Here’s a simple recipe for a whole-food version of a tasty cranberry beverage, what I call my Pink Juice:
1 handful fresh or frozen cranberries
500 ml water
8 teaspoons erythritol (a naturally derived low-calorie sweetener; read more about erythritol and other sweeteners in part 2)
Place all the ingredients in a blender and blend at high speed. Pour over ice and serve.
At just twelve calories, this recipe has twenty-five times fewer calories and at least eight times more phytonutrients than typical cranberry juice drinks.80
For an extra boost, blend in some fresh mint leaves. You’ll get a weird-looking green foam on top, but not only will it taste good, you’ll be happy to know that you’re chugging down berries and dark, leafy greens, two of the healthiest foods on the planet. Bottoms up!
Coffee
Back in 1986, a group of Norwegian researchers came across an unexpected finding: Alcohol consumption was associated with liver inflammation (no surprise there), but coffee consumption was associated with less liver inflammation.81 These results were replicated in subsequent studies performed around the world. In the United States, a study was done with people at high risk of liver disease—for example, those who were overweight or drank too much alcohol. Subjects who drank more than two cups of coffee a day appeared to have less than half the risk of developing chronic liver problems as those who drank less than one cup.82
What about liver cancer, one of the most feared complications of chronic liver inflammation? It is now the third-leading cause of cancer-related death, an upsurge driven largely by increases in hepatitis C infections and nonalcoholic fatty liver disease.83
The news is good. A 2013 review of the best studies to date found that people who drank the most coffee had half the risk of liver cancer compared to those who drank the least.84 A subsequent study found the consumption of four or more cups of coffee a day was associated with 92 percent lower risk among smokers dying from chronic liver disease.85 Of course, quitting smoking would have helped as well; smoking may multiply by as much as tenfold the odds of those with hepatitis C dying from liver cancer.86 Similarly, heavy alcohol drinkers who consume more than four cups of coffee per day appear to reduce their risk of liver inflammation—but not by nearly as much as people who cut down on alcohol.87
Liver cancers are among the most avoidable cancers, through hepatitis B vaccination, control of hepatitis C transmission, and reduction of alcohol consumption. These three measures could, in principle, wipe out 90 percent of liver cancers worldwide. It remains unclear whether coffee drinking has an additional role to play, but such a role would be limited compared with preventing liver damage in the first place.88
But what if you’re already infected with hepatitis C or are among the nearly one in three American adults89 with nonalcoholic fatty liver disease? Until relatively recently, no clinical trials had put coffee to the test. But in 2013, researchers published a study in which forty patients with chronic hepatitis C were placed into two groups: The first group consumed four cups of coffee daily for a month, while the second group drank no coffee at all. After thirty days, the groups switched. Of course, two months is not long enough to detect changes in cancer outcomes, but during that time, the researchers were able to demonstrate that coffee consumption may reduce DNA damage, increase the clearance of virus-infected cells, and slow the scarring process.90 These results help explain the role coffee appears to play in reducing the risk of liver disease progression.
A commentary in the journal Gastroenterology entitled “Is It Time to Write a Prescription for Coffee?” explored the pros and cons.91 Some insist that we must first identify the active ingredient in coffee beans that’s protective. After all, more than one thousand different compounds have already been found in coffee.92 More studies are needed, but meanwhile, moderate daily ingestion of unsweetened coffee should be considered a reasonable adjunct to medical therapy for people at high risk of liver damage, such as those with fatty liver disease.93 Keep in mind that daily consumption of caffeinated beverages can lead to physical dependence, and caffeine withdrawal symptoms can include days of headache, fatigue, difficulty concentrating, and mood disturbances.94 Ironically, coffee’s tendency to be habit forming could turn out to be a good thing. If the liver health benefits are confirmed, then daily consumption may ultimately prove to be an advantage.95
With liver disease, as always, prevention is the key. All the most serious liver conditions—liver cancer, liver failure, and cirrhosis—can start with an inflamed liver. That inflammation can be caused by an infection or the buildup of fatty deposits. Liver viruses can be prevented by common-sense measures. Don’t inject drugs, do get vaccinated, and do practice safe sex. Liver fat can also be prevented by common sense measures: Avoid excess consumption of alcohol, calories, cholesterol, saturated fat, and sugar.
CHAPTER 9
How Not to Die from Blood Cancers
Eleven-year-old Missy had leukemia. It was in remission, thanks in part to the yellow bags of chemo that hung from the IV pole she rolled down the hospital halls. Missy was one of my first patients in my pediatrics rotation during medical school at the Eastern Maine Medical Center in Bangor—home to Stephen King, moose-crossing signs, and billboards advertising lobster ice cream.
During this time, I was in full Patch Adams regalia, from the fuzzy pink rabbit ears on my head down to the plastic rainbow Slinkys trailing at my feet. On every button of my white doctor’s coat hung a Beanie Baby, in every buttonhole was crammed a stuffed animal’s foot. Missy drew a smiley face on my beanie hippo and named the rooster attached to my stethoscope “Elvis.”
She loved to paint pictures for me and signed each one of them, in all caps: FROM MISSY. In these pictures, she still had her curly brown locks. In reality, though, her head was completely bald. She refused to wear a wig, which only made her smile seem brighter.
I painted her nails a pale pink, and she painted mine a lovely purplish brown.
I remember the morning after she gave me the manicure. My senior resident took me aside after rounds. “Your fingernails are getting in people’s way,” he said.
“Huh?” I asked.
“The attending physicians are complaining,” he replied. “This is a conservative profession.”
I tried to explain that I didn’t paint them myself, upset that I even felt the need to explain at all. The senior resident knew that Missy had done it, but he didn’t seem to care. “Medicine,” he said, “is also an anti-emotion profession.”
Later, the chair of the department had a talk with me. A number of the attending physicians were concerned I was “too enthusiastic,” “too dramatic,” and “too sensitive.”
My wife remarked they probably just had Slinky envy.
The next day, head down, I walked into Missy’s room.
“I’m sorry,” I told her. “The doctors made me take off the nail polish.”
I held up my hands to show her. She inspected them and said, with great indignation, “If you can’t wear it, then I’m not going to, either!” So I helped her take off her polish, bemused and empowered by such solidarity from an eleven-year-old. (I let her paint my toenails instead.)
I remember the last note I wrote in Missy’s medical chart. Hospital progress notes are written in SOAP format, a mnemonic for Subjective findings, Objective findings, Assessment, and Plan. I wrote: “Assessment: 11yo girl finishing last round of maintenance chemotherapy. Plan: Disney World.”
Childhood leukemia is one of the few success stories in our war on cancer, with ten-year survival rates as high as 90 percent.1 Yet it still affects more children than any other cancer and is ten times more likely to be diagnosed in adults, among whom current treatments are much less effective.2
What can we do to help prevent blood cancers in the first place?
Blood cancers are sometimes referred to as liquid tumors, since the cancer cells often circulate throughout the body rather than get concentr
ated in a solid mass. These cancers typically begin undetected in the bone marrow, that spongy tissue in the interior of our bones where red blood cells, white blood cells, and platelets are born. When healthy, your red blood cells deliver oxygen throughout your body, your white blood cells fight off infections, and your platelets help your blood to clot. Most blood cancers involve mutations of the white cells.
Blood cancers can be categorized into three types: leukemia, lymphoma, and myeloma. Leukemia (from the Greek roots leukos, or “white,” and haima, or “blood”) is a disease in which the bone marrow feverishly produces abnormal white blood cells. Unlike normal ones, these imposters aren’t able to fight infection. They also impair the ability of your bone marrow to produce normal red and white cells by crowding out healthy ones, creating a diminished healthy blood cell count that can lead to anemia, infection, and, eventually, death. According to the American Cancer Society, fifty-two thousand Americans are diagnosed with leukemia, and twenty-four thousand die from it every year.3
Lymphoma is a blood cancer of lymphocytes, which are specialized types of white blood cells. Lymphoma cells multiply quickly and can collect in your lymph nodes, small immune organs that are spread throughout the body, including the armpits, neck, and groin. Lymph nodes help to filter your blood. Like leukemia, lymphoma can crowd out healthy cells and impair your ability to fight infections. You may have heard of non-Hodgkin’s lymphoma. Hodgkin’s lymphoma can strike young adults, but it’s a rare and usually treatable form of lymphoma. As its name suggests, non-Hodgkin’s lymphoma (NHL) includes all the other dozens of types of lymphoma. They’re more common and can be harder to treat, and their risk increases with age. The American Cancer Society estimates that there are seventy thousand new cases of non-Hodgkin’s lymphoma each year and about nineteen thousand deaths.4
Finally, myeloma is a cancer of plasma cells, which are white blood cells that produce antibodies, the proteins that stick to invaders and infected cells to neutralize or tag them for destruction. Cancerous plasma cells can displace healthy cells from your bone marrow and make abnormal antibodies that can clog the kidneys. About 90 percent of myeloma sufferers are discovered with masses of cancer cells growing in multiple bones of their bodies, hence the common term for this condition, multiple myeloma. Each year, twenty-four thousand people are diagnosed with multiple myeloma, and eleven thousand die.5
Most people with multiple myeloma live for only a few years after diagnosis. Though treatable, multiple myeloma is considered incurable. That’s why prevention is key. Fortunately, dietary changes may reduce our risk of all these blood cancers.
Foods Associated with Decreased Risk of Blood Cancers
After following more than sixty thousand people for more than a dozen years, University of Oxford researchers found that those who consume a plant-based diet are less likely to develop all forms of cancer combined. The greatest protection appeared to be against blood cancers. The incidence of leukemia, lymphoma, and multiple myeloma among those eating vegetarian diets is nearly half that of those eating meat.6 Why is this greatly reduced risk of blood cancers associated with a more plant-based diet? The British Journal of Cancer concluded, “More research is needed to understand the mechanisms behind this.”7 While they are figuring out the reasons, why not get a head start and try adding more healthy plant foods to your plates today?
Greens and Cancer
The key to cancer prevention and treatment is to keep tumor cells from multiplying out of control while allowing healthy cells to grow normally. Chemotherapy and radiation can do a great job of wiping out cancer cells, but healthy cells can get caught in the crossfire. Some compounds in plants, though, may be more discriminating.
For instance, sulforaphane, considered one of the more active components in cruciferous vegetables, kills human leukemia cells in a petri dish while having little impact on the growth of normal cells.8 As we’ve discussed, cruciferous vegetables include broccoli, cauliflower, and kale, but there are many others in this family, such as collard greens, watercress, bok choy, kohlrabi, rutabaga, turnips, rocket, radishes (including horseradish), wasabi, and all types of cabbage.
It’s intriguing that dripping cabbage compounds on cancer cells affects them in a laboratory, but what really matters is whether people with blood cancers who eat lots of vegetables actually live longer than those who don’t. For about eight years, Yale University researchers followed more than five hundred women with non-Hodgkin’s lymphoma. Those who started out eating three or more servings of vegetables daily had a 42 percent improved survival rate over those who ate less. Green, leafy vegetables, including salad and cooked greens, and citrus fruits appeared most protective.9 It’s not clear, though, whether the survival benefit arose from helping to keep the cancer at bay or from improving patients’ tolerance to the chemotherapy and radiation treatments they were receiving. The accompanying editorial in the journal Leukemia & Lymphoma suggested that a “lymphoma diagnosis may be an important ‘teachable’ moment to improve diet. . . .”10 I would suggest you not wait until a cancer diagnosis to clean up your diet.
The Iowa Women’s Health Study, which has followed more than thirty-five thousand women for decades, found that higher broccoli and other cruciferous vegetable intake was associated with lower risk of getting non-Hodgkin’s lymphoma in the first place.11 Likewise, a study at the Mayo Clinic found that those who ate about five or more servings of green, leafy vegetables a week had roughly half the odds of getting lymphoma compared with those who ate less than one serving a week.12
Some of the plant-based protection might have been due to the antioxidant properties of fruits and vegetables. Higher dietary intake of antioxidants is associated with significantly lower lymphoma risk. Note I said dietary intake, not supplementary intake. Antioxidant supplements don’t appear to work.13 For example, getting lots of vitamin C in your diet is associated with lower lymphoma risk, but taking in even more vitamin C in pill form did not seem to help. The same was found for carotenoid antioxidants like beta-carotene.14 Apparently, pills do not have the same cancer-fighting effects as produce.
When it comes to certain other cancers, like those of the digestive tract, antioxidant supplements may even make things worse. Combinations of antioxidants like vitamin A, vitamin E, and beta-carotene in pill form were associated with increased risk of death in those who took them.15 Supplements contain only a select few antioxidants, whereas your body relies on hundreds of them, all working synergistically to create a network to help the body dispose of free radicals. High doses of a single antioxidant may upset this delicate balance and may actually diminish your body’s ability to fight cancer.16
When you buy antioxidant supplements, you may be doling out money to live a shorter life. Save your cash and your health by eating the real thing: food.
Açai Berries and Leukemia
Açai berries gained celebrity status in 2008 when television personality Dr. Mehmet Oz talked about them on The Oprah Winfrey Show. This spawned a frenzy of knockoff supplements, powders, shakes, and other dubious products bearing the açai berry label but not necessarily containing any of the actual berry.17 Even major corporations have jumped on the açai bandwagon, including Anheuser-Busch with its 180 Blue “with Açai Energy” drink and Coca-Cola with its Bossa Nova beverage. This is an all-too-common practice in the “superfruit” supplement and beverage market, where less than a quarter of products sold may even contain the ingredients their labels claim.18,19 The benefits of these products are suspect at best, but there is some preliminary research on real açai berries, which can be purchased as unsweetened frozen pulp.
The first study published in the medical literature on the effects of açai on human tissue was performed on leukemia cells. Researchers dripped an açai berry extract on leukemia cells taken from a thirty-six-year-old woman. It appeared to trigger self-destruct reactions in up to 86 percent of the cells.20 Also, sprinkling some freeze-dried açai berries on immune cells called macrophages (from the Gre
ek words makros and phagein, meaning “big eater”) in a petri dish appeared to enable the cells to engulf and devour up to 40 percent more microbes than usual.21
Though the leukemia study was done using açai extract at the concentration one might expect to find in the bloodstream after eating the berries, no studies have yet been performed on cancer patients themselves (just cancer cells in a test tube), so more testing is needed. Indeed, the only clinical studies on açai berries published so far were two small industry-funded trials that showed modest benefit for osteoarthritis sufferers22 and some metabolic parameters of overweight subjects.23
In terms of antioxidant bang for your buck, açai berries get honorable mention, beating out other superstars, such as walnuts, apples, and cranberries. The bronze for best bargain, though, goes to cloves, the silver to cinnamon, and the gold for most antioxidants per pound—according to a USDA database of common foods—goes to purple cabbage.24 Açai berries, however, would probably make a tastier smoothie.
Curcumin and Multiple Myeloma
As noted, multiple myeloma is one of the most dreaded cancers. It is practically incurable even with aggressive medical treatment. As myeloma cells take over the bone marrow, healthy white blood cells continue to decline in number, which increases your susceptibility to infection. Reduced levels of red blood cells can lead to anemia, and reduced platelet counts can lead to serious bleeding. Once diagnosed, most people survive fewer than five years.25
Multiple myeloma does not occur out of the blue. It appears to be nearly always preceded by a precancerous condition known as monoclonal gammopathy of undetermined significance, or MGUS.26 When scientists first discovered MGUS, it was aptly named because, at that time, the significance of finding elevated levels of abnormal antibodies in someone’s body was unclear. We now know it’s a precursor to multiple myeloma, and about 3 percent of Caucasians over age fifty have it,27 while the rate among African Americans may be double.28
How Not to Die Page 21