9 Zhang Y, Talalay P.
Anticarcinogenic activities of organic emphasizing carotenoid-rich yellow-orange-red, and
isothiocyanates chemistry and mechanisms Cancer Res
1994,54(suppl 7) S1976-S1981
ND
Judy A. Fulop, MS,
Center forIntegrative Medicine
Northwestern Memorial Physicians Group
680 North Lake Shore Drive, Suite 815
Chicago, IL 60611
E-mail: JFULOP@NMH.ORG
Nutritionist/Dietitian Analysis
Impression: The patient is a 63-year-old woman with a
history of esophageal cancer, after chemotherapy with
5-FU/cisplatin and radiation, followed by esoph-
agogastrectomy. She presents within normal limits for
desireable body weight, at upper end range despite
history of a 19% decrease usual body weight. Nutri-
tional risks include rapid significant weight loss (a ma-
jor indicator for malnutrition in the elderly),
hypoalbuminemia, and microcytic anemia likely sec-
ondary to decreased iron absorption due to decreased
intrinsic factor after esophagogastrectomy. Elevated
lipid peroxides and oxidized LDL, indicative of in-
creased lipid peroxidation consistent with oxidative
damage due to radiation, were noted. Likely func-
tional impairments are gut integrity and hepatic de-
toxification. Symptoms contributing to decreased oral
intake and weight loss include dysphagia, odynophagia,
xerostomia, anorexia, food aversion, eructation, and
fatigue.
Recommended Diet Therapy
Diet of soft, moist consistency to minimize dysphagia/
odynophagia: Congees/porridges (basic recipe 1 cup
whole grain to approx. 6 cups water, add pork, fish,
poultry, beef, vegetables, fruit compotes, and season-
ings as desired); nut butters; bean purees; tofu
spreads; fruit &dquo;butters&dquo;; fruit compotes; fruit &dquo;smooth-
ies&dquo; ; soft, well-cooked vegetables (reserve cooking wa-
ter for broth) ; 8 to 16 oz of fresh vegetable juice daily.
Minimize/eliminate the following, which are associ-
ated with increased esophageal cancer and/or other
cancer risk: Very hot drinks, chilies, alcohol, nitrites,
pickled vegetables, &dquo;mate&dquo;/&dquo;Yerba mate&dquo; tea, cured/
smoked/moldy foods, grilled/broiled foods (or grill/
broil 6 inches from direct flame source and/or mari-
nate first to minimize hydrocarbons).
Increase the following chemopreventive foods quanti-
tatively and qualitatively: Three servings/day of whole
grains (barley, millet, quinoa, amaranth, oats, spelt,
kamut, etc.); 4 to 6 servings/day of vegetables
54
leafy green, cruciferous, and sea vegetables; 2 to 4 serv-
ings/day of fruits emphasizing carotenoid-rich yellow-
orange-red, and flavonoid-rich citrus and red-purple-
blue (18 of 22 case control studies have shown a statis-
tically significant protective association for fruit and
vegetable consumption on esophageal cancer); len-
til/bean-containing dish 2 to 3 times per week; 1 oz, 2
tablespoons of nuts/seeds 3 to 5 times per week; lib-
eral inclusion of mushroom-containing dishes (maitake,
reishi, shiitake); liberal use of turmeric, rosemary,
alliums, ginger, and fish 4 times per week.
Additional for food procurement/
guidelines
preparation: Hormone-free and antibiotic-free red
meat, poultry, dairy, eggs, and organic produce. No
farm-raised fish. Although the American Cancer Soci-
ety estimates less than 1 % of all cancers are due to
pesticides/additives and so on, research is accumulat-
ing suggesting pesticides act as endocrine disrupters
and are deposited in adipose tissues. Given the
unknown etiology of many cancers, and likely
multifactorial etiology, avoid substances that contrib-
ute to cancer risk. Emphasize monounsaturated fats
for cooking oils, restrict polyunsaturated fats for use in
cold food preparation (not heat stable), and decrease
saturated fat and trans fatty acids. Eat small, frequent,
calorie/protein dense meals to promote weight
maintenance.
Therapeutic teas: Green tea 32 to 40 oz daily sipped
slowly to increase salivary catechin levels and oral
mucosa absorption.’ Astragalus tea 1 to 2 cups daily
while white blood cell count and neutrophils are low.
Recommended Supplementation
To minimize xerostomia, management options per pa-
tient preference: Slippery elm bark lozenges, slippery
elm bark tea (2 cups/day), or slippery elm bark extract
(1 :dilution 5 mL TID) as desired (decrease if laxative
effect occurs); betaine anhydrous (trimethylglycine)
toothpaste powder: mix 1/4 to 1/2 teaspoon with
enough water to moisten, brush teeth 3 times daily.2
For oral cavity healing and lymphocyte protection
after radiation therapy, management options per
patient preference: Glutamine powder: 10 g gargle 4
times daily, or 4 g swish and swallow every 4 hours if
stomatitis is still acute/unresolved&dquo;&dquo;; German chamo-
mile oral rinse: 10 to 15 drops German chamomile
extract in 100 mL warm water 3 times daily.
For prophylactic prevention of oral cavity infections,
management options per patient preference: Tea tree
oil: gargle 2 to 3 drops 100% essential oil of tea tree
(Melaleuca alternifolia) in 100 mL of water 3 times
for antimicrobial action.
To minimize eructation, management options per
patient preference: Ginger, fennel seed, or anise seed
tea: 1 cup at end of meals (carminative action).
For microcytic anemia pending further workup: Fer-
rous S04: 325 mg orally, 3 times daily, taken with 250
mg vitamin C to enhance absorption. Recheck anemia
profile and labs 6 weeks post-initiation of oral iron
therapy. May require parenteral iron infusion if levels
are not normalized on oral iron treatment.
For hypoalbuminemia, weight gain, and immune
enhancement: Discontinue commercial weight gain
shake. Hydrolyzed whey protein fortified fruit smoothie
with flax seed (15 g hydrolyzed whey protein concen-
trate in 8 oz of organic soy milk with 1/2 cup fruit and
1 tablespoon flax seed twice daily). Whey protein con-
centrate (WPC) has been shown in animal experi-
ments to exhibit anticarcinogenesis and anticancer
activity via the effect on increasing glutathione (GSH)
concentration.’ WPC increased weight, albumin, and
GSH concentrations in patients with HIV 8 WPC may
enhance the reduced-to-oxidized GSH ratio (GSH/
GSSG) in lymphocytes-a marker of oxidative stress in
reactive oxygen species mediated disease.
Other: High-potency multivitamin/mineral formula
containing the following (or individual supplements
to meet recommended doses as needed): folic acid
400 mcg daily, vitamin B6 5 mg daily, vitamin B12 100
mcg daily, zinc 50 mg daily, selenium 200 mcg daily,
manganese 5 mg daily, beta-carotene 15 mg daily, vita-
min E 400 IU (natural vitamin E [d-alpha-tocopherol]),
magnesium 400 mg daily, molybdenum 250 mcg daily,
calcium citrate 1200 mg daily in 2 divided doses, and
vitamin C 750 mg daily (taken in divided doses with
supplemental iron). Would further individualize
supplementation regimen with additional antioxi-
dants (e.g., CoQ10, alpha lipoic acid, GSH, N-acetyl
cysteine) and nutrients for cell membrane support
(e.g., phosphatidyl choline, taurine, omega-3 fatty
acids) to reduce oxidative damage, pending further
biochemical workup, as well as nutrients to support
digestion and replete intestinal flora, pending further
biochemical workup.
Other
Further workup of microcytic anemia: ferritin,
transferrin, Fe+, total iron binding capacity, percent-
age saturation, B12, folate; stool analysis (digestion/
absorption and intestinal flora); detoxification analy-
daily sis (potential susceptibility to oxidative damage);
speech pathology referral to assess dysphagia/aspira-
tion risk and/or need for swallowing conditioning ex-
ercises ; holistic psychology referral for relaxation
modalities (e.g., visualization, meditation, guided im-
agery) and/or hypnotic suggestion to minimize food
aversion, nausea/vomiting, dysphagia/odynophagia,
and anorexia, and promote weight gain. The patient
should discuss all interventions with her physician be-
fore implementation.
References
1 Yang CS, Lee MJ, Chen L. Human salivary tea catechin levels
and catechin esterase activities, implication in human cancer
prevention studies. Cancer Epidemiol Biomarkers Prev. 1999,8
(1):83-89
2. Soderling E, Le Bell A, Kirstila V, Tenovuo J Betaine-containing
toothpaste relieves subjective symptoms of dry mouth. Acta
Odontol Scand. 1998,56(2):65-69.
3. Huang EY, Leung SW, Wang CJ, et al. Oral glutamine to allevi-
ate radiation-induced oral mucositis. a pilot randomized trial
Oncol Biol Phys 2000;46:535-539.
Int J Radiat .
4. Anderson PM, Schroeder G, Skubitz KM Oral glutamine
reduces the duration and severity of stomatitis after cytotoxic
cancer chemotherapy. Cancer
. 1998;83:1433-1439
5. Anderson PM, Ramsay NK, Shu XO, et al Effect of low-dose
oral glutamine on painful stomatitis during bone marrow trans-
plantation Bone Marrow Transplantation
. 1998,22:339-344
6. Skubitz KM, Anderson PM. Oral glutamine to prevent chemo-
therapy induced stomatitis: a pilot study J Lab Clin Med. 1996,
127:223-228.
7 Bounous G. Whey protein concentrate (WPC) and glutathione
modulation in cancer treatment. Anticancer Res
. 2000,20(6C).
4785-4792.
8. Bounous G, Baruchel S, Falutz J, Gold P. Whey proteins as a
food supplement in HIV-seropositive individuals Clin Invest
.
Med 1993;16:204-209.
MaryBeth Augustine, RD
Beth Israel Center for Health and Healing
245 Fifth Avenue at 28th Street
New York, NY 10016
and
Private Practice
Nutritional Healing
Hartsdale, NY 10530
E-mail: NutritionalHealing.RD@verizon.net
Traditional Chinese Medical Analysis
This patient has a disharmony of the earth phase or el-
ement. The earth phase consists of the central meta-
bolic unit, which includes the Spleen/Pancreas and
the Stomach. (The names of the organs are capitalized
to differentiate the Chinese interpretation of organ
function from Western biomedical theories.) The Yel
low Emperors Classic of Internal Medicine (Neijing Suwen
ca. 250 BC) states: &dquo;The function of the Spleen is to
transform and transport the essence of food and fluids
55