Sunday, July 22, 2007

Recipe - "Broccoli-added" Soup

A take-off of the phrase 'value-added', this recipe is really a modification of Broccoli-Kale Soup on my own web site
(, which I made a few days ago. For some reason, the soup just did not have the 'pizazz' that I remembered from the last time I made it (maybe summer broccoli just isn't as flavorful as fall broccoli?). So today I got inspired to figure out how to make the remaining soup tantalize my taste buds.

Using about 2 cups of left-over soup, here is what I added:
fresh cooked corn scraped off of 3 small ears
one ice cube size serving of pesto

That's it. I just threw all this in the blender and let it go until it was smooth. My husband is at the hardware store, and this new soup is soooo good that I can hardly wait for him to get home to share it!

Don't be shy about 'adding' things together like I just did. Many of the recipes on my web site were simply created out of what I had on hand at the time that I needed to get supper on the table. I do live just a mile from 3 grocery stores, but it is the rare occasion that I really need to run to the store for an ingredient specified in a recipe.

We'll enjoy this soup with some home-made hummus (recipes also on my web site), fresh whole grain bread, fresh fruit, and iced tea.

Use a free hand with the abundance of summer's fresh and local veggies. I'm well on my way to 9+ servings today of fruits and veggies that contain a cornucopia of cancer-fighting and health-promoting phytochemicals.

Diana Dyer, MS, RD

Friday, July 20, 2007

The Ethics of Eating - this Sunday 7/22

When author Barbara Kingsolver still lived in Arizona and I still was criss-crossing the country for my speaking engagements, I used to fanticize that I would find myself sitting next to her on an airplane on what was hopefully a long cross country flight. (and that was even before she had written Animal, Vegetable, Miracle) Regrettably (for me), now that she is settled on her farm in Virginia and I am not traveling nearly so much, I doubt that will happen.

However, as a substitute, here is the next best thing.

Barbara Kingsolver, the lead author of Animal, Vegetable, Miracle along with her older daughter and husband, will be the guest on the nationally broadcast radio show Speaking of Faith, this coming Sunday 7/22 as she talks about her new best-selling book and the ethics of eating. The interview is also be available as a podcast from

I don't know if Barbara had looked ahead to try to plan her family's project of eating only their home-grown or locally produced food for one year, their writing, and the publication of their book with the timing for the re-writing of our country's 2007 Farm Bill. However, the timing, planned or coincidental, is fortuitous. I am truly hopeful that her book and her voice will help swell the increased awareness of the gross mismatch between what the Farm Bill currently funds and what it should be funding in order to optimize the health of our citizens (and dramatically decrease our health care costs). I am hopeful that Congress will both see the wisdom and have the courage to tip the scales so that funds (i.e., our tax dollars) will be significantly shifted to (1) the programs that subsidize growers who produce healthy foods like fruits and vegetables, and (2) to funds and programs that promote good nutrition (i.e., the same foods that our USDA Dietary Guidelines recommend - DUH!) and help make these healthy foods more accessible and affordable to all people, but particularly to children, the poor, the elderly, and other vulnerable citizens of our country.

It's time for a change, and I thank Barbara Kingsolver for speaking up to help us realize that we can all vote with our forks to help to drive this urgently needed and overdue change in how our food is grown and thus how we eat.

My family still writes letters to Santa each year giving hints about what would be appreciated as a gift for Christmas. One of my sons began a tradition a few years ago of asking for a "book that will make me think". Barbara's new book is already in the running for what Santa may deliver this year.

Thanks, Barbara. Maybe I still harbor a tiny hope that I'll still get to meet you someday, however, maybe in a garden or at a Farmers' Market now instead of an airplane. :-)

Diana Dyer, MS, RD

Thursday, July 19, 2007

Walk-wok: Learn from those survivors who are N=1

In response to the comments to my 7/18 postings about the WHEL Study's results, I want to add yet a few additional thoughts. Over the past 10-12 years, I have met numerous cancer researchers who, after hearing me speak about my wide and diverse approach to recovery after cancer, have told me that they wished that they were studying what I and other successful survivors have actually been doing to optimize our odds for long-term survival (all of us often are or at least feel like N=1, i.e., case studies, not validated research studies from which recommendations for other people can be made).

There is a relatively new study being funded by the National Cancer Institute called the Pathways Study, being conducted by the Kaiser Permanente of Northern California that aims to examine the effects of modifiable factors associated with recurrence and survival for breast cancer. Specifically, they will be collecting extensive data on: 1) lifestyle factors such as diet, physical activity, quality of life, and use of complementary and alternative therapies and 2) many genetic factors in the breast tumors. Essentially all newly diagnosed breast cancer patients within that health care system will be offered a chance to be a part of this vital and important prospective study as soon after diagnosis as possible. The entry point into the Pathways Study is an important difference and potential benefit of this study, as most research studying lifestyle aspects of cancer survival wait until after treatment is completed to begin the observation or intervention. (you can click on the title to this posting to link to the full description of the Pathways Study.)

Just as we now know that combining more than one healthy food in a meal (soy and green tea for instance) produce anti-cancer effects that are larger than using either food alone, it is very likely that combining multiple different "self-help" strategies at one time will produce benefits that are larger than using any one alone. (in fact that is the very reason why a typical chemotherapy protocol usually consists of several different types of drugs)

Benefit from a achieving a combination of healthy lifestyle behaviors is exactly what was seen when evaluating data from subgroups within the control arm of the WHEL study. The relatively small group of women who consumed 5+ servings of fruits and vegetables daily PLUS exercised ~30 minutes daily were the only sub-group who experienced a 50% reduction in recurrence. This is a powerful statistic and a powerful message. The principle investigator for the Pathways Study (Larry Kushi, PhD) and I have talked about this concept in the past. I am very hopeful that this new study will add to the picture and ultimately to the recommendations of what each person can do on an individual basis to improve the odds of their own survival.

So, I still recommend eating a wide variety of fruits and veggies (especially dark green leafy veggies, not just peas, corn, orange juice and bananas!) and taking a daily brisk hike!

I always remember that I wear two hats - that of a cancer survivor struggling in the trenches along with millions of others plus that of a health care professional who takes leading by example very seriously. Today my dog and I have already had one brisk 45 minute walk. I am wearing my Life is Good t-shirt that says "Walk on", and I used my wok (which I keep handy right by my stove-top) to make a quick and simple stir-fry for lunch using firm tofu, snap peas, sunflower sprouts, red cabbage, spicy green mustard greens, fresh garlic, and curry powder. :-)

Walk-wok! :-)

Diana Dyer, MS, RD

Wednesday, July 18, 2007

Additional thoughts about the WHEL Study results

This posting contains some of my initial additional thoughts in regards to the WHEL Study results (see my earlier 7/18 posting, too).

I have been waiting for these results almost since the inception of the study. It has been a long wait, and I am grateful beyond words that I am still here to comment on the outcomes. Did I expect different results? Did I hope for different results? Simple as can be, yes and yes. I do not know yet how the media will handle these results, and subsequently how the cancer survivor community and general public will react. However, I will repeat myself here (and if I knew how to bold my font I would do it here, too) - this is NOT the time to throw the baby out with the bathwater.

I want to enlighten or remind everyone of the original definitions of the word "diet":
(1) A way of life
(2) A day's journey

These are the images I keep in mind in contrast to what I hear or read about the constant obsession Americans have with the "diets" they continually seek out to lose weight. In fact, I believe the collective societal definition for the word diet these days has unfortunately evolved to become synonymous with "disordered eating".

As a Registered Dietitian who is a survivor of the childhood cancer neuroblastoma and has had two separate primary breast cancer diagnoses in 1984 and 1995, I made the simple decision after my most recent breast cancer diagnosis to seek a diet and lifestyle that would optimize my odds for long-term recovery and also increase my quality of life. (It has actually been a lifetime journey with even more focus after my 1995 diagnosis.) At that point, I sought out the best advice available at the time about what was known and what was not known about diet, lifestyle, and cancer survivorship from many researchers, including my friend and colleague Cheryl Rock, PhD, RD, the co-principle investigator on the WHEL Study, as the basis for what I have chosen to do these past 12 years to optimize my odds for long-term survival and enhanced quality of life.

By all accounts, I have been successful. So much so, that my oncologist (who knows I have been speaking around the country during this time) actually shyly asked me a few years ago if I gave him any credit for my success during my speaking engagements. I always tell my audience that I am not a research study, but a "case study" of n=1, an individual, a single data point. Thus I know full well that the complete answer(s) to why I survived this long (with 9+axillary nodes and positive deep inner-mammary nodes behind the sterum also) will never be known. However, my answer to him was that I tell audiences I am very likely successful because I have combined the best of all treatments, meaning conventional medicine and all the self-help strategies in the area of complementary medicine (CAM) for which there were clues pointing to potential benefit plus strategies that made sense to me, or somehow resonated with my soul, even before much research had been started, let alone completed in this wide open field of CAM.

I have had the high honor of being invited to speak to the American Society of Breast Surgeons' annual meeting both in 2005 and again this year in 2007. I would like to share what I thought was the most helpful information I gave the surgeons. It was a handout I developed for them to duplicate for their patients that addresses the quandries and questions cancer survivors often ask themselves (and seek advice about from their health professionals). It gets at both the root and the big picture of why I am not (too) distressed about the results of the WHEL study. Optimizing life after cancer is much, much more than just 'diet' in terms of what we eat; it truly is a day's journey, a way of life.

Here is what I gave them to give to their patients who are asking "How can I help myself?":

Lifestyle Changes for Achieving Wholeness and Wellness after Breast Cancer

By Diana Dyer, MS, RD - Author, A Dietitian's Cancer Story

The following suggestions have been learned through my personal experiences and put into the acronym “Help Myself”. However, they are not all inclusive nor in any particular order. I invite you to use some of them as a starting point to find your own unique recovery path to wholeness and wellness after your cancer diagnosis when you are ready to ask the question “What can I do now to help myself?”

H – Help someone or some cause (i.e., do something that adds meaning to your life)
E – Exercise daily doing something you love to do (move more!)
L – Learn to enjoy new whole foods (not processed foods or “junk”) and new recipes
P – Plant a garden (even a small one) to increase your intake of plants plus exercise

M – Meditate or learn some other form of stress management
Y – Yield gently to the changes in life. Although some are frightening, many can open doors to newfound opportunities, health, and wellness
S – Size down the portions of most foods
E – Enjoy more water and green tea
L – Lose weight (if needed) very gradually
F – Find a Registered Dietitian (RD) to be an advisor and cheerleader for recovery


Combining such actions with the best conventional cancer treatment options that were available for me is what I have done, promoted, and called "active hope" for the past 12+ years. There are no guarantees in life at all, plus I recognize that there is more than one path to the mountain top, but doing all of the above has been my best shot for the best possible outcome(s) and has finally led to peace with my 57 years of a cancer survivorship journey.

To cancer survivors everywhere, I continue to send you all my best wishes for health, healing, and "active hope",

Diana Dyer, MS, RD

The WHEL Study results - well................

The long-awaited results of the Women's Healthy and Eating Lifestyle Study were published today in JAMA. This large, randomized, multi-center study studied the effect of a low-fat diet that was also very high in vegetables, fruits, and fiber on the occurrence of additional breast cancer events and over-all survival for early-stage breast cancer patients after therapy was completed.

The short answer is that no substantial difference was found for subsequent breast cancer events or overall survival between the two groups (the intensive diet intervention groups versus the control group). Both groups had a nearly identical rates for breast cancer events during the mean follow-up of 7.3 years (16.7% for the diet group vs. 16.9% for the control group). A nearly identical rate for all-cause death was also seen between the two groups (10.1% for the diet group and 10.3% for the control group) with >80% of all deaths due to breast cancer in both groups. Various subgroup analyses (hormone status, tumor size, age, etc, etc) also showed very few differences between the diet and control groups.

It is important to point out that ~75% of all study participants in both the diet and the control group had already changed their diet before the study started by increasing their intake of fruits and vegetables to ~7 servings/day. However, there did not appear to be an advantage to the few women in the diet group who started at less than 5/day to increasing to 9+/day.

The full article in JAMA is available to read by clicking on the title of this posting.

Take home points:
(1) This is no time to throw out the baby with the bathwater. Keep those healthy lifestyle habits that you are working on for cancer survivorship, cancer prevention, and overall good health!
(2) The data from the control arm of this study (posted on 7/15) clearly showed a 50% reduction in the subgroup of women who did consume at least 5 servings/day of fruits and vegetables plus briskly walked the equivalent of 30 minutes/day for 6 days/week, even in obese women.
(3) Previous data published from the Iowa Women's Health Study have showed significant decreased incidence in primary cancer diagnoses in those women who achieved higher number of cancer prevention lifestyle goals.
(4) The Nurses Health Study has shown a 50% decrease in breast cancer recurrence in those women who briskly walked at least 3 hours/week, and these data showed the most benefit to those women who were initially overweight or obese.

Bottom lines:
(1) I am not changing one thing about what I eat or how I exercise.
(2) I have never felt guilt about not reaching my daily goals of 9+ servings of fruits and vegetables or walking an hour/day.
(3) We have a more defined window of what may be "enough" to achieve optimal outcomes, however, most good science (like this study) usually raises more questions than it answers.
(4) However, I will repeat one of my recommendations from 7/15:
If you are a cancer survivor and have lost significant weight during therapy and/or also have medical conditions such as diabetes, overweight/obesity, multiple food allergies, GI disorders or symptoms as a few examples, I highly recommend seeking the expertise of a Registered Dietitian (RD) at your cancer treatment facility who can assess your overall nutritional and lifestyle requirements to design a plan that meets your individual nutritional needs to improve your overall health.

Science keeps marching on, one step at a time. I extend my deep gratitude and heart-felt thanks to all the women who volunteered to be a part of the WHEL study, all the health care professionals who conducted the study, and the funders of this valuable and much-needed research (The Walton Family Foundation and NCI).

Diana Dyer, MS, RD

Tuesday, July 17, 2007

Eat those greens w/help from another cookbook!

I have often wondered why kale is just 'decoration on the plate' in restaurants, when it often may actually be the most healthy food on the plate! In fact, I usually eat everyone's 'decoration' (only after they have been given my little 'spiel' about the healthy benefits from all 'greens' and still don't want it).

In reality, the variety of kale usually used for the plate decoration (and the common variety available to purchase in grocery stores) is often tough and lacking in flavor (sad to say, sigh........) or so overly strong in flavor that it is hard to eat . However, kale and other greens do not have to be so blah, cooked to death, have pork fat added, etc, etc, in order to convince oneself to eat this healthy food. In fact greens of all types are what I consider a "power food", one of my top 10-20 ultra-healthy foods that I eat on a regular basis for their abundance of health-promoting nutrients and phytochemicals.

I first discovered a different variety of kale when looking at the little seed packages that came from the heritage garden at Monticello (Thomas Jefferson's home in Charlottesville, VA) last year. I purchased one package of Early Curled Siberian Kale. We planted the seeds in our community garden plot, and although we had to compete with the browsing deer, we got a decent sized fall crop. Oh my goodness! I had never tasted kale that was so tender and delicious.

Go to a well-stocked grocery store, your local food co-op, or Farmers Market to look for a wide variety of kale and other greens (hopefully locally grown). Then what to do with them? The best, best, best book I have found with lots of ideas for cooking and eating greens is Spinach and Beyond: Loving Life & Dark Green Leafy Vegetables by Linda Diane Feldt, Moonfield Press, Ann Arbor, MI, ©2003.

Check your local independent bookstore for a copy, or it is also available to order from the publisher and

As I was looking in this book today, I even found a recipe that I had completely read over (i.e., not remembered at all!) during my earlier meanderings through this lovely book - dog treats made with greens!! Oh yea! Our 'grand-dog' Kaya just LOVES vegetables of all kinds, so here is another way for her to enjoy them (plus no worries on my part about the ingredients in the ones from the pet store).

So eat (and enjoy!) your greens. Yum, yum and woof, woof!

Diana Dyer, MS, RD

Tea (real tea) versus extracts

A friend recently asked me what I thought of "green tea extract", a liquid that when a little squirt is added to 6 oz. of water, you receive something on the order of 15X the antioxidant capacity of one cup of green tea. So many thoughts ran through my head with this short question. I hardly knew where to start (or end) my response to her.

In a nutshell, this is what I said. Anytime a product gives you a very large equivalent of anything (especially consumed over a short time frame), essentially that is like taking a drug of the active molecules. EGCG is short-hand for the molecule in green tea that has the most anti-oxidant and anti-cancer activity. It is important to remember that the Japanese and Chinese people drink tiny cups of green tea all day long, thus if there are health benefit from the components of the tea, they are coming in small doses all day long, not one big whopper of a dose. ECGC (and other components less well studied) could be acting very differently in those large doses compared to small even doses. In addition, I actually wonder if part of the health benefits from tea drinking actually come from taking the time to slow down to make the tea and enjoy a few minutes drinking it alone or with friends and family, instead of our American way of doing nearly everything these days (fast, super-size, convenient, and/or with as little effort possible).

Until clinical trials help to define the composition, dose, and benefits of an extract that retails for $20-$30 for a month's supply, I'm choosing to put my money into real food (i.e., real tea).

Thus I do not consume green tea extract myself and cannot recommend it. In fact, I am a dedicated fan to making my own tea and drinking it slowly while I enjoy both the taste and the time involved. I even carry my own tea bags or loose tea when I travel. Unfortunately, it is still not the norm to see green tea available on the airlines, in most restaurants, hotel rooms, or sadly, even as an option at health care conferences.

I ended the note to my friend with the hope that I sounded like the "healthy skeptic", not a cynic. :-)

Here was her response back to me:
"Well and wisely said....usually if something sounds so easy, something is not right! Thanks for your input...greatly appreciated and valued!"

I have a beautiful photo of a pot of tea and teacup that I'm figuring out how to insert into this posting. It's a perfect day to spend indoors puttering on a project like that, as this is our first rainy in weeks and weeks and weeks. I hope all our garden plants are smiling and soaking it up. :-)

Diana Dyer, MS, RD

The Sister Study

Women play many important roles throughout their lives—daughter, mother, and friend—but no relationship is as unique as the one between two sisters. Sister Study researchers hope the sisters of women with breast cancer can play another important role by helping discover how our environment and genes affect our chances of developing breast cancer.

It is still not known if breast cancer is caused by something women come in contact with at work, at home, in their communities or in the personal products they use. That’s precisely what the Sister Study is trying to answer. The Sister Study needs 50,000 women whose sisters had breast cancer to enroll now in order to help discover the environmental and genetic causes of breast cancer. Conducted by the National Institute of Environmental Health Sciences, the Sister Study is committed to enrolling a diverse population of women to ensure the results represent and benefit all women.

I don't have any sisters, but for those breast cancer survivors who do, please urge your sister(s) to participate in this important study. Women of all ethnic and cultural backgrounds are needed to obtain as much real-life, useful information as possible for as many people as possible.

For more information visit or Call toll-free 1-877-4SISTER. Deaf/Hard of Hearing call 1-866-TTY-4SIS.

Diana Dyer, MS, RD

Sunday, July 15, 2007

What do the WHEL Study and the movie Sicko have in common?

Before the credits start to roll, Michael Moore's movie Sicko ends with the simple statement "Eat your fruits and vegetables and take a walk". Good advice for all of us in order to reduce our risk of many chronic diseases such as cancer, heart disease, and diabetes, and thus reduce our interactions (and cost) with the healthcare system.

Now recently reported data from the control group in the Women's Healthy Eating and Living Study (WHEL) has shown that the combination of eating 5 or more daily servings of fruits and vegetables plus walking an average of 30 minutes/day 6 days/week can reduce the risk of breast cancer recurrence nearly 50%. The good news is that these remarkable and hopeful data were true even in women who were obese.

The bad news from this study however, showed only 30% of the non-obese women and only 16% of the obese women in this group adhered to both of healthy lifestyle guidelines. There can be a multitude of reasons why such as low number of the 1,490 women in the control arm of the study achieved these baseline guidelines. Maybe they were told something non-specific like I was ("eat right and exercise") when I asked my oncologist after chemo was completed what I could do to help myself both recover and improve my odds for long-term survival. I didn't know what that well-intended but vague advice really meant for a cancer survivor, and I am a Registered Dietitian! Since 1995, I have been dedicated to finding a better answer to my question than I was given and then sharing the information with other cancer survivors.

Now these specific (and easy to achieve) suggestions may be "what the doctor orders". A very important point to understand is that these remarkable results were ONLY seen when daily exercise was combined with the daily 5+ servings of fruits/veg. The advantage simply was not there if women only practiced one or the other of the healthy behaviors.

My recommendations:
(1) If you are done with your breast cancer therapy, don't wait for this study to be repeated in order to start implementing these two healthy lifestyle recommendations.

(2) If you are currently in treatment for breast cancer, don't wait until therapy is completed to get started on these two healthy lifestyle recommendations. You may not be able to achieve 5+ servings of fruits and vegetables every single day while undergoing your therapy, or 30 minutes of walking every day, but do your best to get started now. It is very likely that additional future research will show that early changes in this manner during therapy will also be helpful.

(3) If you have (or have completed treatment for) another type of cancer, don't wait for this study to repeated for your type of cancer. Follow these same two recommendations now. They are the same recommendations for optimizing your overall health.

(4) If you are a cancer survivor and have lost significant weight during therapy and/or also have medical conditions such as diabetes, overweight/obesity, food allergies, GI disorders or symptoms as a few examples, I highly recommend seeking the expertise of a Registered Dietitian (RD) at your cancer treatment facility who can assess your overall nutritional and lifestyle requirements to design a plan that meets your individual nutritional needs to improve your overall health.

(5) Think of these %'s. A reduction in recurrence of ~50% is truly astounding with strategies that are easy to achieve (available and affordable). Do not wait for more research to try to find a "silver bullet", either a specific food or a specific vitamin, antioxidant, dietary supplement, herb, etc.

Here is the article information. You can find the abstract by clicking on PubMed on my favorite links and type in any key words (I would simply use Rock CL breast cancer):
Greater survival after breast cancer in physically active women with high vegetable-fruit intake regardless of obesity.
Pierce JP, Stefanick ML, Flatt SW, Natarajan L, Sternfeld B, Madlensky L, Al-Delaimy WK, Thomson CA, Kealey S, Hajek R, Parker BA, Newman VA, Caan B, Rock CL.
J Clin Oncol. 2007 Jun 10;25(17):2345-51.

Much more data will be coming out from the WHEL Study over the next year. I'll keep posting it.

Just to let you know that I "walk the walk", I do consume a minimum of 9 (yes a minimum of 9!) servings of fruits and vegetables daily, even on days that I travel. I also walk at least 30 minutes daily. Usually I take my dog for a 30-40 minute walk 2x/day that is a "power walk". I make her move for most of that time (only when we get to a park at the end of our walk do I let her slow down to sniff everything!).

Do I recommend seeing the movie Sicko? Yes.................if I can synthesize my thoughts about it, I'll post them later.

In the meantime, at the risk of sounding like your mother but really as your cheerleader, eat your veggies and take a brisk walk!

Diana Dyer, MS, RD :-)

Saturday, July 14, 2007

Seasonal Foods Cookbooks

OK - so you found your own Farmers Market, you got brave and adventurous and bought something new that you have never seen before or at least have never used in the past. So how to find recipes? Remember to ask the grower! Many of them have oodles of experience making quick and easy meals with their vegetables. Of course you can go to an internet search engine and type in xxxxxx recipe and see what pops us. However, if you are vacationing somewhere (camping, at a cabin, etc) where you are buying and cooking your own food, have an internet meltdown, or simply enjoy or even prefer browsing through cookbooks, you'll want one or two of your own that specialize in vegetables.

Two that I own and love are the following:
From Asparagus to Zucchini: A Guide to Farm-Fresh Seasonal Produce by the Madison Area Community Supported Agriculture Coalition (available on Amazon)
A Year in a Vegetarian Kitchen: Easy Seasonal Dishes for Family and Friends by Jack Bishop

Last night I was looking at a beautiful purple and green kohlrabi that I had bought (simply because it was so beautiful) wondering what to do with it. Surprisingly, A Year in a Vegetarian Kitchen did not list kohlrabi in the index, but From Asparagus to Zucchini had an abundance of recipes, so I grated it to make a modified coleslaw using all kinds of grated raw veggies tossed with a tahini salad dressing. (yum, yum - there was a small portion remaining that I think I'll go eat right now!)

Although I have not seen it, Deborah Madison also has a book that my colleagues from the Hunger and Environmental Nutrition (HEN) Dietetic Practice Group love called Local Flavors: Cooking and Eating from America's Farmers' Market.

Check one or two out from your local library or just find a recipe from one of your own favorite cookbooks. Buy a new vegetable and get eating!

Bon appétit!

Diana Dyer, MS, RD

Friday, July 13, 2007

Local Foods - My migration back home led by spinach

My husband LOVES spinach, and always has, even in childhood. Thus we have bought and eaten a lot of it throughout our 30+ years of marriage. However, 10 years ago when I read that spinach was #2 on the first report from The Environmental Working Group that listed "the dirty dozen" (i.e., the fruits and veggies with the highest amount of worrisome pesticides), I went on a campaign to buy only organic spinach. At that time (1997), organic spinach was hard to find in grocery stores. This specific conundrum is what led me to find and join Tantre Farms, one of the CSA's (Community Supported Agriculture) in my area.

The very first time I served some fresh spinach from our CSA share (just simply lightly-steamed, nothing else), my husband looked up from his plate and asked me what I had done differently with this spinach. I asked him what he meant by that question, and he responded by saying it was the best spinach he had ever eaten in his entire life. That was not only quite a statement coming from a life-long spinach fan (!!), but a defining moment for me.

The number one reason why people eat what they do is taste. My husband's experience has led me to wonder if one of the reasons why people do not eat the recommended 5-9 servings/day of fruits and vegetables is that the eye-popping, taste-bud tingling taste as been bred out of most varieties in favor of other characteristics like enhanced packing and shipping ability. This spinach had everything going for it (the perfect trifecta, so to speak!): it was raised organically, it was locally grown plus very recently picked, and it was affordable.

Alas, my traveling schedule these past 10 years made it difficult to always be available to take a weekly shipment of food from our CSA, so I dropped our membership. In the following years, I was pleased to finally find frozen organic spinach by Cascadian Farms available in grocery stores. However, I often gasped at the price (always over $3.00 for a little container). Thus I was thrilled when a Trader Joe's arrived in my city, and they had frozen organic spinach for less then $2.00 for a larger size than what was available by the other brand. I bought lots of the Trader Joe's brand. Then one day, some new labeling caught my eye on the back of the bag - Grown in China. Hmmm.......The next time I bought some, I noticed some new labeling on the front of the bag - Grown on a family farm (still says grown in China on the back of the package).

Now I had many more conumdrums running through my mind.....and this was at least a year before the U.S. spinach fiasco in the fall of 2006. The questions in my mind were more generic than simply related to one specific food. I wondered how in the world I could really be reassured that an individual small family farm in China really had an organic produce production consistent with the USDA standards, how in the world each farm could be inspected and how each shipment could be checked, how in the world that bag of spinach coming frozen from China and being shipped 2/3 of the way across the US could really cost way less than the organic spinach produced in the US......(I was having these nagging worries about the use, cost, and global consequences of the oil needed for cooling and shipping a bag of spinach this distance even before the release of Al Gore's movie An Inconvenient Truth.)

One day my husband noted that I had not bought spinach lately..........What to say, how to sort out all these new thoughts, where were they leading? For a variety of reasons, they have led me to migrate "back home", back to "my farmer" at my CSA. I am still not a full-fledged member of Tantre Farms, but I am at their booth at my Farmers Market each and every Saturday or Wednesday that I am in town, stocking up on their organic and locally grown, recently picked, so tasty that is is "tinglely", and very affordable produce to supplement what is missing from our own garden.

Now of course, we have the former head of China's Food and Drug Agency being executed for taking bribes in regards to drug approvals, plus the multitide of additional problems with pet and human foods and other products imported from China. Good golly.........what has happened to our world? I am not an isolationist, and I don't know if I am ready to take on the complete "local food challenge", but I do know that I am well on my way back home to intentionally be a larger part of my own local community. It feels very good, and it the right thing to do for many reasons. As such, I appreciate and applaud the intention of the title of the new book about consuming local foods, Plenty by Smith and Mackinnon.

I have read and re-read the Hopi quotation in my July 12 post. I find something meaningful in every single line. As I end this post to make supper with my locally grown veggies, I hope you will also get to "know your garden (or your farmer)". At the very least, you may find it easy to increase your intake of fruits and veggies because you are discovering how mouth-watering delicious really fresh fruits and vegetables can taste!

Diana Dyer, MS, RD

Thursday, July 12, 2007

It should be "The 2007 Food, Health, and Farm Bill"

This post should also read URGENT!! for all people vitally interested in real food and real health for our local and regional communities.

Congress is getting very close to finalizing the 2007 Farm Bill, done every 5 years, which determines how billions and billions of our tax dollars are spent. You have an opportunity right now to voice your concerns about how your dollars have been spent in the past plus your opinions about how you would like your money spent in the future.

In a nutshell (paraphrasing from, current farm and food policies create an unfair playing field - one that works at the expense of healthy foods, local markets, family farmers, and the environment. Your help is urgently needed to bring our communities access to affordable. healthy, sustainably-produced, and locally-grown food today.

Many individudals and health, nutrition, and environmental organizations have been spending considerable time understanding the language and components of the bill, monitoring the progression of this bill, and then communicatng the importance, urgency, and opportunities for citizen input to this bill.

There are many places to read more detailed information about this bill, a summary of the concerns, and hopes for its final composition. One place is an article in the San Francisco Chronicle on July 11 (linked to the title of this posting). I also urge you to read information on the following web sites:
• Center for Health and Environment
• The Healthy Farm Bill and
* The Environmental Working Group
• Sustainable Agriculture Coalition
• Community Food Security Coalition

I have already written several letters to both of my senators and my congressional representative urging them to consider my points of view when writing or voting on the bill this month. Again, using information from, these are the points that I have emphasized for inclusion in the 2007 Farm Bill:
(1) Increase access to healthy affordable food, such as farmers markets and farm-to-school programs, plus hospitals and nursing homes,
(2) Help build a new generation of entrepreneurial farmers serving local and regional markets,
(3) Ensure fair access to agriculture programs for socially disadvantaged farmers and ranchers,
(4) Expand conservation and farmland protection programs to help farmers meet consumer demand for healthier and sustainably-produced foods.

I always stress to them that my concerns and perspectives are as a Registered Dietitian focused on both cancer prevention and cancer survivorship but also (and maybe even more importantly) as a mom, a potential grandmother, and a concerned citizen and voting constituent of their state.

Please, please, please take this opportunity to add your voices in support of these potential changes to the 2007 Farm Bill. which will improve the economics and overall health of your community by increasing the availability and affordability of healthy, locally and sustainably produced foods. One place that you may contact your senators and representative to send a short note of support is at the following web site:

I will close with this quote, which seems quite apt for this moment. I can especially relate to the lines "know your garden" (I added "or your farmers") and "do not look outside yourself for the leader".

"You have been telling the people that this is the Eleventh Hour,
now you must go back and tell the people that this is the Hour.
And there are things to be considered . . .
Where are you living?
What are you doing?
What are your relationships?
Are you in right relation?
Where is your water?
Know your garden (or your farmers-DD).
It is time to speak your Truth.
Create your community.
Be good to each other.
And do not look outside yourself for the leader."
Then he clasped his hands together, smiled, and said,
This could be a good time!"

• Attributed to an unnamed Hopi elder, Hopi Nation, Oraibi, Arizona

Yes, this could be a 'good time' if enough citizen input is provided now. I am hopeful.

My late-planted beans are coming up, and the tender shoots and/or remaining seeds have not yet been discovered by my local chipmunks, groundhogs, and birds! (wish me luck) :-)

Diana Dyer, MS, RD

Monday, July 9, 2007

Recipe - Chai-flavored iced tea

Here is another personal favorite recipe from my web site. In fact, I have used just the chai mix by itself to make delicious iced tea without even mixing it with milk or soymilk. It was very refreshing to drink after working in my garden (today was hot, hot, hot!). I made refrigerator iced tea by taking ~4 Tbsp. of mix, putting the mix into a small cotton bag with a pull drawstring (found this at my local food co-op), suspending the bag into a large glass canning jar that holds 6-8 cups of water. I then put the jar into the refrigerator and let it seep for an afternoon. The resultant tea is a beautiful clear light brown color, crisp-tasting, and delicious. I drink it "straight" without adding any milk or honey. I even re-use the bag of chai mix a second time with a smaller amount of water (4-6 cups).

Chai Mix

Most chai is either too sweet or too spicy for my tastes. However, it is a very healthful drink filled with natural compounds that have health-promoting properties. So I looked around for recipes and fiddled with some to come up with a drink that is mildly spicy and can be adjusted to one’s own level of sweetness desired. Just typing this recipe fills my senses with its robust aroma!

1 cup of bulk green tea leaves plus 2 Tbsp. of bulk black tea leaves (can often find in a natural food store or an Asian grocery store)
2 Tbsp. dried chopped ginger (I found this at a natural food store)
1 Tbsp. cinnamon chips broken into small pieces (put 2 sticks in a small zip lock bag and hit several times with a rolling pin to break into small pieces)
1 Tbsp. whole cloves
1 Tbsp. whole cardamon seeds (also found in a natural food store)
2 teaspoons whole anise star seeds (from natural food store – can purchase in bulk)
2 teaspoons whole black peppercorns

Mix the tea and spices.
Add 2 Tbsp. of the blend to 2 cups of liquid in a small saucepan. I use one cup of unflavored soymilk and one cup of water if I am going to serve it hot.
I use 3 Tbsp. of mix and 2 cups of soymilk if I am going to chill it with ice cubes.
Simmer gently for 20 minutes and then strain out the tea leaves and spices. (Try to keep from boiling.) Don’t skimp on the time of simmering. Sweeten to taste with honey.
This recipe makes enough for 32 cups of chai and fits into a 4x6 plastic bag.
The teas and spices all have components with cancer-fighting activity, so feel free to enjoy this traditional drink from India often.

You may click on the title of this post to go to the page on my web site where you can easily print this recipe. Yum, yum!

Enjoy, enjoy! :-)

Diana Dyer, MS, RD

Phytochemicals "phyt" cancer!

It was worth it to wait to make my tabouli recipe until the summer's first locally grown organic tomatoes became available. Oh my, yes, yes, yes - the taste was delicious and I had an immediate flash-back to last summer! I had a second big scoop, and although not sweet, it was like having dessert - yum, yum, soooo good.

Recent research has shown that over a 10 year growing period, organically grown tomatoes had an increasingly higher content of health-promoting phytochemicals than tomatoes conventionally grown under the same weather conditions. In fact, the ten-year mean levels of two phytochemicals called quercetin and kaempferol in organic tomatoes [115.5 and 63.3 mg g-1 of dry matter] were 79 and 97% higher than those in conventional tomatoes (64.6 and 32.06 mg g-1 of DM), respectively.

Why is this important? Phytochemicals are molecules produced by plants in order to protect themselves from disease, insects, or other stresses. So it makes sense that there would be higher levels in organically grown plants than those raised conventionally with chemical sprays to reduce competition from weeds, insects, and disease. These very molecules that are helping to protect the health of the plant also have increasingly recognized importance for our health, too. Both of the phytochemicals studied in this research have demonstrated anti-cancer activity against human cancer cells. They likely have additional health-promoting actions, too.

Thus, when I made a personal goal of maximizing the number of cancer-fighting foods going into my body, I also made a goal of seeking out not just any tomato (or fill in the blank) but those that also have superior taste (thus I am going to WANT to eat more of them!) plus also have more "bang for the buck" in terms of cancer-fighting activity.

Here is the full citation for the article I mentioned. You can click on PubMed under my Favorite Web Sites and find the abstract for the article using the key words "quercetin tomatoes".
Mitchell AE, Hong YJ, Koh E, Barrett DM, Bryant DE, Denison RF, Kaffka
S. Ten-Year Comparison of the Influence of Organic and Conventional
Crop Management Practices on the Content of Flavonoids in Tomatoes. J
Agric Food Chem. 2007 Jun 23.

Find your local Farmers' Market this week and purchase some organically grown tomaoes to try my cancer-fighting Tabouli recipe! In addition, I still saw tomato plants for sale at our Farmers' Market last Saturday, so it's not too late (but hurry) in my area to get some in the ground or in pots on your deck or patio. Plant some basil in an adjacent spot or pot, too, for a summer of delicious smells while waiting for delicious and healthful tastes!

Diana Dyer, MS, RD

Saturday, July 7, 2007

Most popular recipe on my web site!

Can you guess what it is? Week after week after week, my recipe for Tabouli is the most popular stop on my web site (after my home page). In fact the search term "tabouli" is the most common search term (on both google and yahoo) that people use to find my web site. Surprisingly to me, far more common than the terms "cancer nutrition" or some variation of those words.

So since we finally have fresh garden grown tomatoes at our farmers' market, it is time to start making my #1 all-time favorite food again! The first time my husband and I made it, we could not stop ourselves and ate the entire batch, which the recipe said was enough for 6! Here it is:


Tabouli Salad (adapted from the original place I found the recipe over 30 years ago, Diet for a Small Planet by Frances Moore Lappe)

The quickest way to get started eating this phytochemical-packed traditional Lebanese dish is buy some at a deli. My regular grocery store carries Tabouli pre-packaged in a little plastic tub. It's great to pick up to eat when traveling. Anyhow, if I have time, I "doctor it up" after I take it home by adding more diced tomatoes, sliced green onions with tops, and pre-cooked lentils or garbanzo beans. Most of the time there is enough dressing, but if not, just add another dash of lemon juice and olive oil.

Now for making the recipe from scratch (truly the best).

1 1/2 cups dry bulgar (buy dry bulgar is in the health food section of your grocery store or at a natural foods store)
4 cups boiling water
1 cup cooked, drained beans - garbanzo, lentil, or small white beans (can cook from scratch or use canned, pre-cooked beans from your pantry shelf)
2 cups fresh parsley - minced (can use your blender or food processor for this, or a chef's knife also works great ). In the summer, I use half parsley and half fresh mint. Don't worry about the amount - more is better here.
2 - 3 bunches green onions - sliced, both white and green parts
3 - 4 medium tomatoes, chopped (in the off-season, I spend the money on the vine-ripened tomatoes for the best flavor)
1/2 cup or more fresh lemon juice
1/4 cup extra-virgin olive oil (this is the first recipe I ever bought olive oil for)
1 tsp. salt

Pour the boiling water over the dry bulgar in a medium to large bowl and let sit ~1-2 hours until water is absorbed. Drain very well using a colander. Bulgar will now be light and fluffy.
Once bulgar is done, mix all the ingredients together. Chill for several hours or overnight.
Beautiful to look at and absolutely delicious to eat! Enjoy :-)

I really don't think it is possible to improve my Tabouli recipe, but here are two modifications that add a twist without taking anything away: Feel free to use either or both adjustments.

* Use the whole grain quinoa instead of bulgur (I use quinoa by Bob's Red Mill, which is already washed and ready to cook).
* Use lemon balm in place of regular mint. Be careful if you grow this in your garden as it spreads like crazy, just like the other mints.

You may click on the title of this post to go to the page on my web site where you can easily print this recipe. Yum, yum!

Off to watch the remaining minutes of the women's finals at Wimbeldon (some day I'll get there to watch in person!).
Diana Dyer, MS, RD

Thursday, July 5, 2007

Local Foods

I need to take the current book I am reading back to the library tomorrow (Animal, Vegetable, Miracle by Barbara Kingsolver). I am not finished, but I want to make a few comments now. I have also read the following books: Plenty by Alisa Smith and JB Mackinnon, The Omnivore's Dilemma: A Natural History of Four Meal by Michael Pollan, Food Politics by Marion Nestle, Fast Food Nation by Eric Schlosser, and Hope's Edge: The Next Diet for a Small Planet by Frances Moore Lappé and Anna Lappé.

All these books have a common theme, although all come at it from a different perspective: what we choose to eat makes a difference, in essence, we are voting on many issues at once each time we use our fork. Whether we choose to spend out time gardening or seeking out our locally produced foods, cooking, putting up (canning, freezing, drying) foods to be used as our own healthy convenience foods at a later time (or during the winter months) versus choosing the conspicuous consumption of food that has already been processed using a multitude of the cheapest ingredients possible and transported over 1000 miles, we are making decisions several times each day that are affecting the health of our planet, economies, and all people.

I'll be talking much more about all of this in my future blogging. Right now, I'll just say that I am very excited because I have a good lead for a truly local source of humanely and organically raised chickens, turkeys, and eggs. I'll add that I'll be checking out Animal, Vegetable, and Miracles by Barbara Kingsolver from the library again (long waiting list) and I'll bet that I ultimately purchase this book. In the meantime, you can visit for recipes from the book and information and inspiration for "going local". (Again, sorry that you'll need to cut and paste this url until I figure out how to make the link active - I guess I'd rather spend time weeding that being a computer geek!)

Signing off to get a load of books ready to ship to Amazon and then out to the garden!

Diana Dyer, MS, RD

Nutrition Education Failing

A review of studies has shown that millions and millions of dollars spent on nutrition education for children in schools and even the few advertisements for healthy foods on TV are not helping kids change their eating habits away from the junk that is so pervasive.

The most telling comment in the article is a quote by a pediatrician who said that basically parents need "to get religion" about all aspects of healthy lifestyles in order for children to avoid obesity or reverse it. I can completely relate to that comment! After my childhood cancer experience, my parents decided to learn everything they could about nutrition and even became early subscribers to Prevention Magazine in the 1950's! My family (myself and 3 brothers) ate very differently growing up than all my friends (for example - I never saw white bread until I went to high school and ate lunch at school for the first time - we only ate whole wheat bread way back then!). We were all active (my dad made sure that we all had the skills for what he called a lifetime sport, which was tennis), he had us doing physical fitness type of exercises at night along with our homework in the evening, we ran around the block as many times as we could in the evening, too. I took all that lifetime of habits and used them with my family, too.

So why my worry?

The number of overweight and obese children is staggering, appalling, and heart-wrenching, plus getting larger every year. If these children do not die of heart-disease or complications of diabetes at ages that are way too young, they are set-ups for any one of many different cancer diagnoses that are increased with overweight and obesity (post-menopausal breast cancer endometrial cancer, kidney, colon, gall bladder, and prostate). And I can them all from experience that they don't want to deal with any one of those if they don't have to!

I don't know the answer(s) to solving this childhood overweight/obesity problem, and make no mistake, it is a huge problem with staggering emotional and economic fall-out to come. The answers are certainly multi-faceted and still to be determined.

However, as my younger son is beginning his teaching career as a middle school science teacher (he is "the outdoor/science guy" - they loved him in his interview for many reasons, including the fact that he asked about their School Wellness Policies, school gardens, and getting urban kids into the outdoors), I am widening the scope of my vision beyond cancer survivorship to begin thinking more than I have in the past about cancer prevention. I'll keep you posted as I think more about this problem and help my son figure out what options he has in his position to help the next generation learn the connections between their knowledge, behavior, and their current and future health.

You may click on the title of my blog posting to view the entire article. (I think I have figured out how to do this - hope, hope!)

Diana Dyer, MS, RD

Monday, July 2, 2007

Does your insurance company cover nutritional counseling?

If your cancer center does not yet have a Registered Dietitian(s) (RD) on staff as part of the team of oncology professionals providing your comprehensive cancer care, check to see if your insurance company is now including nutrition counseling sessions as part of your coverage. Here is an example of one company that has seen the light and is leading the way!
Independence Blue Cross, the Philadelphia region's largest health insurer, will begin providing its members up to six nutrition counseling visits per year starting July 1. The new benefit, free to most members, is designed to complement IBC's other programs focused on encouraging healthy lifestyles, including cash reimbursements for consistency with fitness and weight-loss programs.

"We are dedicated to helping our members lead healthier lives," said Joseph A. Frick, IBC's president and CEO. "Since obesity is both preventable and treatable, we at IBC want to proactively educate the community about its risks."

Dr. I. Steven Udvarhelyi, IBC's senior vice president and chief medical officer, noted that being overweight increases the risk of many chronic diseases including hypertension, high cholesterol, type 2 diabetes, arthritis, heart disease, stroke, gallbladder disease, osteoarthritis, sleep apnea and some cancers.

Beginning July 1, adults and children covered through IBC's Personal Choice and Keystone Health Plan East HMO and point-of-service products will have access to six nutrition counseling visits per year with their physician or a registered dietitian. There are no out-of-pocket costs to members when the services are provided by in-network providers. However, a referral for nutrition counseling is required for HMO members. Deductible and coinsurance cost sharing will apply for visits to an out-of-network provider and for self-referred visits by point-of-service members.

I recommend that you call your health insurance provider to ask when they will be providing this level of preventive care for nutrition. Some companies will provide 1 or 2 visits/year with an RD, which is not adequate to evaluate a person's nutritional needs, rank priorities, work with the patient to determine which behaviors need changes, develop a plan, provide the information and motivation to implement the plan, reassess a patient's progress (or lack) and needs, continue counseling and cheerleading, communicating with the patient's other medical team members as necessary, etc, etc. You get the picture that 1-2 visits per year is like throwing one bucket of water on a fire that has been smoldering if not raging for years!

I LOVE seeing progress like this that really gives some strength to the FRESH START data (see previous post today). It's one thing for me to be saying that people will benefit from individualized nutritional counseling, but to both have published data in hand and the means to actually help people put this into practice by having access to multiple visits with an RD are two huge steps forward. :-)

Signing off to work in the garden,
Diana Dyer, MS, RD


I had a great week "doing nothing". Well, I spent less time at my computer than usual, but I am still getting projects completed or delegated and off my desk. So this post is not about my "fresh start", but the FRESH START Trial done at Duke University's Cancer Center, which evaluated tailored versus generic advice to cancer survivors for improving diet and lifestyle behaviors after a cancer diagnosis.

This study (funded by NCI, AICR, and The Komen Foundation) mailed cancer survivors either generalized information about ways to improve eating and increase exercise OR they were mailed information that was tailored to improving an individual's current specific dietary or lifestyle behaviors during a 10 month time period. Then these same people were followed for one year and called to check on what they were eating and how much they were exercising.

After 10 months of mailings and one additional year of follow-up, the study found that both arms significantly improved their lifestyle behaviors (P < .05), which is good. However, the important point is that significantly greater gains occurred in the FRESH START intervention group versus the control group. For example, when comparing the intervention group to the control group, 34% versus 18% practiced two or more goal behaviors (P < .0001); the intervention group increased exercise minutes per week by 59.3 minutes versus +39.2 minutes (P = .02); the intervention group increased consumption of F&V per day by +1.1 serving versus only +0.6 servings in the control group (P = .01); the intervention group decreased total fat intake by –4.4% versus –2.1% (P < .0001), saturated fat by –1.3% versus –0.3% (P < .0001), and BMI by –0.3 versus gaining +0.1 kg/m2 (P = .004).

Why is this study important? Because cancer survivors have other health problems, too, and are also at higher risk of developing other chronic (but preventable) and costly health problems such as diabetes, heart disease, and osteoporosis, besides secondary tumors, all of which can lead to early death or significant decrease in quality of life. All of the information given to encourage diet and lifestyle changes can lead to decreasing risk for developing these other chronic diseases and other cancers.

I have been advocating for the past 10+ years that cancer survivors would benefit by having individualization of diet and lifestyle information, rather than people being told to simply "eat right and exercise". I didn't know what that well-intended but much too general advice really meant for me!! I needed a consult for myself with a dietitian who had experience with oncology at that time, and I had to first push my doctor for a referral (I didn't take "No" for an answer), and then look outside my own cancer center at that time to find one.

My advice? Don't wait for this study to be expanded or repeated or for the materials and method used to be fine-tuned and/or made available for use at your cancer center. If you are a cancer survivor, ask for a referral (and insist if you have to!!) to a Registered Dietitian (RD) who has experience with oncology patients. I repeat, don't wait. You can reduce your risk of developing additional health problems plus optimize both the quality and quantity of life by improving diet and exercise habits now. It is not too late!

If your cancer center does not have an RD (or has one who is too, too, too busy because there is only one RD for hundreds if not thousands of patients), you can be an advocate yourself at your own cancer center for hiring RDs to provide nutritional care for all the cancer patients who need it. You can even use this article to show the administrator how individualized nutrition and lifestyle information is beneficial for cancer survivors.

Here is the full citation for the article just published.

Journal of Clinical Oncology, Vol 25, No 19 (July 1), 2007: pp. 2709-2718
© 2007 American Society of Clinical Oncology.

Main Outcomes of the FRESH START Trial: A Sequentially Tailored, Diet and Exercise Mailed Print Intervention Among Breast and Prostate Cancer Survivors

Wendy Demark-Wahnefried, Elizabeth C. Clipp, Isaac M. Lipkus, David Lobach, Denise Clutter Snyder, Richard Sloane, Bercedis Peterson, Jennifer M. Macri, Cheryl L. Rock, Colleen M. McBride, William E. Kraus

Signing off to have lunch outside (72 degrees, clear and sunny, Michigan at its best!)
Diana Dyer, MS, RD