Proper Diet and Exercise for Cancer Patients with Amy Hendel

Last Editorial Review: 10/23/2003

By Amy Hendel
WebMD Live Events Transcript

Amy Hendel will discuss how with proper diet and exercise, cancer patients can lengthen their life and help their own bodies fight cancer.

The opinions expressed herein are the guests' alone and have not been reviewed by a WebMD physician. If you have questions about your health, you should consult your personal physician. This event is meant for informational purposes only.

Moderator: Welcome to WebMD Live. Today we are discussing Proper Diet and Exercise for Cancer Patients with Amy Hendel.

Amy Hendel is the founder of One on One Fitness and Body Jam. Amy is a personal trainer, fitness expert and nutritionist with a background as a physician's assistant. Her mother died of breast cancer, so she works extensively with cancer patients to make sure they eat a healthy diet and have proper exercise.

Does lifestyle really impact the prevention of cancer?

Hendel: I would venture to say that lifestyle is probably one of the most modifiable aspects to cancer prevention that we can currently impact. I believe that many dietary factors can affect cancer risk, and I'd even go so far as to break them down into the types of food we eat, food preparation methods, portion sizes, food variety, and overall calories. I think that most AmericanS do not engage in healthy eating practices, and it's quite obvious that we are developing cancers that specifically reflect that problem. I think its really interesting that four major groups -- The American Dietetic Association, American Society for Nutritional Science, The American Society for Clinical Nutrition, and the Institute of Food Technologists have gotten together to call themselves, FANSA. They all have come together in agreement that if we eat plenty of fruits and vegetables, plenty of whole grains and beans, and if we avoid empty calories, exercise regularly, and if we limit or abstain from alcohol, we can have a major impact on the statistics of cancer. I think that's a pretty profound and manageable statement they're making, and we better wake up and realize that food can be enjoyable but also needs to be approached in a healthful fashion.

Moderator: Are there diets or eating programs specifically for specific cancers?

Hendel: There is a great book out on the market, and it's called The Ultimate Consumers Guide to Diet and Nutrition, the author is James Marti. And he takes a section of his book and discusses 3 cancer diets that are out there in the mainstream, which he believes are quite healthful. The names for the diets are:

Nixon Diet -- this particular one deals with cancer treatment and prevention. It has a number of recommendations for eliminating certain foods called "restrictive" foods, and encourages the eating of high fiber, low fat, particular fat foods, like the monosaturated fats and Omega 3 acids, and Nixon believes that even particularly with colon cancer, fiber fat and calcium have a profound impact on that development. He questions whether diet plays a role in breast cancer, but his recommendations are moderate and manageable.

Simone Diet -- created by Charles Simone, and he's a physician. He wrote a ten point plan on how to approach prevention of cancer, and he makes a pretty standard recommendation of maintaining ideal body weight, decreasing the number of daily calories, eating plenty of fiber, using the supplementation of vitamins and minerals, eliminating salt and food additives, avoiding caffeine.

Bruning Diet -- Nancy Bruning wrote Coping With Chemotherapy Diet, and I think it's extremely helpful for the average cancer patient who has to go through chemotherapy or radiation therapy, because her suggestions help you cope with the deterioration factors that occur when you're undergoing a severe treatment.

Additionally, Andrew Weil has come to the forefront now. He's a Harvard med school grad, who went into botany and plants, and he wrote Spontaneous Healing, and he also lays out an almost 8 week program of slowly changing your lifestyle so you can optimize a healing program. He makes dietary recommendations, and explains how to decrease exposure to toxins. I think his book is an extremely helpful book to anybody who has a strong family history for cancer, or who's undergoing some therapy or who's been diagnosed with cancer. The book covers all those points. Those diets have really specific plans you can follow.

What I find interesting is that if you look across the board at most cancer-recommendation institutes, almost point for point they're in agreement. They want you to stay closer to a plant-based food diet, eat lots of fruits and vegetables, maintain healthy weight and be active, drink alcohol in moderation, stay low even in the good fats, don't want to see heavy use of salt, and want foods prepared freshly. That's out of the American Cancer Society, American Cancer Institute, and many more famous centers around the world.

Moderator: what is the difference between saturated and monosaturated fats

Hendel: Saturated fat would be fat that derives from animal or dairy, because dairy derives from animal. So it's fats that are extremely implicated in cancer production, and those are the foods like red meats with fat built in marbleized, butter, dairy products that are full-fat or whole-fat, and addition to those, there's a subgroup called transfatty acids, and those are things like "coconut oil," "partially-hydrogenated oils," and these are heavily implicated in many diseases, including heart disease, strokes, and those are particularly implicated in colon cancer.

On the other end are the monounsaturated fats, which are things like avocados, olive oil, the fat you'll find in soy or tofu, nuts... these are the foods that we're trying to embrace in moderate amounts, because we believe they help healthy processes and may help prevent heart disease, cancer, and other diseases. We do want those fats as part of our diet. It's kind of the difference between good and bad fat, but in America, we've become so fat-phobic that we embraced a whole new group of foods high in sugars, and I think we went overboard on those in an effort to stay away from fat, and when you look across the book at professionals who talk about health, their principles have always been that of moderation; don't cut it out completely. Treat it as a dessert, or a "treat", an intermittent food.

I think we went overboard when we started to become an obese nation in trying to cut out fat, and became high calorie eaters. That's not any better, because it starts a whole new group of issues. Obesity is definitely being implicated in specific cancer, so if you're going to trade off fat for calories, you haven't accomplished a whole lot.

Moderator: What is the role of vitamins in cancer - are there some to embrace and some that do not help or actually harm?

Hendel: There is a concept out there in cancer genesis called "the free radical concept." There are free radicals that occur in the body, and these are groups of atoms that can cause damage to cells. They can impair the immune system and they can lead to things like infections, degenerative diseases (heart disease, cancer). We do need small amounts of them because they provide energy, but if they overwhelm the system, they can cause things that we believe ultimately lead to cancer. So what we want to do is bind up those free radicals, and stop their function. And the antioxidants are the group of vitamins that do that, particularly Vitamin A, beta carotene, Vitamin C, Vitamin E. Even melatonin is considered an antioxidant, and there are even certain herbs that have antioxidant properties. So the role of vitamins is extremely important in cancer prevention, but you want to be careful because if you've been diagnosed with cancer, and are undergoing therapy, you need someone knowledgeable to tell you what vitamins to be taking, because at the time you're trying to use vitamins to prevent free-radical damage, you might be feeding mutant cells. You really have to approach it in a careful fashion, but if you're talking about cancer prevention, taking antioxidants is extremely important.

Clearly, they have other benefits across the board for other issues. There's a lot of research on this particular topic, and I'm constantly being faxed with various studies being done. And one of the antioxidants is lycopene and up until a few years ago, there was conflicting information about whether it did fight certain cancers. But there is a center called the Fred Hutchinson's Center, and they've done a lot of research on vitamins, and up until recently (their last publication was back in late 1999) they found that some experimentation found lycopene in tomatoes to prevent cancer, and they had the same number of different experiments that showed the opposite. Recently, UCLA's doctor Heber came out with a new study where he showed V8 juice and other tomato products, and he said that he's proven that V8 juice is the cancer warrior of choice. So his study is quite compelling because drinking a can of V8 a day is a really easy thing to do, and if that's all it takes to prevent certain changes or minimize certain changes, it's the really easy thing for the average person to do. And that's a compelling study, and Americans have to take up and notice. Big Macs aren't going to do it, bottom line.

Moderator: Are there free radicals that occur outside the body?

Hendel: Yes, there are free radicals that occur outside the body, but most people that ask that question are referring to environmental stressors that can cause changes. The story in my family is a good indication; I used to walk around quite proudly because there wasn't cancer even in distant relatives. Not a single relative developed cancer until my mother did. She developed it in her 60s, and was on hormone replacement therapy long after her hot flashes had subsided, and I was unaware of that. She had been a woman who had yo-yo dieted all her life, and had a lot of emotional stress in her life, and she spontaneously developed cancer at age 62. I use "spontaneously" with caution, though she had a yearly mammogram. We have to assume that in one year, a very aggressive cancer began to grow, and I'm not sure whether I can attribute that growth to one choice she made, but it's quite obvious that some of her lifestyle choices was a good explanation for simulating something that was there. I like to think of cancer as a dormancy, and only when you flick it does the switch turn the cancer on. She didn't take vitamins, was a very heavy protein eater, and to this day, we don't have an explanation as to why someone like my mom developed cancer. So I clearly implicate lifestyle, those free-radical contributions, her lack of doing stress detoxification, and individuals need to think of all those pieces of the pie as being contributing factors. I would like to comment and say that most professionals believe that lifestyle can ultimately prevent it if it's going to happen; we have to account for the genetic factor and that we're exposed to thing we never think about, but even under those circumstances, leading a really healthy or nutritious lifestyle can possibly prevent or minimize some of the cancers we ultimately succumb to.

Moderator: Do you think hormone replacement therapy (HRT) played a big role?

Hendel: I have to be quite honest and say that I'm very bothered in which her therapy played out. My mom went through menopause in her late 40s, and I do recall that she suffered on and off from hot flashes, but she ultimately came through and was being pretty good about her calcium. There wasn't a strong family of heart disease in my family, so it was by surprise that she was on HRT. And had she consulted with me, I wouldn't have suggested it to her. I do believe heart disease is the #1 killer in women, and that's why we use HRT, but that not information is getting out about lifestyle changes. I try to work hard with people, and if they are going through menopausal symptoms and they can't stand it, I will say "fine, go on a short course of HRT to get through these bothersome side effects of menopause," but once they're through, I feel that we owe our patients a heavy introduction to the lifestyle choices they can be taking so ... In my mom's case, I wish we had talked about it more. I'll always be bothered by the fact that there were other choices out there for her.

Moderator: What types of exercise do you recommend for patients at various stages of their treatment?

Hendel: First of all, I think it's really important to take note of Lance Armstrong. He's a walking testimonial to the dedication of somebody through exercise, and the role it plays in helping someone through a dreaded disease like cancer. He entered his stage of cancer being in extremely good health; he exercised daily, ate fantastically in healthy choices, but I'm definitely convinced that he came out of it because of the role that exercise as well as nutrition played in his life. I think it helped him to have this goal to work towards, and even an average individual if they can say "just ten minutes of walking today," it gives them a short term physical goal to work towards to get them in a mindset to put aside the unhealthy aspect of cancer. I'm very compelled by many of the mind/body exercises out there, like yoga, which is an incredible resource of exercise to help an individual through exercise, and I think that's because of the breathing techniques and posture that's involved. The movement and meditation help the person get in touch with their inner spirit, and if you're as battling as serious an illness as cancer, yoga can really help. The relaxation aspects of it helps an individual to calm inner feelings they're having. I would call yoga a complementary therapy, and I think it improves your feeling of well-being, but it's not a singular treatment for the disease. I'd use them as one of many pieces of pie to combat the illness. Another form of exercise I like is tai-chi, and a mind/body experience that I think is good to deal with. I think going for massages, meditation, acupuncture, are all great addendums to help you cope with this disease. 

I know that in working with patients personally, that if they can maintain a percentage of their regular exercise schedule during the course of treatment, it helps them focus on something else than the breaking down of their bodies. Keeping a certain percent of muscle will help with your system, and not only the mind body exercises, but even the actual weight-training exercises is beneficial to someone who can manage it. If you're extremely debilitated, you shouldn't engage in it, but if it's a regimen that you've embraced, you should try to keep it going even through the treatment. If you haven't embraced it yet, get a buddy and have someone mentor you through the exercise experience as you're dealing with cancer.

There's even one less well known form of Oriental exercise called Qi Gong, and it involves movement, meditation, and you're trying to strengthen the body's energy. It derives from martial arts, but it's a very slow and intense type of exercise, and you're being forced to focus in on the internal reservoirs you have, and I think it'd be a very beneficial group of all the exercises, to be beneficial to somebody who's even doing standard exercising.

Moderator: What types of foods are best for cancer patients?

Hendel: Let's talk about some of the foods out there that will specifically help, and I like to turn to cereal. I think it's somewhat of a comfort food. If you choose a high fiber cereal, I think it'll cleanse your system and help you potentiate your energy sources, and there are particular ones I like to recommend -- Kellogs All Bran, All Bran Extra Fiber, Brand Buds, Raisin Bran, and even though Raisin Bran has a somewhat high sugar content, it's balanced out by its fiber content. Cancer patients sometimes gets a craving for sugar. Once again, I like cereals a lot, and they go down easy, especially if you use soy milk. In terms of other foods, I think you can get fiber and plant nutrition through soups, so I like low-sodium, organic soups like Health Valley, which puts out dozens which are high in fiber with protein content, and you want to maintain muscle mass which is important for fighting the debilitating effects of cancer, so a high protein minestrone or bean soup is a great way to go, and they go down easy and light. If you're undergoing radiation or chemotherapy, you need foods that don't go down too heavy, because you're battling nausea.

And if we can talk about phytochemicals, and these are named carotenoids, isoflavins, and they seem to have tremendous potential for anti-cancer. I like to go through a couple of them, so people know what they're getting from what foods. Flavinoids are the number one; it is believed to be one that protects against cancer, and you can find it in citrus fruits, apples, onions, green tea, and wine. Another one is Genistein, and we believe that one blocks the formation of new blood vessels, so you can cut off the blood supply to a tumor, and it's in soy beans and tofu. Another group are the Indoles, and we believe that they stimulate the production of anticarcinogenic enzymes, and may protect against breast cancer. The foods you find in that are broccoli, cabbage, brussels sprouts, and other members of the cabbage family. The Isoflavins, which are very popular, seem to inhibit estrogen production, and once again we're back to soy beans and soy products. And polyphenols are ones we find in green tea and do believe it has an antioxidant effect. Other foods in general that you want to embrace are brussels sprouts, kale, scallions, garlic... mostly what you want to see is a broad variety of different colored plans and fruits. If you're choosing your proteins, try not to go heavy on the animal foods, but use beans or egg whites, fish. These are the foods you want to try to eat in larger amounts, so it gives you a broad choices and one can say this is such a bland diet. But these are foods that if you go into the supermarket, there are so many choices and you can buy organic versus regular. So one can't say that you'll suffer too much if you can't have certain foods.

Moderator: Would you recommend cutting out or down on dairy?

Hendel: I have a real struggle with the dairy product issue. On the one hand, osteoporosis is so rampant right now because we are living longer, but as a person who is a nutritionist and is a exercise provider, I think the calcium aspect of milk is important. But I do believe there are other ways to get calcium, and you can get adequate sources of it from leafy vegetables, soy, calcium-fortified orange juice, or even take supplements. A person can chew Tums or new Viactive chews. Or you can take those calcium horse pills. So I think you have to make a personal decision on that; I do like small amounts of dairy products in my diet, and I am a vegetarian. But there are groups of individuals out there, and Andrew Weil is one of them, who believes that the dairy group may not be as beneficial as we've thought. I don't condemn the food group, but I do think it's a personal choice.

Just because we've gone back to nutrition, there is one individual who's diet plan I'd like to mention -- Mishio Kushi, and he's one of the individuals funded by the NIH back in the 70s to do cancer research. He came out with a book called Cancer Prevention Diet, and he talks about key foods that are important to have, cancer inhibiting macrobiotic foods, and believes in yin and yang cancers. And he talks about specific yin and yang considerations; if you have this kind of tumor, its a yin tumor and you have to eat a certain way. I think that it's a very hard diet to follow; he does have a center back on the East coast, where you can go and learn cooking techniques, and he has disciples around the world who teaches the cooking techniques. I have a feeling that if I was struck with cancer, I don't have such a love with food to embrace his eating plan wholeheartedly, but I do recommend it for individuals with serious cancers and don't have too many choices with optimal therapy. But if you love food, and food deprivation will provide a serious disappointment for you, it's not the way to go. I had a family who came to me, with the wife who wanted her husband to do this diet, and the husband is seriously ill, and he made it very clear to me that he'd find this diet reprehensible, and from a mind/body connection, my answer is that I didn't think the diet would work for him because he was so negative about the diet. You want the individual to be behind the choices they're making to help their illness. I don't think that choice is for everybody, and one has to explore their options and where they want to be for cancer prevention or its treatment.

Moderator: What typical lifestyle habits do people need to change when diagnosed with cancer?

Hendel: I saw a wonderful article many weeks ago, called "Five Fairly Painless Ways to Decrease Risk", and the recommendations made were ones I say all the time. My number one choice is eat less red meat. Make it several times a month at most, and try not to eat well done meat within that subgroup. My second choice is eat at least five daily servings of fruits and vegetables. There are 200 studies that show that fruits and vegetables can reduce various cancers of the body. And as I mentioned before, in this particular subgroup, tomatoes do seem to have an impact on cancer. Produce is also packed with lots of antioxidants. Three, restrict alcohol intake to once a day for women, and twice for men. We do see that drinking is tied to higher rates of cancer. My next choice is to take folic acid and other antioxidants. Folic acid also has an anti-cancer potential against lung, cervical, and colon cancer. Then what we spoke about before; reduce your saturated fat and salt intake. If you're going to eat fat, choose from the good ones -- olive oil, avocados, nuts, soy and tofu... and choose from the Omega 3 groups. Those are the ones that are very beneficial to you. And an excellent diet cannot make up for a lack of exercise; thirty minutes a day of activity for 4 to 5 days a week will reduce the odds of obesity and to develop certain cancers. 

I think it's also interesting to note that everyone has heard of H&R Block. And I think that most individuals don't know that Richard Block, it's founder, was diagnosed back in 78 with inoperable lung cancer, and he was told by his surgeon that he had 3 months to live. A friend of his insisted that he get a second opinion from a local oncologist, and this oncologist told him that he could cure the cancer, and put together a group of multi-disciplinary oncologists to offer him some options -- he underwent therapy, surgery, chemotherapy, and immunization therapy (quite radical in those days), and he's now living 22 years later cancer-free and feeling great. A few things he mentioned as he discusses his particular route to health, was that you needed to lead a healthy lifestyle. You had to strengthen your immune system, maintain your weight through life, and if you're afflicted with cancer, then don't lose weight as you're undergoing therapy. He felt it was important to have a positive outlook and engage in many of the mind/body exercises out there. Ultimately, today, he still exercises and still eats the same way he did 22 years ago when he underwent this whole catastrophic event, so one has to assume that there are cancers that are not beatable, and no matter how hard you fight and engage in good lifestyle choices, they're still going to win. But we have to take our information from all the times people succeed in battling the cancers when the odds seem to be insurmountable. And diet and exercise plays a huge aspect to overcoming those types of cancers.

Moderator: How has the treatment of cancer changed over time?

Hendel: I think if we look at many of the studies that have evolved in the last twenty years, they weren't implicating diet back then as being a contributor to therapy or prevention. There were acknowledging that smoking was a contributor, and there were environmental causes of cancer. But I think that what's evolved is that particularly in Western culture, we see what happens when western culture goes into other cultures. If you look at the oriental group, when you see Chinese individuals or Japanese individuals come to America and westernize, you see certain rates of cancer go up in these populations. When certain fast food groups invade society that have never encountered that type of food, we see changes in the statistics of cancer in those areas. And one has to assume that it may not be the only cause, and we may not be able to point a specific food at the food or cause, but over 20 years, we've seen what happens in other populations when the western diet enters their realm, and we have to acknowledge that phenomenon. And based on that, you just have to log onto the many health websites that are on the net. One such as yourself, and the others out there, and across the board, they're making the same recommendations, to lower your fat, take vitamins, increase daily activity, limit alcohol, cut out smoking, and all across the board, they agree. I think you have to be compelled that so many groups have gotten together and agree on many of the recommendations.

A couple pieces of information -- supporting this view, there was an experiment that went on genetic and environmental factors on prostate cancer, and they did a 5 year study of Asian men, and notes they had lower instances of prostate cancer and benign prostatic cancer. Most of the men who were vegetarian also had lower instances of prostate cancer. And across the board, they said that probably this was because both the Asian men and the vegetarians had diets that had huge amounts of those phytochemicals we talked about. They felt this was a commonality this group had. In addition to that, if we talk about reviews in GI cancers, most people who are involved in cancer therapy of the GI tract believe that obesity has a profound impact of developing colorectal adenoma, and general cancers of the GI tract. So I'm not just citing one piece of research, but I'm indicating there are numbers of research projects going on, and they're coming up with the same evidence. I'm not suggesting that one engage in strange, alternative therapies to deal with this, or one engage in strange cultural recommendations that don't really pervade our culture... I'm simply saying that we can make simple modifications and changes in our lifestyle to seriously impact what's going on in our environment around us. Our children are being exposed to processed foods, high calorie foods, high sodium foods, allergens and environmental issues that we didn't get exposed to until we were adults. They're getting exposed to it at very young ages, and I wouldn't be surprised if we saw some cancers show up much earlier in this population of youth.

Moderator: What are some good methods to lift the spirits of children with cancer?

Hendel: I had a daughter who had a serious problem with motion illness, and she was open to biofeedback, and with a small introduction, she was able to take charge of an issue quite overwhelming for her. So I think children are a population who don't have preconceived notions or our prejudices, and if we introduce them to soy, exercise that's fun, meditation, guided imagery, I think that on a whole, they are readily willing to embrace these things as long as we don't introduce them with prejudice. A lot of the hospitals around the world do animal therapy, clowns, and certainly music has a profound impact on children on how they view life and illness. But we have to start the message to them with a really young age, and if they see mom and dad going out and trying exercise, trying new foods, and see supports coming from their adult models, I think on the whole, kids are really quite amiable to trying new things and listening to suggestions.

Just to give you a little background on my exercise history, I'm currently 40 years old and have been a personal trainer for almost 15 years, but its only recently that I went back to teaching classes. One of the many reasons I went back was to prove to myself that at 40, I could do it. I lead a very healthy lifestyle, and practice what I preach. I felt so many individuals out there as baby boomers, who are potentiating at this point... Katie Couric with her husband's battle with colon cancer. I think of her as a role model. My business has always reflected those principles of leading a healthy lifestyle. So many of the clients are average housewives, and stay at home moms, but because I have a medical background, I'm able to see more complicated individuals. I have people who come to me who have been diagnosed with cancer, or post-cancer therapy, and want to get their energy levels back, so my practice revolves quite significantly around individuals who have been sick or have the potential to get sick. I run Body Jam in Encino, California and we teach boot camp classes which are resistance training to music; they're somewhat aerobic in nature, and we get varying age groups. And people basically do it at their own pace, but it's a nice way to come in to a social environment, and do exercise that's going to benefit you. So that's been something I recently engaged in and am having a lot of fun with it. 

But I went to get out the word that if I can teach classes at 40, its not asking too much of anybody to pick up some exercise and do it. You don't have to do something structured; it can be as simple as going for a walk. Pick something you love to do and do it because it is a deterrent down the road for diseases.

Moderator: Thank you for joining us, Amy. WebMD members, please join us every Tuesday at 9 pm EST here in the Sport and Fitness Auditorium for our live weekly event. Next week, we will be discussing "Volumetrics: A Systematic, Lifetime Approach to Eating," with Barbara Rolls, Ph.D.

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Last Editorial Review: 10/23/2003