Positive Health Online

I work with breast cancer clients referred to me by The Nigel Porter Unit at The Royal Sussex County Hospital. The women I see may be preparing for surgery, going through chemotherapy or radiotherapy, be on hormone therapy or be dealing with secondary cancer. This article sets out the nutritional guidelines I use.

Nutrition

Food and drink are nearly always concerns for the women I see. Their attitude is partially affected by their family. I often hear someone say, "I can't do something separate for myself. It means having to do two different meals". Other barriers include bad nutritional practice in general. Sometimes it's about cost, for example; organic is more expensive. The basic suggestions I make include:

• Have a moderate intake of fish (preferably deep sea oily fish, such as salmon, tuna, mackerel, herring, pilchard) and white meat and poultry (preferably organic);
• Have plenty of organic fruit and vegetables;
• Eliminate or reduce intake of: saturated fats, alcohol, everything refined (including white bread and flour), tap water, red meat, smoked and cured meats, excessive salt, chemical preservatives and processed foods, hydrogenated margarine, food additives, wheat, tea, coffee, sugars and sweeteners and dairy;
• Drinking at least 2 pints of filtered or mineral water daily;
• Increase intake of protective foods including: alfalfa, almonds, apples, apricots, asparagus, aubergine, avocado, bananas, beetroot, bok choy, broccoli, brown rice,

Brussels sprouts, green cabbage, cantaloupe melon, carrots, cauliflower, chicory, Chinese leaves, chives, citrus fruits, eggs (in moderation), flax oil or flaxseed (balances oestrogen in the body due to its phytoestrogen effects, regulates blood sugar level by slowing down the body's absorption of carbohydrates, good for constipation, regulate blood glucose), French beans, garlic, ginger, grapes, green pepper, green tea, horse radish, kale, kiwi fruit, kohl rabi, leeks, lentils, lettuce, linseeds, liquorice, olive oil, onions, oriental mushrooms (maitake/reishei/shiitake), parsley, pears, pecans, pineapple, potatoes, pulses and beans, pumpkin, pumpkin seeds, radish, red and black berries, runner beans, seaweeds (kombu, kelp, nori, arame, laver bread, dulse and wakame), sesame seeds, soy products, spinach, spring onions, sprouted broccoli, squash, sun dried fruit, sunflower seeds, swede, sweet potato, tomatoes, turkey, turmeric, turnip, walnuts, watercress, wholegrain bread, yellow and red peppers;

• Use olive oil for frying;
• Avoid microwaving food, char-grilling and barbecuing foods and deep frying or smoking food;
• Avoid aluminium or non-stick pans; Use stainless steel, enamel or Pyrex cooking utensils. Use pans with close fitting lids and avoid using copper pans, which encourage oxidation and vitamin C loss;
• Avoid smoking fat – if you cook with fat, don't let it become so hot that it starts to smoke (the EFA linoleic acid is destroyed at this temperature);
• Prepare food immediately before cooking as vitamin C is destroyed once cells are damaged. Wash produce in cider vinegar (or water and vinegar) to remove pesticides. Don't chop too finely and scrub vegetables rather than peeling them. Once food is cooked, eat it straight away;
• Avoid commercial detergent. Wash cooking utensils in environmentally safe detergent, or use bicarbonate of soda and rinse thoroughly under a hot running tap.

Preparing for Surgery

Two days before going to hospital, I recommend the client begins a course of arnica homeopathic remedy to lessen the bruising, swelling, and soreness. I usually recommend 30c morning and night a day before, the day of surgery and for a few days after surgery. I also recommend the remedy nux vomica 30c for sickness following surgery. A further homeopathic remedy that is useful after surgery is hypericum, which aids pain relief and healing of nerve damage (which is very common with lymph node dissection).

Certain foods will also help your body prepare for the shock of surgery, especially those that are rich in an amino acid called L-arginine, which stimulates the thymus gland, which in turn stores the infection-fighting T-lymphocytes or T-cells until they are needed to ward off disease. Ironically, levels of L-arginine drop during times of stress – but you can increase them again by eating more poultry and fish, which are excellent natural sources, and by taking a supplement.

Following surgery, I recommend clients drink at least 2 litres of filtered or still mineral water each day to flush toxins out of the body and soothe the lining of the gut, which will be disturbed by antibiotics. Drinking Aloe Vera juice can also help.

Rubbing vitamin E oil onto a scar can help speed up the healing process (to do this, break open a standard soft capsule). Another regenerating goodie is rosehip. Rosa mosqueta is sourced from the Brazilian rainforest and was originally developed to help reduce wrinkles around the eyes. To minimize scarring, apply to the wound once it has healed and massage into the affected area.

Nutrition and Chemotherapy

Nausea and Vomiting:

• Rinse the mouth often to eliminate any bad taste;
• Take small sips of fluids or suck on ice cubes an hour or so after feeling sick to settle the stomach;
• Eat a cracker or toast to help put something back into the stomach without causing upset;
• Eat slowly and chew food well for easier digestion;
• If nausea is a problem in the morning, eat dry foods like cereal, toast or crackers before getting up;
• Drink cool, clear, unsweetened fruit juices, such as apple or grape juice, or light-coloured sodas, such as ginger ale, that have lost their fizz and do not contain caffeine;
• Suck on mints, or tart sweets (avoiding tart sweets if there are mouth or throat sores);
• Prepare and freeze meals in advance;
• Avoid sweet, fried or fatty foods;
• Rest, but don't lie flat, for at least 2 hours after you finish a meal;
• Avoid food for at least a few hours before treatment if nausea usually occurs during chemotherapy;
• Eat a light meal before treatment;
• Nausea is helped by teas made from ginger, fennel seeds, coriander, orange, mandarin peel and mint. Other spices which help include aniseed and cinnamon;
• Keep up fibre intake, as constipation can become a serious problem (often caused by the anti-nausea drugs which are administered with the chemotherapy).

Taste

• Brush your tongue with a toothbrush and water (and a little minty toothpaste, if the taste and smell don't bother you). Tongue brushing helps things to taste better. No doubt you have been advised to use good oral hygiene, rinse with slightly salty water and avoid lacerating your mouth/tongue/throat.

Hair loss

• Use vitamin E 1600ius daily, starting one week prior to chemotherapy;
• Drink lots of diluted orange juice;

Fact Box

Presuming you have healthy kidneys, drinking several pints of water one day before your treatment, during the infusion and for 2-3 days after your treatment will help to flush the chemotherapy through, otherwise there is a risk of cystitis.

Mouth Sores

Buy yourself a bottle of Milk of Magnesia. Pour off the top of the liquid that rises to the top. Dip a Q-tip into the remaining thick cream-like substance and rub on your sores. The substance breaks down the acid that causes these sores. Another tip for mouth sores is to snip the top of a vitamin E capsule and pour the contents directly on the mouth sore.

"Vitamin C augments the effectiveness of radiotherapy and can help decrease the anaemia, pain, appetite loss and weight loss experienced by those on this form of treatment. Vitamin C also protects the heart for those on the chemotherapeutic drug Adriamycin (as does CoQ10). Vitamin C also enhances the effectiveness of chemotherapeutic agents 5-Fluoracil and Bleomycin. Vitamin E reduces cardiac and skin toxicity and hair loss for those on Doxorubicin, protects lymph tissue against Bleomycin, and decreases cardio-toxicity of Adriamycin. Beta-carotene potentiates the effectiveness of 5-Fluoracil, Methotrexate and Cobalt therapy. Selenium is also radio- and chemo-protective, and protects kidneys against cisplatin. Radiotherapy decreases levels of vitamin E, B12, folic acid and C, so it is a good idea to ensure a diet rich in these substances or supplementation while on radiotherapy."[1]

During chemotherapy, clients' appetites can fluctuate. I tend to recommend 'grazing' with protein at every sitting. It is obviously important that the client gets good protein and complex carbohydrate but it is equally important that they eat what they fancy – regardless of goodness. There needs to be some pleasure in life!

Coping with Radiotherapy

• Keep some Aloe Vera gel in the fridge and apply liberally;
• Take kelp tablets, and other dark green things, like barleygreen, spirulina or seaweed. Miso soup is excellent. Seaweed products will help to counteract iodine deficiency and, with bananas and ocean fish, help to keep your sodium-potassium balance right;
• Avoid the supplement genistein, which may have the effect of protecting any cancer cells from radiotherapy.

Hormone Therapy

Another area I work in is with the side effects of hormone therapy. When a client comes to me suffering from, normally, hot flushes and night sweats, due to tamoxifen or zoladex, I use nutrition to ease the symptoms. Supplements such as vitamin E, flaxseed, magnesium, vitamin C, vitamin B complex, selenium and Co-Q-10 can help ease symptoms. Additional help comes through homeopathy. I am wary of using herbs because of their interaction with cancer treatment drugs and, also, homeopathy works so much more quickly,especially those that are good for hot flushes. I often ask the women to keep a flush diary detailing when a flush happens, on what part of the body and any noticeable triggers. This can produce information such as a flush happening after food or a hot drink, after exercise or sitting in a traffic jam that can be used to help manage symptoms.

Fact Box

Health Canada is advising the public not to take certain drugs with grapefruit juice. Although interactions between grapefruit juice and certain drugs are well documented in medical and scientific literature, this information may be unknown to the public. There are several substances in grapefruit that interfere with the way the body handles certain drugs. Consuming grapefruit juice (fresh or frozen) or grapefruit sections can increase, or less commonly decrease, the effects of some drugs, which could lead to serious or even life-threatening adverse reactions. As little as one glass of grapefruit juice can cause this effect. It is advisable not to drink grapefruit juice or eat grapefruit in any form, if you are taking medication for cancer (such as tamoxifen), until you have talked to your doctor or a nutritionist about the potential for an adverse reaction. While sweet oranges and their juice do not appear to cause the same reaction, sour orange juice, such as that from Seville oranges, may have an effect similar to grapefruit juice. Tangelos are a hybrid of grapefruit and may also interfere with drugs. Most other citrus fruits, such as lemons, limes, citrons, naturally sweet oranges and tangerines are considered safe. National Association of Pharmacy Regulatory Authorities, 402-222 Somerset Street West, Ottawa, ON K2P 2G3, Canada. Tel: (613) 569-9658. info@napra.ca. www.napra.ca/docs/0/509/513.asp.

Weight Management

Another issue I work with is weight gain, due to hormone therapy, and weight loss, due to stress. When the issue is weight gain, it is often tied up with bad body image, for example maybe the woman has had a mastectomy. I approach this issue from the self-confidence and health angle, rather than the "let's lose weight" angle. Based on nutritional data, we work together to create a healthy eating plan. If appropriate, we link in a food diary, which monitors emotional responses and eating habits. My approach is very much about creating a flexible programme with the client that they can incorporate easily into their daily life – with the odd deviation for good measure! There have been several women who have come to me following diagnosis but before surgery, who have lost weight due to trauma. These women need careful supporting and reassurance, as well as a nutritional programme aimed to build them up in readiness for surgery and recovery and possibly further treatment.

As well as nutrition, I also use reflexology, Reiki, stress management therapy, head and shoulder massage, relaxation training, guided imagery and colour, style and image makeover as part of complementary cancer care. But it is nutrition that always forms the core for self help for most of the women I work with.

Supplements

In the first session, we talk about the importance of antioxidants and I recommend a daily supplement intake of:

• 1000mg (up to 3000mg) of vitamin C with bioflavonoids;
• Vitamin E 400iu. Selenium and vitamin C aid absorption;
• Selenium 200mcg.

Any further supplements are tailored around prioritizing health needs and financial status. Other supplements I might recommend include:
• Bee pollen, which provides more than a dozen vitamins, 28 minerals, 11 enzymes, 14 beneficial fatty acids and 11 carbohydrates and is made up of around 25% complete protein, consisting of at least 18 amino acids. It enhances vitality, strengthens the immune system, is a natural anti-histamine, regulates blood pressure and assists constipation (a side effect of chemotherapy);
• Zinc for immune function – 15-25mg;
• Flaxseed oil (capsules) each day;
• Oligomeric Proanthocyanidins which are 50 times more potent than vitamin E and 20 times more than vitamin C as an antioxidant. Sources are Pycnogenol (a patented form of pine bark extract) known as Pine Bark Extract and Grape Seed Extract. These may also reduce allergic reaction by inhibiting histamine. Therapeutic doses: pine bark extract would be 30mg and grapeseed extract would be 100mg. NOTE: There is a clinical trial funded by Cancer Research UK and conducted by The Royal Marsden Hospital and The Institute of Cancer Research, to look at the healing properties of grape seed on radiation fibrosis; a type of scarring that causes tissue to become hard and stiff;
• Co-Q-10 is a component of every living cell. As body levels of Co-Q drop, so does the general state of health. Co-Q-10 is best absorbed with flaxseed oil. Therapeutic dose is 10-90mg per day;
• L-Glutamine is a fuel for the digestive lining which has been shown to protect the digestive tract through chemotherapy. It is considered essential to the body when the immune system is depressed and is beneficial as a healing agent after surgery. Glutamine helps to alleviate the side effects of chemotherapy such as diarrhoea, mouth ulcers and 'leaky gut'. NOTE: Should be avoided if there is cancer of the digestive tract;
• Vitamin B complex 50mg;
• Beta-carotene. (Active cancer: 25,000iu daily. Maintenance level: 10,000 daily). Or you could juice carrots;
• Chromium GTF (Active cancer: 100mg daily. Maintenance level: 50mg daily);
• Magnesium 100-200mg;
• Chlorella. There has been much research with regard to chlorella and tumour regression. Macrophages are cells that are active against cancer cells, foreign proteins and chemicals. A natural way to help fight cancer is to stimulate macrophage production and macrophage activity in the body. Chlorella stimulates the production of interferon in the body, which in turn stimulates macrophage production. Other studies have shown that it stimulates a white blood cell to exhibit anticancer cell activity. This combined action in stimulating the immune system gives chlorella an excellent anti-tumour capacity. It is also a natural source of beta-carotene;
• Lactobacillus bacteria. Lactobacilli are the natural bacteria found in our digestive tract. They have a number of benefits, such as producing B vitamins that help to boost the immune system. They protect against the invasion of other pathogenic bacteria, thus freeing up the immune system to act on the invasion of cancer. They can generally help to detoxify carcinogenic toxins that may form in the digestive tract;
• Garlic possesses potent anti-viral, anti-bacterial, and anti-fungal activity. Scientific studies have shown that it stimulates various facets of the immune system.

Fact Box

Those on Warfarin should not use vitamin E or Co-Q-10.

References

1. Daniel R. Healing Foods, How To Nurture Yourself amd Fight Illness. Harper Collins. 1996.

Resources

Arnot B. The Breast Cancer Prevention Diet. Newleaf.
Bruning N. Coping with Chemotherapy. Avery Publishing Group.
Davies S and Stewart A. Nutritional Medicine. Pan.
Glickman H. Foods that Fight Cancer. Optimum Nutrition. Volume 16: No 1: 16-21. 2003.
Grape Seed and Radiotherapy. Breast Cancer Care News. Spring 2003.
Holford P. Boost Your Immune System. Piatkus.
Holford P. Say No to Cancer. Piatkus.
Olivier S. The Breast Cancer Prevention and Recovery Diet. Michael Joseph.
Physicians Committee for responsible Medicine and Vesanto Melina. Healthy Eating for Life to Prevent and Treat Cancer. Wiley.
Plant J and Tidey G. The Plant Programme. Virgin.
S Yeager. New Foods for Healing. Rodale Press Inc. 1998.

Further Information:

Bristol Cancer Help Centre. Tel: 0117-980 9500; www.bristolcancerhelp.org
The Cancer Resource Centre. Tel: 020-7924 3924; www.cancer-resource-centre.org.uk
The Cavendish Centre (Sheffield). Tel: 0114 278 4600. www.cavcare.org
Directory of Complementary Therapy Services in UK Cancer Care. Macmillan Cancer Relief. ISBN 0953678520. Tel: Macmillan CancerLine 0808 808 2020; www.macmillan.org.uk
Integrated Cancer Care (St Luke's Cancer Centre at the Royal Surrey Hospital). Tel: 01483 406818;
www.integratedcancercare.org
Laurel Alexander Dip. Nut. LNCP. MAR. Tel: 01273 564030;
www.laurelalexander.co.uk
New Approaches to Cancer. Tel: 0800 389 2662; http://80.177.61.246/newapproaches
Wessex Cancer Help Centre. Tel: 01243 778516.