Category Archives: Diet and Exercise

LOW-FAT DIET AND WATCHFUL WAITING FOR PROSTATE CANCER

Many men with early-stage, less aggressive prostate cancer are now opting for active surveillance or watchful waiting.  But in my opinion, the focus should be on the active part of active surveillance and not just watching and waiting around to see your PSA go up.  And in my opinion, active means focusing on diet and exercise. 

So why should men change?  Because study after study now suggest that low-fat eating, along with exercising and reducing stress, can stop or reverse the progression of prostate cancer in its early stages. The research was spearheaded by Dr. Dean Ornish of the University of California at San Francisco, best known for using the same approach in treating coronary heart disease. 

Although the studies were small, the results were huge.  By eating a low-fat diet, PSA levels actually decreased after only a few months.  And in another Dr. Ornish study, the low-fat diet, along with exercise and stress reduction, actually changed the way cancer genes behaved. Remarkably, the low-fat diet switched on tumor killer genes and turned down tumor promoter genes. 

Dr. Ornish told the prestigious journal Scientific American, “We found that simple changes have a powerful impact on our gene expression…Genes may be our predisposition, but they are not our fate.”  Read More Here

So what is good for prostate cancer treatment is usually good for prostate cancer prevention.  If you have prostate cancer, or if your spouse or significant other has a risk of prostate cancer, I would take a careful look at the Dr. Dean Ornish program on the internet.  And you’ll also lose weight and help prevent heart disease. Talk about a win-win program.  There is a lot of good stuff on the Dr. Ornish website. 

If you have any questions about your prostate cancer, please call me, Dr. Edward Hughes, at 855-DAYTON1.

Watch this TED Talk by Dr. Ornish as he discusses the importance of lifestyle and disease.

 

Exercise to Keep Cancer Away

Dr. Edward Hughes discusses the importance of exercise not only to prevent cancer, but to prevent cancer recurrence. Exercise is especially important for breast cancer survivors to prevent lymphedema. Share this video with everyone you know.

Your Risk for Breast Cancer-Genetics vs. Lifestyle?

Did your genetics put you at risk for breast cancer or your lifestyle choices?

Did your genetics put you at risk for breast cancer or your lifestyle choices?

In a landmark study in 2015, Dr. Bert Vogelstein of the Johns Hopkins School of Medicine showed that 2 out of 3 breast cancers are due to bad luck – changes in your DNA caused by lifestyle choices.  But if nature deals you a bad set of genes, all is not lost.  There is hope. 

By analyzing genetic and lifestyle risk factors for breast cancer in over 26,000 women, Dr. Nilanjan Chatterjee of the Johns Hopkins School of Public Health concluded the 28.9% of all breast cancers could be prevented. In fact, women with the highest genetic risk factors were no more at risk if they did not smoke, drink a lot of alcohol, use hormonal therapy at menopause, or had maintained a normal body weight.  Dr. Chatterjee’s study was reported in the May 26, 2016 issue of the Journal of the American Medical Association Oncology.  

Healthy lifestyle changes really are important to prevent cancer.  Even if you have a family history of breast cancer.  A 30% reduction in your risk of breast cancer is under your control.  So eating right, exercising, and getting yearly mammograms are key to not only preventing breast cancer but catching it early. 

If you have any questions about your breast cancer or its treatment, please feel free to call me, Dr. Edward Hughes, at 855-Dayton 1

3 New Studies On Prostate Cancer You Need to Know About

1.  Stop PSA Screening  –   Not so Fast!

In 2012, the US Preventative Services Task Force (USPSTF) came out against routine PSA screening  for prostate cancer in men, regardless of age.  But the major study used for this recommendation was likely flawed.

More importantly, since 2012, the number of men diagnosed with advanced stage prostate cancer is increasing (Cancer Epidemiology Biomarkers Prev.  2016; 25:259-263).

Dr. Richard Hoffman, an expert in shared decision-making about prostate screening, told Medscape Medical News that “abandoning PSA screening is proving harmful.”

 From my own vantage point in our clinic, PSA testing for men ages 55-70 makes a lot of sense.  Urologists and radiation oncologists are now well aware of overtreatment of patients with early-stage prostate cancer.  Active surveillance can be offered for a number of our patients.  But missing advanced stage prostate cancer or aggressive prostate cancers can be deadly.  Most of the patients that I see in my clinic are not aware of the fact the prostate cancer is the second biggest killer of men in the US, second only to lung cancer.

2.  Artery-Sparing Radiation May Help with Erectile Dysfunction 

Dr. Patrick McLaughlin of the University of Michigan Medical School reported on the benefits of using MRIs in radiation planning for patients with early stage prostate cancer.  His study was published recently in the British journal, Lancet Oncology.  While sparing the critical arteries and nerves going into the prostate gland, Dr. McLaughlin and colleagues reported that 92% of men were still able to be sexually active even 5 years after radiation. 

In my opinion, Cyber Knife offers the best sparing of the arteries and nerves leading into the prostate of any of the radiation technologies.  And at First Dayton Cancer Care, our patients have the choice of Cyber Knife or IMRT or IMRT combined with temporary, robotic seed implants.

3.  Atkins Diet Can Help Some Side Effects of Hormonal Therapy for Prostate Cancer 

Dr. Stephen Freedland of Cedars-Sinai Medical Center in Los Angeles reported on the low carbohydrate diet and hormonal therapy at the recent American Urologic Association (AUA) annual meeting.

While on hormonal therapy for prostate cancer, the Atkins diet or low carbohydrate diet resulted in better blood sugar control and weight loss than in those men who ate a regular diet.

So there is some hope in managing the side effects of hormonal therapy or androgen deprivation therapy (ADT) for patients with prostate cancer.  Unfortunately, there was no difference in PSA levels. 

If you have any questions about your prostate cancer, please feel free to call me, Dr. Edward Hughes, at 855-DAYTON1.

SOMETIMES WEIGHT LOSS CAN BE A BAD THING

Weight loss is not always a good thing when you are a cancer patient.

Weight loss is not always a good thing when you are a cancer patient.

Often times people experience sudden weight loss that sends them to see a doctor. All too often this is the symptom that leads to a cancer diagnosis. Cachexia-the loss of muscle mass associated with cancer-is a fancy word for an all too common symptom of newly diagnosed patients with advanced lung cancer.  Every doctor knows cachexia when they see it, especially in patients with locally advanced lung cancer. Patients experience loss of muscle instead of fat because muscle is easier for the body to metabolize into the much needed calories. Cancer itself can also cause a dramatic inflammatory response which adds to this loss regardless of how many calories are eaten.

The overall weight loss and loss of muscle mass in cancer patients can be profound. Cachexia affects 50-80% of cancer patients. And the results of cachexia can lead to a continuing decline in overall health and continued impairment of immune function. Remarkably, cachexia is the direct cause of death in 20% of cancer patients. So patients with locally advanced lung cancer are already behind the 8 ball even before starting treatment, treatments that may include chemotherapy and radiation therapy. A vicious cycle starts that can lead to further loss of appetite and fatigue, compounding the cachexia.

But a recent study published in the journal Lancet Oncology shows that help is on the way for locally advanced lung cancer patients who suffer from cachexia (Lancet Oncology February 19, 2016) Dr. Jennifer Temel, a cancer specialist at Harvard’s Dana-Farber Cancer Institute, looked at 2 different phase 3 studies-the gold standard of clinical studies-of 979 patients with advanced cancer.  653 of these 997 patients were treated with the new drug Anamorelin and 326 were treated with a placebo-a pill with no active ingredients.

After only 12 weeks, those patients who took the drug Anamorelin gained weight compared with patients who took only the placebo.  Of course, there were side effects-the main one was elevated blood sugar.

From my point of view as a cancer specialist, the studies with Anamorelin are a good start. Our advanced lung cancer patients need all the help that they can muster to help combat the side effects of chemotherapy and radiation therapy.  More research will be needed to refine the role of Anamorelin to treat cancer related weight loss and muscle loss. But I’m glad that help is on the way.

If you have any questions about your cancer, please feel free to call me, Dr. Edward Hughes, at 855-DAYTON1

Bad Luck May Account for 2 out of 3 Cancers

201511301054

You may not be in as much control as you think.

 

 

Can You Prevent Cancer Just by Eating Right and Exercising?

As the Season Holidays are upon us, you’ll hear a lot about improving your health through lifestyle choices. The ads to sell you expensive fitness equipment will be coming on strong.  So get out your list of bad habits and dust off your holiday resolutions.  You’ll also hear a lot about how healthier lifestyle choices can reduce your risk of cancer. But by how much?  And where do you get the most bang for your buck? At the gym? At the dinner table? Colleen Doyle, MS, RD the managing director of the American Cancer Society’s “Healthy Eating, Active Living Environments” program stated “Right now, at a time when it’s estimated that 14% of all cancer deaths in men and 20% in women are related to being overweight, 64% of adults are overweight, including 28% who are obese.” In October, the World Health Organization pulled out all the stops by placing eating red meat and processed meat like bacon in the same cancer-causing category as tobacco, asbestos and formaldehyde.  Don’t get me wrong, I think exercising, eating right, stopping smoking, limiting alcohol, and staying out of the sun really can help in preventing cancer. But hold on, it appears you can’t control everything.    

Are Lifestyle Changes Really the Whole Answer?

In a breakthrough study in the January 2, 2015 issue of the prestigious journal Science, the internationally recognized cancer researcher Dr. Bert Vogelstein and his bio-mathematician colleague Dr. Cristian Tomasetti from Johns Hopkins Medical School concluded “Two thirds of all cancer incidence across tissues is explained by random mutations that occur when stem cells divide.”  To put it another way, the bad luck of random mutations or changes in DNA account for 2 out of 3 of all cancers. So does this mean that most causes of cancer are out of our control? Lifestyle choices and family heredity certainly play a role, and account for 1 out of 3 of all cancers.  The key finding is that the “bad luck” of stem cell mutations or changes in your DNA that happen by chance over your lifetime play a much bigger role-twice as much.

Maybe We Should Focus More  On Screening?

Drs. Vogelstein and Tomasetti came to a blockbuster conclusion and stated, “We should focus more resources on finding ways to detect such cancer at early, curable stages.”  From their study of stem cell mutations as the cause of cancer, it seems we should focus even more of our efforts on screening, not less.  Recently, the American Cancer Society recommended drastically decreasing screening for breast cancer with mammography.  The US task force recommended not screening at all for prostate cancer with a PSA test.

But I believe we need to double down on screening.  Medicine has developed powerful tools for screening the common cancers, and better tests are being developed all the time.  For my money, Dr. Vogelstein’s study shows that it’s more important to screen for cancer.  And in some ways, it’s easier to do.  So add cancer screenings to your list of resolutions for 2016.

Breast cancer – 2D and 3D mammograms

Cervical cancer – Pap smears and pelvic examinations

Colon cancer – colonoscopy

Lung cancer – low-dose CT scans

Prostate cancer – PSA and digital rectal exams

 

 

NO CANCER RISK FROM YO-YO DIETING

The Food Pyramid has changed since you first learned it in Kindergarten.

The Food Pyramid has changed since you first learned it in Kindergarten. Click on image to learn more.

 

Nearly half of all adult Americans can breathe a sigh of relief. Weight cycling or so-called yo-yo dieting-does not appear to increase their risk for getting cancer.

In a 10 year study of over 96,000 men and women, who lost more than 10 pounds only to regain that weight, Dr. Victoria Stevens and co-researchers from the American Cancer Society found that yo-yo dieting did not increase the risk of getting cancer.  The yo-yo dieting study was reported in the July issue of the American Journal of Epidemiology.

The study looked at the following 12 cancers:

BREAST                COLON                 ESOPHAGUS        KIDNEY

LIVER                    LUNG                    MELANOMA      NON-HODGKIN’S LUMPHOMA

PANCREAS           PROSTATE            RECTUM            STOMACH

Of note, the effect of yo-yo dieting on the risk of breast cancer was not reported. Dr. Stevens noted that BMI or body mass index may have clouded a study reported in 2005 that found a link between the risk of breast cancer and yo-yo dieting.

SO WHAT DO I RECOMMEND? 

The whole lifestyle approach is key-smart food choices and daily exercise.  I like the hybrid approach between the Mediterranean diet and the DASH diet-Dietary Approaches to Stop Hypertension.  And one glass of wine is allowed each day!

The key points of the diet is eating at least 3 servings of whole grains, a green leafy vegetable and one other vegetable each day.  Snack on nuts most days, have a serving of beans every other day, and eat poultry and berries at least 2 times per week, with fish once per week.

The hard part is avoiding the 5 unhealthy groups-red meat, butter and stick margarine, cheese, pastries and sweets, along with fried and fast foods.

Stay healthy Dayton!  If you have any questions, call me Dr. Hughes at 855 DAYTON1.

 

Weight Loss in Head and Neck Cancer Patients: It’s Not Just the Cancer That Can Kill You

It’s Not Just Loss of Arm Strength But Also Your Heart Strength That’s Affected

At First Dayton Cancer Care, I see and treat many patients with head and neck cancer each and every week.  I tell them that the big battle ground will be nutrition.  I tell them I don’t want to see them lose weight because it will be muscle rather than fat that they will lose.  After I tell my patients about all the side effects of chemotherapy and radiation treatment, an overwhelming experience to say the least, many patients just smile and say “I need to lose a few pounds anyway.”

Unintentional weight loss in cancer patients-called cachexia-not only results in loss of muscle mass but also may account for loss of heart muscle function.  Cachexia is defined as >5% weight loss and 3 of 5 other factors-loss of muscle strength, fatigue, lack of appetite, loss of muscle mass, low albumin and high C-reactive protein. In a remarkable summary of many studies, Dr. Couch and colleagues showed the cachexia is a major factor in the death of many head and neck cancer patients (Head Neck; 2015; 37: 594-604).  The surprising finding is that heart trouble related to cancer weight loss may account for up to 20-30% of head and neck cancer patient’s deaths.  Even if they are first cured of their cancer.

My clinical instinct over the years was that nutrition was one key to survival.  But I never thought that weight loss in cancer patients could affect their hearts to such an extent.  If Dr. Couch’s studies hold up, head and neck cancer specialists will lose up 30% of patients from cachexia, not cancer. But even more frustrating is the fact that while intentional weight loss is fixable by good nutrition alone, cachexia or unintentional weight loss in cancer patients, is not.  So much more medical work and research is needed here.

Don’t get me wrong.  The medical and technological breakthroughs in head and neck cancer care have been nothing short of miraculous over the past decade.  But I think head and neck cancer specialists need to take nutrition, especially new ways to battle cachexia, much more seriously than in the past.

 Diagnosing Cachexia-Related Muscle Loss Is Not As Easy As You May Think

 Diagnosing muscle loss seems easy, doesn’t it?  Plain and simple.  Just have the doctor or nurse weigh you and examine you.  And taking a good medical history may help.  But it’s not just that easy.

As head and neck cancer doctors, we rely “heavily” on BMI or body mass index-a formula based on height and weight. The BMI alone may mislead cancer doctors, especially in men who have more muscle mass than women.  That’s also true in men and women who are obese – underestimating loss of muscle mass. The change in BMI alone is likely to be misleading as a measure of loss of muscle mass or cachexia.  In fact, the gold standard for body composition assessment- a CT scan of the lower spine and pelvis- is rarely used to diagnose cachexia related loss of muscle mass.  I know of not a single cancer clinic in the country that uses CT scans to assess body composition to diagnose cachexia in cancer patients.

                                                                 CANCER CACHEXIA =

3 or more symptoms                                    +                    Weight Loss > 5% within 12 months

  • Fatigue
  • Loss of Appetite
  • Decreased Muscle Strength
  • ↑CRP or ↓ Albumin
  • Low Fat-Free Muscle Mass on CT Scan
 So What Can A Head and Neck Cancer Patient Do to Diagnose Cachexia?

First and foremost, be upfront and honest with your head and neck cancer specialist.  Do tell your doctors about any loss of muscle strength, fatigue, and lack of appetite.  Ask your doctor about blood tests that measure if you are anemic, have a low level of the blood protein called albumin, or increase in the level of the broad protein called C-reactive protein or CRP for short.

The syndrome of cachexia in head and neck cancer patients-unintentional weight loss, loss of muscle mass, anemia, lack of appetite, and fatigue-is all too common.  But what is starting to be learned about this cancer syndrome may also have profound effects on your heart muscle, resulting in 20-30% of deaths in head and neck cancer patients.

So much more time and money for medical research into cachexia is long overdue.

 

5 Things You Need to Know When You Finish Cancer Treatment

Eating Healthy is part of the Top 5

Eating Healthy is one of the 5

Now what? Is that it? Am I done with cancer? How do I keep it away? How do I know it’s not back? Why do I feel lonelier now than I did during treatment?

These questions often plague a cancer survivor. It can be frightening to finish treatment. For the past few months you have seen physicians, nurses, therapists and other health care professionals sometimes daily; and now you are on your own. Here are 5 things I tell my patients.

  1. Make sure you have a treatment summary and a survivorship plan from each of your cancer specialists. And make sure that your primary care physician has a copy too.
  2. Understand that the transition from cancer specialists back to your primary care physician may result in a lot of anxiety for you and your family. That is normal. And o.k. Trust this doctor.
  3. Make sure you and your primary care physician keep a watch for signs of late treatment side effects. Let your primary care physician know about any new symptoms that you may experience. While I don’t want you to become paranoid, I do want you to communicate with your doctor. If your physician has any concerns, he will send you to see your cancer specialist. You can always contact your specialist if you are not satisfied.
  4. Keep up to date screening recommendations for people with your type of cancer. Follow the survivorship plan carefully. Also continue to have the recommended screenings for other types of cancers. Just because you had one type, unfortunately doesn’t make you immune to others.
  5. Embrace new healthy habits, like a good diet and daily exercise. You have been given another chance. Make the best of it.

Many survivors have a New Normal. It will take some time for your body to find this new normal. Your energy levels, eating habits, and appearance may have changed. Find out what is best for the new you. Worrying about recurrence is a part of this new normal. It can be healthy as long as it doesn’t consume you. Following these 5 steps can help you to be a healthy, happy survivor.