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Nutrition Tips for Cancer Patients; Legumes as a protein source

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Legumes: A Favorable Protein Alternative
Cindy Collins, PhD, RD
Raquel Rivera, SA

Cancer patients pay special attention to their protein intake. Protein is a necessary macronutrient for survival. It supplies the needed building blocks for antibodies which fight infection, for enzymes and for tissue repair. Usually the first source of protein considered is animal protein. Animal protein is sometimes called heme protein because it contain a blood line. Examples of heme protein are beef, chicken, fish or turkey.
Another source of protein comes from plants. This source of protein is often called non-heme protein.  Non-heme protein is not as naturally absorbable by the body but it has other advantages.  One particularly good example of a non-heme source is a legume which is also loaded with phytochemicals, soluble fiber, folate (B vitamin), lignans and soponins.  Legumes come in many varieties such as kidney, black, yellow split, garbanzos and red lentil; they pack in fantastic nutritional density (per serving).

Here are a few ideas on how to incorporate legumes into your diet:

•    dried beans or sprouts on top of a salad
•    red lentil, yellow split pea or black beans are great legumes to make soup (recipe below)
•    all of the varieties can be used mixed with a grain (brown rice, couscous, wild rice)
•    pickle the beans together with apple cider vinegar, spices and extra virgin olive oil
•    mix with vegetables in a sauté, picking rainbow assorted vegetables for best nutrition
•    puree beans and use as a dip- add in some lemon, fresh garlic, extra virgin olive oil; season with anti-cancer spices (turmeric, curcumin, ginger, basil)

Here are a few recipes to get you started:

Easy Lentil Soup

Ingredients:
•    1 cup green lentils
•    36 oz. fat-free, reduced-sodium beef broth
•    1 carrot, finely chopped
•    1 garlic clove, minced
•    1 medium onion, finely chopped
•    1 tsp. dried thyme
•    1 bay leaf
•    1 leek, trimmed and chopped*
•    2 cups chopped Swiss chard leaves*
•    Canola oil spray
•    1 Fuji apple, peeled and diced
•    Salt and freshly ground black pepper, to taste

Instructions:
1. Place lentils, broth, carrot, garlic, onion, thyme and bay leaf in a medium Dutch oven or large saucepan. Bring to a boil over medium-high heat, reduce to a simmer and cook until lentils are tender, about 45 minutes. 

2. *For a chunkier soup, add leek at this point. Simmer 20 minutes, then stir in Swiss chard and simmer 20 minutes more. 

3. Meanwhile, spray a medium non-stick skillet with canola oil and heat oil on medium-high heat. Add apple and sauté until golden on all sides, about 3 to 4 minutes.

4. When lentils are tender, stir in apple and remove bay leaf. Season to taste with salt and pepper. Serve as is for a soup with texture. For a creamy soup, purée half in a blender and combine with remaining soup. Serve garnished with crushed pretzels, if desired.
Nutritional Information:
Makes 4 servings.Per serving: 238 calories, 0 g. total fat, 42 g. carbohydrate, 15 g. protein, 10 g. dietary fiber, 747 mg. sodium.

http://preventcancer.aicr.org/site/News2?abbr=dc_rc_&page=NewsArticle&id=7230

Hummus

Ingredients:
•    2 (15-oz.) cans no-salt-added chickpeas, drained, liquid reserved
•    5 garlic cloves, minced
•    1/3 cup tahini
•    5 Tbsp. freshly squeezed lemon juice
•    2 Tbsp. chickpea liquid
•    1 Tbsp. extra virgin olive oil
•    Salt to taste
•    Paprika or parsley sprigs for garnish, optional

Place all ingredients except salt and optional garnish in food processor. Process until mixture is coarsely puréed. Add salt to taste. Serve at room temperature or chilled. Garnish with a dash of paprika or parsley sprigs.  Makes 10 servings

Per 1/4 cup serving: 144 calories, 7 g total fat (1 g saturated fat), 16 g carbohydrate, 6 g protein, 
5 g dietary fiber, 13 mg sodium.

http://preventcancer.aicr.org/site/News2?abbr=pr_hf_&page=NewsArticle&id=22197&news_iv_ctrl=1087

Three-Bean Salad with Tangy Coriander-Chili Dressing

Ingredients:
•    1 can (about 15 oz.) kidney beans, rinsed and drained
•    1 can (about 15 oz.) garbanzo beans (chick peas), rinsed and drained
•    1 can (about 15 oz.) black or pinto beans, rinsed and drained
•    1 can (about 15 oz.) corn, rinsed and drained (optional, in place of 1 can beans)
•    1/2 cup fresh lemon juice
•    2 Tbsp. extra virgin olive oil
•    4 garlic cloves, finely minced
•    1/2 Tbsp. chili pepper flakes, or to taste
•    3 Tbsp. crushed dried cilantro (coriander leaves)
•    Salt and freshly ground pepper, to taste

Instructions:
1. Mix beans and corn in large bowl and set aside.

2. In blender, place juice, oil, garlic, chili flakes and cilantro (coriander). Purée until smooth and well blended. Adjust seasonings if needed, adding salt and pepper to taste.

3. Toss beans with dressing. Cover and chill, stirring occasionally, 3 to 4 hours or overnight.

Nutritional Information:
Makes 4 1-cup servings.Per serving: 344 calories, 9 g. fat (1 g. saturated fat), 49 g. carbohydrate, 17 g. protein, 17 g. dietary fiber, about 600 mg. sodium.

For more information please refer to:
www.myplate.gov
www.aicr.org

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Nutrition Tips for Cancer Patients; Patients Poorly Served by Online Nutrition Info

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Gupta Guide: Cancer Patients Poorly Served by Online Nutrition Info
From Charlene Laino, Contributing Writer, MedPage Today
Published: March 27, 2013

When it comes to directing cancer patients to solid nutritional recommendations online, physicians are likely to find themselves at a loss.

A review of the websites of 21 National Comprehensive Cancer Network (NCCN) institutions revealed that only four (19%) provided nutritional guidelines.

Another seven (33%) linked to external oncology sites — but only 44% of these sites offered nutritional guidelines for cancer patients.

The real clincher, said senior author Colin Champ, MD, of Thomas Jefferson University in Philadelphia, was that many of the recommendations contradicted one another.

“There is a lack of consistent dietary guidelines,” he said in an interview.

“Half of the sites recommend a low-fat diet, while the other half recommend a calorie-dense diet that often advocates the consumption of high-fat foods. Specific foods recommended avoiding by some centers and sites are encouraged on other sites.

“The external referenced websites advocate a variety of nutritional approaches that are inconsistent with each other and NCCN member websites,” the researchers wrote.

While most physicians now agree that dietary factors may influence cancer outcomes, a large part of the problem is that research on cancer and diet is constantly evolving, according to Colin.

Given that data suggest two-thirds of cancer patients go online for guidance, “it’s imperative to fund randomized studies on diet and develop consistent, evidence-based nutritional guidelines for patients,” Colin said.

The findings were published online in Nutrition and Cancer: An International Journal.

Among the inconsistencies found online:

Some websites recommended avoiding vegetables that were calorie-sparse or caused intestinal bloating, including beans, peas and broccoli, cabbage, while others endorsed these foods.

A recommendation to avoid saturated and hydrogenated fats by one NCCN institution conflicted with those of other NCCN institutions as well as several external websites.

All sites advocated consuming protein during treatment, but they differed in how much protein should be consumed.

Additionally, the information was not always cancer-site specific, Champ noted. That’s problematic since recommendations for patients with metabolically active tumors such as head and neck cancer may diverge dramatically from those for patients with localized breast or prostate cancer, he said.

In part, the conflicting recommendations may simply be mirroring inconsistencies within the general data, Colin said. “For example, epidemiologic and experimental data have generally pointed to fat intake as a risk factor for obesity and cancer, and initial recommendations were based on these data.

“However, newer studies question such results, and extrapolating from this data may yield vastly different recommendations than those that are currently employed,” he said.

“Determining which approach would be appropriate for the cachectic patient or for patients with early stage, low-risk cancer should be a focus of research, and these dual concerns should be reflected in nutritional guidelines,” the researchers wrote.

The external websites that were referenced by NCCN institutions were those of the National Cancer Institute, the American Cancer Society, the American Society of Clinical Oncology, Cancer Nutrition Center, Caring4Cancer, American Institute for Cancer Research, NIH Office of Dietary Supplements, Pubmed, and CancerRD.

The authors declared no financial disclosures.

The “lack of consistent nutritional guidelines” for cancer patients — and for many other patients as well — is a failing that needs to be confronted, and corrected, by us as clinicians. This is an important issue. Share your thoughts and read what your colleagues are saying by Adding Your Knowledge below. — Sanjay Gupta, MD.

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Nutrition Tips for Cancer Patients: Glutamine for Neuropathy

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Help for Chemotherapy-induced Neuropathy
by Cindy Collins, PhD, RD

Many cancer patients who undergo chemotherapy treatment complain of pain, numbness (dysesthesiasis), burning, or a prickling and tingling sensation (paresthesias) in their extremities. It is commonly reported by 30-40% of patients and may be accompanied by loss of motor function, diminished reflexes and other functional impairment that interferes with quality of life. The condition is referred to as chemotherapy-induced peripheral neuropathy, or CIPN, because it affects the peripheral nervous system; you feel it in the periphery of your body. Sometimes CIPN is experienced as an inability to perform simple tasks such as buttoning, holding a coffee cup, or managing a pen or pencil.

CIPN varies by the chemotherapy agent and by individual patient. It may come on very quickly, within hours of treatment, or within weeks or months after treatment, even peaking after treatment is completed. It appears that some symptoms resolve and others are irreversible. Occasionally radiation therapy can contribute to the symptoms CIPN.

If symptoms of CIPN become more severe after treatment, patients should be screened for diabetes, Vitamin B12 deficiency, hypothyroidism and paraproteinemias. The amino acid glutamine has been studied for its use in preventing CIPN. The studies are difficult and sometimes conflicting in their results, in part due to the lack of a standardized tool for assessing the symptoms of CIPN.

Glutamine is the most abundant circulating amino acid in our bodies. Amino acids make up proteins and many of them, like glutamine are stored in our liver and our muscle. Glutamine stores can become depleted with cancer. Because glutamine is especially needed in rapidly dividing cells, it was once thought that it might help cancer cells grow. However, the research has shown that glutamine instead decreases tumor growth, may even make the tumor cells more sensitive to the chemotherapy, and upregulates the immune system.

A recent review of the research has produced the following conclusion for ingestion of oral glutamine in the prevention of neuropathy. Thirty grams per day, in powdered form, is the most effective dosage of glutamine. Patients who took oral glutamine in this dosage reported fewer symptoms of peripheral neuropathy. Nerve conduction studies did not support this outcome; the symptoms were described by patient self-report.

Larger well-controlled studies are required to confirm the self-report of patients. There are two studies currently being conducted, one with breast cancer patients taking paclitaxel and the other with metastatic colorectal patients taking oxaliplatin. You can read about these studies at the NIH Clinical Trials website. http://clinicaltrials.gov

Patients who have high ammonia levels or hepatic encephalopathy should refrain from glutamine supplementation. All patients should ask your doctor and oncology dietitian before proceeding.
For further reading: Oncology Nutrition Connection Vol 20, No. 4, p 3-9.

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Cancer Related Fatigue; Minimizing The Symptoms

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Tired of Being Tired?
by Corrie Trottier, MS, RD, LD/N

Cancer Related Fatigue (CRF) is a common side effect that many patients experience during radiation treatment as well as post-treatment. The following are methods to minimize the symptoms and help management fatigue.
• Food Diary: record what you eat during the day and make sure your diet is rich in fruits, vegetables, complex carbohydrates and lean protein.
• Hydration: a key element in keeping the body at optimal functioning levels. Water or water-rich fruits and vegetables help to keep body tissues moist, flush out toxins and make nutrients more readily available. In addition, hydration is involved in bringing oxygen to cells throughout the body and regulating temperature.
• B vitamins: help the body form healthy red blood cells and make energy from the food you eat. Sublingual B12 is placed underneath your tongue and absorbed directly into the bloodstream, and provides a boost of energy.
• Rhodiola rosea extract: studies illustrate improved physical endurance, mental performance, and reduced stress-induced fatigue in humans.
• Stay active!: Yoga has shown significant improvements in fatigue specifically among breast cancer patients. Tai chi has also been shown to increase energy levels and help with balance.
• Massage: has been shown to reduce pain, fatigue, stress, anxiety, nausea, and depression. Ongoing studies are being conducted for the usefulness of massage therapy and CRF.

In 2012, the Journal of Cancer Research published a study titled, “Music Therapy Reduces Radiotherapy-Induced Fatigue in Patients with Breast or Gynecological Cancer: A Randomized Trial.” In the study, participants in the music therapy group had an average of 10 music therapy sessions which lasted 30-40 minutes throughout various periods of their treatment plan. The results showed significant findings; music therapy was effective in reducing cancer related fatigue and symptoms of depression for women with breast or gynecological cancer undergoing radiotherapy. Furthermore, music therapy improved the quality of life for these patients.

Most of us have a time of day where we naturally feel more fatigued. The most important thing about fatigue is not to become discouraged by it. Allow yourself time to relax and plan activities that require energy for your high energy times in the day.

References:

http://www.drweil.com/drw/u/ART02030/massage-tips.html

http://www.mskcc.org/cancer-care/herb/rhodiola

http://cancerres.aacrjournals.org/cgi/content/short/72/24_MeetingAbstracts/P2-12-04?rss=1

Study Reveals That Plant Based Foods Protect Against Aggressive Prostate Cancer

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Plant-Based Foods May Offer Reduced Risk for Aggressive Prostate Cancer

ScienceDaily (Oct. 19, 2012) — President George W. Bush made no secret that he detested broccoli. With all due respect to our former leader, researchers have found one more great reason to add fruits, vegetables, herbs and tea to your diet.

A study by Susan Steck of the Arnold School of Public Health finds that a high intake of flavonoids, a group of compounds found in plants, may lower the risk for highly aggressive prostate cancer.

“Incorporating more plant-based foods and beverages, such as fruits, vegetables, herbs and tea, into the diet may offer some protection against aggressive prostate cancer,” said Steck, an associate professor at the Arnold School and an affiliated scholar with the Center for Research in Health Disparities.

“Filling your plate with flavonoid-rich foods is one behavior that can be changed to have a beneficial impact on health,” she said.

Steck presented her findings at the International Conference on Frontiers in Cancer Prevention Research. The annual event is sponsored by the American Association for Cancer Research, whose mission is to prevent and cure cancer through research, education, communication and collaboration.

Prior preclinical studies have shown that flavonoids have beneficial effects against prostate cancer, but few studies have examined the effect of flavonoids on prostate cancer in humans.

Steck and her colleagues used data from 920 African-American men and 977 white men in the North Carolina-Louisiana Prostate Cancer Project who were newly diagnosed with prostate cancer. Participants completed a self-reported dietary history questionnaire to assess flavonoid intake, which was measured using the U.S. Department of Agriculture’s 2011 Database for the Flavonoid Content of Selected Foods.

Men with the highest total intake of flavonoids had a 25 percent lower risk for aggressive prostate cancer compared with those men with the lowest flavonoid intake.

“We found that higher total flavonoid intake was associated with reduced odds for aggressive prostate cancer in both African-American and European-American men, but no individual subclass of flavonoids appeared to be protective independently, suggesting that it is important to consume a variety of plant-based foods in the diet, rather than to focus on one specific type of flavonoid or flavonoid-rich food,” Steck said.

In addition, the risk for aggressive prostate cancer was even lower in those men younger than 65 and in current smokers with the highest levels of flavonoid intake. Dietary questionnaire results revealed that citrus fruits and juices, such as oranges and grapefruits, tea, grapes, strawberries, onions and cooked greens were the top contributors to total flavonoid intake among the participants. “The results support public health recommendations and guidelines from organizations such as the American Institute for Cancer Research to consume a more plant-based diet,” Steck said. “In particular, consuming more flavonoid-rich foods may be beneficial for those people who are at increased risk for cancer, such as smokers.”

The above story is reprinted from materials provided by University of South Carolina, via Newswise.

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Researchers have found one more great reason to add fruits, vegetables, herbs and tea to your diet. (Credit: © Serghei Velusceac / Fotolia)
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Nutrition Tips for Cancer Patients: Eat Your Almonds

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Eat Your Almonds
by Cindy Collins, Phd RD

Almonds are considered one of the best nuts to consume. They are a source of the healthy fats and calcium as well. But, many people are concerned about the calorie content of almonds. Well, it turns out you absorb only 25% of the stated calories on your whole almond label.

A study reported in the American Journal of Clinical Nutrition and summarized in the Nutrition Action Health Letter demonstrated the lower absorption in 18 healthy individuals. Rather than the calculated and predicted 250 calories for a 1 ½ oz serving, study participants absorbed only 200 calories. Likewise, they absorbed 360 calories from a 3 oz serving of almonds, rather that the predicted 500 calories. Some researchers thought this might predict an increase in weight loss if almonds were included in a weight loss diet. So far that has not proven true. In addition, the studies of lowered caloric absorption apply to whole almonds only; sliced or slivered almonds have not been studied.
Nutrition Action Healthletter September 2012

New Study Points to Benefits of Early Breast Cancer Screenings

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By Kathleen Doheny
HealthDay Reporter

THURSDAY, May 3 (HealthDay News) — More than half of women in their 40s diagnosed with breast cancer after a routine mammogram had no family history of the disease, finds a new study that may add to the debate over the timing of breast cancer screening.

The researchers say their results point to the value of annual screening mammograms for women 40 to 49. But others remain unconvinced.

Family history usually means a first-degree relative with the disease (parent, sibling or child). Of those without family history who were found to have breast cancer, “64 percent of these women had invasive disease,” said researcher Dr. Stamatia Destounis, a radiologist at Elizabeth Wende Breast Care Center and a clinical associate professor at the University of Rochester in New York.

Destounis was to present her findings at the American Roentgen Ray Society annual meeting in Vancouver on Thursday.

This is one of numerous studies undertaken to determine the ideal age for women to begin screening mammograms and the appropriate intervals between screenings. In 2009, the U.S. Preventive Services Task Force (USPSTF) sparked controversy when it recommended screening mammograms every two years for women aged 50 to 74, but not younger.

The USPSTF advised women 40 to 49 at average risk of breast cancer to discuss the pros and cons with their doctors and then decide about the value of screening. That was because the task force found a small benefit for the younger women and moderate harm, such as false positive results.

However, the American Cancer Society and other organizations continue to recommend annual screening beginning at age 40.

Earlier this week, an analysis published in the Annals of Internal Medicine concluded that women in their 40s who have a family history of breast cancer or extremely dense breasts should consider getting a mammogram every two years.

Healthy Food Choices; controlling our moods

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How Food Affects Mood:  Research Revealed

By Cindy Collins, PhD, RD
According to the US Center for Disease Control and Prevention, the risk for developing depression is directly linked to the average American diet. Current research has enhanced our understanding of the link between mood and food. The ideal goal would be to affect our moods in a positive way through the control of our dietary intake. Another very beneficial result of controlling our diets is to optimize our brain function with consumption of certain nutrients or combinations of nutrients.
Healthy food choices just might provide a piece to the puzzle when it comes to mood.  A study published in the 2010 British Journal of Psychiatry, concluded that a dietary pattern consisting of vegetables, fruit, meat, fish and whole grains was associated with lower odds for depression when compared to the typical American diet of processed or fried foods, refined grains and sugary products.
In 2004, a study published in Archives of Internal Medicine, scientists determined that depression is strongly associated with C-reactive protein (CRP), a biomarker of levels of inflammation in the body that is also linked to promotion of recurring disease. This suggests that we should consume foods which contain which are nutrient dense, specifically with foods that have natural anti-inflammatory properties. These include nuts like almond and walnuts, fish oils and turmeric to name a few.
These findings and others suggest that foods may have the potential to aid in the enhancement of mood. And, don’t throw out the carbohydrates altogether. Complex carbohydrates may play a role here too. When the body receives a balance of fruits, vegetables and lean protein it has a better energy source to carry out important biological functions more effectively.  When consuming carbohydrates, there is an increase in the blood glucose level, which opens biological pathways for amino acids (proteins) to reach the brain to send out the euphoric feeling sent out by the brain neurotransmitter, serotonin.  Drew Ramsey, M.D., co-author of The Happiness Diet believes, “A well-nourished brain will usually take care of itself,” thus demonstrating the importance of good nutrition patterns.

For some examples of good food choices and more information on this topic please refer to:  http://www.lef.org/news/LefDailyNews.htm?NewsID=12988&Section=Nutrition&utm_source=DailyHealthBulletin&utm_medium=email&utm_term=Nutrition&utm_content=Body+ContinueReading&utm_campaign=DHB_120412

Dietary Concerns During Cancer Treatment; Protein- The Framework of the Human Body

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Protein: The Framework of the Human Body

By Cindy Collins, PhD, RD
Many patients new to cancer treatment ask how they can prepare for the road ahead.  The most important building block responsible for healing is protein. Most of the human body is made of muscle, including the organs.  It is so important to consume protein because the body uses it to build, maintain and restore tissues.  Protein nutrition enables the biological system to facilitate many functions that restore skin, muscles and regulate hormone secretions.  Without protein, the body is unable to heal and carry out its essential natural mechanisms.  This is why it is of utmost importance prior to, during, and after treatment to keep more than an adequate protein level in the diet. Protein will aid in your recovery and restore energy that is expended as you move along in the treatment plan.
The next question most patients have is how to increase protein in the diet.  There are several ways to increase the protein into your daily regimen. The important thing is to eat foods you like that are high in protein as well as lean.

Align your emotions during this process with the physical aspects of treatment. It may seem like a lot to handle or remember at times. For this reason, the best thing to do is evaluate what you eat and compare it with this list of excellent sources of protein.  If you fall short, then here are a few examples of how remedy your protein levels.

Ideal Meat Options
Beef (lean):  ground round, round steak, rump roast, sirloin, short ribs, heart, liver
Chicken: breast, dark meat, liver
Pork:  chop, tenderloin
Turkey:  breast, cutlet, dark meat
Veal:  tenderloin, chop, roast
Lamb:  leg, sirloin, roast, chop
Fish/seafood:  tuna, salmon, tilapia, sardines, scallops

Best Dairy Picks
Cheese:  cheddar, swiss, mozzarella, cottage cheese (hard to soft cheeses are lower fat)
Milk:  low fat (rice or whey protein powder increases the protein level when added)
Yogurt: plain, or low-fat

Amazing Bean Selection
Pinto, chickpeas, lentils, black-eyed peas, red, navy, black and white beans

Good Nut Sources
Walnut, pistachios, almonds, cashews, brazil nuts, macadamias, pine nuts

For more information on nutrition and healthy eating go to our SFRO Resources page with “Helpful Links” which will provide you with all the source info you will need to answer questions.  www.sfrollc.com/resources

Head and Neck Cancer Support Group

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SFRO Head and Neck Cancer Support Group

Beginning June 6th, Wednesday, at 6 p.m. SFRO will offer to patients and their family members, a support group for head and neck cancer survivors and patients.

It will be held the first Wednesday of each month at the Jupiter office. Please click here for more information:  http://www.sfrollc.com/images/sfr_images/PDFs/sfro_jupiter_support.pdf

The coordinator is Cathy DeStefano, RNC, OCN,  561- 275-1820,