Judith Sachs There are people who live in small towns or areas where health food stores aren't abundant. How would they use their supermarket to get the healthiest food possible?
The old adage was shop the perimeter of the store. Grocery stores caught on, and changed the layout of their stores. Have a plan before you go to the store, whether you're trying to reduce risk of breast cancer or are undergoing treatment, or develop a remission strategy, we think there is an optimal dietary program.
So plenty of vegetables and fruits, whole grains, more plant-based protein like beans and legumes. The USDA listed beans as having some of the highest antioxidants as compared with other foods. Good high-fat Omega-3 oil in fish is beneficial.
Those are the basic core, so if you have those on your list, it will take out some of the guesswork when you get to the store. Organic vs. non-organic—we feel organic is better if you can find and afford it. But if you can't find organic, don't forego eating fruits and vegetables or legumes. We feel the benefit of eating these foods far outweighs whether they are organic or not.
We talk often enough with our patients, some of whom have been frightened by foods that are not organic. So it's counterproductive, because they avoid the foods that may benefit them. You will lose a critical part of the diet program. Try making friends with someone in the supermarket, maybe the manager, or the buyer, who may help you find foods that are healthful.
There are many healthful foods in the supermarket—you can find whole grains, and uncooked beans. But you can also find beans that are prepared—they may be canned, but as long as there's no sugar in them and little salt, they're OK. There are vegetarian soups without additives. So there are things in a grocery store that can be part of a healthier diet and that's something the whole family can enjoy.
- Question from hockeymom: I'm currently in treatment for Stage IV breast cancer, I don't feel like eating anything. I know I need to keep up my strength and build up my immune system—what do you suggest?
This is a critical issue, because sometimes the treatment can affect quality of life. Eating a proper diet, and having an entire comprehensive program to promote health that includes physical activity and mind/body aspects, good diet, and supplementation can ease the burden of the side effects of therapy.
But we coined a phrase, "volume challenge." That means regular-sized portions may be too challenging. Some patients cannot eat the amount of food they optimally should. So our staff has developed smoothie recipes with concentrated nutrition, but in smaller quantities that can help build lean body mass. So I would recommend you consume something like a whey protein smoothie with oat or soy milk as a base, adding fresh fruit.
If calories are a challenge, there are some creative ways to increase them such as adding nut butters—MCT (medium chain triglycerides). Your body uses that as a preferred source of fuel, so it's an easy way to increase calories.
And we want to be careful about adding high Omega-6 fats, which may add fuel to the fire by increasing inflammation. There is a lot of literature about the links of Omega-6 oils with heart disease.
Cinnamon seems to be an appetite enhancer. Back to something Dave mentioned about protecting lean tissue—we do a body composition analysis. We watch to make sure that our patients, if they do lose weight, are not losing lean or muscle mass. You can do this through exercise, but also through the types of food you eat.
We watch that with our patients as they traverse this cancer recovery task to make sure that is protected. I was just talking with some patients about how sometimes when you're in chemotherapy, some of the whole grains like brown rice, while good for you, can feel heavy. Long-grain brown rice is fluffier and lighter than short grain brown rice. But there's also a grain called quinoa, (pronounced keen-wah). It is a wonderful grain because, first of all, it has a good protein profile with essential amino acids, so you get additional protein benefits along with the benefits of whole grain. Whole grains have B complex vitamins like pyridoxine, which is necessary for the immune system.
But quinoa cooks very light, and goes down light and easy, especially in these hot months or if your appetite isn’t big. It cooks in a very short time—10 minutes—and there are many foods that go well with this wonderful grain.
- Judith Sachs Appetite is sometimes stimulated by the environment in which you eat, so use a beautiful crystal glass for your smoothie. Setting the table with a candle and beautiful china can help. Also, use smaller plates for the smaller portions.
- Penny Block When someone's appetite is diminished, presenting a huge plate of food can be daunting and will send the appetite plummeting even more. So Dave counsels patients to eat small meals throughout the day instead of just a huge portion less frequently. But I love your idea of creating an atmosphere.
Quite often we have our patients embarking on a new diet plan, taste rules, and they don't want to lose out on the enjoyment of dining with others. Not only is the uptake of nutrition important, but we don't want achieving a good diet to be stressful. You should have a love of eating, not dreading your next meal.
Penny mentioned whey protein and the wonderful grain quinoa. There are some amino acids called branch chain amino acids. Out of the food known to us, whey protein is highest in these branch chain amino acids because it helps increase lean body mass.
There is some great research into Omega-3 oils that helps wasting syndrome that can happen with more advanced cancers. So we try to encourage eating foods high in Omega-3, or even fish oil supplements to enhance lean muscle tissue.
- Question from Trina: I get confused by all the jargon in natural foods. What's the difference between “natural,” “organic,” and “certified organic”?
The USDA has come out with clarification as to certified organic. You can go to their website for that. The important thing is you'll find different jargon for having total organic ingredients, or some organic ingredients have been added.
The term that's still ambiguous is “natural.” As someone who has been involved in natural foods for years, even I am confused. So don't be fooled by a picture of grandma churning butter on the label! It's important to look for the word “whole” in the first ingredient. Make sure the terms on the label are in plain English. If you can't pronounce it, you probably shouldn't eat it.
- Penny Block When David said not to be misled by the term natural, people are spending a lot of money unnecessarily on “natural sugar” or “natural cane juice.” Even if it says “organic cane juice,” it's still sucrose. It's a great marketing tool, but not a great tool for your body.
- David Grotto If you're going to position your food dollar to where it has the most bang for the buck, if you choose something organic, there is research to show organic vegetables may be more nutrient-dense than non-organic. So in that case, it makes more sense to buy organic vegetables than organic sugar.
- Question from Lisa: I've read that curry can help prevent cancer. Is this true? How does it work? How much should I eat?
Typically the main ingredient in curry is a herb called turmeric which contains a compound called curcumin. A recent study showed it may inhibit melanoma cancer. It helps signal cancer cells that they are no longer welcome, and should die, but also has anti-inflammatory benefits. It may be beneficial for a number of cancers.
Men and women are equally affected by heart disease, and what we're finding with the dietary strategy we're discussing today is that it is helpful to avoid a number of conditions for the whole family.
- Judith Sachs Since curry powder contains a number of herbs, is it better to just buy the turmeric?
- David Grotto There are dietary supplements of curcumin available. But they are best given under the care of a licensed professional. We're really talking about not a single bullet if you want, not a single food, but we don't know about the potential synergy of all these foods. So you may not have a super high level of turmeric in your diet, but what will happen if you combine it with a low Omega-6 and high Omega-3 diet.
- Penny Block In addition to that, it's not really going to work if you eat sugary cereal then put a little turmeric in the meal at dinner. Dave is wondering why I'm having trouble holding back a giggle—I remember making a no-egg tofu salad for sandwiches, and it must have been dark in the kitchen because I put in way too much turmeric and the kids said that kids at school laughed at their bright yellow egg salad. Turmeric is very yellow! And you would be yellow too if you ate it in enough concentration.
Our big concern is that people think if they don't like turmeric, they're avoiding the benefit if they don't eat it. But everyone can find a favorite vegetable or something else. Let's not focus on one food; let's find an overall diet and lifestyle strategy. I help my patients make themselves a priority so all these things fall into place.
Often we get mothers with breast cancer who are so busy with their family, kids, maybe elderly parents, and are not making enough time for their own diets. This has to happen before any of this other stuff happens.
- Judith Sachs People shouldn't be discouraged about thinking they have to change everything all at once. You don't have to eat only broccoli and turmeric! You can make small changes every week, and still end up with an optimal diet.
- Penny Block Some people find that if they don't go “cold turkey” on junk food they have a problem getting to what they feel is an optimal diet. But other people, as you said Judith, need a plan to get there. But you do need a plan, otherwise you get stuck in transition. That is critical. Think individually about what pace will work for you. Even make a contract with yourself that spells out how you will manage this.
- Question from Bridge: I'm interested in information regarding whether or not soy and flaxseed are good for our diet. Also, what about organic meat—should we use only organic meat products?
Of course, and Penny and I were just talking about this, in the 10 years I've been here, soy has been a subject of controversy especially in the breast cancer population.
But for over 25 years, our message about soy has been the same—soy in moderation. We still feel it's an appropriate part of the diet. When we look at the components of soy, like isoflavones, which itself can have some estrogenic properties, it may be better for some populations to supplement with that than for others.
But with whole soy foods (our preference is for traditional soy foods, like miso and tempeh, edamame, tofu, or soymilk), we feel that soy may be very beneficial even for those with estrogen-driven cancers, some soy is probably OK. In the integrative therapies journal recently, a group of soy researchers and clinicians was polled and the conclusion was that consuming traditional soy foods, especially fermented soy foods, didn't really have a downside.
There is recent research showing that miso soup (miso is a fermented soybean puree) was shown to inhibit breast and prostate cancer. The growth of cancer cells was substantially reduced in this soybean extract.
So there are different qualities of soy as well, and we may absorb the fermented soy more effectively. Also, we know about different kinds of estrogen—estrogen alpha and estrogen beta, and soy products often hit the beta receptor and are more beneficial. We come right back to: Soy can be good in moderate amounts. In this country, we discovered soy was beneficial, so people went tofu-crazy, and ate it all day. So you can eat it, but remember, it's part of the total plan and not the answer on its own.
- Question from cilla: Do antioxidants make chemotherapy drugs like Adriamycin less potent? Do they interfere with radiation therapy?
Like soy, there has been a lot of debate on the role of antioxidants. We have seen first hand that selective use of antioxidants and other conditional nutrients (based on patients' unique biochemistry, their radiation treatment, etc.), there is significant lowering of side effects. With Adriamycin, we use co-enzyme Q10.
Heart function can become compromised when using Adriamycin, so by using the co-enzyme Q10, our patients have minimized effects on their cardiac function. But we tailor antioxidants to the patient. We don't make blanket statements that all antioxidants are good for everyone. We recently saw a study on small cell lung cancer that showed the people receiving antioxidants compared to those who did not receive antioxidants, did better.
These results do not support the concern that antioxidants might protect cancer cells from the free cell effects of chemotherapy. We're finding that appropriate use of antioxidants may protect healthy tissue, and increase the effect of the cancer killing cells.
- Penny Block There was a good discussion of this in the Integrated Therapies journal and a summary stating the preponderance of evidence indicated that antioxidants did not interfere with chemotherapy. Antioxidant supplement users were less likely to have a breast cancer recurrence.
- David Grotto The study I’m citing, by Fleischauer et al, was of a breast cancer population, about antioxidant supplements and risk of breast cancer recurrence and breast cancer related mortality among postmenopausal women. It appeared in Nutrition and Cancer 2003.
- Penny Block We're trying to reinforce with good science that there will not be a problem with antioxidants, but all breast cancer patients should still discuss this with their doctor and a nutritionist, if possible.
- Question from Max: What's the difference between wild salmon and farm-raised salmon?
Max, both wild and farm-raised salmon are rich in Omega-3 fats. They are equally rich sources. The concern with salmon are contaminants called PCBs. In a recent study, farm-raised salmon was said to have much higher levels of PCBs than wild salmon, but it was looking at salmon from Puget Sound area which does have a higher level of PCBs. Unfortunately, PCBs are unavoidable in our world. Farm-raised salmon from Chile has fewer PCBs in it than that from Norway. We encourage our patients to eat salmon, wild if possible.
PCB content can be more concentrated in the skin so by removing the skin, that removes over 50 percent of the PCBs. Eating farm or wild salmon, no more than four ounces three times a week, because we don't live in a pristine world and we need to be concerned with the chemicals in it. We tailor that to the individual when appropriate.
There are other fish options that are high in Omega-3, so salmon isn't the only choice. There was a survey showing that larger national chains of stores have farm-raised salmon that is quite clean. So there is some interest and concern in response to consumer demand. But it's important to know you can get better farm-raised fish in some health-food stores.
Once again, we're talking about eating the best you can. If you go to a restaurant and order salmon, please enjoy dinner and don't agonize over what's in each mouthful. Eat the healthiest foods you can, and take pleasure in them.
- Judith Sachs For the carnivores in the audience, can you talk about organic meat, and are some sources better than others?
- David Grotto In perspective of an overall diet, we prefer more of a plant-based diet. But for those who want to consume meat, we recommend leaner choices and organic is a preference if possible. If it's not available, then leaner cuts are better because the Omega-6 fats are less. High animal protein in the diet can have correlation with increased risk of different cancers.
- Penny Block It's preferable to have a little meat or poultry with your vegetables, rather than a little vegetable with your meat or poultry. A stir-fry that uses small pieces of meat or poultry might be the best way to go.
- Question from xerxes: My family has been right with me every step of the way through treatment, but when I try to make changes in our meals, they scream. I really don't want to prepare two meals every night—how do I get them onboard?
- Answers - David Grotto I'm applauding you for making those changes! That's probably one of the biggest problem our patients have—what they do profoundly affects their family, so we try to get the whole family involved in that consultation to help them make healthier choices. I have three daughters, so I realize it can be a challenge to get the family on board. But by getting children involved in food preparation, shopping, picking foods they like, that makes a difference. There is research showing that eating together as a family helps children make better decisions as adults. So it's not only eating the right foods, but eating as a family unit that helps.
Getting everyone invested in it is important. Give your children a chance to select something they want to eat during the week so they know their preferences are regarded and respected and they'll feel more involved. And also, make it fun! I know sometimes it feels like it's making two meals, but you can do things that will make everyone satisfied without feeling that someone is eating “healthy” and someone is eating “normal.”
We feel our food is normal, but happens to be healthy as well. For example, if you make chili, you can season it so it tastes familiar. You can get organic taco shells if you want, and make your own tacos with beans, salsa, guacamole, so it's kind of fun and people get to make their individual ways. Among my four kids, not one likes exactly the same things as the others. So if they get maybe one thing they each like in a meal, that makes it a more pleasing experience.
We were talking about the importance of not always having to be “full disclosure” with your family. To this day, my kids think salmon is chicken!
When I first met my wife, she cooked some wonderful family dishes from her Eastern European background. She made a traditional cabbage roll with meat, white rice, and red sauce. So we switched out the white rice and used brown, used a fake meat instead of real meat. She loved it, and introduced it to her grandmother who also loved it until she found out what it was and then said she thought there was something wrong with it!
- Question from Devon: Are dairy products safe?
“Safe” is an interesting way of asking. It's somewhat of a mixed bag when it comes to fighting cancer. About dairy products, there was an interested study in The Lancet that showed that premenopausal women who had a small increase in insulin growth factor (IGF1) had up to 7 times the breast cancer risk of women with lower levels. The reason I bring that up is there was a study of dairy benefits showing insulin growth factor can possibly increase breast cancer. The casein in dairy can increase IGF.
There are some wonderful aspects of dairy we applaud—calcium is necessary to fight osteoporosis, so it's about calcium balance. We also know that dairy contains CLA, conjugated linoleic acid, which is a good transfat that may fight breast cancer, and whey protein which may have profound benefits. (By the way, the “runny” part of cottage cheese is whey and the chunky part is the “curds.”) But because of the IGF, we don't promote dairy for people with breast cancer.
- Penny Block IGF1 is not a chemical that's added by the dairy industry. It's a component of cow's milk, but it can contribute to the growth of breast cancer cells.