New Diet and Exercise Guidelines for Cancer Survivors

The American Cancer Society (ACS) has updated its 2003 guidelines on the use of diet, exercise, and nutritional supplements by cancer survivors. These guidelines, often cited as the official statement of the conventional cancer community on complementary and alternative (CAM) therapies, could be improved.

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The ACS diet and exercise recommendations continue to be authoritative but not as helpful as they could be.

The diet recommendations describe whole foods diets high in fruits, vegetables, and whole grains; low in saturated fat; and low in refined sugars. These are important recommendations as a huge body of research shows that a whole foods diet low in processed foods is one of the most effective ways to prevent cancer.

The ACS exercise recommendations push aerobic exercise for nearly every cancer survivor, consistent with evidence showing improved quality of life during cancer treatment with regular exercise. We would like to see more emphasis on strength training.

The disappointing aspect of the new recommendations is their complete dismissal of the growing body of research showing specific nutritional supplements can help with some of the symptoms cancer survivors face. The official statement argues that because antioxidant supplements could potentially prevent chemotherapy from having full treatment effect, all nutritional supplements should be avoided.

The most striking problem with this generalization is that not all nutritional supplements are antioxidants. L-glutamine, often used for the prevention of neuropathy, and vitamin B6, used for the prevention of hand/foot syndrome, are two examples of the many well-researched non-antioxidant nutritional supplements of potential benefit to cancer survivors. Many more clinical pearls of this nature could and should be part of future versions of these guidelines.

Read the full text of the ACS Guidelines.

References:

1. Doyle C, Kushi LH, Byers T, et al. Nutrition and physical activity during and after cancer treatment: an American Cancer Society guide for informed choices. CA Cancer J Clin. 2006 Nov-Dec;56(6):323-53.
2. Vahdat L, Papadopoulos K, Lange D, et al. Reduction of paclitaxel-induced peripheral neuropathy with glutamine. Clin Cancer Res. 2001 May;7(5):1192-7.
3. Fabian CJ, Molina R, Slavik M, et al. Pyridoxine therapy for palmar-plantar erythrodysesthesia associated with continuous 5-fluorouracil infusion. Invest New Drugs. 1990 Feb;8(1):57-63.

Related Topics:

• WebMD Video: Cancer and Exercise
• Nutrition to Help You Fight Cancer

Technorati Tags: integrative medicine, supplements, antioxidents, cancer, diet, exercise, health-and-wellness

Harmful Substances Watch: Mercury

Fish have made this heavy metal quite famous, and restricted intake of fish has been recommended by a wide variety of public health organizations due to risk of mercury contamination. But do you know your mercury-and-fish limits? Canned tuna is the most likely source of mercury exposure for U.S. consumers who eat fish. Just how much can you eat each week and still stay safe?

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Like all environmental toxins, mercury can be found in great variety of locations and amounts. Some oceans are lined with ores that contain natural mercury deposits. The Mediterranean Sea, for example, contains cinnabar (mercury sulfide) deposits that can leech into the water and find their way into Mediterranean fish. Tuna from the Mediterranean tends to be higher in mercury than tuna from the Atlantic or the Pacific for this reason.


Human activities, however, can be an equally significant source of mercury contamination. Over 100 tons of mercury are released annually into the air by U.S. industries - primarily coal-fired power plants, municipal waste combustion facilities, and incinerators that handle medical waste. Mercury also finds it way into landfills across the country in the form of fluorescent light bulbs, thermostats, and electrical components (including components still used in automobiles).

Once deposited in the soil or in the air, mercury can be transported by natural ecological forces to groundwater, rivers, and oceans. This movement of toxins through our environment (along pathways called "transfer vectors") can bring mercury into the natural habitat of fish thousands of miles away from the original site of contamination.

When it comes to canned light tuna, a good ballpark guideline for safe mercury intake can be based on body weight alone. For every 10 pounds of weight, allow yourself just under one ounce (technically, 0.95 ounces) of canned light tuna per week. If you weigh 150 lbs., for example, limit yourself to 14 ounces (or approximately 2 cans) of tuna. For canned albacore tuna, however, this restriction becomes much greater, because canned albacore averages substantially more mercury than canned light. With albacore, for every 10 pounds of weight, allow yourself only 1/3rd of an ounce per week. In this case, if you weigh 150 pounds, restrict yourself to 5 ounces (less than one can) per week.


While body weight can give you an initial ballpark estimate for restricting your canned fish intake, it's important to note that your body and your lifestyle are unique. You may have other important sources of mercury exposure, and you may have unique metabolic needs when it comes to detoxification of mercury inside your cells. For these reasons, a truly personalized assessment of your mercury exposure and mercury risk can be helpful for planning your fish intake (and other dietary decisions as well).

Several health organizations, including the U.S. Environmental Protection Agency (EPA), have issued advisories cautioning pregnant women (and women considering pregnancy) against excess consumption of mercury-containing fish. For the latest EPA advisory, click here.


References:

1. Adams DH. (2004). Total mercury levels in tunas from offshore waters of the Florida Atlantic coast. Mar Pollut Bulletin 49(7-8):659-63.
2. Hood, E. (2003). A diet rich in fish. High-end consumers face more mercury risks. Environ Health Perspect 111(4):A233.
3. Kraepiel AM, Keller K, Chin HB et al. (2003). Sources and variations of mercury in tuna. Environ Sci Technol 37(24):5551-8.
4. Schober SE, Sinks TH, Jones RL, et al. (2003). Blood mercury levels in US children and women of childbearing age, 1999- 2000. JAMA 289(13):1667-74.
5. Storelli MM, Stuffler RG, and Marcotrigiano GO. (2002). Total and methylmercury residues in tuna-fish from the Mediterranean sea.
6. Food Addit Contam 19(8):715-20.
7. Sunderland EM. (2007). Mercury exposure from domestic and imported estuarine and marine fish in the U.S. seafood market. Environ Health Perspect 115:235-242.

Related Topics:

• WebMD Video: Mercury and Seafood
• Canned Tuna: Avoid if Pregnant?

Technorati Tags: tuna, mercury, toxins, environment, health-and-wellness

A Cautionary Tale - Too Much of a Good Thing

Robert is a now a true believer in natural medicine - having suffered from migraine headaches for many years, a few visits to a naturopathic doctor several years ago resulted in complete remission of his condition. Unfortunately, he is now suffering from chronic diarrhea and visits to his gastroenterologist, family practice medical doctor and naturopathic doctor have not solved the problem.

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Robert, an unusually healthy and fit 60 year old white male, had suffered from migraines for many years. While Sumatriptan was effective in shortening the duration of his headaches, they kept recurring, and he did not like the drug's side effects.

A few years ago, he went to a naturopathic doctor and, through diet changes and nutritional supplements, experienced complete relief. About a year and a half ago, he started developing loose watery stools. Assessment and intervention by his family practice MD, family practice ND, and gastroenterologist who ordered GI x-rays found no cause and no effective treatment.

After hearing him describe his diarrhea as "explosive" and full of air, I immediately thought of solute diarrhea. This kind of diarrhea can happen when a person consumes more of the small molecules that bind water than the body can absorb. Typical examples are too much vitamin C (most people get this kind of diarrhea if they consume more than about 5 grams a day) and candies sweetened with sorbitol (a kind of sugar substitute with fewer calories and not very well absorbed by the body). As his vitamin C content was only about 1,000 mg/day, and he consumed no artificial sweets, I next asked him about magnesium. Too much magnesium can cause the same symptoms, while a deficiency can, in some people, cause migraine headaches.

Turns out that he was taking magnesium supplements, and it had played a major role in relieving his migraines. I asked him to look at everything he was taking that included magnesium. Adding up his multivitamin, meal replacement drink and magnesium supplement, he found he was unknowingly taking a whopping 2,500 mg every day! This is over 5 times the RDA, and most people get diarrhea when they consume more than 1,000 mg. Decreasing his magnesium to a much more reasonable 800 mg per day immediately cured his diarrhea.

Unfortunately, his migraine headaches returned!

This told me he was having trouble absorbing magnesium, both from his intestines and also into his cells. I then recommended pyridoxal-5-phosphate, the activated form of vitamin B6 which transports magnesium into cells.. 15 mg of P-5-P resulted in full remission again of his migraines, and no diarrhea.

My key take away:

It's all about balance. While most natural therapies are safe and often effective, it is always possible to take too much of a good thing.

Related Topics:

• Taking Supplements? Tell Your Doctor
• Test Your Supplements Savvy

Technorati Tags: supplements, migraine, integrative medicine

Flu Season

This week, we find ourselves right in the peak of flu season. Luckily, it looks as though the particular strains of flu going around this year are fairly mild.

Of course, if you are currently suffering through the body aches, respiratory problems, and gastrointestinal symptoms of the flu, it may not feel like a mild flu season. Here are a few recommendations to help get you back to health if you are feeling down.

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If you develop flu-like symptoms and are concerned about your illness, especially if you are among those at high risk for complications of the flu, it's best to check with your doctor. People at high risk for complications include those who are 65 years or older, those who have chronic medical conditions, pregnant women, and young children.

Tests can determine if you have the flu - if you're tested within the first 2 to 3 days of illness.

A doctor's exam can also identify whether you have the flu or a more serious complication. Flu can often be complicated by pneumonia, and when it is, it should be treated aggressively. When secondary bacterial infections, such as pneumonia, are not present, antibiotic therapy is of no help in the treatment of the flu, and should be avoided. You should also never give aspirin to children or teenagers with the flu, as serious side effects could potentially occur. If fever spikes uncomfortably high, Tylenol or cool sponge baths should help.

It is particularly important to drink lots of liquids to maintain hydration during acute illness, especially if diarrhea or vomiting occur. Many people use sugary sports drinks or fruit juice for this purpose; I prefer a nourishing clear vegetable broth or minimally sweetened vitamin and mineral drinks like Emergen-C.

Many traditional herbal treatments have been shown to be effective to treat acute infection. Elderberry syrup, sold in the U.S. as Sambucol, is one of my favorites, especially for children, who enjoy the flavor. Researchers have found it to be both safe and effective. Take one tablespoon four times daily, one and a half teaspoons four times daily for children. Start at the first sign of illness for the best results.

If you have a sore throat, try boiling 4 tablespoons marshmallow root (you can buy this in bulk from many healthfood stores) in 2 quarts of water for a half-hour or until the liquid gets thick and syrupy. Cool, strain, and mix with 4 tablespoons of honey. Use 1 teaspoon at a time as needed until your symptoms improve.

Keep in mind that you can spread infection from the day before symptoms start until about five days after getting sick. Obviously, you can't do much about the day before symptoms start, but try to minimize social interaction and get plenty of rest in the period after getting sick. The extra rest should get you back up and running in a matter of days.

Related Topics:

• CDC recommendations on influenza
• Germ Warfare: Common Cold & Flu Culprits

References:

1. Kinmonth AL, Fulton Y, Campbell MJ. Management of feverish children at home. BMJ. 1992 Nov 7;305(6862):1134-6.


2. Zakay-Rones Z, Thom E, Wollan T, Wadstein J. Randomized study of the efficacy and safety of oral elderberry extract in the treatment of influenza A and B virus infections. J Int Med Res. 2004 Mar-Apr;32(2):132-40.


3. Basch E, Ulbricht C, Hammerness P, Vora M. Marshmallow (Althaea officinalis L.) monograph. J Herb Pharmacother. 2003;3(3):71-81.

Technorati Tags: colds, flu, integrative medicine, natural remedy

Everyday Toxins

Can you name something we depend on each day for our health and well-being that can also serve as the source of more than 100 harmful substances? Answer: everyday drinking water.

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It's difficult to come up with a comprehensive list of potentially toxic substances found in ordinary, everyday drinking water. That's because there are literally thousands of potential toxins and toxic sources. Every year, approximately 150 million tons of solid waste are dumped into our nation's 7,500 municipal landfills. Over time, toxins found in this solid waste can make their way down into the groundwater and eventually pass over into our drinking supply. Waste incinerators, manufacturing waste, and use of treated sewage sludge as an agricultural fertilizer are other common sources for toxic contamination of our drinking water.

The U.S. Environmental Protection Agency (EPA) sets standards -- and routinely monitors -- over 80 different toxic substances commonly found in our drinking water. Many of these substances are common agricultural pesticides, like alachlor, atrazine, or lindane. Others are heavy metals, like cadmium or lead. Also found are plastics like styrene or vinyl chloride. More than 1,000 potentially toxic substances have been found in drinking water from water supplies throughout the United States, and some toxins, like the pesticide atrazine, are found in virtually all city and county-regulated water supplies.

What you can do about all of these toxins is quite simple: you can choose your drinking water carefully, and treat it as an all-important aspect of your diet when it comes to quality. Even if you live in a region where watersheds are fairly clean, you are likely to need some type of home water-filtering system, unless you'd prefer to buy high-quality bottled water. We like solid-block carbon filters (especially the kind that can be installed under the sink). Reverse osmosis filters are also an excellent way to achieve high-quality drinking water.

When it comes to bottled water, we like natural mineral and spring waters (especially those bottled in glass rather than plastic). When water is allowed to naturally percolate down through the soil, it can pick up substantial amounts of many minerals, including minerals like calcium and magnesium that we often have difficulty optimizing in our diet. For this same reason, we typically avoid distilled water, because too many of these beneficial minerals get removed during the distilling process.

For more complete information about drinking water contaminants, click here.

References:

1. Environmental Working Group. (2005). A National Assessment of Tap Water Quality. National Tap Water Quality Database. December 2005 Report. Available online here.
2. Lubick, N. Emerging DBPs in drinking water. Environ Sci Technol. 2006 Dec 1; 40(23):7112-3.
3. Manassaram, D. M.; Backer, L. C., and Moll, D. M. A review of nitrates in drinking water: maternal exposure and adverse reproductive and developmental outcomes. Environ Health Perspect. 2006 Mar; 114(3):320-7.
4. Rodriguez-Mozaz, S.; de Alda, M. J., and Barcelo, D. Monitoring of estrogens, pesticides and bisphenol A in natural waters and drinking water treatment plants by solid-phase extraction-liquid chromatography-mass spectrometry. J Chromatogr A. 2004 Aug 6; 1045(1-2):85-92.
5. Sinclair, C. J.; Boxall, A. B.; Parsons, S. A., and Thomas, M. R. Prioritization of pesticide environmental transformation products in drinking water supplies. Environ Sci Technol. 2006 Dec 1; 40(23):7283-9.
6. Squillace, P. J.; Scott, J. C.; Moran, M. J.; Nolan, B. T., and Kolpin, D. W. VOCs, pesticides, nitrate, and their mixtures in groundwater used for drinking water in the United States. Environ Sci Technol. 2002 May 1; 36(9):1923-30.
7. Thacker, P. D. Pollutants persist in drinking water. Environ Sci Technol. 2005 Feb 1; 39(3):58A-59A.
8. Vieira, V.; Aschengrau, A., and Ozonoff, D. Impact of tetrachloroethylene-contaminated drinking water on the risk of breast cancer: using a dose model to assess exposure in a case-control study. Environ Health. 2005; 4(1):3.

Related Topics:

• Toxins in Dust Raise Risk of Asthma
• Environmental Illness: Toxins in our Environment

Technorati Tags: toxins, environment, drinking water, wellness

Welcome to Wellness!

I am honored and very excited to be WebMD's Wellness and Natural/Integrative Medicine expert. I have been doing this work for more than 35 years, first as a student, then as a clinician, educator, researcher, author, public policy expert and spokesman.

I believe we suffer from a huge amount of unnecessary ill health and disease today because a critically important body of healing wisdom is not understood or being used properly. We have created this blog to make this body of knowledge accessible, practically applicable and safe for you.

My basic beliefs:

1. Each person is their own best doctor and should be in full control of their health and healthcare decisions.


2. Our body has an incredible ability to heal, if we just give it a chance.


3. Our modern diet, lifestyle and environment strongly promote disease and ill health.


4. Health care decisions should be made on the basis of good scientific evidence.

I hate the term "alternative medicine." It requires either/or, one or the other. This is not the best medicine. The best medicine is that which integrates conventional and natural medicine in the best interests of the patient.

Conventional medicine is very good at diagnosis and treating serious injuries and life-threatening disease. At times it seems almost miraculous. In contrast, natural medicine is very good at understanding the underlying causes of disease and ways to use natural therapies to help the body heal and optimize health. Although results are rarely as dramatic as seen in some conventional interventions, the patient suffering for years from an "incurable" disease cured by a simple herb or nutrient considers this as miraculous. Integrative medicine, the collaborative merging of these parallel perspectives in healthcare, is the best medicine.

When starting Bastyr University in Seattle, WA, in 1978, I coined and implemented the concept of science-based natural medicine. I knew that for this medicine to be accepted, it had to have a strong scientific foundation. I also believed we had to do research -- not to prove ourselves but rather to get better.

While I am a true believer in the philosophical concepts of natural medicine (more on that another time), that does not mean that every therapy we use is necessarily safe and effective. The only way to truly know is to do research.

Many in the natural medicine community felt threatened by this perspective. I asked them how they knew their therapies worked. Their response, "Many of my patients get better." My response, "The placebo effect is very powerful and many patients will get better despite what you do. What if you are using a therapy that actually harms the patient, how would you know?" The only way to know is through research.

I realized that for this medicine to be taken seriously and fulfill its promise of health and healing, it had to grow up. It had to develop accredited education, engage in objective research, write modern textbooks (the most current natural medicine textbook when I was a student had been written in the year I was born), develop more consistent clinical standards and become more savvy politically and socially.

To accomplish this, I lead Bastyr to become the first accredited university of natural medicine (not just in the U.S., but in the English speaking world) and to become the first NIH-funded center for natural medicine research; coauthored the Textbook of Natural Medicine (the most widely read definitive work on science-based natural medicine); was appointed to the White House Commission on Complementary and Alternative Medicine Policy; and became founding editor of Integrative Medicine: A Clinician's Journal. I have been licensed as a naturopathic physician in the state of Washington since 1975.

In this blog, I and my special team will cover important topics in wellness and natural/integrative medicine. Every week we will write about new research on food and health, the natural/integrative medicine perspective on important health topics, and the health effects of environmental toxins, and we will answer questions you send us. Right away when you look at our short articles, you will see both our perspectives on an issue and the research we used to form our opinions. Whenever there is breaking news in integrative medicine or in conventional medicine that would benefit from our perspective, we intend to respond within 24 hours (hopefully sooner). Finally, we will periodically tell informative stories about our patients - both successful and unsuccessful.

I think you will find our philosophical approach, firmly based on strong science, refreshing and immediately useful. We hope you will find us a trusted health resource for you and your family.

Coming next week: The problem of "green drugs."