My integrative oncologist has me on a remission maintenance program designed to keep any residual cancer cells from proliferating and also designed to prevent the development of new cancers caused by chemotherapy and radiotherapy.1 The program consists of diet, supplements, and physical fitness, as well as stress reduction and avoidance of carcinogens.
My first integrative oncologist had me on a diet that was organic and mostly vegetarian, with a little grass-fed meat, pastured dairy (meaning it came from grass-fed animals), no refined carbohydrates, and filtered water. On the positive side, I was allowed red wine and dark chocolate. This was not too hard to follow at home, but it was very hard to follow in restaurants. If I insisted on restaurants that served only organic, grass-fed foods, I would lose all my friends. As a result, I cheated quite a bit.
After the first integrative oncologist retired, my new one pointed out that I likely have cancer in my body, so I need to get serious about the diet. Sadly, his diet is even more restrictive. I can have fish, egg whites (and the occasional omega-3 yolk), and whey protein, but no other animal products—no meat, no dairy—and no refined carbohydrates. There are several reasons why meat and dairy is considered conducive to cancer growth.2 First, meat is usually high in iron, which stimulates the creation of free radicals; free radicals cause damage to the DNA, which can lead to mutations. Second, red meat and poultry, especially if they are grain-fed, are packed with omega-6 fats that cause a pro-inflammatory environment that helps cancer grow. Third, meat and dairy contain cholesterol, and high levels of serum cholesterol are linked to poorer outcomes for cancer patients. Fourth, consuming a lot of meat and dairy will increase levels of the hormone estradiol, which can stimulate the growth of tumors. Fifth, milk is high in the protein casein, which may also stimulate tumor growth. Finally, animal protein raises levels of IGF-1 (insulin-like growth factor-1) more than other foods, and too much IGF-1 causes some forms of cancer to grow more easily (mainly breast and prostate).3 In addition, it is known that meat and dairy products, as well as large fish at the top of the food chain provide more than 90% of human exposure to known contaminants such as dioxins, PCBs, and certain pesticides that persist in the environment even though they have been banned for years.4
Fish is healthier than meat and dairy because it is lower in cancer-stimulating factors, and fatty fish is also rich in omega-3 fats, which are antiinflammatory and therefore inhibit the growth of cancer. The best fish to eat are small fatty ones like anchovies, small mackerel, and sardines. Canned sardines are all right if they are preserved in olive oil and not sunflower oil, which contains omega-6 fatty acids. Bigger fish, such as tuna, shark, and swordfish should be avoided because they are contaminated with mercury, PCBs, and dioxins. Salmon should be wild rather than farmed. Although salmon farms are much better than they used to be, they still have major problems. Excessive use of chemicals, such as antibiotics, anti-foulants and pesticides can harm marine life and human health. Chemicals and excess nutrients from food and feces can disturb the plants and animals on the ocean floor and reduce biodiversity. Because viruses and parasites transfer between farmed and wild fish as well as between fish farms, the farms present a risk to wild populations and other farms. Sometimes farmed salmon escape and compete with wild fish and interbreed with local wild stocks of the same population, altering the gene pool. Excess food and fish waste increase the levels of nutrients in the water and have the potential to lead to oxygen-deprived waters that stress aquatic life. In addition, salmon farms also frequently have issues concerning labor practices and worker rights and conflicts with neighbors who share the coastal environment.
Doing without meat or dairy at home is easier than in restaurants. I eat a lot of fish, and I have also learned how to flavor tofu and seitan so they taste good, although I haven’t succeeded yet with tempeh. I cook a lot of beans and lentils. There are organic vegan substitutes for butter and mayonnaise that taste good, but, to me, the substitutes for milk, cream, and cheese are quite nasty. The most tolerable milk and cream substitute I have found is one I make myself from cashews.
In addition to fish, I can have egg whites and whey protein, and I am supposed to consume a lot of organic vegetables and whole grains, and green tea. On the positive side, I can drink red wine and dark beer, and I am also allowed to cheat in a major way four times a year. The diet is actually quite detailed in terms of both allowable foods and serving sizes, but I just do the best I can.
I am also supposed to avoid refined and high glycemic index (GI) carbohydrates, mainly sugar and anything made with processed flour, or grains that have had the whole grain extracted, like white rice, refined cereals, pastas, and snack foods. These are rapidly broken down into simple sugars which are readily absorbed into the bloodstream, causing risky spikes in blood insulin levels. High GI diets have been linked to many diseases, including digestive and hormonally related cancers, such as colorectal, liver, pancreatic, breast, endometrial and ovarian.5 I buy (organic) whole grain bread, pasta, cereal, and rice as well as other whole grains like quinoa, farro, barley, etc. Corn tortillas, chips, and popcorn are whole grains, but they must be organic, because almost all corn in the U.S. is genetically engineered. There are also a number of lower-glycemic natural sugar substitutes. For example, sugar has a GI score of between 65 and 110, depending on the type, but stevia has a GI score of 0. I don’t like the bitter aftertaste of stevia, but I do like agave syrup, which has a low-enough score of 15, and xylitol (which is made from plants), which has a score of 7. When in doubt about a food, I Google its GI score.
I envy people who love vegetables; it’s very hard for me to eat as many vegetables as I’m supposed to. I read a lot of cookbooks and I finally found a helpful tip from a former chef at Chez Panisse.6 She said that as soon as possible after you bring your load of organic, locally-produced veggies home, you should cook them all—roast or sauté them with your preferred seasonings—and put them in glass jars in the fridge. That way you will eat them rather than leaving them to fester in the crisper. When I see them in their jars, they inspire me to do things with them: use them in a salad, a soup, a sandwich, a pasta sauce, a vegetable tart, a curry or other stew, etc. If they are in the crisper, all they communicate is “Help—we are rotting.” This does not inspire me, because nobody wants to eat rotting vegetables. Another tip in the same excellent book is to roast or sauté vegetables longer than you think you should. Most vegetables do not taste good al dente; longer cooking brings out their sugars. These two tips have helped me a lot, but I still can’t say I enjoy spending a lot of time on food preparation. Fruit is easier because most of it tastes good raw, but I am supposed to eat more vegetables than fruit. Part of my protocol also includes powdered vegetables that I add to soups or put in smoothies with flaxseed meal (which contains omega-3s), blueberries (super healthy), cashew milk, and half a banana or some dates to sweeten it. The drink helps to bring up my vegetable total, although not very enjoyably.
Some time ago I read that Beyoncé and Jay Z went on a vegan diet that had meal delivery. I figured that if the company was selling to celebrities the food could not be too terrible, and it wasn’t exceptionally expensive. So I ordered five meals delivered as a trial, but unfortunately, they were quite small and I did not enjoy them. Then my hairdresser told me that she has a farm deliver a box of organic fruits and vegetables every week. This sounded like a good way to make sure I eat enough vegetables and also to make sure I have enough variety, because they will send whatever is in season. You can customize your box, so I usually choose a combination of staple veggies and new and challenging ones. This week the new ones I chose include maitake mushrooms and fresh tarragon. So far, this has been a good way to get more enjoyment as well as health from eating vegetables.
As for meals out, at first I tried going to vegan restaurants, but I did not like them at all. I find that I do much better at regular restaurants. A lot of the vegetarian options don’t work for me because they often contain cheese or butter, but most restaurants serve fish, and I like that a lot. When I go on a cruise or a tour, they will accommodate my diet. However, cruises and tours do not usually serve organic food, so I eat what they have. I pretty much never cheat by eating meat—I save that for special occasions like Christmas, Thanksgiving, and my birthday (maximum of four times a year). If they serve delicious French or Italian bread with no whole grain option, I will eat it, but I will request olive oil instead of butter. I don’t order things that I know have cheese or cream or butter in the sauce, but if it sneaks in without me knowing it, I don’t inquire too closely. I mostly order fruit for dessert, but if there is an unusually fabulous dessert I will eat it, or split it with someone. At home I eat vegan dark chocolate. Sometimes I melt it and use it as a dip for fresh fruit, or I mix in dried fruit or nuts, then put it in the fridge to harden. I also use raw cacao powder mixed with agave syrup or xylitol and cashew milk to make hot chocolate in winter or iced chocolate in summer. I make an easy but satisfying chocolate pudding by stirring the cacao plus sweetener into non-dairy yogurt made with coconut milk.
I think the thing that makes it possible for me to stick to my diet as well as I do is that I know in my heart that eating animals is wrong. (Of course, fish are animals too, but I will just have to forgive myself for that.) Mainly, I am profoundly grateful that I did a lot of serious eating in my previous life, because now I can live on my memories of bistecca Fiorentina, Brazilian churrasco, Korean bulgogi, Spanish bellota ham, suckling pig and lamb, foie gras, and gelato, among many other wonderful, delicious, and deeply fulfilling experiences (sigh).
This might be a good place to mention alcohol. The definitive study, at least for me, was done at the University of Texas and published in the journal Alcoholism: Clinical and Experimental Research in 2010.7 A team led by psychologist Charles Holahan followed 1,824 people aged 55-65 for 20 years. Researchers controlled for variables that might skew the results, such as former problem drinking, existing health problems, socioeconomic status, age, and gender. They defined nondrinkers as those who did not drink during the duration of the study, whether or not they drank in the past; moderate drinkers had 1 to 3 drinks a day; and those who drank more than that were designated as heavy drinkers. Twenty years later, they found that the nondrinkers had the most deaths (69%), followed by the heavy drinkers (60%), but only 41% of the moderate drinkers had died. There is a lot of speculation about the reasons for these findings, but my guess is that drinkers, like eaters, live longer because they are happier and more social.
The studies about alcohol and breast cancer recurrence are confusing and inconsistent. My integrative oncologist allows red wine and dark beer because he thinks their health benefits outweigh the alleged dangers. I am not pleased with this restriction, but red wine and dark beer are enough for me to be happy and social, and I am hoping they will also increase my longevity.
- The remission maintenance program described here is from Block, Keith. Life over Cancer: The Block Center Program for Integrative Cancer Treatment. New York: Bantam Dell, 2009, pp. 532-543. (Go back)
- Ibid. pp. 66-68. (Go back)
- Levine, Morgan E., Jorge A. Suarez, Sebastian Brandhorst, Priya Balasubramanian, ChiaWei Cheng, Federica Madia, Luigi Fontana, Mario G. Mirisola, Jaime Guevara-Aguirre, Junxiang Wan, Giuseppe Passarino, Brian K. Kennedy, Min Wei, Pinchas Cohen, Eileen M. Crimmins, and Valter D. Longo. “Low Protein Intake Is Associated with a Major Reduction in IGF-1, Cancer, and Overall Mortality in the 65 and Younger but Not Older Population.” Cell Metabolism 19, no. 3 (March 4, 2014): 407-17. (Go back)
- Servan-Schreiber, David. Anticancer: A New Way of Life. New York: Viking, 2008, p. 87. (Go back)
- “Sugar and Cancer.” Oncology Nutrition. July 2014. Accessed January 29, 2016. https:// www.oncologynutrition.org/erfc/healthy-nutrition-now/sugar-and-cancer/. (Go back)
- Adler, Tamar. An Everlasting Meal: Cooking with Economy and Grace. New York: Scribner, 2011. (Go back)
- Holahan, Charles J., Kathleen K. Schutte, Penny L. Brennan, Carole K. Holahan, Bernice S. Moos, and Rudolf H. Moos. “Late-Life Alcohol Consumption and 20-Year Mortality.” Alcoholism: Clinical and Experimental Research 34, no. 11 (November 2010): 1961-971. (Go back)