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Nutrition Tips for Cancer Patients: The Multiple Roles of Ginseng

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The Multiple Roles of Ginseng

By Cindy Collins, PhD, RD, LD/N
American ginseng, also known as Panax quinquefolium, is grown in northwest regions of the United States and Canada.  Similar to Asian ginseng, both contain ginsenosides which give ginseng its medicinal properties.  Consumers use this to enhance stamina, strength, athletic performance, and as complimentary treatment for diabetes and cancer.
Studies using Asian ginseng have shown it may boost the immune system, reduce the risk of cancer, and improve overall well being.  An epidemiological study resulted in improvements in survival and quality of life in breast cancer patients.  In addition, a perspective study showed improvement in cancer related fatigue.  In laboratory studies, American ginseng is effective in boosting the immune system.  Additionally, American ginseng has shown to have an anti-inflammatory component.
Ginseng can be purchased in a variety of forms such as: dried root, fresh root, standardized extract, tincture, or fluid extract.  Ginseng can interact with various medications; make sure to contact your medical team for further information. For a fatigue busting juice recipe, see below!
References:
•    http://www.mskcc.org/cancer-care/herb/ginseng-american?aboutherbs=april&loc=txt
•    http://www.umm.edu/altmed/articles/american-ginseng-000248.htm

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Nutrition Tips for Cancer Patients; Whole Grains

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Whole Grains: What’s in a Name?
Cindy Collins, PhD, RD
Raquel Rivera, SA

The grocery store aisle for grains seems to be growing in amount and variety that is offered! How do you make sense of the new options and their health benefits?  The term ‘whole grain’ means the integrity of the grain is still intact.  In other words, it has not been broken to its individual parts. There are three parts to a grain:  germ, bran and endosperm.  Often, when you see a label that reads “refined grain” it means the germ and bran has been removed, leaving behind only the endosperm, which is mainly made up of starch.  Unfortunately, when you consume refined grains, you are losing the nutritional benefits which reside in the germ and bran.   Whole grains are a wonderful way to keep your blood glucose levels even, making you feel fuller over a longer period of time.

Whole grains are full of fiber, vitamins, minerals and phytochemicals, a compound that protect cell function.  Additionally, AICR studies point to specific substances in whole grains that have been linked to lower cancer risk, including antioxidants, phenols, lignans and saponins.  The Mediterranean Diet recommends a diet rich in vegetables, fruits, whole grains and beans.  Furthermore, AICR states this diet, “can help with weight maintenance and, in turn, may decrease your risk of developing cancer.”

Below are some examples of whole grains:

•    wheat breads, rolls, pasta
•    cereals; whole grain oat cereals such as oatmeal
•    popcorn
•    wild rice
•    brown rice
•    kasha (roasted buckwheat)
•    tabouleh (bulghur wheat)

For more information please refer to:

http://www.aicr.org/foods-that-fight-cancer/foodsthatfightcancer_whole_grains.html

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Nutrition Tips for Cancer Patients; Healing Mushrooms

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Healing Mushrooms
by Cindy Collins, PhD, RD

Mushrooms are making the news and we read and see information regarding their nutritional benefit. The ‘healing mushrooms’ are touted for their anticancer properties. Shiitake mushrooms have been favored as a healing mushroom. The actual powerful ingredient in shiitake mushrooms is a 1,3 beta glucan, found in the polysaccharide portion. The polysaccharide is called lentinan.

The shiitake mushroom has some interesting alternative names: hua ga, snake butter, forest mushroom and its genus and species name, pasania fungus. In some countries the lentinan is extracted and used in the clinical setting for its anticancer properties as well as its effect on the quality of life (QOL) in cancer patients.

For example, the authors Yoshino, etal describe in Hepatogastoenterology (2010) the use of lentinan in combination with chemotherapy for patients with gastric cancer. All of their patients had gastric cancer that had either recurred or that was not resectable (removable) with surgery. Twenty-seven patients were enrolled and they took a QOL survey 4,8, and 12 weeks after the initiation of lentinan. The researchers found a significant positive effect of lentinan – the quality of life measured at week 12 was a positive prognostic indicator of survival at 3 years. Much larger studies are needed before lentinan is established as an adjunct to cancer treatment.

For more information:
www.ncbi.nlm.nih.gov/pubmed/20422897
www.mskcc.org/cancer-care/herb/lentinan?

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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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World Cancer Day Information from American Cancer Society

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Thanks to American Cancer Society for this great article and for all the efforts they are putting together to make Feb 4, 2013 a very special day!

Please share it!

World Cancer Day 2013
www.cancer.org
February 4th is World Cancer Day, a time when organizations and individuals around the world send a message: Ending cancer should be a global health priority.
American Cancer Society | Information and Resources for Cancer: Breast, Colon, Lung, Prostate, Skin
www.cancer.org
Dedicated to helping persons who face cancer. Supports research, patient services, early detection, treatment and education. Contact us anytime day or night 1-800-227-234.

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Lowering Anxiety in Breast Cancer Patients Through Mindfulness-Based Art Therapy

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Using Mindfulness-Based Art Therapy to Lower Anxiety in Breast Cancer Patients
by Cindy Collins, PhD, RD, LD/N

Mindfulness-based Art Therapy (MBAT) is a combination of creative art therapy and Mindfulness-based Stress Reduction. A program utilizing MBAT to alleviate anxiety was instituted at the Jefferson-Myrna Brind Center of Integrative Medicine. The physiological underpinning was measured as change in cerebral blood flow as measured by function MRI.

The Mindfulness stress reduction component of the program consisted of awareness of breathing, awareness of emotion, and mindful yoga/ walking/ eating/ and listening. The creative art therapy consisted of expressive art tasks designed for self-expression, facilitation of coping strategies, improvement of self-regulation, and expression of emotional information in a personally meaningful way.

Eighteen breast cancer patients, none in active treatment were randomly assigned to the MBAT or education control group. All participants completed a 90-item symptom checklist before and after the program. Functional MRI scans were performed before and after the program.
The following areas of the brain exhibited increased blood flow in the MBAT group as compared to the control group: 1) left insula (emotional perception), 2) amygdala (experience of stress/emotions), 3) hippocampus (regulation of stress response) and 4) caudate nucleus (reward center). The increased blood flow correlated with a decrease in reported stress and anxiety.

Several researchers have shown previously that Mindfulness-based Stress Reduction achieves reduced anxiety and psychological distress. This has then been associated with improved immunity, quality of life and coping in women with breast cancer. This latest study using MBAT suggests that these changes are mediated by cerebral blood flow and neuropsychological changes.

For more information refer to:
Thomas Jefferson University. (2010, December 3). “Lowering Anxiety Via Meditation With Art Therapy Improves Outcomes in Breast Cancer.” Medical News Today. Retrieved from http://www.medicalnewstoday.com/releases/253447.php.

SFRO: From Our Cancer Patients to You

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Patient to Patient
by Cindy Collins, PhD, Rd

This is first in a series of articles which depict the cancer patient’s experience from their point of view. Our patients wish to share their experience in order to assist, inspire and inform fellow cancer patients, their families and blog readers. It is their hope to help guide fellow cancer patients through the treatment and survivor phase.

Read here about BT, a cancer survivor:

BT is a 54 year old woman who has recently completed treatment for cancer of the parotid gland (salivary gland). Two years ago she ‘left the cold’ of Pittsburgh for the warmth of Florida. Prior to her move she had felt a lump on her own and was given antibiotics by her doctor. She was told that after the antibiotics the lump would go away. It never did; it never grew and it did not hurt. Because it did not feel attached it was assumed it was a cyst.

Once BT arrived in Florida and saw a primary care doctor, she was told that she needed to see an Ear Nose and Throat specialist (ENT). Three weeks later she had surgical removal of the lump. Now without a job and health insurance BT awaited the report on the pathology. She remembers being told her cancer was ‘rarer than a hen’s tooth.’ Have you been to Italy? her doctor asked her. When she replied no, he responded, Well your tumor is there! It had been sent off for special pathology tests.
BT underwent 5 weeks of radiation. She became accustomed to the mask and her fears of wearing it and making it through the treatment, as short as each session was. She recalls finding the cream she needed in the Dollar Store due to difficulty with finances. She used the Magic Mouthwash. She overcame her loss of taste and ate according to the appeal of food texture rather than taste.
Because she did not have medical insurance, BT used the government provided Dentist. With that she was able to have the necessary teeth pulled; however she was surprised to learn that dentures would not be provided. BT mentioned to her radiation therapist her dilemma regarding her teeth. She was young and had hoped to go back to work. How would she do this without teeth? Who would hire her?
After much searching for several weeks by BT and the dietitian, she was turned down by dental schools, affordable dental practices and other facilities that looked like good options. A local dentist who was attending a cancer support group was contacted. Word had spread from the dietitian to cancer survivors that a dentist willing to do the work free of charge was needed.
BT was shocked when she received the phone call regarding her new dentist! He insisted on implants which would be the better choice. He also insisted that he provide a lifetime of dental care to BT, also free of charge.

BT was diagnosed with a second cancer, cervical cancer, while she was in search of a dentist post-radiation for her parotid cancer. This second cancer was treated with surgery.

BT states that she lives “very differently” now that she is a survivor. The help she received from her health care professionals, and then subsequently her new dentist has renewed her hope and her faith in people. She has a new sense of the need to care for herself. She has hung her radiation mask on the wall in her home; she uses it as a reminder of her ability to overcome the cancer. At no time did she falter in her hope for survival BT states, due to the confidence she had in her doctors.
BT states that the two most important qualities that helped guide her through her treatment into survival are her perseverance and her trust in her doctors, coupled with a leap of faith. She had been told her lump would go away. She persisted in getting care. If she were asked would she want to forget this ever happened to her? BT responds, no, she has met so many people and realized once again how much goodness is there for us to share. BT remembers being angry only once – over the fact that she could not sell her platelets to earn money for her dentures. She cried only when diagnosed with the second cancer. BT explains her need for new teeth: I never thought I was a vain person, but I didn’t realize what that would feel like to have no teeth. When asked what the most encouraging thing had been during her treatment and recovery, BT just looked up and flashed a big smile! We laughed.
BT has signed up for several classes at the Survivor Clinic. Always keep a positive attitude, she said.

For this and more cancer survivor and patients stories follow our blog. South Florida Radiation Oncology offers many cutting edge treatments for cancer, so you can get back to living your life!
For more details about our Survivorship Clinic and support groups, go to our Resources page, at http://www.sfroll.com/resources.

News for Cancer Patients: Study Examines Link Between Breast Cancer and Diabetes

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Study Examines Link Between Breast Cancer and Diabetes
Date:12/13/2012 [RSS & Subscription]

THURSDAY, Dec. 13 (HealthDay News) — Postmenopausal breast cancer survivors are at increased risk for developing diabetes and should be screened for the disease more closely, a new study suggests.

Researchers analyzed data from 1996 to 2008 from the province of Ontario, Canada, to determine the incidence of diabetes among nearly 25,000 breast cancer survivors aged 55 or older and nearly 125,000 age-matched women without breast cancer.

During a median follow-up of more than five years, nearly 10 percent of all the women in the study developed diabetes. Compared to those who had not had breast cancer, the risk of diabetes among breast cancer survivors was 7 percent higher two years after cancer diagnosis and 21 percent higher 10 years after cancer diagnosis, the investigators found.

The risk of diabetes, however, decreased over time among breast cancer survivors who had undergone chemotherapy. Their risk compared to women without breast cancer was 24 percent higher in the first two years after cancer diagnosis and 8 percent higher 10 years after cancer diagnosis, according to the study, which was published Dec. 12 in the journal Diabetologia.

“It is possible that chemotherapy treatment may bring out diabetes earlier in susceptible women,” study author Dr. Lorraine Lipscombe, of Women’s College Hospital and Women’s College Research Institute in Toronto, said in a journal news release. “Increased weight gain has been noted [after receiving] chemotherapy for breast cancer, which may be a factor in the increased risk of diabetes in women receiving treatment.”

“Estrogen suppression as a result of chemotherapy may also promote diabetes,” Lipscombe added. “However, this may have been less of a factor in this study where most women were already postmenopausal.”

The study authors suggested that there may be other factors involved for women who received chemotherapy, including glucocorticoid drugs, which are used to treat nausea in patients receiving chemo and are known to cause spikes in blood sugar. In addition, breast cancer patients undergoing chemotherapy are monitored more closely and thus are more likely to have diabetes detected, they noted.

The researchers said it is unclear why diabetes risk increased over time among breast cancer survivors who did not receive chemotherapy.

“There is, however, evidence of an association between diabetes and cancer, which may be due to risk factors common to both conditions,” Lipscombe said. “One such risk factor is insulin resistance, which predisposes to both diabetes and many types of cancer — initially insulin resistance is associated with high insulin levels and there is evidence that high circulating insulin may increase the risk of cancer.”

“However, diabetes only occurs many years later when insulin levels start to decline,” she said. “Therefore, it is possible that cancer risk occurs much earlier than diabetes in insulin-resistant individuals, when insulin levels are high.”

Overall, the “findings support a need for closer monitoring of diabetes among breast cancer survivors,” Lipscombe concluded.

Although the study found an association between diabetes and breast cancer, it did not prove a cause-and-effect relationship.

More information

The American Cancer Society outlines what happens after breast cancer treatment.

– Robert Preidt

SOURCE: Diabetologia, news release, Dec. 12, 2012

Warning Signs and Tips for Understanding Weight Loss in Cancer Patients

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Warning signs and tips to understanding weight loss in cancer patients

by Cindy Collins, PhD, RD

As an oncology dietitian, I often see many forms of weight loss in patients. For many cancer patients weight loss presents a very difficult dilemma. The reasons for weight loss are varied: the cancer itself may increase caloric expenditure; the psychological stress may decrease appetite; medication side effects and the location of the cancer itself (mouth, tongue, throat) may produce disinterest and/or inability to eat. According to the British Journal of Nutrition, 40-80% of cancer patients who receive chemotherapy will risk malnutrition secondary to the disease. The degree of malnutrition may depend on the type of tumor, its location and the staging/treatment strategy.
Malnutrition in turn affects the patient in many ways. It increases the number of complications and side effects during treatment and decreases the quality of life.

For clinicians:
Specific symptoms should alert the clinician to nutritional risk. Nausea, vomiting and constipation, olfactory and taste change, difficulty or pain with chewing or swallowing, reflux and gastroparesis are common gastrointestinal symptoms that need to be addressed immediately. Food aversions in response to negative symptoms associated with eating are not uncommon. Some patients tend to narrow their dietary choices in an effort to relieve GI distress or in response to information in the popular media. Targeting the symptoms and liberalizing the diet might be in order. The oncology dietitian will assess and follow patients for symptoms of GI distress, psychological stress that leads to decreased appetite or poor food choices and knowledge about nutrition.

Special situations
Special situations present an even greater nutrition challenge for some cancer patients.
Villousatropy from radiation enteritis, pancreatic dysfunction, and biliary non-secretion all interfere with digestion and absorption of nutrients. Ascites, infiltration of the small intestine by lymphoma or solid tumors, lymphadenopathy of the intestinal wall or mesentery may result in malabsorption of nutrients. Surgery can present further problems: esophagectomy with vagotomy, gastrectomy (partial or total), intestinal resection and fistulae prevent normal digestive/absorptive processes. Patients who under gastrectomy risk malabsorption of Vitamin B12, iron and calcium and require targeted supplementation.

Ulceration of the bowel, infections and protein-losing enteropathies have been observed in certain cases of cancer patients. Lipid and fat-soluble vitamin malabsorption are likely induced at the same time. Additional theories of weight loss in the cancer patient include host-tumor competition for nutrients, secretion of cytokines, increased metabolic rate, and lack of adaptive energy conservation in the face of decreased intake. These theories continue to undergo research. In extreme cases of malnutrition, anorexia has progressed to cancer cachexia (wasting syndrome): extreme loss of weight, fatigue, muscle atrophy, weakness and significant loss of appetite.

Poor Digestion and Absorption of Nutrients
In addition to targeting specific symptoms that may be leading to decreased dietary intake, poor digestion and/or absorption, smaller volume nutrient-dense meals eaten more frequently seem to promote weight gain and improve nutritional status most successfully. Enteral (tube feeding) and parenteral feeding (by vein) may be required. Elemental diets (hydrolyzed or predigested nutrients) are easily available and may prove beneficial. The oncology dietitian will assess patients for their unique needs and counsel regarding optimizing nutrient intake and achieving good nutritional status.

For more information:
Br J Nutr. 2012 Jun12:1-4. Sanchez-Lara, etal.
CA A Cancer Journal for Clinicians 2012: 27 (4): 205-8. Theologides, A.

Contemplative Care for Terminal Cancer Patients

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Contemplative Care
by Cindy Collins, PhD, RD

There are many changes anticipated with the Affordable Care Act. According to Dr. Diane E. Meier some unnecessary procedures will no longer by ordered by physicians. Doctors will opt for what is best for patients over the long run rather that administering tests and treatments so readily.
Dr. Meier is an expert in the field of palliative medicine and practices at the Mount Sinai Medical Center in New York. She was a keynote speaker at the Buddhist Contemplative Care Symposium, organized by the New York Zen Center for Contemplative Care and the Garrison Institute.

Although it may often go unnoticed, when a patient has an incurable illness and is terminal the physician often suffers along with the patient and family. Their reaction may be cloaked in anger, abruptness or avoidance. Theoretically, if a patient feels abandoned, they may experience depression which can hasten further suffering and death.

Dr. Michael Kearney warned against two typical reactions these physicians may have. One is burnout which can lead to emotional and physical exhaustion, detachment and a sense of failure. The other is compassion fatigue which is characterized by avoidance of thinking about the patient, sometimes demonstrated with irritability and anger.

A study published in the Journal of Palliative Medicine (2008) included 18 oncologists. If they felt their role was one of both biomedical and psychosocial functions they reported finding end-of-life care as very satisfying. However, those who saw their role as primarily biomedical felt distant from their patients and as If they failed when the patient was not healed.

Dr. Kearney’s solution to help doctors affected by the stress of dealing with terminal patients is Mindfulness Meditation. In addition to enhanced self-awareness this may render the physician a better listener and also enable them to give second thought to reaction-based decisions for additional treatment.

For further reading by Michael Kearney, see Mortally Wounded – Stories of Soul Pain, Death and Healing