SuzanneDixon

Not too much

2008-02-27T20:52:00Z

As I mentioned in my previous email, author Michael Pollan cleverly summarizes how to eat for good health with seven words, "Eat food. Not too much. Mostly plants."

I tackled the first part of this statement, "Eat food" in my previous blog. In this blog, I'm going to tackle the second part of the quote, "Not too much." In a future blog, I'll tackle the last two words - "Mostly plants."

When we consider how to eat for best health, what is meant by "Not too much"? To put it simply, if you are within a healthy body weight range for your height, then you are eating the right "amount" of food. Body weight is the single, easiest way to know if you are eating the the proper number of calories for good health. If you are underweight, you aren't eating enough. If you are overweight, you are eating too much.

If you want to learn more about how to determine what a healthy body weight looks like, you can use our Body Mass Index Calculator.

It seems like a simple equation, but clearly, it is not. If it were simple, nearly two-thirds (>60%) of American adults would not be overweight or obese. Yes, nearly two-thirds of adults in the United States are overweight or obese. This is not news to most people. The rates of overweight and obesity have been increasing for years and it has been reported on extensively. But what has not been as well publicized is why this is such a concern for those who worry about cancer risk.

The reason why this is such an important issue in relation to cancer is because overweight and obesity are among the most important preventable causes of a large number of common cancers. According to the Second Expert Report prepared by the World Cancer Research Fund and the American Institute for Cancer Research, body fatness, which is the result of being overweight or obese, appears to substantially increase the risk of esophageal, pancreatic, gallbladder, colorectal, endometrial, kidney, and postmenopausal breast cancers.

Even beyond these cancers for which the evidence is convincing, there are many other cancers for which overweight and obesity likely increase risk as well. And for those who are concerned about cancer recurrence, being overweight also is something that should be addressed. For several cancer types, including colorectal, breast, and possibly prostate cancer, being overweight or obese after diagnosis is believed to increase risk of getting cancer again. The bottom line is that being overweight or obese is a problem for anyone concerned about cancer.

So knowing what we know, why is it so difficult for most people to maintain a healthy body weight? There are several things that contribute to our collective difficulty with overweight and obesity. But one of the most important is our inability to stick to normal portion sizes. This is where "Not too much" comes into play.

Plain and simple, we eat too much. Portion sizes have increased dramatically over the past several decades, to the point that what used to be a normal portion now looks downright skimpy. In addition to this, the type of food we often eat contributes to the "Not too much" issue by providing far too many calories for a given volume of food. In other words, we eat foods that are calorie dense. To understand this issue, consider a food such as potato chips compared with foods like broccoli or carrots. For the same number of calories that are in a small handful of potato chips, you could eat several cups of broccoli and carrots. Potato chips are calorie dense. Broccoli and carrots are not.

Along with lack of physical activity (exercise), these two factors, oversized portions and high calorie dense foods are among the most important causes of overweight and obesity.

One of the single best ways to help yourself reach and maintain a healthy body weight is to eat fewer calorie dense foods and instead replace them with foods that are not calorie dense. You probably can see where this is going and I will elaborate more when I write about "Mostly Plants" in my next blog.

So for now, I'm going to focus a bit on one of the things that I believe contributes to the problem of eating too many calorie dense foods: Processed food. What do I mean by processed food? For a great description, be sure to read my previous blog, Eat food.

One angle of the processed food conundrum is the amount of high calorie sweeteners, such as sugar and high fructose corn syrup that are added to nearly every food we eat these days. This food manufacturing process of sweetening foods beyond their natural level of sweetness adds calories and is part of why processed foods are so calorie dense.

Even more damaging, I believe, is how this practice of sweetening everything has completely "reset" our taste buds and taste expectations. Many people believe this is the fault of the food processing industry, but regardless of who you blame, we are all susceptible to it.

I'll give you an example of how this works. Nearly every commercially prepared bread on the supermarket shelf contains high fructose corn syrup as the 2nd or 3rd ingredient. If you don't Next time you're in the store, try reading a few bread labels. Also be sure to check out the labels of cereal, pretzels, snack foods, and yogurt. Nearly all mainstream brands of all of these foods contain added sweeteners, most typically high fructose corn syrup.

My question is, "Why do we need corn syrup in bread?" Given the way in which the majority of our food supply is manipulated, it's not surprising that nobody wants to "eat your veggies."

But there is some good news. People can relearn how to enjoy real food that tastes like REAL food. We can learn to enjoy the earthy, slightly bitter tastes and pungent flavors of vegetables; the natural sweetness (not added) of foods such as fruit, carrots, and corn.

In doing this, in embracing real food, we automatically begin to address "Not too much". From a calorie density prospective, there's nothing like real food to make sure we eat, "Not too much".

We all need to learn how to enjoy real food more. This doesn't mean we can't have dessert. I'm not interested in being the food police and I think there are a time and place for sweets. But I expect dessert to taste sweet, NOT my bread. Or my vegetables. These foods should taste like grains and plants.

It takes time and practice, but your taste buds and preferences can change. I know, because I've been there. I've learned to love vegetables, but I didn't always. Now, I enjoy just about every vegetable I've ever tried.....other than Brussels sprouts. I've just never liked them. But here's the funny thing: Recently, I had dinner with friends and one person brought roasted Brussels sprouts to share. They were delicious. I have never liked that food. Never. But who knew that when prepared just right, I could them to my favorite foods list?

This is a perfect example of why it's important to be open to new food. Try something several time before giving up. And if you just don't like that one food, there's no need to worry. Nobody has to enjoy every food, but as long as you focus on a wide variety of real food, you'll be eating a cancer fighting diet and fortunately, eating "Not too much"!

And as a final note, I always feel like I need to remind people that eating healthfully is a gift. It is a gift to you, to your family, to your friends, and to anyone who loves and cares about you. Healthful eating is not about punishment. It's about enjoying the best level of health that you can attain for your particular circumstances!

Eat Food

2008-01-18T01:43:00Z

Author Michael Pollan cleverly summarizes how to eat for good health with seven words, "Eat food. Not too much. Mostly plants."

This is so clear and so simple, but what, exactly, does this mean? I'm going to tackle the first part of this quote, "Eat food." in this blog. In upcoming blogs, I'll tackle the other five words ("Not too much. Mostly plants.").

On its surface, the advice to "eat food" seems ridiculously obvious. "Of course," we think, "what else would I eat? Furniture? Books? Shampoo?" But if we delve a little deeper into what "food" is it quickly becomes clear that most of us eat anything but real food.

What Michael Pollan is getting at, and it's something that anyone who has studied nutrition (in the academic sense) understands, is that real food is the real answer to good health. To understand what real food is, think about things that your grandmother, or perhaps your grandmother's grandmother would have eaten. This would include things that look like plants and animals - apples, pears, peaches, tomatoes, cabbage, carrots, eggs, fresh milk or meat, freshly milled whole grain flour, bread and pasta made from this flour, nuts, seeds, broccoli, cauliflower, leafy greens, onions, garlic, the list is endless.

Now think about the things that most of us eat, every single day, for the bulk of our diet - nutrient fortified granola bars, vitamin water, instant and microwavable meals, power bars and candy bars, pretzels, chips, cookies, canned soup or stew, hamburger or tuna helper, fast food, pizza, Chinese takeout, even vitamin-infused diet soda! Again, the list is endless.

If you visually examine these items, the message is loud and clear. The first list contains food. The second list contains edible items. Just because something is edible (can be eaten), doesn't mean it is real food! So how did we get so far from our dietary "roots"? I think this is important to understand, because it will help us get back to eating real food. Eating real food, in turn, will improve our health.

As nutrition science has evolved and researchers have gained an understanding into the nutrients contained in food, the public has received constant bombardment with messages about these individual nutrients... "Eat more folate (folic acid)." "B vitamin prevents heart disease." "Grape phytochemicals fight cancer." "Blueberry extract reduces Alzheimer's disease."

The media loves to trumpet these research findings because they sell so well. It's much more exciting to tell people about some newly discovered, exciting nutrient and how it fights disease than to state the obvious, "Researchers find, for the 100th time, fruit and vegetables reduce disease risk." And frankly, people want to hear about these individual nutrients. It's much more appealing to think that you can eat anything you want, take a nutrient pill, and enjoy the same good health as if you had eaten a healthy, real foods diet.

I'm here to be "the voice of reason," and I can tell you that this simply isn't going to happen. Food is complicated, contains thousands of nutrients that work together to keep us healthy, and cannot be replicated in a pill, potion, supplement, or powder. There are notable exceptions for which taking a concentrated vitamin, mineral, or other dietary supplement may be necessary for good health (see my blog on Vitamin D: Wonder Nutrient).

But if you consider the word "supplement", you can see that it is right in the word - a supplement is TO SUPPLEMENT something. It's not called a "replacement." It's called a supplement and it's designed to supplement a healthy diet, not replace it.

After reading this, you probably think, Suzanne is no fun! No pizza? No Chinese takeout? Absolutely untrue. I enjoy pizza and takeout food as much as the next person and I indulge in this type of food, occasionally! This is the key. As I mentioned in my previous blog, "Nobody eats "perfectly" all the time and nobody needs to for good health."

So go ahead, if you're in a rush and the best you can do is grab a granola bar, that's fine. If you meet friends out for an indulgent meal in a restaurant once a week, enjoy it! If you need to eat a quick microwave meal from time to time for lunch, don't sweat it. Just don't mistake this for real food and make sure that real food remains the centerpiece of your healthy eating plan.

Remember, every time you chose to eat, you can chose to eat healthy. If you didn't make that choice last time around, let it go and focus on the next meal or snack. Always look forward and always do your best to take care of yourself.

Super Foods

2008-01-04T20:56:00Z

People often ask me, "What are the best cancer-fighting foods? What foods should I eat often, even daily, for best health?"

Off the Vine

The simplest way to think about what foods are best for health, including for reducing cancer risk, is to look for items that are as close to their natural form as possible. If a food looks like it did when it came off the tree, out of the ground, or off the vine, then this is what you should be eating. Think vegetables, fruit, whole grains, legumes (beans), nuts, and seeds.

The Corn Example

A terrific example is corn. Consider corn on the cob. It is picked and then you husk it, boil it, and eat it. Other than husking and cooking, when corn on the cob lands on your plate, it looks almost exactly like it did when it was pulled off the plant in the field.

Now consider some of the corn based products in the supermarket such as flavored corn tortilla chips. To make this product, the corn is picked. Then it is dried and milled into corn flour. Additional ingredients, including flavorings, colorings, and oil are added to the corn flour as it is pressed into a tortilla chip. And the oil that has been added often is processed itself. Even the flavorings and colorings are artificial and contain manufactured dyes.

This all occurs before the chip is even baked. And by the time this chip reaches you, it certainly doesn't look anything like corn. This simple comparison gives a good idea about the best way to chose food that is best for health.

Natural is Healthy

The most important thing to keep in mind is that natural = healthy. Stay away from processed food. Focus on real food. This is the kind of food that looks like, well, FOOD.

Fighting for Health

It sounds simple, but often, it is not easy to do. At every turn we are confronted with food that is cheap, easy to prepare, and loaded with calories and fat. Commercials, billboards, fast food, and convenience stores assault us at every turn. How can you make good choices? It takes a little effort, but isn't your health worth it?

It's true, eating healthfully takes a little more time. But if you want to eat better for better health, you can make the time for it. How many hours of TV per day do you watch? How many hours on YouTube or surfing the web? What about all those cooking shows that are so popular? If we all spent just a fraction of the time on preparing and eating healthy food as we do on any one of these other activities, it would go a long way toward improving health.

You don't have to be a gourmet chef, you just have to be willing to spend a few minutes to prepare good food. For a snack, how about skipping the candy bar and trying a piece of fruit and a handful of nuts? It takes no more time, but will pay big dividends in better health and more energy. Or try some of the easy, tasty recipes right here on Caring4Cancer.com: http://www.caring4cancer.com/go/cancer/nutrition/wellness-nutrition/entres-main-dishes.htm. These are designed to deliver maximum taste and nutrition in a minimum amount of time.

Food Should Be Enjoyed

And remember, you don't have to eat this way 100% of the time. Anyone who knows me also knows that I'll be the first in line for dessert! Nobody eats "perfectly" all the time and nobody needs to for good health. These natural, whole, unprocessed foods should make up the majority of the calories that you eat. They don't need to make up every, single calorie.

If this is how you eat most of the time, those occasional treats really don't matter. In fact, I believe food should be enjoyed, so these "less than healthy" foods certainly deserve a place, a small place, in your diet.

The Gift of Health

I have no desire to be the food police and I don't think anyone should be. Rather, I believe that everyone deserves the gift of good health that comes with eating a healthy, delicious, whole food diet. Instead of focusing on what you "can't have" or "shouldn't eat", focus on all of the wonderfully healthy, tasty food you can have. Instead of focusing on deprivation, focus on the abundance that whole foods offer - an abundance of flavor and health.

When you shift your perspective from what you "shouldn't have" to what you "can enjoy", you'll be amazed at how much more you enjoy your food, and in turn, the improved health that comes with better food choices.

Label Reading

As a final note, I wanted to comment on another part of the healthy eating equation. I'm often asked, "What do you look for when you read labels and are trying to pick the best food?"

Label reading? Have you ever seen a label on an apple? The best foods don't have labels!

Not What We Expected

2007-08-01T02:06:00Z

Disappointment

Last week, eagerly anticipated results from the Women's Healthy Eating and Living (WHEL) study were published in the Journal of the American Medical Association (JAMA). The WHEL study is a randomized trial designed to determine possible benefits of a diet rich in vegetables and fruit, low in fat, and high in fiber for women with a history of early stage breast cancer (stages I-IIIA).

The researchers studied over 3,000 women, half of whom were instructed to eat the high vegetable and fruit, high fiber, low fat diet. The goal of this intervention diet was to have the women eat a minimum of 3 servings of fruit, 5 servings of vegetables, and 30 grams of fiber per day, and no more than 20% of total calories from fat. The other half of the women in this study were instructed to follow the control diet - a general healthy eating plan based on the "5-A-Day" program, the goal of which is to eat a minimum of 5 servings of vegetables and fruit per day.

Hopes and expectations, mine included, were that the women following the ultra-healthy intervention diet would have fewer recurrences of breast cancer and fewer new cancers than the women following the control diet. Unfortunately, the results were not what we expected. By "we", I am referring to anyone who follows these large cancer nutrition diet trials and others in the cancer nutrition community with interest and expertise in this area of research.

After 7.3 years of follow up, the women in the intervention group had no better outcomes than the women in the control group who were following the 5-A-Day diet. In other words, the number of breast cancer recurrences, new breast cancers, and deaths due to any cause were about the same in the two groups of women in this study.

I would be lying if I said I wasn't disappointed with these results. This was a well designed study that failed to show a clear cut benefit, in women with a history of early stage breast cancer, of eating a very healthy, vegetable and fruit-rich diet. However, before you throw up your hands and say, "Forget it, why bother to eat a healthy diet, it doesn't even matter..." it may be helpful to look at the big picture of what these results may mean and why it is not a good idea to give up on healthy eating.

Confusion

When interpreting the results of the WHEL study that were published in JAMA, one of the first things to consider is a study that was published just one week earlier. The week before the JAMA article hit the press, other results from the WHEL study were published in the Journal of Clinical Oncology (JCO), another prestigious medical journal. This is quite common.

When researchers conduct a large, expensive study with many participants, they try to get as much information out of it as they can. They compare different sub-groups within the larger study. They analyze the data in different ways. Basically, they want to get as much "bang for their buck" as they can.

So, the week before the JAMA study appeared, the Journal of Clinical Oncology (JCO) study was published. The JCO study found that a combination of eating 5 or more servings of vegetables and fruit per day and exercising for the equivalent of walking 30 minutes per day, 6 days per week significantly reduced the risk of death after early stage breast cancer by nearly 50%! The combination of eating well and exercising resulted in a 44% reduced risk of death and this was true regardless of whether the women were overweight, obese, or at a healthy body weight.

Of note, the JCO study supports the findings from the larger study that were published in JAMA: In early stage breast cancer survivors, a healthy diet alone may not provide measurable protection against breast cancer recurrence, new breast cancers, and death due to any cause. Additionally, it showed that exercise alone probably doesn't provide much benefit either.

So, on the one hand, you have results from the WHEL study saying that an ultra-healthy diet doesn't provide benefit for breast cancer survivors. On the other hand, you have results from the WHEL study saying that if you follow a reasonably healthy diet (5-A-Day) and combine it with regular physical activity, you do see benefit.

Who To Believe

At this point, no one would blame you for being confused. Just consider the conclusions of the two editorials that accompanied the two studies I've been discussing.

The JAMA editorial that accompanied the study showing no benefit from the ultra-healthy diet states, "Unfortunately, available data do not support best practice dietary recommendations to improve long-term prognosis for early stage breast cancer survivors."
Meanwhile, the JCO editorial that accompanied the study showing a great benefit from a combination of healthy eating and regular exercise states, "In summary, the data from the WHEL control cohort add to the growing body of literature that lifestyle does matter in breast cancer prognosis. Increasing physical activity to 30 to 60 minutes per day is a recommendation for the general population and these data suggest that this recommendation should be extended to breast cancer patients and survivors. Similarly, increasing intake of vegetables and fruit is recommended for risk for several diseases, and now seems to aid in improving breast cancer prognosis."

One study concludes that healthy diet doesn't matter. The other concludes that diet does matter.

Important Considerations

What is one to make of this confusing picture? I believe it is important to keep the following points in mind when you think about the two sets of results recently published from the WHEL study.

This study was conducted in early stage breast cancer patients. It does not tell us anything about whether a diet very high in vegetables and fruit, low in fat, and high in fiber provides benefit to people with other types of cancer. All cancers are different and how factors like diet affect risk of recurrence is likely to be different as well.
The women in the intervention group in the WHEL study never reached the low fat target. They were counseled and coached to eat no more than 20% of total calories from fat, yet by year 4 of the study, fat intake averaged more than 27% of total calorie intake in both the intervention and the control groups. We cannot say whether the low fat component of this diet worked, because most women weren't able to reach the target of no more than 20% of calories from fat.
All of the women in the WHEL study (intervention and control groups) gained some weight. Nearly a dozen studies suggest that weight gain after a diagnosis of breast cancer increases risk of breast cancer recurrence. It may be that if a woman does not maintain a healthy body weight, no amount of vegetables and fruit will provide benefit. Furthermore, published results from the Women's Intervention Nutrition Study (WINS) suggest that when women truly follow a very low-fat diet (and in this case, they also lost weight), it may reduce risk of recurrence significantly.
Despite a reported 180 calorie per day decrease in intake, on average, in both the intervention and control groups in the WHEL study, the women gained weight over time. This raises important questions about how accurately the women in this study reported what they were eating. With such a significant decrease in calorie intake, weight loss, not weight gain, would be expected, yet this is not what happened. This points to one of the biggest problems in conducting diet research - it is very difficult to accurately measure what people are actually doing!
At this point, the follow up time for the WHEL study is about 7 years. It may be that as researchers continue to follow these women for many years into the future, the positive benefits of the ultra-healthy intervention diet will become clear and measurable. Perhaps enough time has not elapsed to demonstrate benefit.
The WHEL study results that were published in the Journal of Clinical Oncology (JCO) suggests that a combination of healthy eating and regular exercise can reduce risk of death after early stage breast cancer, possibly by as much as 50%.

Moving Forward

The recently published results from the WHEL study can be confusing; however, this doesn't mean you should give up entirely on making healthy lifestyle choices after a diagnosis of breast or any other type of cancer. I firmly believe that it makes sense to "hedge your bets":

Focus on a variety of manageable lifestyle changes that can improve health.
Maintain a healthy body weight. Consult a dietitian and/or join a weight loss support program for help with this. Research shows that these approaches, particularly when used together, can help with weight management in breast cancer survivors.
Don't "put all of your eggs in one basket". Don't put so much energy into eating a healthy diet that you fail to keep yourself physically active. Likewise, don't spend so much time exercising that you don't have time to prepare and enjoy healthy meals and snacks.
Focus on eating plenty of vegetables and fruit everyday, but don't place unnecessary guilt on yourself if you aren't "perfect" in your eating habits. Moderation is key!
Focus on a low fat diet. Try to keep your fat intake as low as you can, because it is likely that you are eating more fat than you think. Don't feel badly - we all have this problem, me included!
When you do eat fat, go for the healthy kinds - flaxseeds, other nuts and seeds, olive oil, fish.
Exercise some every day. Don't feel like you have to run a marathon; remember that the WHEL study results published in JCO show that just 30 minutes of brisk walking each day is enough to provide health benefit. Make the time for yourself and view this as your time to take care of you.
Work with your healthcare team to take all of the steps you can to keep yourself healthy after a cancer diagnosis.
Don't feel guilty about what you "could have, should have, would have" done with your diet and exercise routines to prevent cancer. Take this opportunity to make the best choices you can from here on out. The goal is to keep yourself as healthy as you can by eating well, exercising moderately, enjoying the support of family and friends, and figuring out what hobbies or activities you enjoy doing that help you relax, manage stress, and feel good.

Nutritionist Suzanne

Vitamin D: Wonder Nutrient?

2007-07-05T19:38:00Z

It seems that every day we read about the next "wonder" nutrient or dietary supplement that we all need for better health. Generally, I treat these reports with a healthy dose of skepticism. It's not that I don't believe in the potential benefits of dietary supplements. Many supplements have proven benefits and can be a useful addition to a healthy eating plan. But it's not often that the next "wonder" nutrient really is necessary as a dietary supplement for everyone. Vitamin D just may be the exception to this rule.

Why D?

Vitamin D insufficiency and deficiency are much more common than health experts previously believed. A large study published in 2005 indicated that at least a third of American adults have low vitamin D levels in the body, which may increase risk of several types of cancer, heart disease, osteoporosis (excessive bone loss), auto-immune disease, and many other serious health problems.

Is It Too Late?

Vitamin D may be even more important for people who already have cancer. This means that even if there's a cancer diagnosis in your past, it's not too late to get the potential benefits of vitamin D. Several studies show that having more vitamin D in the body and/or taking a vitamin D supplement improves survival after diagnosis. This connection between more vitamin D and better cancer survival has been studied for melanoma, Hodgkin's lymphoma, and cancers of the lung, breast, prostate and colon.

The Current Recommendations

Another tip off that we all need more vitamin D is the mounting agreement among health experts that the Recommended Dietary Allowance (RDA), also called the Dietary Reference Intake (DRI), is set too low. A number of health experts who advise the government and nutrition panels that set the RDA and DRI feel that it is necessary to raise these numbers for vitamin D because so many people do not get enough of this nutrient.

At a minimum, it is suggested that these numbers should be doubled to 800 International Units (IU) from the current recommendation of 400 IU for most adults. Recent studies suggest that these numbers need to be as much as three to four times higher than the current level. This would raise the RDA/DRI for vitamin D to 1200 to 1600 IU per day for adults.

Where Do You Live?

As many people know, vitamin D is referred to as the sunshine vitamin. This is because exposure to sunlight can cause the body to manufacture vitamin D. But don't think of this as a free pass to get a suntan. You should never, ever "lay out" in the sun, increase your sun exposure on purpose, or use tanning beds for several reasons. Most importantly, exposure to the sun and tanning beds is the leading cause of skin cancer in this country, including melanoma, the deadliest type of skin cancer.

Furthermore, sun exposure is not a practical way to increase vitamin D for a significant number of people living in the United States. Many people live in locations where for nearly half of the year, the sun is not strong enough to allow the body to make vitamin D. If you live north of the 40th parallel (40 degrees north latitude) you are in this category. And if you don't live this far north, you should be using sunscreen anyway! Since it is not practical or safe to get vitamin D from the sun, it is important to get plenty of the nutrient from food and/or a dietary supplement.

Why Supplement?

In most cases, getting nutrients from food is healthier than getting them from supplements. Unfortunately, for vitamin D, food often does not provide enough vitamin D, making a supplement necessary. Some foods, such as milk and cereal are fortified with vitamin D, but many people do not eat enough of these foods to meet vitamin D needs. Other than this, vitamin D is not found naturally in many foods. Only oily fish, such as salmon, mackerel and sardines naturally contain plenty of vitamin D.

It's also reassuring to know that vitamin D is not as toxic as once believed. This doesn't mean you should load up on dozens of vitamin D pills each day. Vitamin D can be harmful in large doses. But it does mean that taken at moderate levels, vitamin D is very unlikely to cause health problems for most adults.

How Much Is Enough?

Current vitamin D recommendations tell us that most healthy adults safely can take up to 2000 IU per day. We know that the RDA/DRI is set too low, but there is no reason to take extremely high doses of vitamin D. Much of the research on vitamin D indicates that taking 1000 to 2000 IU per day is appropriate for reducing risk of cancer and its recurrence. Remember, after a certain point, more is not better!

Keep in mind that your multivitamin probably contains some vitamin D and you may be getting some of this nutrient from fortified foods. Taking all of this into account, it is reasonable for most adults to take an extra vitamin D supplement that provides around 1000 IU of additional vitamin D per day.

There are some people who should NOT take extra vitamin D. This includes people who have elevated levels of calcium in their blood as a side effect of cancer or its treatment. Also, some experimental cancer treatments are comprised of powerful forms of vitamin D. If you are taking one of these vitamin D experimental medications, do not take a vitamin D supplement.

Rare Recommendation

It is rare indeed for me to recommend a dietary supplement, across the board, for all healthy people, nearly all cancer patients, and for those with a history of cancer. In general, I really push people to get their nutrition from food. But for vitamin D, I'll make an exception! Take your vitamin D, because chances are, you need it.

My Journal Private

2007-06-13T03:01:55Z

This is the default My Journal Private post.

My Journal Friends

2007-06-13T03:01:55Z

This is the default My Journal Friends post.

My Story

2007-06-13T03:01:55Z

This is the default My Story post.

Diet Patterns, Weight Loss, and Health

2007-05-19T22:30:00Z

Fad Diets

The fad diet battles continue. Each week it seems, a new diet plan, book, or program is touted as the best way to lose weight. Weight loss diets come and weight loss diets go, but one that seems to have eternal life is the low carbohydrate, high protein diet promoted most notably by Dr. Robert Atkins in his popular book, Dr. Atkins' New Diet Revolution. Several studies have made direct comparisons between the Atkins' diet and various other diet programs such as Weight Watchers; the high carbohydrate, low fat vegetarian diet promoted by Dr. Dean Ornish; and the South Beach diet.

As predicted, the Atkins' diet is as effective as and possibly even more effective than some of these other programs for promoting rapid weight loss. There is no doubt, and research proves, that following the Atkins diet will result in weight loss, but at what cost to your health?

At this point, you probably expect me to begin talking about how all of the early weight loss that occurs with the Atkins' diet is water weight, that the diet is high in cholesterol and saturated fat, and that the weight loss isn't permanent. While these things generally are true, this isn't the main reason why I believe this diet is a bad choice for most people, and in particular, for people who are concerned about cancer. There are two questions I urge anyone who wants to reach a healthy body weight to ask.

"Is weight loss my only goal?"
"Do I want to both lose weight and enhance my health?"

If your answer is "yes" to question 1., then the Atkins' diet is indeed a good choice. It is effective for weight loss and studies show that even after a year of follow up, people who stick with the low carbohydrate eating plan prescribed by Atkins generally keep weight off as well as people following other types of diets. However, if your answer is "no" to question 1. and "yes" to question 2., the Atkins diet is not for you.

You may wonder how it is that a diet that helps you reach a healthy body weight is a bad choice. The answer lies not in what is in the diet, but rather what is not in the diet.

Diet, Nutrition and Cancer Risk

When researchers first began to take a serious look at the connection between what we eat and cancer risk more than 3 decades ago, they often focused on what is in the diet that may be promoting the development of cancer. There was a lot of effort focused on finding the culprit in the diet, be it sugar, fat, meat, or something else, that led to higher cancer risk.

While some of these early studies did yield answers about how a diet with excessive amounts of meat, sugar, and fat can promote cancer, they also pointed the way to a deeper understanding of the connection between diet and cancer. Health experts began to see that what is missing from the diet is as important or even more important than what is in the diet, in terms of cancer risk. So instead of thinking about what foods or types of diet increase cancer risk, health experts began to think about what foods and types of diet can help prevent cancer.

What research is telling us is nothing short of miraculous. There are many, many foods, that when added to the diet, actively protect our bodies against the cellular damage that eventually may lead to cancer, heart disease, stroke, and many other chronic diseases. These foods, when eaten in abundance, form patterns of eating that actively protect us against cancer. Even more exciting is research showing that even after a cancer diagnosis, what you eat can make a difference in your long term health. It is never too late.

No Self Blame

At this point, I do want to stress that you should not focus on the "what ifs" and "If I only I hads". For some people with cancer, learning about the many ways in which good nutrition can help prevent cancer leads to stress and anxiety over what he or she did or didn't do that may have "caused" cancer. It is important to remember that for any one person, we can never know what led to their cancer. Nobody asks for cancer and nobody deserves cancer! No matter what they did or did not do with their health and lifestyle habits.

We only can say that when we consider large groups of people, those who are in the group that eats a better diet will be less likely to be diagnosed with cancer, but the risk still is not zero. Even among people who do everything "right", such as eat a good diet, avoid smoking and excessive alcohol use, exercise regularly, manage stress, limit sun exposure, and all of the other things we know promote good health, some still will be diagnosed with cancer. As well, even for people who don't do everything "right", such as using tobacco, not exercising, and eating a poor diet, some will never get cancer. It is important to remember this and to let go of self blame.

This might lead you to say "why bother?" I think it's worth the bother because even though eating healthfully cannot prevent cancer or any other disease with certainty, which is impossible at any rate, a good diet, along with other healthy lifestyle choices can help you lower risk as much as possible. I believe it is worthwhile to "stack the odds" in your favor. And remember, even after a diagnosis of cancer, a healthy diet can help you stay healthy.

The Power of Plants

So to get back to our discussion, we need to ask, what are these miraculous, super foods? They are plants.

Keeping in mind that when it comes to cancer, what is missing from your diet is as important as what's in your diet, the answer lies in eating more plants. Plants, meaning vegetables, fruit, whole grains, and legumes, contain thousands of nutrients that help protect your body, right down to the cellular level. These nutrients protect us from the every day damage and wear and tear that comes from just plain living. Hundreds of studies support that eating a more "plant-based" diet will improve health. And getting these healthful nutrients from dietary supplements does not have the same benefit. It is the action of all of these thousands of nutrients that are found in endless combinations in plants that provide protection against cancer and other chronic diseases.

More Plants = Better Weight Management

The other benefit of a plant-based diet is that eating more plants can be a great way to reach and maintain a healthy body weight. Plant foods are less calorie dense than many other foods. For example, picture a large fast food burger, which contains about 600 to 800 calories. Now picture 600 to 800 calories worth of fresh fruit, steamed vegetables, or a whole grain cereal such as oatmeal. Immediately, you can see that for the same number of calories, plant foods provide a much bigger volume. You can eat more plant foods and still consume fewer calories.

This is important because one of the ways that your body regulates appetite is to determine the volume of food you've eaten. The larger the volume you eat, regardless of calories, the more full you will feel. So if you eat the same volume of plant food, you will be taking in fewer calories than if you were eating a burger and this can help with weight loss and weight maintenance.

More Plants = Better Health

We know that we need to eat more plants for better health and this is why a high protein, low carbohydrate diet is not a good choice, especially for someone concerned about cancer. Plant foods contain plenty of carbohydrate, so if you follow a low carbohydrate diet, you will not be able to eat enough plants for good health.

But you don't have to take my word for it. A recent, large scale study of over 22,000 European adults looked at the relationship between protein and carbohydrate in the diet and risk of death from chronic diseases such as cancer and heart disease (European Journal of Clinical Nutrition (2007) 61, 575–581). If you do believe what I've said, what the researchers found won't come as a surprise to you. In that large group of people, those who had the most protein and the least carbohydrate in their diet had the highest risk of death (mortality) from both cancer and heart disease. In the words of the study authors, "Prolonged consumption of diets low in carbohydrates and high in protein is associated with an increase in total mortality."

More Information

You may wonder if following a plant-based diet means you'll never eat meat again. A plant-based diet does not have to be a vegetarian diet, although that is a great choice if you want to eliminate meat altogether. However, you do not have to go completely meatless to get the benefits of eating more plants. Instead, you need to shift the proportions of the food you put on your plate, not on serving sizes or number of servings. About three-fourths of a healthy plate will be covered by minimally processed plant food, including fresh fruit, whole grains, and a wide variety of colorful vegetables. The remaining one-quarter of your plate should contain lean protein, such as legumes (beans), fish, or chicken. Every meal and snack should follow the three-fourths/one-fourth principle. Your snacks may not contain the fish or chicken, but they should be made up of at least three-fourths vegetables, fruit, and/or whole grains.

For more information and ideas on how to incorporate more plants into your healthy eating plan, be sure to see our information on

Healing Nutrition for Optimal Health
Nutrition and Cancer Prevention
Nutrition and Cancer Recurrence

Also check out my video Healthy Eating for the Long Haul and our collection of recipes for a healthy plant based diet .

Nutritionist Suzanne

Did pesticides cause my cancer?

2007-03-21T20:43:39Z

One of the questions I'm asked most often is, "Did pesticides in food cause my cancer?" It's very important to keep in mind that for any one person, we rarely can know what may lead to cancer. Cancer is a complex disease with many factors playing a role in its development. For some people, it's comforting to find an answer, or identify that one thing that "caused" their disease, but with cancer, this usually isn't possible.

However, when considering pesticides in the food we eat, it's reassuring to look at the big picture. Thousands of studies on nutrition and cancer have been conducted in many different groups of people. These studies consistently show that regardless of the form in which you eat your vegetables and fruit - whether they are fresh or frozen, raw or cooked, conventional or organic - the more of these foods that you eat, the lower your risk of cancer. Even more reassuring is the finding that eating more of these foods lowers risk not just of cancer, but of other chronic diseases too, including heart disease, type II diabetes, stroke, hypertension, and obesity.

I believe this tells us something important: If the harm of the pesticides in vegetables and fruit outweighed the benefits you get from eating these foods, you would not see these amazingly consistent results! These consistent results show us that these foods protect against disease and improve health, no matter how they are produced.

What do I eat?

Does this mean I think organic food is a waste of money? Absolutely not!

I eat mostly organic food and I strongly support more people moving to organic food. When pesticides are used in farming, they do go somewhere. We know that they don't remain on the food in large amounts. This means that these chemicals go into the air, the water, and the soil. When you consider this, it becomes clear that the less of these chemicals you add to the environment overall, the better. I believe that the more we can limit use of these chemicals, the better it is for the health of each and every one of us.

Also, I eat organic because I can. I’m very lucky because where I live, organic food is readily available and reasonably priced. Organically grown food is a bit more expensive than conventional produce, but I still believe it is worth the cost. Even though this food is more expensive and it may not make a difference in my personal health, I do feel that for the health of everyone, organic is the way to go.

One additional reason I chose organic is because I believe it’s important to support organic and sustainable agricultural practices as much as possible. By supporting this approach to food production, I hope to contribute to the “economies of scale”. In other words, the more we demand these foods, the more of them will be produced. This, in turn, will lead to better prices for everyone who wants to go organic. Also of importance to me is the health of those who produce my food. Even though it may not directly benefit my health to spend more for organic, I sleep better at night knowing that the foods I eat don’t adversely affect the health of the people who are growing it.

However, it’s important to keep the bottom line in mind. For each individual consumer, just eating more healthy food period is the most important step to take to improve health with a better diet . Eating more vegetables, fruit, whole grains, and legumes (beans) is the most important step you can take to improve health.

Keep Things in Perspective

To put this into perspective, ask yourself the following question. What is the fastest growing organic food sector? It is organic convenience and snack foods! This means that people are eating more organic food, but it’s mostly organic potato chips, crackers, cookies, and instant meals. Obviously, the benefits of going organic in these cases are small, at best.

What if organic isn’t an option for me?

All of these issues I’ve mentioned are important to remember because for some of us, eating organic food simply isn’t an option. We may not have organic choices available or we may not be able to accommodate the extra cost of organic in our food budget. Nobody should ever make the choice to not eat an apple, a salad, or any other healthy food just because it isn’t organic. You are always better off eating these foods, organic or not.

So, eat organic if you can, but always remember that simply making healthier food choices is the best step you can take to use nutrition to improve your health.

If you want to improve your health with good nutrition and other lifestyle changes, you can start by asking yourself the following questions.

Do I eat 10-12 servings of vegetables and fruit everyday?
Do I exercise regularly?
Do I sleep 8 hours a night?
Do I consume alcohol only in moderation or not at all?
Do I avoid all forms of tobacco?
Do I eat the wide variety of healthy foods necessary for good health?
Do I focus on including healthy fat in my diet, such as nuts, seeds, fish, flax, olive, and canola oils?
Do I avoid or limit processed foods?
Do I eat plenty of high fiber, nutrient-rich whole grains every day?
Do I avoid or limit fast food?
Do I maintain a healthy body weight?
Do I have enjoyment in my life and positive, supportive relationships with my family and friends?
Do I manage stress by engaging in hobbies and pastimes purely for pleasure?
Do I try new and different foods and beverages that can improve my health, such as green tea or kale?

The list of steps you can take to improve your health is endless.

If you focus only on eating organic food without first addressing these bigger issues, you won’t be taking advantage of all of the wonderful ways in which you can nurture yourself, inside and out. Focusing on only one small piece of this puzzle, such as organic food, is like a drop of water in the ocean. Instead, dive in and enjoy the whole experience!

So remember, eating organic is a great choice. I eat organic and support organic food production. But I do believe it is important to avoid fixating on this one issue. One should never avoid eating healthy food simply because it is not organic.

Media Reporting & Nutrition Fear

2007-01-04T01:14:24Z

Recent media reports on the connection between red meat and risk of breast cancer bother me, but not for the reason you may think. I'm no fan of red meat and there are many reasons to limit your intake of this food. Red meat can be a source of carcinogenic (cancer-causing) chemicals that are created when it is grilled, barbecued or cooked at high temperatures. Red meat can be high in saturated fat, which is linked to greater risk of heart disease and some types of cancer. Red meat offers very little, if anything, in terms of cancer-fighting nutrients. And finally, the production of red meat is resource-intensive and expensive and it results in much greater environmental damage than producing comparable amounts, calorie-per-calorie, of plant food.

However, even though you won't find me singing the praises of red meat, I think recent media reports have given this food a bum rap. When it comes to health, I may not be a fan of this particular food, but one thing I am a fan of is truthful reporting on the science of nutrition and cancer. And when it comes to health and science reporting, nutrition is one area where misleading headlines are the norm and hysteria is used to attract attention. Reports about the wonders of one food and the evils of another abound. And this is why the recent reports about research findings on red meat and breast cancer risk bother me.

One headline claims, "Red Meat/Breast Cancer Connection Cited." Another states, "Breast Cancer Risk Linked To Red Meat, Study Finds." Within the first few lines of yet another story, you'll find the statement, "But if you're a fan of a steak or ground beef and if you're a woman it's not only ironic, it's potentially life threatening." If you take these headlines and this news content at face value, you would believe that red meat, of any kind and in any quantity, will doom a woman to a future diagnosis of breast cancer! This sounds like scary stuff, but what is the truth behind these headlines?

The study on which these headlines are based was published in the November issue of The Archives of Internal Medicine. The finding from this study that attracted the most attention is that women who eat more than 1.5 servings of red meat per day have nearly two times the risk of breast cancer as compared to women eating 3 or fewer servings of red meat per week . To put this in perspective, when you compare women who eat multiple servings of red meat every day, which includes beef, lamb or pork, to women who eat red meat just a couple of times per week or not at all, you see a higher risk of breast cancer in the heavy meat eaters. Is this surprising?

What else is different between these two groups? And how many women eat red meat multiple times per day, every single day? Do you think that women who eat a lot of red meat every single day differ in terms of their other habits when compared to women who rarely or never eat red meat? People who eat healthfully, including those who eat very little or no meat, often are in better health for a variety of reasons. They exercise more, they are thinner, they eat less fat, they visit the doctor more, and they smoke less than people with an unhealthy diet. Any one of these health habits will reduce risk of cancer, regardless of the presence or absence of meat in the diet!

The truth is, when you look behind the headlines, it's not surprising that eating a diet full of red meat is bad for health.

Hundreds of studies tell us that eating a diet in which the majority of calories come from plant foods including vegetables, fruit, whole grains and legumes is an effective way to reduce cancer risk, regardless of whether that diet contains meat. And if a person's diet does contain a lot of red meat, it is not likely to contain the abundance of vegetables, fruit, whole grains and legumes that are known to reduce cancer risk.

The most important point to remember is that there are many reasons why eating a lot of meat may raise cancer risk. Similarly, there are many reasons why eating plenty of vegetables, fruit, whole grains, and legumes provides protection against cancer and other diseases. Small amounts of meat, as part of a total healthy diet, do not appear to increase cancer risk. However, eating more than a few servings of meat per week and certainly eating several servings per day, particularly of red meat, heavily cooked meat, and processed meat is linked with higher cancer risk.

The key is balance: If you want to eat meat, do so in moderation!

In summary, I don't like red meat, I don't think it's a healthy food, I don't eat it myself, and I certainly don't encourage people to eat more of it! But I also don't like scare tactics and misleading headlines. When it comes to red meat, the recent headlines were unfair and misleading. As with all things in nutrition, the truth nearly always lies somewhere in the middle.

Nutritionist Suzanne

Moderation

2006-11-28T04:40:51Z

Have you ever heard the phrase, "Everything in moderation, including moderation"? With Thanksgiving just behind us and all of the festivities of December just ahead, this phrase takes on special meaning. After all, this is the time of year when moderation usually goes out the window, in terms of eating and many other areas of our lives. But I believe the idea of moderation, even with moderation itself, can help us make smart choices when faced with endless plates of cookies and holiday fare.

I believe this because the truth of the matter is, when it comes to nutrition, moderation is the best way to "have your cake and eat it too." If you eat a healthy diet 90% of the time, indulging in "less-than-nutritious" foods the other 10% simply is not an issue. Nobody has a perfect diet and you do not need one for good health. In other words, you can let go of moderation on occasion - that's the part about "everything in moderation, including moderation" - and still enjoy the benefits of eating healthfully.

You may wonder why the idea of moderation would be important for an individual facing a diagnosis of cancer. It can be important because when faced with cancer, many people reach for certainty and security in a variety of ways. This can include eating the "perfect" diet. Well-meaning family and friends may provide you with information on the "best way" to eat to "fight cancer". Unfortunately, these "best way" to eat plans often do not allow for moderation.

These approaches can be difficult. They may create anxiety for someone who is unable to follow such a stringent eating plan. Often, when undergoing active cancer treatment, a person needs to eat whatever works best at that time, and it may not be a kale salad! When facing nausea, lack of appetite, and other challenges of cancer treatment, moderation and flexibility are key components of good cancer care.

Eating as healthfully as possible at every opportunity is a great idea, but keep in mind that what you eat over the next few months is important because it needs to provide the calories and protein to get you through treatment. It is when planning what to eat beyond this short time frame that you should think about the "best way" to eat and how this affects your longer-term health.

And this is where we come back to moderation:

Focus on variety. Focus on vegetables, fruit, whole grains, and legumes. Focus on color and texture. Focus on having three-fourths of every plate being covered with non-processed, raw and lightly cooked, whole plant foods. And focus on enjoying that piece of cake, or whatever treat is important to you... in moderation, of course.

Nutritionist Suzanne

Change

2006-11-10T20:47:34Z

With the mid-term elections behind us (thankfully!), one thing that probably is on everyone's mind is change. Clearly, no matter what your political leanings or whether you are happy or sad about the election results, one thing that is clear is that we are in for some serious change in the very near future.

This is an excellent reminder to take stock and think about how things change in your life and what this means.

A diagnosis of cancer brings many things, including immense change and upheaval. Along with fear, anxiety, stress, and for many people, an overwhelming feeling of losing control, cancer brings change. Your entire world is turned upside down and much of this is due to all of the changes occurring in your life.

What does change have to do with nutrition? A lot, it turns out.

In addition to the many changes you'll be facing after a cancer diagnosis, changing nutrition needs are an important issue to consider. For most people, change is stressful. We are creatures of habit and we like predictability. Eating is no exception. Most of us eat for more reasons than simply meeting our nutrition needs. We eat when we are happy and when we are sad. We eat to celebrate and to mourn. We eat to experience and strengthen our connections to our family, our friends and our culture. We eat because food tastes good! In short, feeding our bodies often is the last thing on our minds when we decide what, when, where, and how to eat. But when coping with cancer, feeding your body is one of the most important things you can do to help yourself.

Knowing in advance that cancer can change how and when you need to eat can go a long way toward minimizing the stress associated with all of the other changes you are experiencing. If you are having trouble eating well during cancer treatment, the last thing you need is more stress! And resisting change can increase your stress. Instead of adding to the list of things that are causing you stress, try to learn to "go with the flow". Know that your eating habits may change. Accept that being flexible in how, what, when, and where you eat will help you cope with the changes you face.

For example, maybe your typical eating pattern is to have one or two large meals each day. During cancer care, your appetite may be smaller. You may not have the ability to eat enough in one sitting to fuel your body for the whole day. What does this mean? It means you need to "go with the flow" and learn to "graze" or snack on small bits of food all day long. This is one way to feed your body what it needs. This pattern of eating may not feel "normal", but it will help you feel better and get through cancer treatment.

Talk to your family and friends about this. Likely, you'll be amazed to find that when you let people know exactly what you need, they will rise to the challenge.

Maybe one of the ways that you connect with a friend is to meet for dinner on a regular basis. If eating out doesn't work for you because of your changing appetite, energy levels, and nutrition needs, find another way to connect. Invite your friend over to watch a video. Let him or her know that you value their companionship, even if you can't keep your ritual of eating out at this time. You can even plan to have a snack together while watching your video. Just keep in mind that the most important thing to do is to make sure you eat in a way that meets your changing needs and keeps up your connections with family and friends.

Be flexible, go with the changes as best you can, and be sure to feed both your body and your soul!

Nutritionist Suzanne