Fruit & Veggies while on Chemo?
Cancer Treatment: How Eating Fruit And Vegetables Can Improve Cancer Patients' Response To Chemotherapy
ScienceDaily (Oct. 24, 2008) - The leading cause of death in all cancer patients continues to be the resistance of tumor cells to chemotherapy, a form of treatment in which chemicals are used to kill cells.
Now a study by UC Riverside biochemists that focuses on cancer cells reports that ingesting apigenin - a naturally occurring dietary agent found in vegetables and fruit - improves cancer cells' response to chemotherapy.
Xuan Liu, a professor of biochemistry, and Xin Cai, a postdoctoral researcher working in her lab, found that apigenin localizes tumor suppressor p53, a protein, in the cell nucleus - a necessary step for killing the cell that results in some tumor cells responding to chemotherapy.
The study, published in the online early edition of the Proceedings of the National Academy of Sciences, provides a novel approach to conquer tumor resistance to chemotherapy, and suggests an avenue for developing safe chemotherapy via naturally occurring agents.
Normally, cells have low levels of p53 diffused in their cytoplasm and nucleus. When DNA in the nucleus is damaged, p53 moves to the nucleus where it activates genes that stop cell growth and cause cell death. In this way, p53 ensures that cells with damaged DNA are killed.
In many cancers, p53 is rendered inactive by a process called cytoplasmic sequestration. Apigenin is able to activate p53 and transport it into the nucleus, resulting in a stop to cell growth and cell death.
"In therapy you want to kill cancer cells," explained Cai, the first author of the research paper. "But to stop cell growth and to kill the cell, p53 first needs to be moved to the cell's nucleus to function. Apigenin is very effective in localizing p53 this way."
Apigenin is mainly found in fruit (including apples, cherries, grapes), vegetables (including parsley, artichoke, basil, celery), nuts and plant-derived beverages (including tea and wine). It has been shown by researchers to have growth inhibitory properties in several cancer lines, including breast, colon, skin, thyroid and leukemia cells. It has also been shown to inhibit pancreatic cancer cell proliferation.
"Our study advocates the inclusion of vegetables and fruit in our daily diet to help prevent cancer," said Liu, the research paper's coauthor.
The National Institutes of Health supported the five-year study.
Next in their research Liu and Cai plan to design therapies for cancer by finding compounds that are like, but perform better than, apigenin.
Comments
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Fruits and Veggies Cut Cancer Risks
Studies Offer New Insights Into How Plant-Rich Diets Can Offer Protection (continued)Fruit, Vegetables Lower Head and Neck Cancer Risk continued...
To help settle the issue, National Cancer Institute researchers asked 490,802 AARP members about their typical dietary habits and then followed them for five years. During that time, 787 of them developed head and neck cancer.
Results showed that participants who ate about 12 servings of fruit and vegetables per day were 29% less likely to develop the cancer than those who ate three servings per day. Increasing consumption by just two servings of fruit or vegetables per day was associated with a 6% reduction in head and neck cancer risk, researcher Neal Freedman, PhD, a cancer prevention fellow, tells WebMD.
One serving equals approximately one medium-sized fresh fruit, 1/2 cup of cut fruit, 6 ounces of fruit juice, 1 cup of leafy vegetables, or 1/2 cup of other vegetables.
Broccoli Curbs Breast Cancer Spread
While studies have shown that broccoli and soy offer protection against breast and ovarian cancer, how this occurs has not been well understood, says Erin Hsu, MS, a molecular toxicologist at the University of California, Los Angeles.
Her team's laboratory experiments offer one potential clue, showing that diindolylmethane (DIM), a compound resulting from digestion of cruciferous vegetables, and genistein, a major isoflavone in soy, reduce production of two proteins whose attraction to each other is necessary for the spread of both cancers.
In the experiments, the researchers exposed breast and ovarian cancer cells to purified DIM or genistein. Levels of two proteins known as CXCR4 and CXCL12 that promote breast and ovarian cancer spread dropped.
"In other words, DIM and genistein make the cancers more treatable," Hsu tells WebMD.
Both DIM and genistein are being developed for use in the prevention and treatment for breast cancer, although more extensive toxicological studies are necessary, she says.
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Any fruit or vegetable which cannot be scrubbed or peeled should be avoided during chemotherapy that causes neutropenia. It simply isn't worth the infection risk.
Those that can be peeled or washed are fine if people find them palatable.
When your immune system is compromised, any small amount of bacteria can cause a life-threatening infection.
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Great article. Thanks Fla Lady.
How about cooked brocolli. Is the DIM more available in cooked or raw brocolli? Is that known? I'm just thinking about the remark by LJ13 regarding risk of infection. Better to cook it? Or would that destroy its value?
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Raw is alway best. If you want too steam do so just a little. Any time you cook anything you deplete nutrients. Do clean them well, again if you want too use organic veggies. Their is NO research that shows chemo patients are at risk by eating fruit & veggies. LJ13 wants scientific proof. THERE HAS BEEN NO TRIAL TO PROVE ANY RISK. Many oncologist no longer take this stand. Only pharm companies print this on their flyers. It's called CYA. Again if the FDA was doing it''s job we would not be worrying about so called bacterias. What this about immune system LJ13? you always say that it means nothing and not you want to bring this up???
Flalady
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Timothy, cooking any fruit or veggie would likely destroy any harmful bacteria. Some are resistant to higher temps, but this is pretty unusual. I would do more than hit broccoli with a little steam. Broccoli cannot be cleaned adequately and must be cooked thoroughly to destroy bacteria. People have been cooking food for thousands of years and somehow, we still manage to survive as a species. You have to research each food to know which attains optimum nutrient levels whether they are cooked or raw, because it varies.
FloridaLady, you are completely wrong about this. I'm sorry, I have to report your post as, quite literally, dangerous advice for women on chemotherapy. Eating unwashed raw vegetables can not only make neutropenic patients very ill, an infection can kill them. Organic vegetables have no immunity from pathogenic bacteria. You cannot "clean" broccoli or berries adequately.
People die from foodborne pathogens.
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Go ahead a report me I will demand proof you or anyone that means with Trials that prove this has any proof. Do research on chemo drugs "knew it all" a lot of them have Ecoil in there make up. If we are going to die from bacteria we would do it from these chemos.
I want name of one person on this site that has gotten anything from eating raw fruit and veggies!
Show my your medical degree or this sites medical degrees.
Flalady
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The researchers equipped E. coli with a "riboswitch," a segment of RNA that changes shape when bound to certain small target molecules, which can then turn genes on or off. Dr. Gallivan and Topp believe that the riboswitch can be used to equip other types of self-propelled bacteria with "chemo-navigation" systems to move them toward desired targets.
Chemotactic bacteria navigate chemical environments by coupling their information-processing capabilities to powerful, tiny molecular motors that propel the cells forward.
Researchers have long envisioned reprogramming bacteria so that microbes capable of synthesizing an anti-cancer drug, for instance, can be used to target diseased cells while sparing healthy cells of side effects. Likewise, scientists are researching ways to use bacteria to clean up oil spills or remove other pollutants from soil, water and wastewater.
"This new ability to equip motile bacteria with a precise and tunable chemo-navigation system will greatly enhance the impressive arsenal of natural and engineered cell behaviors," says Dr. Gallivan.
These findings are published online in the Journal of the American Chemical Society and will be published in a future print issue.
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Ecoil or other bacteria is on and in everything. Main source is MEAT. This is not even on the list from ACS list. Only posting I can find are from American Cancer Society. One group does not sale me. A patient can not eat anything but many be what comes out of back. Great nutretional value their. Bacteria can be air born...why don't you tell them to know breath. There is no proof that any of can get bad food at anytime.
Flalady
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I did my chemo during the summer months and I craved fruits and salads - no dressing - ate plain. My onc warned me to thoroughly wash all items. I bought organic and washed everything as best I could so maybe I was lucky as I had no issues. Frankly it made me feel better and I changed my eating habits ever since. Addicted to green tea now. You can also purchase organic frozen spinach other vegetables and they have lots of vitamins as picked during peak and immediately flash frozen.
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Organic spinach as well as non-organic was affected by the E. coli outbreak a couple of years ago that killed dozens of people across the US and Canada.
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Neulasta's site (nothing about food)Take other steps to help protect against infection As a cancer patient taking chemotherapy (this is sometimes called chemo), you may be aware how some chemo increases your chance of infection. While this may be true, there are steps you can take to protect against infection.
At every step of your chemo, it's important to help protect yourself against infections. Taking a white cell booster such as Neulasta® (pegfilgrastim) is one way to protect yourself, but there are other everyday precautions that are also helpful, such as the following:
Always wash your hands with soap and plenty of water to avoid transmission of infection through things that you touch. Avoid people with colds or the flu. Avoid large crowds to avoid coming into contact with sick people. Bathe daily and gently dry your skin. Use lotion to help prevent cracks in your skin. Prevent cuts or scrapes, which can provide places for infection to enter your body. 
Use an electric razor instead of a blade to prevent cuts. Handle sharp objects with caution. Wear protective gloves when appropriate. If you get a cut or scrape, cover it with a clean bandage until it heals. Cook food thoroughly to kill infection-causing bacteria that may be in raw food. Watch for signs of infection Be sure to report any of the following signs of infection immediately to your doctor: Fever higher than 100.4°F (38.2°C) Chills Cough or sore throat Loose stools/diarrhea over 24 hours Changes in urination Mouth ulcers or sores in the throat or around the rectum Unusual vaginal discharge or itching Redness, swelling, or sores on the skin Are there any tests that can help monitor for infection? Your doctor determines what kinds of tests are needed. If you are receiving chemotherapy, you may have blood work done anywhere from the day of or up to 7 days before your scheduled treatment. This blood work will include a complete blood count (CBC). A blood sample for a complete blood count (CBC) will also be collected seven to fourteen days following your chemotherapy. The CBC measures counts of different cells in your body, including the white blood cell (WBC) counts. Patients with a low WBC count are at increased risk of infection and may benefit from treatment with a low white blood cell booster such as Neulasta -
FlaLady: Please don't get pulled into this "trick".. we want you around to continue passing on good information! One poster does not a theory make and LJ13 is just tying to put you into a situation with the moderators, don't let her/him! This space needs your input and LJ13 knows that and is trying to draw you into a "problem" with the moderators so you will go away - don't go there - please..
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This is like most things in life...use some common sense. If you white count bottom out be more careful. A lot of of chemo patients do not have low counts but one or two days of treatment cycle. Why avoid something good for you the rest of the time?
Flalady
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Nice backpeddle.
From the USDA, who is in part responsible for regulating the food supply:
(http://www.fsis.usda.gov/PDF/Food_Safety_for_People_with_Cancer.pdf)
• According to the Centers for Disease Control and Prevention,
76 million persons get sick, 325,000 are hospitalized, and 5,000 die
from foodborne infection and illness in the United States each year.
Many of these people are very young, very old, or have weakened im-
mune systems and may not be able to fght infection normally.• A properly functioning immune system works to clear infection and
other foreign agents from the body. However, cancer and its treatments
can weaken your immune system - making you more susceptible to
many types of infections. These infections include those that can be
brought on by disease-causing bacteria and other pathogens
that cause foodborne illness.Major Pathogens That Cause Foodborne Illness
Campylobacter jejuni
Cryptosporidium
Listeria monocytogenes
Salmonella
(over 2,300 types)
Source: ...• Contaminated fresh fruits and vegetablesEscherichia coli O157:H7
One of several strains of E. coli that can cause human illness
Source: ...• Contaminated raw fruits and vegetables, and waterEating at Home:
Making Wise Food Choices
Some foods are more risky for you than others. In general, the foods that are most likely to contain pathogens fall into two categories:
• Uncooked fresh fruits and vegetables ... -
I don't think it was a back-pedal at all. We're not dealing in absolutes here. You said yourself, LJ, that it is specifically neutropenic patients who are most at risk. We are told that chemo CAN make you neutropenic. That is by no means a certainty. The reality is that during chemo, we are most vulnerable to infection between 3 and 7 days after an infusion. It is certainly due to an overabundance of caution that this has become generalized to the entire treatment period, upon which the advice to avoid fresh fruit and veggies is now based.
I also broke the rule about handling cat litter during chemo. Please don't tell on me.
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I ended up in the hospital after my first chemo with netropenia (ANC was 216) - and I tended toward that all through chemo and they added in the Neulasta shots BUT what I was told was that I could eat bananas or oranges IF someone else peeled them for me. They did ask me to stay away from salad while my counts were really low but after that my doc encouraged eating fruits and veggies
Kristy
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Let's see 33% chance that any of the 222,000,000 people in the USA ( guess you're using US #'s?) that might come in contact with any of these. What % of this just happen to be cancer patients?
And a .0016% change it's bad enough to be hospitalized. And how many of this are cancer patients.
I'll take my chances... and have been for the last three years. Never missed a day work on chemo except for treatment.
Flalady
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Commentary by Rachana Jani MD, PGY-1 and Neal Steigbigel MD, Professor of Medicine (Infectious Diseases/Immunology) The idea of neutropenic precautions first emerged in the 1960s when myelosuppressive therapy came to the forefront of cancer treatment. It only made sense that patients with an impaired immune system be nursed in strict isolation. However, these ideals were based on clinical philosophy and continued based on tradition. Typical strategies to prevent infection among neutropenic patients have included a protective environment, dietary constraints, and protective clothing. With the resource burden associated with maintaining protective measures, there are surprisingly few studies systematically monitoring infection rates in neutropenic patients. Most hospitals also institute low microbial or neutropenic diets, however, no recent studies exist that can associate dietary restriction with decreased rates of infection [4,5]. The current evidence for neutropenic precautions is scarce at best.In an evidence-based world, the care of hospitalized neutropenic patients has been sustained by habit and custom. To some extent, it seems inappropriate to use scant resources for unsubstantiated protocols. As the current literature stands, it does not support neutropenic precautions to the extent that most institutions implement - instead, it supports hand hygiene and prophylactic antibiotics in the care of the neutropenic patient
Strategies for Preventing Infection in Cancer Patients with Neutropenia: A Report from the 2007 ONS Annual Congress
Concern about the effectiveness of strategies routinely recommended for preventing infection in neutropenic cancer patients prompted interest in evaluating the evidence base for current recommendations and promoting research on this important topic. The effectiveness of strategies for preventing infection was specifically listed as an area of emphasis in the Oncology Nursing Society's 2005 Research Agenda, and Prevention of Infection was one of the four topics addressed in the first round of the "Putting Evidence into Practice" project.[1],[2] The review of evidence produced in this project highlights the limited research available on various environmental and pharmacologic strategies other than prophylactic antibiotics and colony stimulating factors such as filgrastim or pegfilgrastim for preventing infection in neutropenic cancer patients.
The recommendations for practice developed from the evidence review focus on neutropenic cancer patients who are not undergoing hematopoietic stem cell or bone marrow transplant and who do not have febrile neutropenia and do not have an established infection. The results of the evidence review are available in a brief card format for quick reference in the clinical setting (PEP Card), a more detailed version of the PEP card, and an evidence table.[3],[4],[5] All three of these documents are available on the Oncology Nursing Society Web site at http://www.ons.org/research/outcomes.
Preventing, recognizing, and managing infection emerged as major themes of the 2007 ONS Congress held in Las Vegas, Nevada. Podium and poster sessions included research reports, clinical recognition and management of febrile neutropenia and sepsis, analysis of ethical issues in preventing infection, and reports of clinical projects designed to improve use of the evidence base for preventing infection.
Preventing Infection
Dietary Restriction: Raw Fruits and Vegetables
One of the controversial strategies recommended for preventing infection is a dietary manipulation prohibiting the consumption of raw fruits and vegetables by neutropenic cancer patients. The initial recommendation for the neutropenia diet was based on concern about the possibility of bacterial contamination of raw fruits and vegetables. The neutropenic diet has been adopted in many institutions but there have not been any published randomized controlled trials to test the underlying assumption that eliminating raw fruits and vegetables would prevent infection.
Alison Gardner, PhD, RN, of M D Anderson Cancer Center, Houston, Texas, reported on a randomized trial comparing a neutropenic diet that does not allow raw fruits or vegetables to a diet that includes raw fruits and vegetables in patients with acute myelogenous leukemia or myelodysplastic syndrome receiving inpatient front-line chemotherapy in a ‘protected environment.'[6] The primary outcomes are infection and death. Preliminary results from 150 of the projected 188 subjects showed similar rates of infection between the two diet groups (29% raw fruit and vegetable group vs. 32% neutropenic diet group). This study is especially important because it uses a rigorous study design and is being conducted with patients hospitalized in a setting designed to minimize exposure to other potential sources of infection.
A team from the University of Iowa Hospitals and Clinics led by Linda Moeller, RN, BSN, used the Iowa Model of Evidence-Based Practice to Promote Quality Care to evaluate the evidence supporting the restriction of fresh fruit and vegetables in the diet of neutropenic cancer patients.[7] This team concluded that diet could not be linked to bloodstream infection and that safe food handling practices were more likely to reduce food-borne infection than restricting fresh fruits and vegetables. A practice change was implemented that included provider education, eliminating most dietary restrictions, educating patients about safe food handling/food preparation, and modification of the institutional neutropenia precautions policy. The team compared blood stream infection rates before and after the practice change and found no increase in infection rates.
The ONS lists dietary restrictions under: Effectiveness Not Established - Interventions For Which Insufficient Data or Data Inadequate Quality Currently Exist.
Diet modifications for neutropenic patients
• Published studies have heterogeneous samples, interventions, and imprecise findings. No recent studies have linked dietary restrictions with a lower risk of infection for neutropenic patients with cancer; however, basic principles, such as avoiding uncooked meats, seafood, eggs, and unwashed fruits and vegetables, may be prudent. Multivitamin supplementation for patients with cancer anticipating neutropenia requires further study.
My personal opinion as an infusion nurse with Oncology and Clinical research background is that there is no clinical evidence supporting the restriction fresh fruits and vegetables while receiving chemotherapy as long as they are washed thoroughly (and yes it is possible to effectively wash broccoli, berries, etc.) and you are not severely neutropenic (ANC < 500/mm3), or have any other signs of infection or fever with or without neutropenia. Many of our foods contain bacteria as LJ13 has pointed out, but these are a concern for anyone, not just persons undergoing chemotherapy. With colony stimulating factors such as filgrastim or pegfilgrastim (Neupogen and Neulasta) neutropenia is much less of a problem for people receiving chemotherapy. To avoid eating fresh fruits and vegetable and forgoing all the healthy benefits derived from them because they may be contaminated by pathogens is to me is like not wanting to get into a car because you may get into an accident (platelets may be low during chemo).
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Wendy,
Thank for the excellent article and your knowledgeable input. Bottomline...there is no proof on to change your diet...I wish so many patients knew this and could make better food choices.
Flalady
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When the people who regulate the food supply suggest that immuno suppressed individuals avoid raw fruits and veggies that cannot be washed (such as broccoli, berries, etc.), that speaks to their confidence in regulatory processes.
The cited study is small (n=188) and the study group was patients with acute myelogenous leukemia or myelodysplastic syndrome receiving inpatient front-line chemotherapy in a protected environment. Little wonder that infection rates are small.We out here do not live in protected environments. Many women in treatment find that Neupogen and Neulasta are not covered by their insurance plans. People without insurance can't afford these treatments.
Wendy, after the E. coli outbreak, FDA stated clearly that leafy greens cannot be washed adequately to remove bacteria. If you can't wash flat leaves, you sure can't wash berries and broccoli adequately.
Bottom line: avoiding raw fruits and vegetables that cannot be washed well (or peeled) harms you in no way for the period of neutropenia.
In each of the outbreaks that have occurred recently, it was children, elderly people, and immunosuppressed people who became extremely ill and/or died. AFAIK none died from sepsis, which is what the study measured. E coli O157:H7 is more likely to cause renal failure, and it and other pathogenic bacteria kill by means of severe dehydration and other causes more than sepsis.
The nadir is typically at 10 days, not 3-7 as Stacey claimed.
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I know it was a long post, so it was probably easy to miss the exculsion for anyone who is immunocompromised: The recommendations for practice developed from the evidence review focus on neutropenic cancer patients who are not undergoing hematopoietic stem cell or bone marrow transplant and who do not have febrile neutropenia and do not have an established infection. As far as WBC count are concerned: and adult person is considered immunocompromised if ther absolute WBC count is </= 1000 or ANC is </= 500 (sorry in my original post I just said < 500). Also many medical sources not only define adult immuno-compromise as these WBC/ANC levels, they also include a time frame of 7 or more days.</p>
LJ13 is absolutely right that these studies were done in a protected environment, and that we do not live in such an environment. Yes, we are exposed to many pathogens daily, but we do not advise anyone undergoing outpatient chemotherapy to cloister themselves at home and avoid contact with anything or anybody in order to avoid an infection. Anyone undergoing outpatient Chemotherapy is more likely to pick up an infection by talking on the phone at work, going in or out of a public bathroom or from handling money than they are from eating washed fruits and vegetables (and yes I can come up with study results for how much pathogenic bacteria has been cultured off of doorknobs, telephones and money along with many other common everyday items that many people would not even think of as being a potential source of infection - and like fruits and veggies all of these items are hand to mouth transmission).
On the other hand a protected and controlled environment is IDEAL for clinical research - it is actually a researchers dream. The more controlled and protected the environment the more accurate, reliable and valid the results. A very small well controlled study is vastly more valid and reliable than a large study without the controls. That is precisely the reason most studies must be large because if they cannot control all the variables they have to be large in order to be valid and reliable. In other words, the more variables (factors) that can be controlled the smaller the study can be and still be reliable and valid. Thank you LJ13 for pointing that out.
Another good point that LJ13 brought up is that the patients in one of these studies were being treated for AML and myleodysplastic syndrome. It is important to understand that AML requires a more aggressive treatment regimen than other types of cancers. AML patients need to be treated right away and will begin their regimen within hours or days of diagnosis. Most patients with AML will receive chemotherapy while in the hospital. Chemotherapy treatments for other types of cancers are often provided on an outpatient basis; however, AML treatment requires extended hospitalization due to the use of strong drugs that severely suppress the immune system. Most of the normal bone marrow cells as well as the leukemia cells will be destroyed by the treatment. During chemotherapy and the following couple of weeks, the patient's blood cell counts will probably be dangerously low. The myleodysplastic patients were probably undergoing bone marrow transplants. Patients with these diagnoses undergo therapies that essentially wipe out there bone marrow completely, making them much more immunocompromised and susceptible to infection than patients undergoing outpatient Chemotherapy regimes and thus they are IDEAL subjects for a study about infection.
I do not doubt there are women who do not receive neupogen or neulasta due to insurance reasons, but the vast majority of insurances: private, Medicare, and Medicaid in fact do cover Neupogen and Neulasta (you can check out Amgen's web site about insurance reimbursement) For those people who are uninsured or under insured Amgen has a patient assistance program and in my experience they are extremely receptive in providing assistance to anyone who is unsinsured or under insured. Working in an infusion center in a non-profit Hospital, the large majority of patients we treat are either uninsured, under insured or on Medicare or Medicaid and I cannot think of one person who was unable to receive Neupogen or Neulasta due to insurance (or lack of) issues - there are many programs available for these issues. Rather than lack of coverage, co-pays and out of pocket expenses required by insurances may be more of the problem, I know I had a $5000.00 out of pocket expense which is a lot of money. Procrit, Epogen and Aranesp are more of a problem with coverage since Medicare determined that it is cheaper to pay for transfusions than it is for these drugs and therefore rarely cover them and unfortunately most other insurances have followed suit.
In regards to the spinach e-coli outbreak, yes, as with all these outbreaks it is the very young, elderly and those who are immuno-compromised who are most suceptible and suffer the most. But what the FDA's actual statement was is "washing produce would not have prevented the recent E-coli outbreak involving spinach" This is because the FDA concluded that the e-coli was actuallly "internalized into the spinach through the root system" (meaning it was actually inside the spinach - not on the outside of it where it could be washed away). The CDC actually conducted a human study with the contaminated spinach and concurred the the FDA about the "internalization" of the e-coli bacteria.
The spinach e-coli contamination was a horrible incident, but it was not isolated, There have been many other food contamination, including the recent peanut butter incident. Now I will never argue that peanut butter and/or any of the billzillion (sp?) products that contain peanuts can be adequately washed.
Speaking of washing, actually this is what the FDA currently has published about washing fruits and vegetables:
Begin with clean hands. Wash your hands for 20 seconds with warm water and soap before and after preparing fresh produce.
- Cut away any damaged or bruised areas on fresh fruits and vegetables before preparing and/or eating. Produce that looks rotten should be discarded.
- All produce should be thoroughly washed before eating. This includes produce grown conventionally or organically at home, or produce that is purchased from a grocery store or farmer's market. Wash fruits and vegetables under running water just before eating, cutting or cooking.
- Even if you plan to peel the produce before eating, it is still important to wash it first.
- Washing fruits and vegetables with soap or detergent or using commercial produce washes is not recommended.
- Scrub firm produce, such as melons and cucumbers, with a clean produce brush.
- Drying produce with a clean cloth towel or paper towel may further reduce bacteria that may be present.
As far as I'm concerned, the dead horse has been beaten. I'm certain there may be others who want to continue beating this dead horse, but I have not found any compelling evidence that would prevent me from eating washed fruits and veggies whether I was receiving Chemotherapy or not as long as I did not have a fever, symptoms of infection, WBC </= 100, ANC </= 500, etc. And as my professional organization (ONS) has recommended I would not advise against it (with already described exceptions) . I have not found any documented cases of infection caused by eating washed fruits/veggies or any studies that the FDA conducted that would contradict ONS's Evidence Based recommendation. </p>
As with making decisions about anything in our lives and for the treatment of our cancer(s) each of us must weight the benefits against the risks - I personally feel that for me the benefits from fresh fruits and veggies outweigh the risks and I'm not going to worry about things out of my control, like another food contamination incident.
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When are you considered neutropenic (sorry if I am butchering this word)? Is it all throughout chemo, or only during certain times, or only when you are clinically below a certain level of???
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Timonthy,
Best to ask each time you have blood work what our WBC count its. Above noted less/equal to 100 ANC </= 500. Ask your doctor what he considers as a concerned level. As noted is usually is not more than a few does after treatment. If you are getting blood shots as noted you are experiencing low counts. Only certain chemo bring the blood very low. Adriamycin is one of them. I only have had low blood on this chemo the other eight chemo did not bring my blood below a concerned level.
Flalady
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Neutropenia is the condition in which your blood contains an abnormally low number of neutrophils - an ANC </= 1000/mm3 is considered a neutropenia (some sources put it a level of </= 1500 mm/3) . This is a level at which most chemotherapy will be held or doses reduced. Neutropenia (a low ANC - absolute neutophil count) can occur when the total WBC count is within normal range (4,000-10,000/mm3). It does not mean that you are severely immuno-compromised - the reason chemotherapy is held or reduced is prevent your ANC from dropping to levels where you would be immuno-compromised.</p>
A profound/severe neutropenia is an ANC </= 500/mm3 - it is at this point that most medical resources consider someone receiving Chemotherapy to be immuno-compromised. It is at this level when washed fresh fruits/veggies would be an considered a danger. </p>
With neutropenia (ANC </= 1000/mm3) you may want to avoid fresh fruits and veggies or follow ONS (Oncology Nurse Society) Recommendation for Evidence Based Practice - to avoid fresh fruits and vegetables if you have neutropenia and experience a fever (febrile neutropenia) or any other signs of infection: fever, chills, cough, congestion, sore throat, diarrhea, difficulty or painful urination, cloudy urine, malaise, and not feeling well, to name a few. </p>
Most oncologists will give patients a list of symptoms to report immediately - if you experience any of those symptoms, I would avoid fresh fruits and veggies until you are cleared by you oncologist.
Neulasta and/or Neupogen are sometimes given as a supportive chemotherapy medication to prevent chemotherapy-induced neutropenia (they are given 24 hours after chemo based on you pre-chem ANC level and type of chemotherapy you are receiving). Many insurances will cover supportive chemotherapy agents which include not only neupogen and neulasta. Some insurances will not cover neulasta or neupogen as a supportive medication unless you have had a documented case of febrile neutropenia, infection, or ANC </= 500 mm/3.</p>
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Sorry I made a Major Typo on my posting prior to Timothy's : In the last paragraph: WBC count should be </=1000 not 100. </p>
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- 86 Coping with Holidays, Special Days and Anniversaries
- 828 Employment, Insurance, and Other Financial Issues
- 101 Family and Family Planning Matters
- Family Issues for Those Who Have Breast Cancer
- 26 Furry friends
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- 706 Recipe Swap for Healthy Living
- 704 Recommend Your Resources
- 171 Sex & Relationship Matters
- 9 The Political Corner
- 874 Working on Your Fitness
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- 394 Bonded by Breast Cancer
- 3.1K Life After Breast Cancer
- 806 Prayers and Spiritual Support
- 285 Who or What Inspires You?
- 28.7K Not Diagnosed But Concerned
- 1K Benign Breast Conditions
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- 603 Site News and Announcements
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- 39 Mod Announcements, Breastcancer.org News, Blog Entries, Podcasts
- 4 Survey, Interview and Participant Requests: Need your Help!
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- 586 Alternative Medicine
- 255 Bone Health and Bone Loss
- 11.4K Breast Reconstruction
- 7.9K Chemotherapy - Before, During, and After
- 2.7K Complementary and Holistic Medicine and Treatment
- 775 Diagnosed and Waiting for Test Results
- 7.8K Hormonal Therapy - Before, During, and After
- 50 Immunotherapy - Before, During, and After
- 7.4K Just Diagnosed
- 1.4K Living Without Reconstruction After a Mastectomy
- 5.2K Lymphedema
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- 591 Pain
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- 8.4K Surgery - Before, During, and After
- 109 Welcome to Breastcancer.org
- 98 Acknowledging and honoring our Community
- 11 Info & Resources for New Patients & Members From the Team