SEARCHING FOR THE CANCER DIET PATIENTS TURN TO VEGETABLES, GRAINS, OMEGA 3S IN HOPES OF KEEPING DISEASE AT BAY.

Byline: Story by Mariko Thompson Staff Writer

Bob Each is a dietitian's dream. He loads up on fruits and vegetables. He favors lean proteins in the form of soy, fish and the occasional turkey burger. He chooses ``good'' fats in olive oil and avocado while avoiding ``bad'' fats found in butter and red meat.

The 59-year-old Agoura Hills resident has reason to be motivated. He was diagnosed with prostate cancer nearly eight years ago and has outlived his doctors' prognostications several times over. He can't say for sure that his low-fat, vegetable-rich diet has extended his life, but he likes to think it has.

``Hope is the biggest feature,'' Each said. ``I have very advanced disease. There's no way I can be fixed with today's technology. Diet is part of the plan that contributes to my survival.''

During treatment, cancer patients are encouraged to eat whatever they can to keep up their strength. With early detection efforts and treatments improving the odds of surviving cancer, an increasing number of Americans are asking how they should eat after treatment.

Dietitians say little research has been done in this area. What experts recommend to the country's estimated 9 million cancer survivors has been based on observations of what appears to prevent cancer in the first place, said Cheryl Rock, professor and registered dietitian at the Rebecca and John Moores University of California, San Diego, Cancer Center.

``In terms of the science, there have been few studies on how nutritional factors relate to recurrence of cancer,'' Rock said. ``The gold standard is a clinical trial. It's particularly important in diseases that are complicated.''

Can food help?

While many of the recommendations for cancer prevention appear to apply to recurrence, there are intriguing exceptions that point to the need for more research, Rock said.

For example, studies suggest that eating a diet rich in vegetables lowers the risk of breast cancer in young women and also prevents a recurrence in survivors. But the same finding hasn't held true for alcohol. Studies have linked alcohol with a modest increase in breast cancer risk. Yet drinking alcohol doesn't appear to raise the risk of recurrence in breast cancer survivors, she said.

``You really can't make assumptions,'' Rock said. ``There are changes in biology'' after cancer treatment.

Rock is a co-investigator for the Women's Healthy Eating and Living Study (WHELS), which involves more than 3,000 breast cancer survivors in the western United States. The study is examining whether a plant-based diet prevents recurrence and, if so, what the optimal number of servings per day should be. Another trial sponsored by the National Cancer Institute, the Women's Intervention Nutrition Study (WINS), is looking at whether reducing dietary fat has an impact on recurrence.

Though observational data suggest diet plays an important role, other variables could be at work, notes John Pierce, head of cancer prevention at the UCSD cancer center and lead investigator of the WHELS study. Those variables include genetics, exercise and weight. The results of the WHELS and WINS studies should form a clearer picture of diet's role.

``We're going to see how much diet really helps and how much change you need to do,'' he said.

Part of the whole

Until science provides concrete answers, what rules should people follow after being diagnosed with cancer? First of all, don't confuse the potential health benefits of certain foods with a cure, said Barrie Cassileth, chief of integrative medicine at Memorial Sloan-Kettering Cancer Center in New York and co-editor of the American Cancer Society's ``Eating Well, Staying Well After Cancer.''

Patients would be unwise to substitute a special diet for standard cancer treatments, she said. Surgery, chemotherapy and radiation have boosted the cure rate for cancer to 65 percent in the United States. In undeveloped countries that rely on ancient traditional remedies, the cure rate is only 20 percent, Cassileth said.

``There are many diets sold by proponents as cancer cures,'' she said. ``This is total nonsense.''

Lately, Tamar Apelian, clinical nutrition manager at Glendale Adventist Medical Center, has fielded questions about coral calcium, an expensive supplement touted as a cancer treatment. Nutrition experts say coral calcium doesn't live up to the inflated claims. It's not much different from the run-of-the-mill calcium supplement except in price, according to the Berkeley Wellness Letter.

``With herbal supplements, there are no valid recommendations,'' Apelian said.

Once treatment is finished, dietitians recommend a plant-based diet. Every May, Apelian leads a discussion on nutrition at the hospital's annual Feast for Life event, where a dinner based on American Cancer Society guidelines is served. The American Cancer Society recommendations for people who have finished treatment include five to seven servings of fruits and vegetables per day, high-fiber foods including whole-grain breads, and low-fat dairy products.

Dietitians place fruits and vegetables at the foundation of a healthy diet because of the phytochemicals providing protection to the body's cells. Some patients worry about exposure to trace amounts of pesticides on produce. Diana Dyer, an Ann Arbor-based registered dietitian who runs the Web site www.cancerrd.com., says they should feel no pressure to buy organic. Studies linking high intake of fruits and vegetables to cancer reduction have been based on conventionally grown produce, said Dyer, who survived a childhood cancer and breast cancer.

``Where your budget allows, choose organic,'' she said. ``If that's not in the budget, wash them well. Let that little piece of worry float away.''

Dietitians also say people need to educate themselves about ``good'' fats and ``bad'' fats. Stick to unsaturated fats, which have a beneficial effect on cholesterol levels. These can be found in olive oil, nuts and avocado. Also eat flaxseed and certain types of fish, such as ocean-caught salmon, containing omega 3 fatty acids. Reduce saturated fats found in meat, whole-fat dairy products, and palm oil. Trans fats, found in many snack foods and margarine, act like saturated fats. Trans fats appear as ``hydrogenated'' or ``partially hardened'' on ingredient lists, Dyer said.

``People don't need to be as fat phobic as they have in the past,'' Dyer said. ``It's important to read food labels.''

Many cancer survivors also are concerned about processed or convenience foods. Again, the key is being an educated consumer. Dyer notes that some companies sell healthy convenience foods. A falafel mix made of legumes and spices that needs only water is a better choice than a box of macaroni and powdered cheese that requires milk and butter, she said.

Dyer continues to be an advocate for more research on nutrition and cancer recurrence. Proceeds from her book, ``A Dietitian's Cancer Story,'' go toward an endowment at the American Institute for Cancer Research for nutrition studies.

``The concept of the cancer survivor is on the radar screen now,'' Dyer said. ``The paradigm is changing. You can't do that without incorporating nutrition as a component of true comprehensive cancer care.''

Mariko Thompson, [phone]

mariko.thompson(at)dailynews.com

The colors of healthy eating

Most Americans eat only three servings a day of fruits and vegetables instead of the recommended five to nine. Not only should you strive to eat more than five servings, you also should incorporate the seven different color groups, according to Dr. David Heber, director of the UCLA Center for Human Nutrition and author of ``What Color Is Your Diet?'' Each group provides different phytochemicals that confer protective benefits from disease, including cancer. And no, iceberg lettuce and french fries don't count toward your daily servings, Heber said.

Here are the seven color groups and their potential benefits:

Red

Tomatoes, pink grapefruit, watermelon 

Contains lycopene; improves prostate health

Red/Purple

Grapes, red wine, grape juice, prunes, cranberries, blueberries, blackberries, strawberries, red apples

Contains anthocyanins; reduces risk of heart disease

Orange

Carrots, mangoes, apricots, cantaloupe, pumpkin, acorn squash, winter squash, sweet potatoes

Contains alpha- and beta-carotenes; promotes eye health and protects from heart disease and certain forms of cancer.

Orange/Yellow

Orange juice, oranges, tangerines, peaches, papayas, nectarines

Contains beta-cryptothanxin; reduces risk of cancer

Yellow/Green

Spinach, collard greens, mustard greens, turnip greens, yellow corn, green peas, avocado, honeydew melon 

Contains lutein and zeaxanthin; contributes to eye health

Green

Broccoli, Brussels sprouts, cabbage, bok choy, kale 

Contains sulforaphane, isothiocyanate and indoles; produces cancer-fighting enzymes

White/Green

Garlic, onions, celery, pears, white wine, endive, chives 

Contains allicin and quercetin; reduces risk of cancer and heart attack, lowers cholesterol.

CAPTION(S):

8 photos, box

Photo:

(1 -- cover -- color) Food fight

Can diet ward off cancer?

(2 -- 8) no caption (fruits, vegetables, bread)

Phil McCarten/Staff Photographer

Box:

The colors of healthy eating (see text)