diet questions

NatureGrrl

diet questions

NatureGrrl

I've seen various mentions of things one should/shouldn't eat with breast cancer/chemo.

For now all I know for sure is that I've been told by my oncologist's office, and these things I trust and follow:

I shouldn't eat any soy again because of the psuedo-estrogens in soy.  Ever.

I need to stay away from anti-oxidents because they may interfere with chemo.  That's temporary.

Don't drink alcohol (a rare glass of wine is ok) for the same reason as anti-oxidents.

Try to keep caffeine and sugar to a minimum. 

But I also see references to things I don't understand or conflict with what I've been told. For example, the phyto(psuedo)estrogens in soy are so minute that most physicians agree they aren't likely to cause problems in ER+ people.  No green tea (why?  and does that mean no black tea?).  Stay away from dairy.  Stuff like that.

Does anyone have a good resource for what is and isn't ok with breast cancer?  I want something reliable and documented, not just someone's thoughts or anecdotal information. 

Very confusing.  Help!

jenbal

Dear Nature Girl -- I'm surprised you haven't had a ton of replies to your query, but I'll try to help. The information is confusing, but I recently attended a seminar by an RD at the University of Colorado Cancer Center (an NCI CCC), and she presented a ton of information, all from published peer-reviewed journal studies. I'll try to distill it for you:

Basically, all of us, whether in treatment or past, should stick to the fundamentals of a healthy diet: lean protein, lots of fruits and veg and whole grains (2/3 of any meal), lo- or nonfat organic (no hormones) dairy, at least 64 oz water/day; minimize saturated fats, trans fats, and sugar (including refined carbs); get at least 30 minutes of sweat-inducing weight-bearing exercise per day; multivitamin and calcium plus D supplements if recommended by your doc.

Beyond that, there are some specifics for us:

You're right about keeping alcohol to an absolute minimum during treatment and to less than 1 drink/day forever. Alcohol is definitely linked to a higher risk of estrogen positive cancers, although the relationship to recurrence is less clear. Best to steer clear.

Increase cruciferous fruits and veg, flax, and fiber to optimize estrogen metabolism.

Actually green tea is highly recommended: 3 cups/day has been shown to reduce rates of recurrence of Stage I and II cancers. However, it must be home-brewed (steep at least 8 minutes), not bottled, instant, powdered or decaf. Black tea is also beneficial but not as much (lower concentrations of beneficial compounds).

Limit Omega 6 fats and increase Omega 3s (fish, fish oil, enriched eggs, flax, walnuts, green leafy veg). Keep overall fat intake to about 20% of diet (~33 grams/day) -- linked to a reduced rate of recurrence for ER positive (15%) and ER negative (66%) cancers.

Mega or high levels of antioxidants should be avoided during treatment because they can interfere with chemo effectiveness. Intake of antioxidant foods is fine. Multivitamin is fine, but make sure folate does not exceed 400 and NO iron.

The evidence on soy is really confusing and contradictory. It seems the thinking now is that wrt cancer risk generally, high intake of soy is only beneficial if it's pretty much lifelong or at least starts in late childhood/adolescence. To start scarfing tofu at age 35 is probably not going to help prevent cancer. Once cancer has occurred, there is no compelling evidence to support a complete elimination of soy from the diet -- nor to promote high intake. Moderate use of soy foods is likely not harmful and may have some overall health benefits. However, soy supplements should be avoided. 

If you are on Tamoxifen, watch out for interaction with antidepressants -- Wellbutrin, Prozac, Paxil, Cymbalta, and other meds such as Benadryl can interfere with Tam's effectiveness. Check with your doc. 

So that's the scoop. Basically it boils down to common sense and a few extra cautions that can be checked with your doc. You're right to be careful about sources -- anything recommending extreme departures from standard good diet rules should be viewed with suspicion, in my opinion. As Michael Pollan says, Eat food, not too much, mostly from plants.

Cheers, Jenbal 

dlb823

Hi, NatureGirl  ~  Jen's given you a great overview. I agree with and follow everything she's laid out for you, as well as supplementing with Green Tea Extract (because you can only drink so much of it in a day), I3C, and a few other cutting-edge nutrients. 

A couple of books that I found helpful are:

1.  Beating Cancer With Nutrition, Patrick Quillin, PhD, RD, CNS & formerly a VP with Cancer Treatment Centers of America 

2.  The Anti-Estrogenic Diet, Ori Hofmekler

You may both also want to check out the "Natural Girls" thread here.  It's full of great information on diet, supplements and other natural issues.  Deanna

NatureGrrl

Thanks, both, for the replies... Jenbal, especially for the long and detailed information!  You're right, mostly common sense and healthy eating, with a few caveats for bc folks.  I'm going to print out your reply and keep it in my notebook so I have it handy in case I forget details.  Good to know about green tea, too -- I'm drinking 64-96 oz. of water a day and although normally I prefer my fluids as water (not juice or something else), I have to admit, I'm getting really tired of water for the first time in my life!

I'm going to ask again about soy... I don't have to eat it often but it sure would be nice to  have some Thai green curry with tofu and eggplant once in awhile!  (I just don't like Thai food with meat and I really miss the tofu).

Deanna, I'll check out both those books and the thread as well.

Thanks again so much for replying!  

PS73

I agree with the conflicting info.  Thanks for posting this, Im meeting with a dietician tomorrow and Ill have some more q's for her.  

 Curious about the NO IRON comment though.  My onc nurse suggested it for me since Im borderline anemic. Could you please maybe elaborate for me on this.  Im a bit worried about the iron, Im always low - haven't been able to donate blood in years. Also the no dairy.  Would yogurt be ok or even goats milk yogurt?  Some other posters mentioned how healing it is for your mouth while going through the AC.  Thanks so much!!

jenbal

PS73: First a clarification -- Dairy is GOOD, but lo- or nonfat is best and make sure it is hormone free. You badly need the calcium and D for bone protection, and it's looking like D is protective against a number of cancers, and milk, in particular (hormone free) looks like it could be protective against cancer, too. So go for the yogurt. (Greek goat's yogurt is especially helpful for a bad sunburn, by the way -- slather it on like Noxema and it will take all the sting away and help with healing. Just be prepared to be a little fragrant for a few days!)

Re the iron -- I'm not sure of the reason for this. I had to leave the seminar a little early, and this was covered after I left, so I'm going from the handouts on this. Personally, I've always avoided iron supplements because they tend to make me nauseous and mess up my -- em -- elimination, if you catch my drift. If you think of it, ask your dietician about it and see what she says.

NatureGrrl: you should be fine with the Thai green curry once in a while. I've been craving -- and indulging in-- Miso soup lately. Just don't overdo it or use supplements. 

Deanna: I'd really caution against any concentrated extracts or extra supplementation of antioxidants during chemo!! They can end up protecting the cancer cells from the oxidation that is meant to kill them.

Jenbal 

dlb823

Jenbal ~  You're right about antioxidants.  I finished chemo in October, and didn't start the Green Tea Extract until recently.  But you know, when I was on chemo, I was taking my normal supplements, which my onc had said were all fine.   Then I read on one of the threads here that some oncs were saying no Vitamin C at all for the reason you explained.  So, concerned about it, I decided to temporarily stop taking the 500 mg. of C I've taken for 25 years -- and promptly got terribly sick.  This was just before my 4th & last chemo tx, and it probably took me 2 mos. to recover from the pneumonia-like cold I came down with.  So, while I agree no excessive antioxidants, I'm not sure stopping cold turkey if you're used to being on them is good either.  At least it wasn't for me.    Deanna

NatureGrrl

PS73, if you learn anything new, please post.  I always welcome new info!

I'm especially interested in learning more about the no iron recommendation -- especially since I've been urged to eat more protein/red meat for the iron.  I had my first aranesp shot for anemia a few weeks ago, and then afterwards read that it can cause shorter life of the individual/increased tumor growth.  So why the heck are we getting it?  What don't I know?  I'll be asking today when I go in!

I know research can be conflicting, depending on parameters of the study, how large the sample group was, what kind of controls (if any!) are used -- so two studies on the same topic can give conflicting results.  I can be patient with that as long as I can get good information on the study itself and find out what exactly was done. I've never been as grateful for the science part of my background as I am now!  But it certainly seems like there's plenty of room for more research in a lot of these areas. 

Too much disease, too few answers, but I'm so grateful for what we do know.  Thanks, everyone, for chiming in.  It really helps!

kfinnigan

I asked my pcp about taking my multivitamin, with or without iron.  I was thrown into menopause during chemo last Sept. and she replied:  I would recommend a regular multivitamin for you. If you don't eat meat/ leafy greens, then I would recommend the mvi with iron.  I also asked my Gyn last month about the iron and she said I didn't need to take it in my multi since I didn't have my period anymore.  If anyone else has any info, please share!! thanks  

dlb823

Whether or not we need to supplement w/iron is individual, and for women depends a lot on age/menopausal status.  Research within the last 10 years shows that iron deficiency is no longer common, and getting excess iron, which our bodies store, can actually be a health risk. This applies to everyone, regardless of bc.  Most responsible vitamin manufacturers now offer their multi-vitamin formulas with and w/out iron, to allow us to decide if we want that extra iron.  Here's an article that explains it pretty well:

http://www.articlealley.com/article_205412_17.html

Kari, both of your doctors are correct.  If you've been thrown into menopause via chemo and eat a pretty well-balanced diet, chances are you don't need extra iron.  On the other hand, if you avoid iron-rich foods, or if you feel you have classic symtoms of iron deficiency anemia, then it might be a good idea to have your iron checked the next time you have bloodwork.    Deanna

kfinnigan

Yes Deanna!!

AnneN

Another good book, with very specific food recommendations (and lots of them):

Anticancer: A New Way of Life, by David Servan-Schreiber.

He's a physician and cancer survivor who combed the medical literature after his first recurrence to find out what would reduce his risk of future recurrences. This book is a compilation of what he learned.

He strongly recommends home-brewed green tea and a half-hour of exercise a day. Also many kinds of veggies and berries, and dark chocolate that contains at least 70% cocoa. Lots of charts, good easy-to-follow explanations. Great book. 

NatureGrrl

I have two of the three books on hold at the libraries and am hoping to find the third to look at; thanks for those suggestions.

I like the veggies and berries ideas (already what my body's been asking for and I've been giving it as best I can!  Trust that intuition!) and oddly enough, about the only sweet treat that appeals to me is dark chocolate.  Funny how your body guides you if you listen!

I was told yesterday at my oncologist's that there is need for more research on soy since some of it is conflicting, in spite of several studies showing the potential for harm is small, and although I can occassionally, rarely have my treasured tofu (happy dance!), my oncologist still doesn't want it to be part of my regular diet because of my ER+ and HER+ receptors.  Won't kill me to keep it to a minimum so I'll go with his advice.

Right after I snag me some Thai green curry with tofu and eggplant!  YUM!!

Also was told that the iron in my multivitamin was ok but to avoid extra.  As mentioned by others, this (and other issues) are going to be person-by-person, but it's so helpful to have everyone's input!

My biggest frustration is the excercise component -- I haven't hardly even had a decent walk for at least 6 weeks, let alone a half-hour a day (but I can't beat myself up over it, either -- when I'm almost too tired to get up and go to the bathroom I can't worry about walking a couple of miles!).  Now that I'm past the AC I hope to be able to get regular walks in and build back up to some stregth, length, and speed.

Carol

glassist

I'm starting chemo July 21st.  I'm vegetarian and wondered if anybody else here is and what advice they might give me.

bluedasher

There is a difference between drinking green tea and taking a green tea supplement. Green tea leaves have a lot of vitamin K which can inhibit blood clotting. It is a fat soluable vitamin so there isn't an amount to worry about in the green tea that you brew. There is also catechin in green tea which can slow clotting but they did a study with the equivalent of 10 cups of green tea a day and didn't see any effect on clotting. I was told not to worry about drinking green tea during chemo but not to take supplements. Chemo can decrease platelets, mine got low enough at one point that I got patechiae on my legs so you don't want to take something that might further hurt clotting.

I'm surprised that your oncologist gave you aranesp during chemo. When my anemia got really bad, my oncologist gave me transfusion (I needed 2 units halfway through and two after) because the red blood cell stimulating drugs like aranesp can encourage tumor growth. I thought that the drug warning for them now says to not give them for adjuvant chemo. 

Don't beat yourself up about the lack of exercise during chemo. I felt bad about how weak I was at the end of chemo but I found my strength built back up pretty quickly once they stopped pumping Taxotere and Carboplatin into me. I've got about 3 months of Herceptin left.

NatureGrrl

bluedasher, aranesp is very common during chemo, at least in my experience with other cancer patients and from my reading.  I know many people who have had it.  I was concerned about the warning and that's what I talked to my oncologist and NP about yesterday.  As with any drug, if there's ANY evidence (even a very small chance), the warning has to be there (don't you love the three pages of tiny type you get with every prescription?)    This is what is going one with aranesp.  It's highly unlikely to cause tumor growth or shorter life based on the studies but it can happen.  It becomes a case of looking at the pros, cons, liklihoods of problems, and benefits.  It's the same with many chemo related drugs:  The big warning for Herceptin is the heart damage, but it's commonly and regularly used.  I'm certainly not going to pass on the chance of Herceptin (providing I pass the mugascan tomorrow  -- hopefully the Adriamycin didn't already damage my heart). 

All that said, I'm careful enough that I won't take aranesp unless I really need it and continue to feel comfortable about it.  I will continue to ask about it/monitor it for my own peace of mind.  No matter how good a dr. is, we're all our own best and often only advocates!

If I don't crash over the weekend, my regular walks will resume, no matter how short they are!  Good to hear your strength built back up quickly.  I know the last three days I've felt TONS better so I have high hopes for my recovery possibilities.  Hang in there and thanks for sharing your hope and progess!

jenbal

Dear glassist -- I haven't come across any specific information for vegetarians (although I'm sure there is some -- try checking some of the mainstream books at your local library or bookstore), but here's some suggestions: You'll need protein so be sure you are getting it somehow. You said vegetarian, not vegan, so I'm assuming that means you'll eat eggs and dairy, which is good. You don't say whether your cancer is hormone receptor positive, but that would be an issue for a lot of soy intake, which you should ask your doc or a registered dietician about. Otherwise, you are probably already eating a good, healthy diet, so just keep it up! --Jenbal 

bluedasher

NatureGrrl, yes I understand the nature of drug warnings but in the case of Aranesp, Procrit and the other RBC production stimulating drugs, it seems pretty clear.

They have been commonly given during chemo in the past but I think it has become uncommon since new drug warnings came out in mid-2008. The data say it is a more life threatening risk than the Herceptin heart risk. The drug warning says under Cancer: 

ESAs are not indicated for patients receiving myelosuppressive therapy when the anticipated outcome is cure. 

"myelosuppressive" means therapy that inhibits blood cell production - e.g. chemotherapy. And thanks to Herceptin, the anticipated outcome for Stage I and II or even Stage III HER2+ cancer is quite good so this statement appears to apply. Later in the document (page 5) it repeats this and explains that it is because of the absence of studies that adequately characterize the impact of Aranesp.

Then it goes into the case study results. There are two breast cancer studies mentioned. The BEST study for metastatic breast cancer where one of this class of drugs (Epetin) decreased 12 month survival by 6 points (70% vs 76%) and the PREPARE study gave Aranesp with neo-adjuvant breast cancer treatment where it decreased 3 year survival by 4% (86% vs 90%) and relapse-free survival by 6% (72% to 78%). 

I take Herceptin despite the small risk of heart complications because it improves my survival and risk of recurrence. The data available don't say that Aranesp and other similar drugs do that. Why take it when a blood transfusion will address the anemia with much lower (almost miniscule) risk?

bluedasher

Deleted duplicate post - submit wasn't working and I guess I ended up trying one too many times.

NatureGrrl

Can you give me the source for those studies so I can read them myself? Aranesp is still quite common, here in IN (in Indy and in Lafayette), in Dallas, TX, and in at least two other areas that I know of. -- all highly reputable cancer centers. So I'm curious to see the studies to see what their parameters and controls were and why so many oncologists are still using aranesp in spite of the studies -- if the studies are good, that's valuable information; if they aren't, that's also valuable information. My oncologist seemed aware of the studies and still felt aranesp was not a high-risk drug.  If I can get the papers and read them I can also take them to my oncologist and see what he feels isn't valid, or maybe give him new information that will help him change his practice.  I'm not satisified with selected quotes (sorry, it's the scientist in me, it's not that I doubt the papers but if I can't read them completely myself I don't know what they really say).  Thanks for following up on this for me -- I certainly want to do what's best!  And I'm sure many others here would be interested, as well.  I just need to be well-informed and well-armed with the correct information.

NatureGrrl

glassnit, I  haven't seen too many vegetarians, but I'm was one for many years and even now eat very little meat.  I miss tofu! even though I didn't eat it lots --  just having the restriction on me made me miss it   Jenbel covered it well -- get your protein, find out about your hormone receptors to find out if soy has to be a restriction for you (they said I could have it rarely, so at least I can still enjoy some of my favorite dishes from time to time), and eat lots of veggies and fruits.  Your chemo may impact what tastes good to you and what doesn't and I found I had to flow with that; for me, lots of berries and some other fruits tasted good, whole grains, etc., but some high fiber veggies played havoc with my digestion for awhile. Yogurt was very soothing and cream of wheat and oatmeal (the old-fashioned kind) got me through the worst times. Eggs were my protein main stay (hormone free for me, same with what little dairy I eat).  You should be fine.  The big concern I've heard is getting lots of protein and drinking lots of water.  Between eggs and beans and the rare meat I can tolerate I'm doing ok; I would think you will, too, and you may be ahead of the game if you're already doing the healthy stuff.  Good luck!

bluedasher

NatureGrrl, my source was the FDA approved drug info for Aranesp:

http://www.accessdata.fda.gov/drugsatfda_docs/label/2008/103951s5195PI.pdf 

I'll be interested in what you learn by delving deeper and also on what your oncologist says. Has he given a reason why he didn't use a transfusion? I can understand wanting to read the papers. I wish the BCIRG 006 study would release more results - the latest that they have put out is 2006 with 4 years of follow-up. I went through that with a fine tooth comb when deciding on chemo.

Mine was very definite about wanting to avoid using these drugs. There seem to be regional practice differences, like TCH being more common in the West Coast and AC-TH in the East Coast for treating HER2+ cancers. Its odd considering that they all see the same studies. 

NatureGrrl

Sorry to keep bothering you... that link won't work at all for me (I can open new pdf's but that one won't open for me). I even started with the FDA site and found the links but none of the pdf files will open from their site.  If you can email it to me may be I can open it? or if you can send it as a different document type, if not too much trouble?   spring creative at gmail dot com (no spaces, of course).  If not, I'll keep doing research on my own.... frustrating! 

My oncologist doesn't use infusions unless hemoglobin drops below a certain point; doesn't use aranesp unless it's below 9.-something and then they use the lowest dose possible.  Mom had a couple of transfusions when her hemoglobin was really low but I don't remember the cut-off point.  I'll definitely be asking more questions before I allow another aranesp.

Thanks again!

NatureGrrl

OK,,, in case anyone is reading this and wondering about the outcome of my research and thoughts and discussion with my oncol. and NP...

First, I have to say, I know the FDA and therefore the drug companies have to put out the "dire" warnings if there's the least chance of someone being affected in an adverse way by any drug.  Take a look at that very-fine-print-handout you get with any script and you'll know what I mean!  So I always take those warnings with a grain of salt, but I do take them seriously enough to check into them if they seem like a concern for me.

The studies that the FDA uses as a reason for its warning against aranesp are studies with the following parameters:

all doses given were high-end doses.

all doses were given regularly as long as the person's hemoglobin was below 12.  In most cases, that meant weekly.

all studies were short-term: Weeks of treatment, rather than months. To be expected since most treatments only last weeks.

most groups of the various studies were relatively small except where results were compiled (groups of studies lumped into one, despite different cancers, etc.).

all follow-up was also relatively short term -- a three year follow-up to see who was still around, who was still well, who was having reoccurance.  This is regardless of original prognosis and other health issues that can impact the outcome.

What does this mean? It means the studies are valid, within their parameters. 

It also means that they aren't valid for different doses and timing of doses and other parameters.

And it also means a long-term follow up (10-20 years out) could well show a dramatically different outcome.

Worth noting is that even the chemical company says that longer and different studies are needed.

I went in armed with printouts, information, and questions, and had a long talk with my oncol. and NP.

They have been using aranesp for many years.  They use it at the lowest possible dose, and only when the person's hemoglobin drops below 10, not 12.  They have read the studies, seen the same differences I saw in the actual treatment they give vs. the study treatments, have never had a patient react adversely, and would stop using aranesp immediately, for all their patients, if they felt it was compromising their patient's treatment in any way. It was a long conversation and I won't go into all of it but I'm very comfortable with what I heard from them and what I had concluded on my own.  When the warnings/studies first came out, they and a large group of other researchers fought the warning against it because they saw so many holes in the studies that they felt didn't apply to "real world" application. But see my note above about the FDA -- they have to cover their rear.

So, for example, in my case, I've received aransep once.  As I get further out from the A/C (last treatment was 6 weeks ago), my need for aransep will decrease.  So it's likely I won't even need it again.

I came out of the conversation and my own thoughts and research comfortable with the way my dr. is handling this.  They do have patients who refuse the aranesp and that's always an option for anyone.  So far, I don't see any need to stop it that's any greater than my need to stop Herceptin because of possible heart damage (an equally serious and possible outcome).  For me, the benefits outweigh the potential but unlikely more harmful consequences.

It's always a crap shoot, isn't it?

Hope this helps someone else or at least gives another perspective!

PS my oncol does use transfusions, but only in more dire cases.