Lung cancer and B vitamins: what’s the deal?

The American Institute of Cancer Research (AICR) recommends avoiding supplements for cancer protection. Unfortunately, due to the fact that supplements are not regulated in the United States and that they have not been studied for long term use, many things remain questionable.

As a dietitian, I always encourage food first, as the naturally occurring form of vitamins is metabolized in context with other phytochemicals. Moreover, the chemical form of vitamins in food vs. supplements can be different. Of course, there is a time and a place for certain supplements if someone is deficient, or is at risk of a deficiency or for a therapeutic purpose. However, if and when possible, food sources are preferred.  

Last week, there were several media reports stating that B vitamins are associated with an increased risk of lung cancer. After reading the journal article, I wanted to report back the facts.

The study

  • The study looked at characteristics of 77,118 participants over the course of ten years. People were ages 50 to 76 years old.
  • They found that men who took the highest amounts of B6 and B12 from individual supplements were 30-40% more likely to develop lung cancer. The results were statistically significant and the association was stronger in people who presently smoked.  
  • Dietary intake of B vitamins was estimated through food frequency questionnaires.

As you take a deeper dive into the results, there were many aspects of the study that were not made obvious by media that are important to take into account:

  • The entire population was from western Washington State
  • The participants who were more likely to develop lung cancer “tended to be older, male and less educated at baseline....were more likely to be current cigarette smokers at baseline, have more pack-years of smoking, and had positive histories of chronic obstructive pulmonary disease and cancer”
  • B vitamin supplemental use was higher among women than men but there was no associated found in women
  • The authors make a note that “there were too few patients among never smokers to evaluate associations”
  • Authors did not find any significant associations with dietary intake

The questions

  • Can we generalize the findings from a specific region to other populations/is there something unique about the environment that could have contributed to the findings?
  • Were the men in the study more likely to be exposed to other environmental factors increasing their risk that perhaps the women were not as likely to be exposed to? For example, what kind of work did the people do in the study/could they have been exposed to construction areas, etc.
  • Does the form of B vitamins make a difference (methylated vs. not)?
  • Should blood levels of B vitamins (dietary vs supplements) have been assessed via serum levels vs questionnaires to check for variation in absorption/ accuracy of reports?
  • The fact that there were too few patients who were never smokers to draw any conclusions is misleading. When they say that the rate of lung cancer was higher in smokers who took B vitamins, are they comparing this population with former smokers as opposed to people who have never smoked?

My conclusion (but certainly read the original article and form your own!)

More studies need to be done and more populations need to be examined to see if there is an actual relationship between B vitamins and lung cancer.

In the meantime, unless you need to be taking supplemental B6 and B12, hold off and get it from foods, especially if you are male and a current or former smoker.

Foods high in B6 and B12:

  • Fortified cereals
  • Beans
  • Poultry
  • Fish
  • Dark green vegetables
  • Papayas
  • Oranges
  • Cantaloupe
  • Shellfish
  • Eggs
  • Nutritional yeast

Brasky TM, White E & Chen C. Long term, supplemental, one-carbon-metabolism-related vitamin B use in relation to lung cancer risk in the vitamins and lifestyle cohort. 2017. J Clin Oncol. 35.

Naturally sweetened banana bread

I have made this recipe a few times now and I know it’s good based on how quickly it is eaten!

Enjoy!

Ingredients

  • 2 bananas (the riper the better)
  • 2 eggs
  • ¼ cup almond butter
  • 2 tbsp melted coconut oil
  • ¼ cup coconut or almond flour
  • ½ tbsp cinnamon
  • ½ tsp baking soda
  • ½ tsp baking powder
  • ½ tsp vanilla
  • Pinch of sea salt

Directions

  • Preheat your oven to 350 degrees Fahrenheit
  • Combine your bananas, eggs, and nut butter, and coconut oil in a bowl and blend using a hand blender. Alternatively, you could use a food processor or regular blender.
  • Once all of your ingredients are blended, add in your coconut flour, cinnamon, baking soda, baking powder, vanilla, and sea salt and mix well
  • Pour your batter in a greased loaf pan
  • Place in your preheated oven and bake for 55-60 minutes or until a toothpick inserted into the center comes out clean
  • Remove from oven let cool
  • Slice and serve

 Variations

  • Cranberry Orange - Only use 3 tablespoons of butter. Add zest of one whole orange diced, juice of one whole orange, and1 cup dried cranberries or fresh if you want
  • Chocolate Blueberry - Add 1 cup of fresh blueberries and ½ cup of cocoa powder
  • Pumpkin Pecan - Reduce the almond butter to ¼ cup and add ½ cup of pumpkin puree and 1 cup of roughly chopped pecan pieces

Source: adapted from https://civilizedcavemancooking.com/recipes/desserts/paleo-banana-bread/

 

The sunshine vitamin: vitamin D

Vitamin D was once only known for its role in bone formation but now is recognized for other functions. Vitamin D helps to boost the immune system and may help reduce disease risk and progression. Most recently, a study published in the Journal of the American Medical Association, found that women with breast cancer who had the highest blood levels of vitamin D (more than 25.10 ng/mL or greater)  had statistically better survival than those with lower levels. Researchers also found that women with breast cancer who had serum vitamin D levels less than 16.75ng/mL had more advanced forms of breast cancer than those with higher levels. While there may be other confounding reasons as to the study results, such as the fact that people who take vitamin D may be more proactive about their health, etc, ask your doctor about your serum vitamin D level.

We normally create vitamin D from the sun’s UVB rays but there are many factors that affect our ability to do so. For example, at certain latitudes, when the earth is tilted away from the sun, we do not physically get the UVB rays that we need to make vitamin D. In New York, this amounts to somewhere between October and March. In addition wearing sunscreen (while important for skin cancer prevention) blocks UVB ray absorption. Vitamin D is considered a fat soluble vitamin and is better absorbed when taken with a meal. People with darker skin tones and older people have a more difficult time in synthesizing adequate amounts.

Unfortunately there are not many foods rich in vitamin D but see the list below for some ways to get started incorporating them into your diet. If needed, many people do supplement. To raise your serum level by 10ng/ml, you need to take 1000IU of vitamin D.

Foods high in vitamin D

·         Fatty fish (tuna, salmon, sardines, mackerel, herring)

·         Egg yolks

·         Dairy products and dairy alternatives

·         Mushrooms       

Yao S, Kwan ML, Ergas IJ, Roh, J, Cheng TYD, Hong CC, McCan S, Tang L, Davis W, Liu S, Quesenbery C, Ambrosone CB, Kushi L. association of serum level of vitamin d at diagnosis with breast cancer survival. JAMA Oncol. 2016. 4188

Turkey day and holiday fare

It’s that time of year again-Thanksgiving is around the corner along with the holiday season!

  • Use tips from the mindful eating blog to help guide your intake including chewing every bite slowly and eating off a smaller plate.
  • Use the healthy plate model when framing your plate: make the base of your plate a non-starchy vegetable.
  • Try to minimize the calories you drink. I don't know about you, but I'd rather have dessert instead!
  • Eat with your non-dominant hand to give your brain exercise (and to slow you down).
  • Be sure not to skip breakfast that morning so your body does not go into primal hunger overdrive.
  • Go for an after-dinner walk rather than sitting on the couch and dozing off right away.

Below are a few healthy, festive recipes to enjoy along with your favorite, classic ones.

Chickpea stuffing

Ingredients:

  • 4 cans of chickpeas rinsed well
  • 2 shallots
  • 1 cup vegetable broth
  • 1/2 tsp salt
  • 1/2 tsp pepper
  • 1/2 tsp paprika
  • 6 large carrots, chopped
  • 2 celery stalks chopped
  • 1 package of mushrooms, sliced
  • 2 eggs or 2 tbsp of flax plus 6 tbsp of water

Directions:

  • Pre-heat oven to 375F
  • Drain and rinse chickpeas well
  • Heat 1/2 cup of broth in a large sauteing pan
  • Add in shallots, carrots and celery until onions/celery and stir for about 10 minutes, or until vegetables get a little soft
  • Add all ingredients to a greased 9x9 baking dish, stirring in remaining 1/2 cup of vegetable broth
  • Bake for 1 hour until top looks golden and crispy

 

Cauliflower stuffing

Ingredients:

  • 2 tbsp olive oil
  • 1 onion, chopped
  • 2 large carrots, peeled and chopped
  • 2 celery stalks, chopped or thinly sliced
  • 1 small head cauliflower, chopped finely and put in a food processor so resembles "rice" (you can also buy it already don this way)
  • 1 c. chopped mushrooms
  • kosher salt to taste
  • Freshly ground black pepper
  • 1/4 c. Freshly Chopped Parsley
  • 2 tbsp. chopped fresh rosemary
  • 1/2 c. vegetable or chicken broth

Directions:

  • Heat skillet over medium heat. Add in olive oil, onion, carrot, and celery and sauté until soft, 7 to 8 minutes.
  • Add cauliflower and mushrooms and season with salt and pepper. Cook until tender, 5 to 10 minutes more.
  • Add parsley and rosemary stir until combined, then pour over vegetable broth and cover with a lid. Cover until totally tender and liquid is absorbed, 15 minutes.

 

Butternut squash apple soup

Ingredients:

  • 2 cups vegetable stock
  • 2 cloves garlic, peeled and minced
  • 1 carrot, peeled and diced
  • 1 Granny Smith apple, cored and diced
  • 1 medium (uncooked) butternut squash, peeled, seeded and diced
  • 1 sprig fresh sage
  • 1 white onion, diced
  • 1/2 teaspoon salt, or more to taste
  • 1/4 teaspoon freshly-ground black pepper, or more to taste
  • pinch of ground cinnamon and nutmeg
  • 1/2 cup low fat milk or almond or coconut milk

Directions:

  • Add vegetable stock, garlic, carrot, apple, butternut squash, sage, onion, salt, pepper, cayenne, cinnamon and nutmeg to a large slow cooker. Toss to combine.
  • Cook for 6-8 hours on low, or 3-4 hours on high, or until the squash is completely tender and mashes easily with a fork.  Remove and discard the sage.  Stir in milk.
  • Use an immersion blender to puree the soup until smooth.  Taste, and season with additional salt and pepper if needed.
  • Serve warm, with optional garnishes if desired.

 

Apple Crumble

Ingredients:

Filling Ingredients:

  • 6 cups finely chopped apples
  • 1 tbsp coconut oil
  • 2 tsp cinnamon
  • ½ tsp allspice
  • ⅛ tsp nutmeg
  • ⅛ tsp cloves
  • ½ cup maple syrup (or liquid sweetener of your choice)
  • 1½ tbsp lemon juice
  • Optional: a handful of raisins or dried cranberries

Topping Ingredients:

  • 1 cup almond flour (or any other nut flour)
  • ½ cup slivered almonds
  • ¼ cup maple syrup (or liquid sweetener of your choice)
  • 1 tbsp coconut oil
  • 1 tsp cinnamon
  • optional: an additional 2 tbsp slivered almonds for topping

Directions:

  • Preheat oven to 350F. Oil a pie dish (or any similar size pan) and set aside.
  • Mix all filling ingredients in a mixing bowl. Transfer to the pie dish and spread evenly.
  • Mix all topping ingredients (except slivered almonds reserved for garnish, if using) in a separate small mixing bowl until coarse crumbs form. Sprinkle this mixture over the apples in the pie dish. Garnish with slivered almonds if desired.
  • Bake in a preheated oven for approx 30 minutes, until the crumble turns golden brown.

Source: http://www.unconventionalbaker.com/recipes/simple-paleo-gluten-free-vegan-apple-crumble/

 

A "Nut"rition Nut

As a nutrition nerd, I got a burst of excitement at my local grocery store after seeing sacha inchi on the shelf; I read a study on the nutritional potency of sacha inchi a few years prior and couldn’t believe I saw it before my eyes:

https://www.hindawi.com/journals/ecam/2013/950272/.

Sacha inchi is a nut grown in Peru that has the “shape of an m&m” (as one of my friend’s phrased it when I offered her a taste). It definitely has a unique taste; I personally like it better mixed in with something like oatmeal or yogurt.

Sacha inchi is considered a complete protein; meaning it has all the essential amino acids. This is unique to plant-based proteins which tend to be incomplete sources. One serving has 9 grams of protein; this helps to keep you satiated for longer periods of time. In addition, sacha inchi contains a ton of omega 3, 6 and 9 unsaturated fats, giving it heart healthy, anti-inflammatory, disease fighting benefits.

As with most nuts, keeping the serving size to ¼ cup will allow you to maximize the benefits without overdoing the calories. I often find single serving nut tins to help keep me in check: http://almonds.handsservices.com/

Now you can be a nutrition nerd too: when someone asks you what the heck sacha inchi are, you can tell them of all the benefits. Happy eating!

To fast or not to fast....breast cancer edition

As a follow up to “Bite on this: Fasting during chemotherapy” http://savorhealth.com/bite-on-this-fasting-during-chemotherapy, a new study published in the Journal of the American Medical Association further explored the role of fasting during chemotherapy but with a more realistic spin. Unlike previous research that showed that fasting 3-5 days around chemotherapy lessened side effects and increased the efficacy, this study found that fasting for only 13 hours per night was associated with decreased breast cancer recurrence. In reality, fasting for 13 hours per night may translate to eating dinner by 7pm and breakfast at 8am the next morning; definitely not as bad as not eating at all!

This was independent of BMI. The researchers also controlled for other variables like estrogen and progesterone receptor status. Of course, the study has its weaknesses: the data was based on 24-hour diet recalls which may or may not be accurate; perhaps people who fast less than 13 hours per night have more stressful lifestyles, are eating less healthful foods at night or have disturbed sleep patterns. Also, since this was only done in people with breast cancer, the findings may not be able to be extended to other cancer sites.  Ultimately for people fighting a breast cancer diagnosis, fasting for 13 hours per night may be another tool to help flip the odds in their favor.

Rate Your Plate!

Want to know if the whole grain cereal you are eating is actually healthy [just as an aside, if it doesn’t say 100% whole grain it only has to be 55% whole grain]? If that granola bar is better than a candy bar? If that yogurt is chock full of sugar? While each food decision that you make does not have to be a perfect one, the Environmental Working Group or EWG food tracker website can help to keep you informed about your decisions. The EWG rates foods based on nutrient concerns, ingredient concerns and processing concerns. Scores are based on a scale of 1 to 10 with 1 being the best and 10 being the worst.

Here’s quick snap shot of a few searches.

http://www.ewg.org/foodscores/

 

 

EWG.png

One Ingredient Made Three Ways

This blog is devoted to three of my favorite, nutrient-dense and versatile ingredients to use in cooking.You'll be amazed by how many ways you can prepare these foods to satisfy your tastes and preferences:

1) Cauliflower

Don’t be fooled by its lack of color. This powerhouse packs nutrients like vitamin C, vitamin K and glucosinolates (studied for cancer prevention) with only 25 calories per cup. While many of us a knee-jerk reaction from memories of eating soggy steamed cauliflower, there are actually many delicious and interesting ways to prepare this vegetable.

Check out these recipes for cauliflower rice, cauliflower pizza, and cauliflower mac and cheese.

 Cauliflower rice:

http://meljoulwan.com/2014/03/25/roasted-cauliflower-rice/

 Cauliflower pizza:

http://detoxinista.com/2014/02/vegan-cauliflower-pizza-crust/

 Cauliflower mac and cheese:

http://www.grassfedgirl.com/primal-gaps-low-carb-cauliflower-mac-and-cheese/

 

2) Chickpeas:

Chickpeas are a great source of healthy, sustainable plant protein. The nutty-tasting beans pack nutrients like folate, iron and zinc. Since canned beans usually have BPA in the lining, unless otherwise specified, look for BPA-free cans, boxes, or bags of dried beans. Here are three of my favorite chickpea recipes:

 Deep-dish cookie pie:

http://chocolatecoveredkatie.com/2011/05/31/deep-dish-cookie-pie/

 Chickpea burgers:

http://www.food.com/recipe/chickpea-burger-338863

 Chickpea rosemary soup:

http://www.food.com/recipe/creamy-chickpea-rosemary-soup-133563

Also keep your eyes out for chickpeas pasta (delish!)

 

3) Avocado:

Packed with healthy unsaturated fats like the kind found in olive oil, avocados also have nourishing nutrients like vitamin E, potassium, and B vitamins.  Besides guacamole, avocado is great in the following ways:

Avocado mousse:

http://www.wellplated.com/avocado-chocolate-mousse/

 Avocado lime ice pops:

http://simplegreensmoothies.com/green-smoothie-recipes/avo-banana-kale

 Spicy corn and avocado soup:

http://heatherchristo.com/2015/08/11/spicy-corn-and-avocado-soup/

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If you’re like me, a busy week means less time for food shopping, meal planning and cooking. Check out the 'My Favorite Things' tab for some of the best non-perishable goods to keep on hand for quick and easy meals and snacks: http://www.hillarysachsnutrition.com/my-favorite-things/

March is National Nutrition Month: Savor the Taste of Eating Right

March means 2 things: spring is on its way and National Nutrition Month (NNM) is here. NNM is a celebration of picking, buying, tasting, savoring….FOOD! In light of this year’s theme is “Savor the Taste of Eating Right”, here are some of my favorite herbs and spices to use in my cooking followed by some flavorful recipes. Enjoy!

Parsley-Helps to activate a powerful antioxidant, glutathione, to help the body rid of excess toxins. It is also a great source of folic acid, an important B vitamin essential that ensures healthy cell division.

Basil-Is a great source of magnesium and vitamin K, two nutrients important for bone health. 

Ginger–Is a warming spice with immune boosting, anti-inflammatory and digestive benefits. Ginger has been shown to be even more effective than Dramamine for motion sickness. In addition, studies show that gingerols, the active ingredient in ginger, may prevent the growth of colorectal and ovarian cancer.

Cilantro-Is traditionally used in Indian and Latin cooking. Cilantro not only adds a flavor boost but also protects against the foodborne illness, Salmonella.

Turmeric-Is a powerful spice with a variety of health benefits. Studies show that turmeric helps to prevent cancer cells from getting into the blood supply and growing and may even protect against Alzheimer’s and heart disease. Its anti-inflammatory properties make it similar in effectiveness to NSAIDS like advil.

Rosemary-Is protective against dangerous gut bacteria, like H. pyrlori as well as staph infections. Studies show that marinating meats with rosemary helps to decrease hetrocyclic amines, a cancer causing toxin found in the char marks.

Oregano-Contains thymol and carvacol, two essential oils that have natural anti-fungal and antibacterial properties. Oil of oregano also can help combat the flu and yeast infections.

Cinnamon-Plays a role in blood sugar control. There are 2 main kinds of cinnamon: Ceylon and cassia. Cassia cinnamon is the one you typically see in the store. Ceylon cinnamon is also known as “true cinnamon” and is preferable over Cassia. Ceylon is free of coumarins, a chemical that could be toxic to the liver in large amounts.  

Garlic-Contains sulfur compounds that increase blood flow, are anti-microbial and protective against stomach cancers. Slice it at least 5 minutes before exposing to heat to preserve the beneficial phytochemical: allicin. Garlic also has many general uses: mix with water and natural soap to spray on plants as a natural pesticide, ruba sliced clove on acne to help control pimples.

 

Indian Tomato Chicken

Ingredients

  • 1 large onion, chopped
  • 4 cloves garlic, chopped
  • 1 slice fresh ginger root
  • 1 tablespoon olive oil
  • 2 teaspoons ground cumin
  • 1 teaspoon ground turmeric
  • 1 teaspoon salt
  • 1 teaspoon ground black pepper
  • 1/2 teaspoon ground cardamom
  • 1 (1 inch) piece cinnamon stick
  • 1/4 teaspoon ground cloves
  • 2 bay leaves
  • 1/4 teaspoon ground nutmeg
  • 6 skinless chicken thighs
  • 1 (14.5 ounce) can whole peeled tomatoes, crushed

Directions

  • Place onion, garlic and ginger in a food processor and process into a paste. Heat oil in a large skillet over medium heat, add onion paste and saute, stirring continuously, for about 10 minutes.
  • Stir in the cumin, turmeric, salt, pepper, cardamom, cinnamon, cloves, bay leaves and nutmeg. Saute, stirring, for 1 to 2 minutes. Place chicken pieces in skillet and stir them around with the spice mixture until they are well coated.
  • Saute for another 4 minutes, then pour in the tomatoes with liquid and stir. Reduce heat to low and simmer for 1 to 2 hours, or until the oil has separated from the liquid. Stir occasionally. (Note: If you simmer uncovered, the sauce will thicken; add water, or keep covered while simmering.)

Source: www.allrecipes.com

 

Spaghetti squash with avocado pesto

Ingredients

  • One 4-5 pounds spaghetti squash halved and with seeds scooped out
  • 1 tsp extra virgin olive oil
  • 2 garlic cloves
  • 1/4 cup fresh basil
  • 2 tbsp fresh lemon juice, or more to taste
  • 1 tbsp extra virgin olive oil
  • 1 medium ripe avocado
  • Water, to thin out (I use around 2-3 tbsp water)
  • Fine grain sea salt, to taste (I use between 1/4-1/2 tsp)
  • Black pepper, to taste

Directions

  • Preheat oven to 375F. Wash spaghetti squash and place on an old tea towel (this helps prevent it from slipping) or cutting board. Slice off stem, flip cut side down, and then carefully slice it in half, lengthwise. Remove seeds + squash guts and set aside.
  • Brush the cut-sides with oil and then season with salt and pepper. Place cut side down on a baking sheet lined with parchment paper and bake for 35-45 minutes, depending on the size of the squash. Squash is ready when the strands scrape off with a fork fairly easily. My 5 pound squash took 40 mins.
  • Meanwhile, make the avocado sauce. Add the garlic and basil to a food processor and mince. Now, add in the lemon juice and olive oil and stop to scrape down the sides of the bowl.
  • Slice avocado in half and pit. Scoop out the flesh and drop it into the processor with the motor running. Add water, 1 tbsp at a time, to thin out the sauce as needed. Stop to scrape down the bowl. Add salt and pepper to taste and process again. Feel free to add more lemon or oil, adjusting to taste, if desired.
  • When the squash is ready, flip over and allow to cool slightly so it’s safe to handle. Grab a fork and scrape off strands of squash until you have two empty “shells”. Place strands onto a plate (or just serve in the shells), season with s & p, and top with the avocado sauce. Sauce will keep for 1 day in the fridge in an air-tight container

Source: ohsheglows.com