Tuesday, September 25, 2007

Cancer Survivorship Care Plans

Calling all cancer patients!!

Ask your cancer doctors (surgeon, medical oncologist/hematologist, radiation oncologist) which one of them is going to develop and explain your Cancer Survivorship Care Plan at the end of your treatments. Don't go home after treatment is completed simply to say to yourself "What do I do now? What's next? What do I need to monitor?" or worse, and I mean this sincerely, simply put your head in the sand or your blinders on while saying "Whew, that's over with, now I can forget this ever happened".

My own oncologist candidly told me several years ago that the oncology community didn't even know there was a ball game in town (i.e., unmet survivorship concerns) to have dropped the ball. How's that for being straight forward?

Grass roots efforts have changed that understanding, with the oncology community catching up by gradually developing guidelines for survivorship concerns geared to specific cancers and specific cancer treatments. They consist of a written summary of your diagnosis and treatments along with recommendations for specific follow-up health issues of concern based on the type of treatments.

These written guidelines are not yet developed for all cancers, there is no "mandate" requiring them (yet) as part of true comprehensive cancer care, and there is concern that doctors won't have the time anyway to actually use them to help you take care of yourself after the cancer treatments. SO, I highly recommend that YOU (the patient) insist on your doctor doing so.

Survivorship concerns are legitimate concerns and frankly are a "problem of success". If cancer was not diagnosed early enough to be considered treatable, there would be very little call for more proactive and coordinated care for those people living years, even decades, after a cancer diagnosis, as is frequently the case these days.

These care plans are to include specific nutritional and lifestyle recommendations for optimizing health and wellness after cancer, too, so make sure that those concerns are included and discussed in your cancer survivorship care plans. Don't let your doctor tell you nutrition does not matter or to just "eat right and exercise". Ask for a referral to a Registered Dietitian who can help assess your current nutritional status post-treatment, ALL of your nutritional concerns (i.e., do you need to lose weight or gain weight, are you at risk for or already have developed diabetes, heart disease, osteoporosis, etc, in addition to wondering what foods are the best to eat to reduce the risk of your type of cancer recurring). She will also help prioritize and pull all these concerns together, work with you in a step-wise fashion to develop a plan for the changes that are both helpful and reasonable, and then be your cheerleader along the way as you make these changes for your health.

Take care of yourself! Speaking up to ask for these cancer survivorship care plans as a component of your full comprehensive cancer care is important. Don't by shy. Think of your self-advocacy as "Active Hope"!

Diana Dyer, MS, RD

Friday, September 21, 2007

A New Food (but I'm the last to discover it!)

Ha, ha, ha - I love a good laugh, even at my expense. :-)

My husband and I stopped at a little farm stand on the west side of Michigan this week, looking at all the varieties of apples. The woman working at the stand urged us to try the Honeycrisp apple. We were hesitant. Why? They were enormous, there were only three of them in the basket, plus they weren't beautiful. The woman was very surprised that we had not heard of this variety. She even assured us that they were Oprah's favorite apple and that Oprah herself had even stopped at that farm stand. (!!) Hmmmmmmm.......... Well, ok, I suppose anything is possible, and I'll try anything once.

When we got back to the cottage we were renting for the week, we washed one and cut it into at least a dozen slices (I told you they were large!). Well, I was humbled; yes, it was startlingly delicious, not too sweet and with a great crisp texture.

Imagine our surprise when we later talked to both of our sons to tell them about this apple and both of them (yes, BOTH of them!) told us that they know all about these apples. Well, what planet have we been on that we have missed this variety? I just had to laugh and laugh and laugh. One son works at Whole Foods and said that his store has 15-16 varieties of apples in their produce section and that they sell one Honeycrisp for each of every other variety they sell on a daily basis. Our other son said he has been buying Honeycrisp at his Farmers' Market for years, but he knows that you have to get there early to get them as they are sold out of that variety in the first hour of sales.

Well, as I said, I just laughed and laughed and laughed. Yes, what planet have I been on? Maybe this just proves the point about my own advice - get down to your local Farmers' Market (early!), farm stand, or local grocery store and look for something new to try in the produce section. I'm thinking that there are just so many foods to try that it is a challenge to find them all. However, that won't stop me from trying.

Mostly I'm just so proud that my boys appreciate real food. Years and years ago when my boys were still quite young, I had a friend tell me she was amazed that I actually spent so much time and energy to make so much of our food from scratch. Having my boys know more than I did about this variety of apple has made all the time and effort that I put into cooking real food worthwhile. :-)

What new food have you tried recently?

Diana Dyer, MS, RD

Thursday, September 13, 2007

Recipe - Pure and Simple Pesto

I have tried many variations of pesto (using kale, adding flaxseeds, with roasted red peppers, etc) all of which are wonderful. However, our garden is actually bursting with basil this year, so it was time to finally bring in the harvest to get the pesto made and in the freezer.

I have a friend who makes hers with a mortar and pestle but I use my food processor, which makes short work of this recipe.

Basic Pesto Recipe

* 2 cups fresh basil leaves, packed (I mean it, don't skimp, pack the leaves in!)
* 1/4 cup freshly grated Parmesan cheese
* 3-4 Tbsp. extra-virgin olive oil
* 3-4 Tbsp. pine nuts
* 3-4 garlic cloves, peeled and smashed with the side of a large knife

I divided everything into 3 batches and after first chopping the basil in the food processor (be careful not to overdue the chopping or the basil can turn brown), then add the rest of the ingredient to the food processor, pulse a few times to blend (but still leave it a bit chunky) all together. I mix all three batches in a larger bowl, then put dollaps (~ 1 Tbsp) of the pesto into ice cube tray cubicles, freeze a few hours, pop them out into a zip-loc freezer bag, and then you are set for multiple uses all winter long.

This is not a purely local food. The last time I looked, I have not found Michigan olive oil or pine nuts. However, both the basil and garlic were from our garden, so I think that counts for something!

Now lick the spoon, scraper, knife, food processor bowl, anything you have used to get every last little bit of this delicious seasoning - yum, yum!

Diana Dyer, MS, RD

Wednesday, September 12, 2007

Tangerine Peel Fights Cancer

A new research study in the news today reported that a molecule called Salvestrol Q40, found in tangerine peel, destroyed cancer cells in a laboratory setting. Every winter when tangerines come into season, I periodically add a whole one to my soy shake recipe, peel and all. I have been doing this for 12 years. I love the taste (zing!) and I always figured there must be something good in those peels. I know that other researchers have been studying various molecules in other citrus peels for their anti-cancer activity, too, although there are not yet a lot of published studies.

Don't wait for a new chemotherapy or chemopreventive drug to be developed from this research. Eat your whole foods now, yes, including the peelings (at least a little bit, once in a while!).

Here is the basic recipe for Diana's SuperSoy and Phytochemical Shake:

2 1/2 oz. soft or silken tofu (1/6 of a 1 lb. block)
3/4 cup of soy milk
1 large carrot or 6 - 8 baby carrots
3/4 cup of orange juice
3/4 cup fresh or frozen fruit
1-2 tablespoons of wheat or oat bran
1-2 tablespoons of wheat germ
1-2 tablespoons of ground or whole flax seed

Don't be afraid to vary the recipe and spice it up. Adding a whole tangerine is a great addition. :-)

Diana Dyer, MS, RD

Tuesday, September 11, 2007

How tough it is to navigate the waters of dietary supplements

Recently, there was an inquiry and subsequent discussion on a professional listserv on which I participate regarding the possibility of increasing platelets during cancer therapy with diet and dietary supplements. One responder (whom I greatly respect) suggested considering the use of a dietary supplement that contains compounds called alkylglycerols.

I have both a personal and a professional interest in this discussion as my own platelets levels have been lower than the normal range for decades, at least since my early 30's and even before I had any chemotherapy. The most likely reason is that my bone marrow (where platelets are produced) suffered some significant and irreparable damage secondary to the radiation therapy that was used to treat my neuroblastoma diagnosis when I was 6 months of age. Thus I have read a lot of information (research and testimonials) about various recommendations for improving platelet counts and platelet function (if you don't have many, it's good to have the ones you do have working well!).

In a nutshell, I have not found anything of any substantive value that has had a direct impact on improving my total platelet count, particularly when they were quite low (much less than 100,000). With all sincere respect, I admit that I probably think about this interesting information differently than my colleague and most other Registered Dietitians (even those highly knowledgeable about complementary medicine) because my training was first as a biologist, then a nutritionist. As such I am uneasy about the availability and promotion of certain dietary supplements like the alkylglycerols. Alkylglycerols are sourced from sharks that are a by-catch of unsustainable fishing practices. Also, the bulk of data bolstering the recommendation of this product are in vitro only. For these, and many other reasons, I see serious problems with this picture.

My biggest concern is that the economics clearly are being placed ahead of the science, which can have very serious consequences. As an example, when the New Zealand fishing industry finally figured out how to get rid of the layer of fat under the skin of the orange roughy fish, orange roughy became a fish highly promoted for "heart health" because it was so lean. Prior to that it was considered a junk fish, actually called "slimefish", and never eaten because the composition of the fat caused severe diarrhea when consumed.

Very rapidly, orange roughy was available to eat everywhere, and people were consuming a lot of it. The life cycle of the fish had not been studied adequately before it became all the rage. It turns out that the fish needs to be alive for at least 20 years or so before it is even sexually mature. Essentially the orange roughy population collapsed and is now under strict fishing management in Australia and New Zealand. Sadly, it is not necessarily regulated from other sources like China and Namibia, and it will take decades for the population to recover. It has been over 15 years since I have purchased orange roughy either for home use or at a restaurant.

How is this example related to the source of alkylglycerols? The source of this compound is from sharks caught in the trawling nets that are dragged along the bottom of the ocean (disrupting ecosystems in ways we have only begun to have a glimpse of understanding) in order to catch, you guessed it, primarily orange roughy in the deep waters off the coasts of New Zealand. Shark populations world-wide are at historically low levels with half of the 100 million killed each year the result of by-catch. One side of my brain says it seems good to use the by-catch for research on understanding how some molecules may promote health, but the other side of my brain argues that creating a hot market for a product from the by-catch before the science is really strong will only slow down if not eliminate reasons for the fishing industry to change damaging and non-sustainable practices.

Healthy people, healthy economies, healthy planet - it is really really hard to keep all the necessary factors in mind to guide our recommendations and actions as nutritionists (and as human beings). My first dream was to become an environmental biologist and that dream and early training still influence my thinking and actions.

More info about consuming fish that are good for us and good for the oceans can be
found at:http://www.montereybayaquarium.org/cr/seafoodwatch.asp

My bottom line: when considering the use of dietary supplements, read, read, read. Get much more complete information about the product you are considering than what you will obtain from anyone selling it (MLM, clinic or professional office, health store clerk, web site, etc). Seek out the advice of a Registered Dietitian (RD) who can help you determine your goals and then sort through the research available to help you make the best decision for your situation. Only you can really determine the big picture that is important to you (your comfort circle) for evaluating which supplements may provide benefit. Of course this same process is true for any CAM or conventional therapy.

I recently heard a friend say that getting old is not for wimps. I would expand that to say that taking charge of your health is not for wimps. However, if you don't do it, someone else will. Who better than you to know what is best for you? My approach is "Active Hope"; I hope I have given you some "food for thought" to make it your approach, too. :-)

Diana Dyer, MS, RD

Monday, September 10, 2007

Diana Dyer Cancer Survivor Endowment at AICR

Way back in 1999, I initiated discussions with The American Institute for Cancer Research (www.aicr.org)about giving a substantial financial donation to the important work they do, which is funding research that focuses exclusively on nutrition and cancer and then developing various means of educating the public about eating healthier diets and tastier foods to help prevent cancer.

At that time, there was very little awareness of the need for research and subsequent science-based nutritional and lifestyle recommendations to help the millions and millions of people who are cancer survivors make the best choices to optimize their odds for long-term survival that offered true hope, not just hype (or worse, potential harm).

AICR enthusiastically shared my vision and sense of urgency regarding this lack of research and education for cancer survivors. To help them broaden their goals and mission, I established The Diana Dyer Cancer Survivors' Nutrition and Cancer Research Endowment, which is managed by AICR. My endowment annually helps to fund an AICR research project that is focused on a nutritional strategy (either during treatment or recovery) that will hopefully enhance the odds for long-term cancer survivorship or optimize the quality of life after a cancer diagnosis.

My selection for 2007 is an important project that urgently needs answers. I am helping to fund research by Renee Royak-Schaler, PhD at The University of Maryland who is studying "A culturally-specific dietary plan to manage weight gain among African American breast cancer survivors." The other projects that I have funded are all listed on on my web site at the following URL:
http://www.cancerrd.com/faqs/faq53.htm (sorry that you have to cut and paste - I really thought I had finally figured out how to make the link for you - not yet I guess)

My endowment is primarily funded by the proceeds from the sale of my two books, A Dietitian's Cancer Story plus the Spanish language edition, Historia De Cancer De Una Dietista. In addition, I am very grateful to all the people who have made their own personal donations during the past seven years to my endowment, which greatly helps increase the level of research that can be funded each year. You may read more about my endowment at the following URL:

It is very hard to believe that my book was first published 10 years ago at my neighborhood Kinko's. It has been reprinted 12 times since then (however now at a "real" book printer), and because it is still selling very well, I am getting ready for yet another reprint because there is still so much more nutrition research for cancer survivors that needs funding!

Diana Dyer, MS, RD

Health Insurance for Cancer Survivors

Your health: Caring for cancer
Published: 9/9/2007

When cancer strikes, you might use your health
insurance more than ever before. You might also
encounter more problems getting coverage. To help pts
navigate these challenges, the advocacy group National
Coalition for Cancer Survivorship has updated its
guidebook, "What Cancer Survivors Need to Know About
Health Insurance."

The booklet describes pros & cons of different types
of insurance policies, Medicare Part D & laws that
protect cancer survivors. It also includes resources
for additional help and info. The book is available in
English & Spanish.

Download a free version or request a copy:

Diana Dyer, MS, RD

Saturday, September 8, 2007

Books - Plenty and Appetite for Profit

I'm re-reading Plenty/The 100 Mile Diet by Smith and Mackinnon, and I had better hurry up because I have another book on reserve at the library called Appetite for Profit: How the Food Industry Undermines our Health and How to Fight Back by Michele Simon. I think this book by Simon will be right up there with one of my favorite books Food Politics by Marion Nestle. I'll let you know.

I admit to finding it "curiouser and curiouser" that the vast majority of people who are writing books about these important food policies are not within the nutrition community per se.

Diana Dyer, MS, RD

September is Eat Local Challenge Month!

Try it - you'll like it! Yes, find the day, time, and location of your local Farmers' Market and get down there to meet your local farmers, your friends, make new friends, smell the basil (oh wow, it's almost intoxicating at this time of year!) and buy something!

The web site linked to the title of this blog will inspire you and guide you to increasing the amount of locally produced foods into your diet, whether for a meal, a day, a week or an entire month.

I picked up my half bushel of red sweet peppers this morning from Tantré Farms stand at our local market, plus some beautiful red and yellow stemmed chard and local sweet corn. Then we talked to a young couple bringing an old orchard back to life organically and made arrangements to purchase a bushel of green grime apples later in the month to make our winter's supply of applesauce. After that we signed the petition urging Al Gore to run for President, bought whole grain muffins plus coffee and then sat down to people watch and just drink in the happy atmosphere and beautiful sights and smells.

All this plus dog walking and we were home by 10 am, with my husband now off to pick gallons of tomatoes at our community garden and start canning again this afternoon. I'll pick some beauties to slice and dry. too, as I am having great fun with my new (used) dehydrator.

I have not had time to do any of this years and years. I LOVE being on sabbatical. The house smells GREAT! :-)

I recently read that the Iowa State University Leopold Center for Sustainable Agriculture concluded in their 2006 economic impact analysis that if Iowans ate five servings of Iowa-grown fruits and vegetables each day for three months, they could help create nearly 4,100 new jobs — more than all the new ethanol plants have created in Iowa.

Now there's a challenge that is likely achievable for most of us in most states, at least at the height of the harvest season. Help your state's economy (which we REALLY need in Michigan), help save your planet, eat delicious and more nutritious foods all at the same time by voting with your fork. I could go on and on and on, but I am really eager to get back into my kitchen and start roasting my organically and locally grown red sweet peppers. I'm looking forward to pulling them out of the freezer all winter long. :-)

Diana Dyer, MS, RD

Wednesday, September 5, 2007

Select Michigan Day - Sept 13, 2007

Everywhere I look, I am reading and hearing more and more about the benefits of purchasing locally raised food and other products. The Michigan State legislature has officially designated September 13, 2007 as its third annual Buy Fresh, Buy Local - Select Michigan Day. Find a local Farmers' Market, a local farm stand, or a grocery store that purchases and highlights locally produced foods.

I'm celebrating this event by purchasing a large amount of organic red sweet peppers from a local farm that I will roast and freeze to have available during this winter. I am always distressed that organically grown sweet peppers are nearly impossible to find in stores anytime of the year, but especially during the winter. Even then these conventionally grown peppers have often been imported and cost a bundle, all for a food that the Environmental Working Group has put near the top of their list of vegetables that are the most heavily contaminated with pesticides. So I am very excited about my upcoming purchase this coming Saturday morning and look forward to spending my afternoon roasting and freezing my winter supply of locally grown organic red sweet peppers for a very reasonable price!

Addendum: I just realized that I left this post in the draft folder and didn't publish it - whoops! I must have gotten distracted. Now I have my peppers so it's off to the kitchen for an afternoon of roasting and freezing, looking forward to a winter of yummy and healthy roasted red peppers on pizza, in hummus, pasta, sandwiches, and on and on and on!

Let me know what you bought from your Farmers' Market. :-)

Diana Dyer, MS, RD

Tuesday, September 4, 2007

Recipe - Vegetarian Stuffed Peppers

What to have for supper? My Farmers' Market is tomorrow, and I want to avoid going out to the grocery store today if possible. What is in my refrig, freezer, and pantry that I can use without needing to go to the grocery store today?

Here is what I came up with for a Stuffed Pepper recipe that was easy, delicious, and combined the use of some fresh veggies, left-overs, food from the freezer, and even one jar of freshly processed tomatoes that did not seal.

1 very large green pepper (I mean large - this pepper was probably the size of my 2 fists put together)
1 medium onion, small dice
3 small cloves fresh garlic, peeled and smashed or diced small
1 Tbsp. extra-virgin olive oil
1/2 cup from 2 cups of left-over cooked brown rice
1/2 cup of cooked pinto (or other variety) beans (I cook mine from scratch and store them in ziploc bags in the freezer so I can shake out just the amount I need for a recipe)
1/2 cup of 1 pint of canned tomatoes (if using store-bought canned tomatoes, open a 15 ounce can) - I used the heritage variety called yellow Kellogg Breakfast tomatoes from our garden, a variety originally developed by the Kellogg family here in Michigan
4 veggie "meatballs" from the package in my freezer (I used those made by Green Giant)
Freshly grated parmesan cheese

To assemble:
Cut the green pepper in half length-wise, scoop out the seeds, pare out any white pulp.
Sauté the onion and garlic in the olive oil until softened, maybe 5 minutes, taking care not to burn
Place onion and garlic in a bowl. Add 1/2 cup rice, beans, 1/2 cup tomatoes - mix and smush the tomatoes if needed
Spray a medium size baking dish with no-stick spray (I use olive oil).
Place green pepper halves into dish, open side up.
Place 2 "meatballs" into each empty green pepper half.
Then spoon the rice and bean mixture into each tomato half.
If there is any extra mixture, place it into the baking dish. Add the rest of the tomatoes and rice to the baking dish around the green peppers.

Bake covered at 325 degrees for 45-60 minutes or until filling is hot and green pepper is soft and easy to cut.
After removing cover, grate a bit of cheese over the pepper filling. It should melt in a minute if you replace the cover while setting the table.

This was a great supper for two people. I served small slices of whole wheat sourdough bread to sop up all the extra sauce, water and some red wine and fresh fruit. Yum, yum!! Even my husband commented that this was the best stuffed pepper recipe we have ever made.

Notes: I think it really helped to even out the cooking of the peppers by having the rice already cooked instead of counting on it cooking during the baking of the pepper. One thing I always do is make a big batch of rice in my rice cooker so that I have extra to use during the week. Here was a recipe made easy and delicious because I had the rice cooked up and ready to go. Canned beans and canned tomatoes could also be used and are always be on my pantry shelf or in the case of beans, in my freezer when I am organized!

Enjoy, enjoy the cornucopia of the end of summer harvest! Find your local Farmers' Market and purchase one or a bushel of something to eat tonight and also put away for a taste of summer in January!

Diana Dyer, MS, RD

Sunday, September 2, 2007

Recipe - End of Summer Salsa

Run down to your local Farmers' Market, farm stand, or even your own backyard to get your locally grown, end of summer, ripe tomatoes. Really this recipe can be made anytime, but make sure you are using vine-ripened tomtoes! My niece made this recipe recently for a family gathering. My husband also remembered that we had this salsa served at my niece's college graduation celebration last year. So make a big bowl of it, buy some baked chips, and dip away as you consume multiple foods with cancer-fighting and overall health promoting ingredients. Use any extra as a topping for baked potatoes, veggie tacos, refried beans, scrambled eggs or tofu, etc, etc. Olé!

Salsa Recipe
6 large cloves of garlic minced
1 bunch of green onions white parts thinly sliced or 1/2 sweet onion minced
1 bunch cilantro thinly sliced as a bunch down to the stem
5 roma tomatoes (or the equivilent) small diced
2-3 tablespoons tomato paste (optional)
10-12 good shakes of ground cumin
10-12 good splashes Red Hot Sauce
juice from one lemon
coarse salt (just a pinch to start)
Combine all the first ingredients.

1 Tbsp. canola, olive, or any other mild oil. Add the oil slowly to suspend the ingredients.

If an even "tomatoier" salsa is preferred, add an additional 2-3 tablespoons tomato paste, mixing first with a little bit of water or additional oil before adding to other ingredients.

Thanks, Candice, for sharing your mouth-watering recipe!

Diana Dyer, MS, RD