Lung Cancer: Some Facts You Should Know.

I thought I’d break briefly from pure nutrition to talk about lung cancer, though I’ll suggest the two are definitely related!  My goal is to inform, and to build awareness for what I consider to be one of the most alarming trends in health today.  Cancer of any kind is scary and terrible, but most of us know far less about lung cancer than we should. 

Here is my beautiful mom – she looks not a day over 30, right?  So lucky I’m her offspring.

She’s 58, has never smoked in her life, and is otherwise completely healthy.  But on June 22 of this year, she was diagnosed with Stage IV adenocarcinoma of the lung, a form of non-small cell lung cancer.  Talk about a shock. 

A few more facts and figures that may shock you as well:

The Statistics 

(Source: LUNGevity)

• Lung cancer is the leading cause of cancer death, regardless of gender or ethnicity.
• Lung cancer impacts one in 14 Americans and kills more than breast, prostate, colorectal, leukemia, and melanoma cancers combined.
• Lung cancer kills almost twice as many women as breast cancer, and more than twice as many men as prostate cancer.
• About 55% of all new lung cancer diagnoses are among people who have never smoked or are former smokers.
• Lung cancer accounts for 14% of all new cancer diagnoses but 27% of all cancer deaths.

Adenocarcinoma, the form my mom has, is on the rise among young, female never smokers according to this recent Harvard study.  Worth a read.  So yes, it is relevant to us all.

Also, about 85% of lung cancer can be attributed to smoking.  Given the prevalence among smokers, I think we get at least two unfair and unfortunate bi-products:

1. There is a stigma.  It kinda drives me crazy when the first question people ask is whether my mom is a smoker, and yet it’s the first tidbit I offer if they don’t ask (NO! She never smoked!)  I’m equally guilty, and yet obviously the disease is no less awful and no more deserved by a smoker than a non-smoker. 
2. Research dollars are hard to come by.  Perhaps because the majority of cases are at least partly preventable, when counted in terms of research dollars per cancer death, lung cancer comes up in the loser’s slot

FY 2010 Federal Research Dollars 
Per Death

So perhaps it won’t be a surprise to learn that survival rates have not improved as they have for other types of cancer.  They’re still bad. 

Five Year Survival Rates ...
Little Progress for Lung Cancer

Federal spending from the combines FY2010 research dollars of the National Cancer Institute, Department of Defense and Centers for Disease Control and Prevention. Estimated cancer deaths from the American Cancer Society: Cancer Facts and Figures 2010. 5-year survival rates [based on year of diagnosis] from the SEER Cancer Statistics Review 1975-2008. Source: Lungevity.org

On top of that, early detection strategies are being considered, but are costly and come with their own risks (e.g. CT scans and radiation), and there are few symptoms in early stages of the disease.  As a result, many cases are caught too late for surgery or radiation.  I like to think things are changing on that front - they have to, right?  For example, last month, Arizona recognized this company for their new and promising technology for early detection of lung cancer without x-rays .  Woo hoo!  We want more!

After much research, thought, and prayer, my mom opted not to do intravenous chemotherapy.  Instead, she takes a pill once daily that targets her cancer directly, but doesn't wreck her immune system, and doesn't cause her to be sick or lose her hair.  Not to mention the countless other horrendous side effects of traditional chemotherapy.  Perhaps as (more?) importantly, she’s completely changed what she puts in her mouth, and she’s adopted yoga and light exercise to keep her body and mind in tip top shape.  Doctors weren’t sure what to expect, but most of them thought “maintenance” of the cancer would be a success given its pattern and advanced stage.  Guess what?  After a few months of complete diet overhaul, targeted supplements prescribed by the Block Center for Integrative Cancer Treatment in Chicago, and her Tarceva, the cancer is 50% gone.  50%!!  We have learned beyond the shadow of a doubt that that the mind, body, and spirit are inextricably linked.  She has taken control and is kicking cancer's booty.  She’s an outlier already, and she’ll continue to be one.  She’s a rockstar. 

Most of what I’ll share on nutrition and wellness in this blog will be what I’ve learned through my mom’s journey so far.  I have been living at home with her for the past 6 ish months on a leave from work, co-creating her diet and wellness plan with her, and doing it myself as well.  (I have the world's best husband and employer).  We both feel like a million bucks.   Really.  She’s the epitome of, and the continued inspiration for, being Very Almost Healthy!

Thanks for reading.  If you learned anything new, go tell someone else!  Spread the word, build awareness.  It helps!  And if you’re looking for ways to deploy your charitable giving dollars next year, consider LUNGevity.  I’m not affiliated with them, but find them to be an amazing organization and they are funding research for early detection and targeted treatment specifically for lung cancer.  Or, when the weather turns warm again, participate in one of their “Breathe Deep” 5Ks in your local area.  We did a bunch this year as a family and had a great time!  If my mom, our adorable and aging beagle, and all of us can run or walk 3.125 miles, so can you.

Twinkies for Breakfast: Sugary, Sugary Cereals.

We have all heard that breakfast cereals can actually be pretty bad for us, but did you ever REALLY believe that?  I mean, it’s enjoyably shaped grains over which we pour milk - how bad can it be?  According to a recent study, pretty bad.  I used to eat Honey Nut Cheerios like they were going out of style - sometimes multiple times per day.  Guess what?  They’re packed with sugar.  And Cap'n Crunch?  That guy got me through many a morning back in the 7th grade.  That one's no good either, in any of its many varieties apparently!  The problem with all the sugar is that if you start the day with a big dose like the one that comes in many breakfast cereals, chances you’ll “crash” in the afternoon are higher.  So are the chances you’ll continue to crave sugar (given that it creates a chemical high that is addictive) throughout the day.  It may even mean you sleep poorly that night. 

According to this recent Environmental Working Group study, here are the worst offenders.  Note that the worst of the bunch, Honey Smacks, has as much sugar as a Twinkie.  Yep, a Twinkie.  43 others have as much sugar as 3 Chips Ahoy Cookies in one serving.   

10 Worst Children's Cereals

Based on percent sugar by weight

1. Kellogg's Honey Smacks at 55.6% sugar (the TWINKIE!!)
2. Post Golden Crisp
3. Kellogg's Froot Loops Marshmallow
4. Quaker Oats Cap'n Crunch's OOPS! All Berries
5. Quaker Oats Cap'n Crunch Original
6. Quaker Oats Oh!s
7. Kellogg's Smorz
8. Kellogg's Apple Jacks
9. Quaker Oats Cap'n Crunch's Crunch Berries
10. Kellogg's Froot Loops Original

So if any of these (or many of the others on their full listing) are in your cupboard, let me encourage you to make a change.  Next time you shop, go for unsweetened, unflavored oatmeal and add some nuts and (sulfite-free) cranberries.  Or, go really crazy and go for quinoa instead.  Not only a whole grain but a complete protein that I'll rave about in an upcoming post.  Better yet, skip the cereal all together and opt to start your day with a green smoothie!  Check out this previous post for an easy recipe.       

If you do want to stick with dry cereal, and I totally get it because I like it too, go check out the full study at EWG.org for a listing of good brands, both for big and little kids.  At home, because Corn Flakes used to be a staple as well, we like Nature's Path Organic Corn Flakes, which are sweetened with fruit juice not sugar.  That same company makes a great line of delicious, organic, reasonably priced cereals with very short ingredient lists, so see if your local grocer carries it and give it a shot!  No more Twinkies, no more Twinkies...

Here’s to healthy bones: non-obvious sources of calcium.

Before I bade (bade?  I looked it up, it's right) Bessie farewell, I always thought milk was essential.  My mom has had osteoporosis for several years and I assumed my best defenses were milk and Viactiv (those “chocolate” calcium chews?).  Well, I’ve learned since that those probably weren’t my best options.  Read my previous post for all the reasons I decided to move away from dairy. 

When I tell people I don’t do dairy anymore, the most common response is “Well, then how do you get your calcium?”  So I thought I’d tell you!  Even if you consume dairy, it's fun to know where else you're getting your calcium.  It's in table form below, from a book called The Cancer Survivor's Guide.  The only difference is that I sorted by absorbable calcium in descending order.  Who sorts alphabetically when there are numbers involved?!  I also eat sardines on occasion and take a high quality calcium supplement.  No offense, Viactiv.  I'm sure you're great.  But your first ingredient is sugar, followed by several kinds of corn syrup, and then some milk and more sugar... no wonder you're so tasty!

Perhaps as importantly, I exercise.  Several studies have shown that exercise is a better option for building healthy bones, and one study showed that milk consumption does not actually correlate with hip fractures (a proxy for bone strength).  So, in the words of one of the heroes of nutrition in my opinion, Dr. Walter Willett, “Skip the milk.  Walk your cow!”



According to the National Academy of Sciences, recommended daily calcium intake levels are below.  Some may be surprised to see how "low" the levels are, based on what some of our calcium supplement providers may prefer us to consume (more!).

• 1,000 milligrams/day for those age 19 to 50
• 1,200 milligrams/day for those age 50 or over
• 1,000 milligrams/day for pregnant or lactating adult women

Calcium in plant foods
Food	Serving size	Calcium content	Fractional absorption	Estimated absorbable calcium per serving
Collard greens, boiled	1 cup	358 mg	52%	186 mg
Kale, boiled	1 cup	188 mg	59%	111 mg
Turnip greens, boiled	1 cup	198 mg	52%	103 mg
Broccoli, boiled	1 cup	178 mg	53%	94 mg
Mustard greens, boiled	1 cup	152 mg	58%	88 mg
Chinese cabbage, boiled	1 cup	158 mg	54%	85 mg
Tofu, set with calcium, firm	1/2 cup	258 mg	31%	80 mg
Rice milk, calcium-fortified	1 cup	300 mg	24%	72 mg
Soymilk, calcium-fortified	1 cup	300 mg	24%	72 mg
Sesame seeds, unhulled	1 ounce	381 mg	21%	58 mg
Rutabaga, boiled	1 cup	72 mg	61%	44 mg
Brussel sprouts, boiled	1 cup	56 mg	64%	36 mg
Cabbage, green, boiled	1 cup	50 mg	65%	33 mg
Beans, white	1 cup	161 mg	17%	27 mg
Cauliflower, boiled	1 cup	34 mg	69%	23 mg
Beans, great northern/navy	1 cup	121-128 mg	17%	21-22 mg
Almonds, dry roasted	1 ounce	80 mg	21%	17 mg
Beans, pinto or red	1 cup	82-89 mg	17%	14-15 mg
Sesame seed butter (Tahini)	1 Tbsp.	64 mg	21%	13 mg
Spinach, boiled*	1 cup	244 mg	5%	12 mg
Figs, dried	10 medium	135 mg	n/a	n/a

*Spinach contains oxalic acid, which hinders calcium absorption.

Sources: Weaver C. M., W.R. Proulx, and R. Heaney.  Choices for achieving adequate

dietary calcium with a vegetarian  diet.  Am J Clin Nutr. 1999; 70(suppl):543S-548S. 

Weaver, C.M., and K.L. Plawecki.  Dietary calcium: adequacy of a vegetarian diet. 

Am J Clin Nutr. 1994;59(Suppl):1238S-1241S.  Keller J. L., A. J. Lanou, and

N. D. Barnard.  The consumer cost of calcium from food and supplements.  J Am

Diet Assoc. 2002;102:1669-1671.

Farewell Bessie, hello dairy alternatives.

I’ve made a lot of changes to my diet over the past few months, but among the most dramatic is the elimination of dairy.  For milk and yogurt, I don’t miss it because there are non-dairy substitutes that I like just as well such as soy, almond or rice based products.  Cheese, I’ll admit, I miss!  The fake cheese substitutes are nasty and don’t really qualify as “real food” so I consider them special treats for special occasions (read: Amy's Rice Macaroni with Non-Dairy Cheeze, AKA “mac and cheese” is delicious!)

So why the drama?  The first time I considered the removal of dairy was at The Block Center for Integrative Cancer Care in Chicago, where my mom decided to seek a third opinion.  To the dietician there, it seemed so obvious, and yet not in an arrogant way, that dairy was simply an unnecessary, maybe even harmful, part of an adult diet.  Shortly after that visit, we started taking a nutrition course offered through The Cancer Project and the Physicians Committee for Responsible Medicine which supported the notion that dairy can be bad. 

There are, as usual, plenty of dissenting (and informed) voices out there, and understandably so.  We’ve been drinking milk for years and plenty of milk drinkers are perfectly healthy. 

With that caveat, here are some of the reasons that I decided to go dairy-free:

• According to a one study, Harvard researchers found that adult males who consumed more than 2 servings of milk per day had a 60% increased risk of prostate cancer compared to those who generally avoided milk.  Check out this Harvard article on Milk and Calcium intake for osteoporosis, cancer of the prostate and ovary, and other fun facts.  
• The Harvard Nurses Health Study, one of the largest, longest running studies of women's health on record, found an increased risk of breast cancer in premenopausal women who had higher levels of IGF-1 (insulin-like growth factor, found in cow's milk as well) in their blood. 
• For those worried about osteoporosis, there are countless other (and by some counts better) sources of calcium!  More on non-obvious sources of calcium in later post, but think leafy greens, nuts, and beans.
• In people who are prone to mucus, eliminating dairy can help lessen the load.  Ask my hubby Paul, the snottiest man I know, what the elimination of dairy has done for him! 
• There are lots of tasty and readily available alternatives that don’t come with the above concerns, so I thought why not give them a try?

Shopping tips for those interested in giving Bessie's alternatives a try:

• Silk is a great brand for soy or almond milk that is pretty easy to find and they never use GMOs, even in their non-organic products.  We use Silk Organic Unsweetened Soymilk regularly.  See picture below for a comparison with dairy milk, right off the side of the carton of Silk.  We also do Rice Dream organic rice milk.
• Wildwood makes an organic unsweetened soy yogurt that works nicely with granola and fresh fruit and in recipes that call for yogurt or sour cream. 
• Amande makes a good almond based yogurt, and better yet, they use fruit juice rather than sugar to sweeten it.  It’s not organic, but I think that’s because organic almonds are ridiculously expensive…ever bought organic almond butter? 
• Stoneyfield makes a nice organic soy yogurt, though they do sweeten with sugar. 
• Earth Balance makes a great (non-hydrogenated) vegetable oil spread that we use as a butter substitute.  Works well for spreading and baking alike.  We like the soy original version, which is a yellowish container.
• Not very healthy, but almost healthy (maybe) and good for the transition period: Daiya brand shredded soy cheese, which you can buy standalone or on your Tofurky brand pizzas. Be on the lookout when you’re fake cheese shopping.  “Casein” is milk protein and hides out in a lot of “non-dairy” items, so make sure to read the label.

Some meaningful caveats below. 

• Kids.  For kids, dairy is likely an important part of a well-balanced, growth-promoting diet.  But organic is definitely worth the investment to avoid incorporating extra hormones (rGBH) and antibiotics that come from conventionally produced milk.
• Breast cancer.  Soybeans contain phytoestrogens, which fall into the category of “confusing” in my opinion.  Some physicians and nutritionists consider them to be cancer fighters and others consider them carcinogenic.  At least for breast cancer, it seems safer to avoid soy until studies can be more conclusive. 
• Availability of dairy alternatives in small towns.  I know it can be challenging for those living in smaller cities and towns to find some of these dairy alternatives.  Unfortunately, ordering online is even tricky because most of them require refrigeration.  If you can't find these products at your local grocer, ask!  They may be in non-obvious places.  Call around to other nearby stores to see if anyone else is carrying the products.  In time, they will be more readily available.  I'm sure of it!  And in the meantime, don't stress.  Consume low fat dairy in moderation and be well.

Organic produce: is it all or nothing?

Where are you in the organic movement?  I know some people who buy only organic food and personal care products, others who opt for organic meats and dairy, others who might buy the organic apples if they’re on sale, and even some who actively avoid organic as a way to take a stand for conventional agriculture and/or against foodie elitists.  It’s always fun to talk about!

If you buy all organic all the time, you can stop reading now.  I’ll tell you nothing new (in this post anyway, hopefully I can be helpful in the next!).  But if you fall anywhere else on the spectrum, let’s discuss the merits of organic.  And for this post, I'll stick to fruit and vegetable produce. 

To cut to the chase, I think it’s important to eat as much organic as you can (especially the stuff you eat every day), but I don’t think it’s the end of the world to go conventional for some items, some of the time.  I mean, if you just can’t go another day without rutabaga and your local grocer isn’t carrying organic that day, by all means, grab the conventionally grown tuber and go home happy and guilt-free.

For less urgent decisions than the must-have rutabaga, I use the Environmental Working Group's Dirty Dozen and Clean Fiftteen list to guide my shopping trips.  The dirty dozen are known to contain high levels of pesticides (sometimes upwards of 50 different pesticides!), so you should go organic.  The clean fifteen have the lowest pesticide content (after typical washing), so you can buy the conventional if you must.  Do remember that conventional produce is often genetically modified, even if it’s not slathered in chemical pesticides.  More on GMOs in a later post.

Dirty Dozen (dirtiest listed first)

1. Apples
2. Celery
3. Strawberries
4. Peaches
5. Spinach
6. Nectarines
7. Grapes
8. Bell peppers
9. Potatoes
10. Blueberries
11. Lettuce
12. Kale/collard greens

Clean Fifteen (cleanest listed first)

1. Onions
2. Corn
3. Pineapples
4. Avocado
5. Asparagus
6. Sweet peas
7. Mangoes
8. Eggplant
9. Cantaloupe
10. Kiwi
11. Cabbage
12. Watermelon
13. Sweet potatoes
14. Grapefruit
15. Mushrooms

I took this at the Farmers Market in San Francisco: organic bell peppers in every color!

 

Spinach is my new Folgers.

Unless you dig the color green like I do, you might think a bright green drink looks odd, but I promise I’ve never had someone say a green smoothie is not delicious.  Even my 3-year old nephew, who generally prefers non-vegetable food, has been known to say, "Get out the salad mommy, let's make smoothies."  I used to drink coffee all day and most of the night long.  Now I drink green smoothies in the morning, and some green tea throughout the day, and I honestly don’t miss the Joe.  

Let’s discuss.  When you think of a smoothie, do you think of milk or yogurt as a “base”?  Rid yourself of that thought for a moment because green smoothies have neither.  They are simply greens (I like spinach or kale), fruit, water and a few ice cubes if you like it slushy.  That’s it! 

Not sold?  A few more votes in favor of giving it a try:

• Green smoothies help you get in an extra serving (or two) of vegetables for the day.  Use this calculator assembled by the CDC to determine what you need.  Most of us need more!
• The plethora of vitamins, minerals and anti-oxidants contained in the drink are readily absorbed by your body because the blender does the first step in digestion for you. 
• Fiber!  You’ll get a big dose from the leafy greens and the fruit, especially the apple, which helps keep your gut in good, clean shape.  In fact, according to Dr. Andrew Weill, “The insoluble fiber in apples attaches to LDL cholesterol in the digestive tract and removes it from the body; adding one large apple to the daily diet has been shown to reduce serum cholesterol by up to 11 percent.” 
• It’s a quick and easy breakfast to make (and take on the go) for those of us who have trouble finding time for breakfast.
• They taste really good. 

Very Almost Healthy challenge for the week:

1. Go buy a big thing of baby spinach, a bunch of bananas and a bag of apples.  (I’m assuming you’ll be making more than one smoothie this week J  All you need for a serving is one banana and one apple.)
2. Wash the spinach!  Even if it says triple washed, wash it, especially if it’s not organic. 
3. Throw a handful of the spinach in a blender with about a ¼ cup of water and blend until you have green liquid. 
4. Drop in a banana (I like to peel and freeze mine ahead of time) and a sliced apple, and blend again.  If the smoothie is too thick to blend, add a little bit of water and try again.
5. Drink it. 

It’ll be awesome.  I won’t say it often, but in this case I will: I promise.

Berry Healthy: Cranberries!

My family celebrated Thanksgiving early this year, so I thought I’d share with you a tried and true, easy and delicious recipe to add to your menu this week.  It’s a cranberry sauce, but it doesn’t take on the shape of a can because it comes from whole fresh fruit!  My wonderful hubby, Paul, made ours this year following this recipe, and it was a hit all around the table!

Very Healthy: When I think of these tart little guys, I typically think of the associated women’s health benefits, and the not-so-refreshing pure cranberry juice I’ve ingested to reap them.  But I read in a newsletter this week from Dr. Weill that “recent studies have also linked consumption of cranberries and cranberry juice with healthy cholesterol levels, improved gastrointestinal health and the prevention of kidney stones.”  Sounds like we should all eat two servings!

Almost Healthy: If you go for dried cranberries to get your fix, look for those sweetened with juice and with no other ingredients.  Many dried fruits are sweetened with sugar, and then loaded up with sunflower oil and sometimes other preservatives.  If you do nothing else in the way of label sleuthing, at least make sure they are sulfite-free.  These nasty little preservatives have been banned from salad bars for years, but the food industry is still allowed to use them, and dried fruits are some of the most notorious culprits.

Shopping tip: Remember when buying fresh cranberries for your sauce to look for organic.  You’ll get the best taste and avoid the pesticides.  Fresh cranberries are deep red in color and firmer in texture. 

Raw Cranberry Sauce

1 bag (8 oz) fresh cranberries, cut in half

1 apple, chopped

1 pear, chopped

1 orange, quartered (rind on is optional – rind makes it a tart slightly crunchy mixture, this is our preference! Make sure to wash the rind well if using in the recipe)

2 Tbsp. fresh mint, chopped

1 tsp. Triple Sec liqueur

1 tsp. agave nectar

Blend all ingredients, including orange peel if you choose to use it, in a blender.  You will probably have to start out by blending for a few seconds, and then stopping, pushing the fruit down toward the blades with a wooden utensil, and then blending again.  Careful not to blend your pusher!  Add a tablespoon or two of water if you must, but more than that will make your sauce watery.  We added a few mint leaves as garnish to the dish – very pretty, don't you agree? :) 

Serves 10.