Inspire Health: Care Guide

inspirehealth’s guide to

Supportive Cancer Care A resource for people living with cancer and their families.

2

inspirehealth

JOIN US TO

Inspire Change InspireHealth is a not-for-profit charitable organization funded by individuals (like you!), private foundations, corporate partners, and the BC government. With your support, we will be able to offer supportive cancer care to more and more Canadians living with cancer. Help us inspire change in our health care system. Please donate now by visiting, www.inspirehealth.ca or by calling 1.888.734.7125.

InspireHealth is grateful to our Community Partnership Funders for funding the expansion of our program: the BC Ministry of Health, Lotte and John Hecht Memorial Foundation, and corporate, private, and patient donors.

About InspireHealth InspireHealth was founded by two medical doctors in 1997 with the intention of providing person-centered care and support of health and well-being to people living with cancer and their families. Our approach is wisdom-based and research-informed and respects patients’ choice. InspireHealth continues to be a working model of supportive cancer care that is inspiring change in our health system towards a system that embraces self-responsibility, health and well-being, empowerment and self-care as primary components of care.

Our Purpose Our Founders Dr. Rogers is recognized for being a Canadian leader in Integrative Medicine.

Dr. Rogers had a special interest in integrative cancer care for over 30 years.

In 1977, he co-founded the Thera Wellness Centre, an organization devoted to working with the whole person towards optimum healing. Dr. Rogers also taught medical students at the University of British Columbia (UBC). Following a lifelong interest in nutrition, natural healing and complementary therapies, he founded the Centre for Integrated Therapy in 1992. In 1997 Dr. Rogers and Dr. Gunn formed the Centre for Integrated Healing which was the foundation for InspireHealth. In 2001, Dr. Rogers was appointed to the Order of British Columbia, the province’s highest

Dr. Roger Rogers, co-founder, b.a., b.s.w., m.d., o.b.c.

honour, for his pioneering work. Dr. Rogers retired in 2005 and died peacefully on November 22, 2011 at the age of 83. The Hecht Foundation created the Dr. Roger Rogers Prize in 2007, which awards a $250,000 prize biennially to a leader in

+ Provide supportive cancer care for people living with cancer and their families, in a caring and informative environment, guided by physicians and other health professionals.

+ Inspire lasting lifestyle changes that enhance quality of life, reduce cancer recurrence and may improve survival.

complementary and alternative medicine.

Dr. Gunn has had a lifelong interest and great respect for the healing potential of the human body and the role of the mind, body and spirit in health and healing.

Dr. Gunn has a clinical appointment with the UBC School of Medicine and has played a leadership role in InspireHealth’s research department and programs. In 2009 he was awarded $125,000 by the Dr. Rogers Prize committee for vision, leadership and

+ Research the effectiveness and cost-effectiveness of supportive cancer care for prevention, health and well-being.

integrity in the field of Integrative Medicine. Dr. Gunn is recognized nationally as a leader in integrative medicine, and works collaboratively with other organizations to integrate the concepts of health and healing into mainstream medicine. In 2015 Dr. Gunn retired from InspireHealth after 18 years of service as CEO.

Dr. Hal Gunn co-founder, b.sc., m.d.

InspireHealth is a not-for-profit charity that receives annual funding from

+ Educate the public, physicians and other health professionals about the effectiveness of supportive cancer care.

British Columbia Ministry of Health to cover clinical services. All other costs are supported by private and corporate donors and foundation grants. The year 2011 marked a significant milestone for InspireHealth and supportive cancer care in British Columbia. The Provincial government and the Lotte and John Hecht Memorial Foundation provided additional funding to expand from a single centre in Vancouver to three centres (Vancouver, Victoria and Kelowna), plus a virtual program, InspireLife

+ Play a significant leadership role in the creation and provision of person-centered care in our health system.

Canada, to serve rural and remote British Columbians and cancer patients across the country. With this additional funding, InspireHealth was able to expand its team to include physicians, nurses, nutritionists, exercise therapists, and clinical counsellors.

2

inspirehealth

+ Inspire one another to live healthy, joyful, and passionate lives.

2

“A human being is part of a whole, called by us the ‘universe’, a part limited in time and space.

He experiences himself, his thoughts, and feelings, as something separated from the rest—a kind of optical delusion of his consciousness. This delusion is a kind of prison for us, restricting us to our personal desires and to affection for a few persons nearest us. Our task must be to free ourselves from this prison by widening our circles of compassion to embrace all living creatures and the whole of nature in its beauty.” albert einstein

3

Contents

1

p. 6

2

Introduction

p. 16

3

p. 22

8 Research

The InspireHealth Philosophy

The Foundations of Health and Healing

8 Programs and Services

19 Remarkable Recoveries

24 Will to Live

11 Consultations with Health Professionals

20 The Evolving Cancer Care Model

24 Hope

12 Our Classes

20 The Multifactorial Nature of Cancer

27 Joy and Laughter

15 Community

24 Spiritual Connection 27 Empowerment 28 Body-Mind Awareness 28 Emotional Connection 30 Stress Reduction 32 Reducing Toxins 36 Nutrition

inspirehealth’s guide to

Supportive Cancer Care A resource for people living with cancer and their families.

This book is not intended as a substitute for the medical advice of physicians.

Please consult with your doctor on matters pertaining to health, symptoms that may require diagnosis or medical attention and treatments. Every person is unique, and diagnosis and treatment must be individualized by his or her doctor.

4

inspirehealth

36 Exercise 36 Sleep, Rest And Relaxation 38 Supportive Therapies

InspireHealth’s Guide to Supportive Cancer Care

4

p.40

Nutrition 42 Inspiring Food Transformations 51 Recipes

5

p. 56

6

p. 64

Introduction to Supportive Modalities

A Message from InspireHealth

58 Exercise

66 Notes

61 Meditation

74 Bibliography

62 Yoga 62 Support Groups 62 Massage 63 Manual Lymph Drainage 63 Acupuncture

“What lies behind us and what lies before us are tiny matters, compared to what lies within us.” ralph waldo emerson 5

INSPIREHEALTH

Introduction

“Healing may not be so much about getting better, as about letting go of everything that isn’t you - all expectations, all beliefs -and becoming who you are.” rachel naomi remen, md

I

nspireHealth provides a supportive cancer care program for people living with cancer and their supports. We integrate healthful nutrition, appropriate exercise, and emotional and spiritual support with standard cancer treatment for a comprehensive wholeperson approach to care. This supportive approach honours the value of standard cancer treatment while at the same time recognizes the importance of individual choices that support health and well-being at the level of mind, body and spirit.

6

inspirehealth

Inspirehealth’s Guide to Supportive Cancer Care

7

Introduction “Decision-making can be an intuitive process in which you pull data from your mind, your heart, and your intuition, relying upon the guidance of your higher self.” gary zukav

Engagement in Health Self-care, empowerment and engagement in health are important principles of our approach. Informed personal choice is supported and honoured, and participants are encouraged to play an active role in their own treatment choices, self-care and health program. There is growing evidence that taking charge of one’s own health can significantly improve quality of life and may reduce the need for hospital visits. It is important to note that people who exercise regularly and eat healthfully can still develop cancer – cancer is a multifactorial illness and for each person the combination of risk factors is different. However, we can all learn to take better care of ourselves – mind, body and spirit.

Standard cancer care such as surgery, chemotherapy and radiation treat the disease but do not address the broader context of health or the underlying factors that predispose to or help prevent cancer development.

InspireHealth was founded to provide care that helps people explore the many ways in which they can support their own health and well-being during and after cancer treatment. By welcoming family members and patients’ chosen supports, InspireHealth may also play an important role in cancer prevention as support members engage more fully in their own self-care practices.

Decision Making A diagnosis of cancer presents many decisions that can feel overwhelming. Although we may not always realize it, we do always have choices and for some they are important to explore.

At InspireHealth, we offer an open and nonjudgmental environment that supports your optimal decision making.

Feeling settled, confident, or hopeful about a choice we make can be an important step towards reducing stress and bringing a sense of readiness for what’s next.

InspireHealth’s programs are designed to be safely integrated with standard cancer treatments to enhance health and well-being.

8

inspirehealth

RESEARCH InspireHealth provides research-informed clinical services and programs. Our health professionals, including physicians, nurse practitioners, exercise therapists, clinical counsellors, and nutritionists, keep up to date with current research and information. Evidence continues to build confirming the value of supportive care for people with a diagnosis of cancer and for preventative measures.

Research Updates Our clinical research team creates one of our periodic newsletters, Research Updates, which analyzes and reviews important studies in cancer care to inform and educate readers about healthy lifestyle factors. Each study is carefully translated to be read and understood by those who do not have a scientific background. To receive Research Updates, please visit our website at www.inspirehealth.ca.

PROGRAMS & SERVICES At the philosophical heart of InspireHealth’s programs and services is the recognition that personal autonomy, personal choice and self-care play essential roles in health and well-being. Personal empowerment and choice are encouraged, supported and honoured by the physicians and health professionals at InspireHealth.

We offer a range of programs and services at our three locations and also through our virtual centre, InspireLife Canada.

Lower Mainland – Vancouver

604.734.7125 Vancouver Island – Victoria 250.595.7125 Southern Interior – Kelowna

250.861.7125 Toll-Free Phone Number 1.888.734.7125 Virtual Centre – InspireLife Canada www.inspirehealth.ca/inspirelifecanada

InspireHealth’s Guide to Supportive Cancer Care

A. The LIFE Program InspireHealth’s LIFE Program consists of 12 hours of education and interactive learning over a two-day period. It includes an introduction to supportive cancer care and an exploration of InspireHealth’s Foundations of Health and Healing. Meditation, exercise, nutrition, stress reduction and healthy sleep practices, group sharing and healthy communication are explored. The goal of this program is to provide an opportunity for people to explore the ways in which their mind, body and spirit can contribute to health and well-being.

Participants are encouraged to bring family members or other support people with them to the LIFE Program.

A healthy lunch and snacks are provided for all participants on both days. Please visit our website for the dates of the LIFE Program in your area.

There are four parts in the LIFE Webinar Series: Part 1: Foundations of Healing Learn an optimal approach to engage the mind, body and spirit to create a solid foundation for health and well-being.

Part 2: Nutrition - Inspired to Eat Healthy This module will teach you the key areas for nutritional change to enhance your health. Even small changes to your diet may help to optimize your body’s healing potential.

Part 3: Self-Care and Support This dynamic webinar explores ways of discovering deeper levels of awareness, strategies to manage stress and how we can support authentic, healthy communication.

B. LIFE Webinar Series InspireHealth’s LIFE Webinar Series is a supportive cancer care education program that can be accessed online from anywhere. Four live sessions are provided in a convenient online format during which participants can ask questions of the facilitating health professional.

Through this program participants will learn powerful ways to prevent cancer, alleviate symptoms of cancer treatment, reduce the likelihood of recurrence, and optimize health and well-being.

A high-speed internet connection is required to participate. Please visit our website for dates and registration information.

This program is open to anyone who is eager to take an active role in their own health and well-being. This program is right for you if: + you have received a cancer diagnosis, recent or past, or; + you are supporting someone with cancer, or; + you are interested in cancer prevention.

Part 4: Physical Activity - Inspired to Move Understand how exercise can help reduce cancer risk, lessen side effects of treatment and enhance the effectiveness of cancer treatments. You’ll learn how simple and intentional movement helps you feel better and contributes to your health and well-being.

“These two days have marked a turning point in my life. I feel I have turned a corner, where the sun is shining. Thank you for helping me find out about my power, my choices, my future.” inspirehealth member 9

“The whole program is informative, creative, inspirational, and from the heart. It’s very thought provoking and helps me through this healing journey that I am on.” inspirehealth member

C. Life Enhancing Advanced Program (LEAP) As a follow-up to the LIFE Program, participants are encouraged to return for four LEAP group sessions facilitated by one of our InspireHealth physicians or health professionals. These sessions provide a forum to further explore the Foundations of Health and Healing introduced in the LIFE Program. Participating in these group sessions fortifies and inspires greater levels of self-care and self-awareness. There are four themed LEAP Sessions: Mind Learn how to use your mind to promote health.

Participants will explore barriers such as external and internal stressors and become aware of thoughts, beliefs and attitudes that restrict our ability to care for ourselves. Participants will learn about the mind-body connection to help address fear, anxiety, guilt and other distressing emotions.

10

inspirehealth

InspireHealth’s Guide to Supportive Cancer Care

“Simply relax, be who you are. Sink deeply into who you are and appreciate yourself.”

Spirit Connecting with our own unique sense of spirit can help us transform our fears and worries and bring us a natural sense of peace, joy, gratitude and freedom.

Participants will explore how spiritual connection supports health and allows us to move with more ease through the many cycles of life. Topics may include spirit, death and dying, aging, meaning and purpose, and tapping into our inner wisdom.

CONSULTATIONS WITH HEALTH PROFESSIONALS Physicians or Nurse Practitioners

Body Come home to your body. Deepen your relationship with your body and let go of excess stress by practicing listening to, and acting upon, the body’s messages.

Learn the art of deep, relaxed breathing and take home a breathing practice that settles the mind and body.

Share your exercise and sleeping routine inspirations and challenges. Leave with a renewed sense of connection with your body and motivation to care for your body in new and more significant ways.

Passion Passion is in all of us. We may experience being disconnected from our passion but it is always awake and alive within us. In a dynamic group setting, we explore passion: what it is (and what it isn’t), how to connect with the ‘spark’ inside all of us and how to express ourselves more fully and authentically. Discover how connecting with our passion expands our horizons and helps us feel more alive!

The individual medical consultation with a physician or a nurse practitioner provides an opportunity for those with a cancer diagnosis and their loved ones to discuss all aspects of the medical diagnosis. This comprehensive consultation includes a discussion of medical history, social support, emotional well-being, and any questions, concerns, stress and/or decision-making that the patient may have.

The role of InspireHealth physicians and nurse practitioners is to provide guidance on supportive approaches to optimize health and well-being while going through cancer and its treatments. Participants are expected to maintain strong relationships with other members of their health care team, including their family physician, oncologist, surgeon and, if appropriate, palliative care physician, all of whom provide important components of care. The family physician plays a key role in helping access and coordinate services within our health care system, so it is important to maintain an ongoing working relationship with him or her.

Nutrition team Good nutrition plays a key role in both cancer therapy and prevention. Our individual nutrition consultations are designed to take a look at your overall health and 11

Introduction “I felt supported and validated by helpful professionals – but more importantly I felt I regained my power and can go home and implement what I’ve learned – I can validate myself.” inspirehealth member

diet picture, and recommend foods, eating habits and lifestyle choices that are best suited to you. The nutrition team will educate you on the ‘whys’ behind the choices, empowering you to apply these principles at meal and snack times, in grocery stores and in restaurants.

You will leave with a sense of direction and ease in determining the most appropriate food choices for you.

Clinical Counsellors Taking time out to reflect and listen to your own deeper needs, at your own pace, can be an important part of your personal healing process. Feelings of anxiety, depression, fear, grief, stress, anger, trauma and relationship conflict can surface during this transformative time. Counselling provides a safe place to explore your relationship with yourself, your health, your cancer and your loved ones. Learning about your thought patterns, stressful triggers and emotions can be helpful to reduce stress and feel more empowered, resourced and at ease in your life.

Exercise Therapists Physical activity is very beneficial during all stages of the cancer journey, as confirmed by research. Our exercise therapists have experience recommending exercise tailored for individuals with cancer. During an initial consultation, with your input, the exercise therapist determines your starting point, assesses any limitations and creates a personalized program that will help improve your strength, endurance, balance and posture, and increase your appreciation for and your confidence in your body. The movement and exercises are specifically tailored for you and are intended to help with physical issues from cancer and any side effects from cancer treatment.

12

attend group classes and programs of their choice to learn new ideas, and perspectives and to discuss challenges and share experiences to ensure a longterm commitment to a healthy lifestyle.

Patients are welcome to bring family members or other support people with them to all consultations and most classes.

OUR CLASSES Ongoing classes assist in integrating simple and helpful approaches to optimize health and provide a whole person approach to health and well-being. Class instructors take into account each participant’s unique circumstances. Classes are available for patient and support members. Most of the following classes are offered at all three InspireHealth locations. Please check your schedule.

Cooking for Health Join our nutrition team for a series of demonstration cooking classes on the preventative and therapeutic potential of whole, natural foods. Learn to incorporate and prepare the foods that promote health into your daily routine. Each class covers vital nutrition information, and introduces delicious meal and snack ideas. Participants will have the opportunity to sample some of the foods prepared in class.

Relaxation & Visualization Take extraordinary care of yourself. Infuse your world with TLC and deep relaxation. Soothe your body, mind and spirit in a caring atmosphere through breath work, music and healing imagery. Wear comfortable clothing and just bring you – this is your time!

Follow Up Appointments

Meditation

Follow-up appointments are available with all of our health professionals. Patients are also welcome to

Meditation helps to still the busy mind so that we can be more relaxed, optimistic, and at peace. Our meditation

inspirehealth

InspireHealth’s Guide to Supportive Cancer Care

classes help reduce stress, tension, anxiety and depression, and can help participants relearn a skill often lost since childhood: the ability to relax at will and return to inner balance. Our meditation classes are designed to introduce you to basic meditation or to support your existing practice. The focus is on calming the mind, developing mindfulness and acceptance, and connecting with your intuitive wisdom. In addition to on-site meditation classes, we also offer meditation online. Please check our website for details.

Exercise Classes A consultation with one of our exercise therapists is required prior attending our exercise classes.

Starting to exercise and getting back on track are processes of inspiration, support and motivation. Come and experience the resounding benefits of incorporating exercise and movement into your life and healing process. Improve energy, emotional resilience, cardiovascular endurance, balance and muscle strength in a fun and dynamic group setting.

“These classes make practical all that the doctors are trying to instill in us and they are very much needed for cancer patients – and everyone else.” inspirehealth member

13

Introduction

Yoga Our classes provide a gentle introduction to yoga, inviting you to watch and listen to your body and your breath as you go through simple achievable movements.

Through this practice you are invited to learn how to pace yourself, so that you can open to a deeper level of connection and contentment within yourself. Every class is a combination of movements and positions, stretching, focused breathing, and relaxation.

Laughter Yoga Laughter is the best medicine! In this class, you will have a chance to lighten up and enhance your immune system through simple breathing techniques and easy movement designed to inspire the body to laugh. Since you can’t worry and laugh at the same time, Laughter Yoga can help you take a break from your worries and even see them in a new light.

Support Groups Support groups provide a safe and supportive atmosphere in which to share and explore the physical, mental, emotional and spiritual challenges of dealing with a cancer diagnosis - your own or that of a loved one. Opportunities are provided to gain insights and fresh, supportive perspectives on your experiences.

Learn and share practical life-affirming communication and self-care skills. Separate support groups are available for patient members and support members.

14

inspirehealth

InspireHealth’s Guide to Supportive Cancer Care

“Re-examine all that you have been told. Dismiss what insults your soul and your very flesh will become a great poem.” walt whitman

COMMUNITY InspireHealth invites members to contribute to our community in a number of ways, including participation as a speaker to share your experience of InspireHealth.

Join InspireHealth staff at public talks and our own inhouse Education Sessions (InspireHealth’s introductory talk), or provide personal written accounts, social media images and video to share your InspireHealth experience with others.

To enhance the community experience, InspireHealth offers social media websites like Facebook.com and Twitter.com that share links to media stories on nutrition, physical activity, stress management, new research, and stories on the human spirit. The InspireHealth monthly e-newsletter (delivered by email-only) is available to all members and shares all new InspireHealth initiatives, class schedule updates, and events in the community.

Sign up for the e-newsletter on www.inspirehealth.ca or at one of InspireHealth’s centres.

We gratefully encourage members to promote InspireHealth in their own communities. Our team is available to give public talks at community groups, spiritual institutions, or the workplace. Members who are interested in organizing a fundraising event to benefit InspireHealth, please contact our team who will provide event support.

Volunteering If you or someone you know is interested in volunteering your time with InspireHealth, please contact us to arrange an interview. We look forward to welcoming you to our dynamic and inspired team.

15

2

INSPIREHEALTH

Philosophy

“There is no perfect path for healing. Every path is unique.” hal gunn, md, co-founder of inspirehealth

S

urgery, chemotherapy and radiation play important roles in cancer treatment. However, these treatments do not address the underlying factors that may predispose to cancer development, or the many aspects of physical, emotional, mental and spiritual support that are important for quality of life.

There is growing evidence that supporting health through nutrition, exercise, restful sleep, emotional support and stress reduction can play an important role in the healing process. Scientists are exploring what ‘healers’ have known for centuries - that our minds and bodies are inseparable and that healing can involve more than medical treatments alone. InspireHealth’s programs provide support for all aspects of healing mind, body, and spirit – before, during and after standard cancer treatments.

16

inspirehealth

17

Philosophy “When we are no longer able to change a situation - we are challenged to change ourselves.� viktor frankl Supporting our overall health can facilitate the healing process and improve our quality of life. Becoming actively engaged in mindful-based practices (e.g., meditation, relaxation and visualization, slow walks in nature) can enhance mood, energy levels, coping and improve both disease-related and treatment-related symptoms such as pain, nausea, vomiting and insomnia.

Psychoneuroimmunology research (i.e., the study of the relationship between the mind, body and immune system) is exploring the many pathways by which mind-body practices are linked to improved health.

We believe that it is important to connect with your heart and take charge of your health by designing your own plan - one that feels exactly right for you.

18

inspirehealth

Research studies have demonstrated that mind-body practices can enhance the response of the immune system. Further research is needed to clarify how these immune system changes may benefit clinical outcomes and survival.1 Empowerment, engagement and personal choice are the principles at the heart of InspireHealth’s philosophy.

By engaging in the many ways we can support ourselves (e.g., nutrition, exercise and stress reduction) we can enhance our quality of life. Our physicians and health professionals work together with you to create a health plan that best suits your unique needs.

InspireHealth’s Guide to Supportive Cancer Care

REMARKABLE RECOVERIES Although quite rare, there are people who fully recover from advanced cancer. The majority of these people exhibit many or all of the following characteristics:

This transformation can bring authenticity to their life as they connect to their deepest values, prioities and aspirations. They may see their cancer as a ‘gift’ that helped transform their life in a new and positive way.

1. They have a deep belief in their body’s ability to heal.

Even for people diagnosed with untreatable cancer.

5. They bring a new authenticity to their relationships with others and the world around them.

2. They regain a sense of control in their lives - a feeling that they can substantially impact their own health and healing.

6. They fully reassess their lives - often making significant changes to their diet, lifestyle, career, goals, and relationships with others.

3. They assume responsibility for creating a recovery program that is right for them. They take charge of their health.

7. They often change their diet away from refined, processed foods towards healthful, wholesome foods. They eat significantly more vegetables and plant-based foods, healthier fats, and good quality proteins. Many believe vitamins and supplements are beneficial to their recovery.

4. They undergo a ‘spiritual transformation’ - an awakening of their true values and aspirations.

8. They take more time to relax and enjoy their life.

For many, meditation or prayer becomes an important part of their daily life.

9. They learn to ‘listen’ to their bodies and to surrender to, rather than resist, the day to-day fluctuations of energy, symptoms and emotions that accompany the healing process. In doing so, they learn to take better care of themselves.

10. They release any sense of guilt about fully caring for themselves. Many who have easily cared for others now learn the importance of prioritizing their own self-care.

11. They reconnect with their sense of community and reclaim the joy that comes from being of service to others.

It is important to note that these characteristics are linked to remarkable recoveries as associations not as cause and effect. However, taking care of ourselves in ways that are meaningful for us can create a solid foundation for health and healing at the levels of the mind, body and spirit.

If you would like to read more about these concepts, the following books may be of interest: “Remarkable Recovery: What Extraordinary Healing Tells Us About Getting Well and Staying Well,” by Caryle Hirshberg and Marc Ian Barasch and “Radical Remission: The Nine Key Factors That Can Make a Real Difference” by Kelly A. Turner, Ph.D. 19

Philosophy

THE EVOLVING CANCER CARE MODEL Historically, standard cancer treatment was based on a ‘tumour-based model’, which seeks to cure cancer by directly treating the tumour with surgery, chemotherapy and radiation, as illustrated in Figure 1 on the next page.

Surgeons and oncologists have substantial expertise in prescribing individualized cancer treatment regimens.

With research demonstrating the benefits of nutrition, exercise and stress reduction before, during and after cancer and its treatments, a new cancer care paradigm is emerging as illustrated in Figure 2. Every effort is made to enhance well-being and health in the healing process. Personal empowerment, choice and self-care are honoured and supported.

There is growing acceptance and support for this person-based model of care as practiced at InspireHealth. We believe it represents the future of cancer care.

“We don’t see things as they are, we see them as we are.”

THE MULTIFACTORIAL NATURE OF CANCER Cancer is a multifactorial illness. In other words, there is not one ‘cause’ of cancer – there are many factors that contribute to cancer development and many factors that can help prevent its development. These factors can include diet, exercise, age, genetics, toxin exposure, gender and ethnicity.

Genetics Only 5-10 % of all cancers are caused by inherited gene mutations (changes). More commonly, cancer is caused by acquired gene mutations. Factors such as tobacco use, ultraviolet or other radiation exposure, viruses and age can damage genes causing mutations which can then lead to cancerous cell growth. In addition, damaged and healthy genes alike can be “turned on” and “turned off” in relation to environmental factors. Therefore, even if we have inherited or acquired a gene that predisposes us to cancer development, lifestyle factors may impact the degree to which that gene is expressed.

anais nin

Chemotherapy Chemotherapy

doctor

C patient

Radiation Radiation Surgery

Figure 1: Cancer-Based Model – From the perspective of the cancer-based model, the patient plays no active role in their treatment or recovery. Since the focus is on the cancer, little effort is expended to support patients in exploring the benefits of healthful diet, exercise, spirituality and emotional support or other methods to enhance the patient’s well-being. Focusing solely on the cancer can leave patients feeling disempowered and unsure about how to contribute to their own health and well-being.

20

inspirehealth

InspireHealth’s Guide to Supportive Cancer Care

Emotional and Spiritual Support Mind-Body Practices

person

Sleep & Rest

Stress Reduction

Chemotherapy Chemotherapy

self

C

Radiation Radiation Surgery

Health Professionals Supportive Therapies

Exercise Nutrition

Figure 2: Person Based Model – In this model, the person plays a fundamental role in their own health and well-being. Although surgery, radiation and chemotherapy can play a very important role in treating the cancer, it is the person and their health - mind, body and spirit – that is the focus of care.

Change Your Lifestyle and Change Your Genes Some studies have focused on how lifestyle factors might alter the expression of our genes, potentially effecting positive changes in our overall health. In one study2, 30 patients with prostate cancer had their gene activity checked before and after a program of intensive lifestyle and dietary change. They ate a low fat, plant-based whole foods diet, and walked at least 30 minutes a day. In addition, they did an hour of yoga, meditation, abdominal breathing and imagery daily, and participated in a weekly support group. At the end of 3 months, more than 500 genes changed the way they worked. Genes with beneficial effects, including tumour suppressing genes, became more active.

Genes with deleterious effects, including some cancer promoting genes, were switched off. In another study3, participants practicing daily meditation were more likely to have gene changes that could help counteract

cellular damage related to chronic stress. Some of the gene expression changes were those that may be involved in cancer initiation and progression. A third study focused on the effects of consuming a broccoli rich diet in men at increased risk for prostate cancer development.4 It demonstrated that eating 400g of broccoli per week was associated with switching on genes that can prevent cancer development and switching off genes that can help cancer spread. One study author, Dr. Ornish stated, “People should realize that genes may be our predisposition, but they are not our fate.”

It is important to note that people who exercise regularly and eat healthfully can still develop cancer.

Cancer is a multi-factorial illness and for each person the combination of contributing factors is different.

However, we can all learn to take better care of ourselves – mind, body and spirit.

21

3

THE FOUNDATIONS OF

Health & Healing

“In the midst of my darkness I found the sun within myself.” albert camus

OPTIMIZE YOUR POTENTIAL ll aspects of supporting the mind, body, and spirit (e.g., exercise, nutrition, stress reduction, etc.) are interrelated and each contributes to the benefit provided by the others in a synergistic way.

By engaging in the many ways we can support mind, body and spirit, we create solid foundations for health and recovery and optimize our body’s healing potential.

An optimal cancer care program incorporates all of these important foundations, built one upon the other, foundation upon foundation, as illustrated in the following diagram.

22

inspirehealth

Inspirehealth’s Guide to Supportive Cancer Care

23

Health & Healing “Our deepest fear is not that we are inadequate. Our deepest fear is that we are powerful beyond measure.” marianne williamson

The Foundations of Health and Healing A diagnosis of cancer provides an opportunity to fully love and care for yourself. During the initial process of treating their cancer, many people overlook the basic foundations of health and healing. To help optimize the body’s response to medical treatments, it is important to create strong foundations for health and healing.

Let’s explore each of these foundations, which work synergistically to support well-being and health, beginning with the most fundamental - the will to live.

WILL TO LIVE Will to live is rarely an all or nothing phenomenon.

For the majority of us, aspects of our life bring us joy.

For example, time spent with loved ones, hobbies we love, and fulfilling work can enhance our will to live. Other aspects of our life such as dysfunctional relationships, stressful work, or loneliness can bring emotional pain and stress which can lessen our joyful engagement in life.

HOPE When we connect with hope we connect with possiblity.

Having a deep belief in our ability to heal – on the levels of mind, body and/or spirit – can support our healing.

If we are told that our illness is ‘terminal’ or ‘untreatable’, we may feel hopeless. It is important to remember that statistics give us probabilities while hope opens up possibilities. Continuing to hope for a cure is not necessarily death-denying.

Hope may provide an opportunity to re-affirm one’s life, values and relationships. Hope can also change throughout the course of an illness. For some patients, hope may inspire a transformation from fear and anxiety to acceptance and peace. An initial hope for a cure may shift to a hope for meaning, legacy or healing relationships, and finally to hope for a peaceful death.

SPIRITUAL CONNECTION Enjoy Life-Affirming Activities It is important to spend time engaging in activities that make your life joyful and meaningful. Spending time with people with whom you feel uplifted, engaging in life affirming activities, and living in the joy of the moment can maximize the will to live and create a solid foundation for health, healing and well-being.

Healing is Personal Healing is personal and unique for each of us. At a deeper level of self, most of us already know many of the most important things we need to do to feel good or healthy. However, many of us have forgotten how to listen to this intuitive wisdom. Our busy mind can override our common sense.

Listen to Yourself Learn to listen to your body to get a sense of when you feel most alive and fully engaged in life. Nurture these activities and relationships. Learn to pay attention and identify situations that seem to drain your energy. Work to resolve conflicts causing these feelings. Design the life you’ve always wanted to live and begin living it.

24

inspirehealth

“My religion is very simple.

My religion is kindness.” dalai lama

InspireHealth’s Guide to Supportive Cancer Care

Figure 3: Foundations of Health and Healing

Standard Medical Therapies Supportive Therapies Sleep, Rest & Relaxation Exercise Nutrition Reducing Physical Toxins Emotional Connection Body-Mind Awareness Empowerment Joy and Laughter Spiritual Connection Hope Will to Live 25

Health & Healing

“Hope is not the expectation that things will turn out well, it is the belief that there is meaning no matter how things turn out.” vaclav havel

Listen to Discover Your Own Healing Path While many of us have all the conveniences of modern life, most of us have become too busy to relax. The ‘information age’ has brought with it activities that fill our day from the time we wake up until the time we go to bed. Modern life is so busy that few of us take time each day to be at peace with ourselves and the world.

It is when we are in a place of peace that we can begin to hear the voice of our deeper wisdom. Many of the most important things we need to do to support our health and healing are waiting there to be discovered.

Taking time to quiet our mind allows us to listen to our deeper level of self and discover our own healing path.

Prayer, breathing, meditation, yoga and spending time in nature are examples of things we can do to quiet our mind and connect within.

26

inspirehealth

Prayer and Spirituality Can Play an Important Role For many people, spirituality is expressed through a religious framework. For others, spirituality is experienced through connecting with nature, connecting with others and connecting with one’s deepest authentic self.

Prayer, meditation, yoga and other peaceful activities have been found to be of value in the healing process. By quieting the conscious mind and focusing on the body or the breath, meditation and yoga can relax our body, create a sense of peace and connect us to our wisdom. Contemplative practices may support a deeper spiritual connection. Those who already have a spiritual connection in nature, family and friends may discover a deeper sense of peace and relaxation with the addition of a queting practice. In essence, our spirituality connects us with our deepest values and aspirations - bringing authenticity to our lives, our work, and our relationships.

Whether we connect through a religious framework or our own personal sense of spirituality, a spiritual connection can help us to live life more fully and experience a greater sense of well-being.

Exploring Death and Dying While emotional and spiritual healing are always possible and can substantially contribute to our health and well-being, physical healing is not an inevitable

InspireHealth’s Guide to Supportive Cancer Care

outcome of cancer treatment and self-care. An open and honest exploration of our stress, fears, thoughts or worries about death and dying or about our own or our family’s future can help us to become more and more accepting of the uncertainty in all of our lives and about the inevitability of our death. Talking about our feelings and concerns about dying, rather than suppressing or avoiding them, can be beneficial. Your InspireHealth doctor or counsellor would welcome this conversation.

Expressing our thoughts and feelings can also create an opportunity for continued or greater intimacy with loved ones. At such times, relationships can deepen in profound ways. There are also practical reasons for talking openly about death and dying. Making wishes known about medical and personal matters, and being financially and legally organized, may allow a sense of preparedness. This in turn can support a return of our focus and energy on healing and living. Talking about these important subjects is not the same as giving up.

It is about being open and honest in order to engage most fully in one’s life.

JOY AND LAUGHTER Connect with Your Joy for Life and Laughter Joy and laughter can be healing. During illness and challenging times, joy and laughter can lighten our burdens and connect us with others. Science is beginning to reveal how important joy and laughter are in supporting our health. Mirthful laughter has been associated with stress reduction and improvements in several aspects of immune function. For example, natural killer cell activity, immunoglobulin production, helper T cells and cytokines have all been shown to increase in laughter studies. Humour and laughter have been shown to lessen anxiety and pain, reduce production of stress hormones, and increase well-being in patients with cancer.1,2 Not only do laughter and humour increase our immune function and well-being, there is evidence that they may also have an impact on survival as well.

Researchers interviewed 66,140 residents of a small city in Norway, and assessed their sense of humour. After following the study participants for 7 years, they found that those who scored in the top quarter for humour appreciation were 35% less likely to die during the study period.3 For the 2,015 residents who had cancer, those

who scored in the top quarter were 70% less likely to die during the study period. The researchers reviewed the diagnostic records and confirmed that this survival benefit was independent of cancer stage/type.

Laughter is healing. Joy and laughter are important, and perhaps especially so in the context of serious life challenges like a diagnosis of cancer. Our body’s physiology responds to laughter in ways that support health, well-being and healing. Rent a funny movie, attend a Laughter Yoga class, tell a joke to friends, smile.

Embrace joy and laughter.

EMPOWERMENT Enhance Your Sense of Autonomy by Taking Charge of Your Life When we participate in our own self-care, we enhance our sense of autonomy, a feeling that we can impact our own health and life, a sense of being in charge.

Numerous studies have shown that patients who become actively involved in choosing their treatments/ recovery plan are more likely to follow through with their treatments, less likely to have complications and more likely to have favourable outcomes than those who simply take a passive role.4

A Cancer Diagnosis Can Be Frightening Being told that you have cancer is often a very frightening experience. Due to the technical nature of standard cancer treatments, treatment decisions are often made by specialists. Patients can become bystanders in their own care and can feel overwhelmed by uncertainty, and by procedures, treatments and side effects that they do not fully understand.

As well, we have observed that foremost on the minds of many cancer patients are the questions: “Why me? – What did I do wrong? – What could I have done differently?” These questions are a natural response to a significant diagnosis that can generate thoughts and feelings of despair, blame, worry, regret and/ or resentment toward self or others, often adding further stress to an already challenging situation. As a consequence, people with cancer can often feel isolated, frightened and depressed. In this context, patients may feel unable to contribute in a meaningful way to their recovery and, as a result, feel a sense of loss of control over their own health and life.

27

Health & Healing

At InspireHealth, we help people living with cancer to reframe their experience from possible blame, self-recrimination or disempowering fear or confusion.

We support them to gain a broader understanding of cancer and the healing process, develop selfcompassion and create a practical action plan for self-care. In this way patients develop their selfawareness, ability to choose, acceptance, ability to live with uncertainty and enhance their sense of being in charge of their lives and health.

BODY-MIND AWARENESS Our body-mind connection is an incredible resource for healing. By learning to connect with our bodymind’s wisdom, we can tap into the healing resources of emotion, sensation, intuition, imagery, memory and mystery. Research has shown that healing modalities such as meditation, relaxation techniques, yoga and visualization all facilitate this mind-body connection and support immune system function.5

Visualization Affects Our Health Research has demonstrated that visualization of exercise increases muscle mass and strength almost as much as exercise itself.6 In one study, cleaning staff, when informed about the health benefits of their work (i.e. physical activity) lost body fat, decreased their blood pressure and increased their lean muscle mass even though their activity levels hadn’t changed.7 What we think and feel directly affects our health.

The powerful potential of the mind-body connection is illustrated by the placebo effect – sustained treatment response to a ‘fake’ treatment such as a sugar pill, or sham surgery - which has been well documented for a wide variety of illnesses and treatments. Our mind is a powerful tool to assist our healing.

“Learn to get in touch with the

Touch Is An Important Element Massage and other modalities such as therapeutic touch, reflexology and acupressure can facilitate and deepen our body-mind awareness and connection.

With the guidance of a practitioner trained in these modalities, we can begin to connect with our body and inner guidance.

Although these techniques and modalities enhance body-mind connection, simply listening to and acting upon what your body is telling you is also very helpful.

For example, fatigue is a common symptom of people living with cancer. From a self-care perspective, fatigue may be our body’s way of telling us to rest or to take care of ourselves in other ways such as drinking water, eating, stretching or moving our body. It is important to feel our energy levels and adjust our activities accordingly. As we quiet our mind and deepen the intimate connection with our body, we can begin to listen with greater awareness to what our body is telling us and use this information to guide our choices and self-care.

silence within yourself and know that everything in this life has a purpose” elisabeth kubler-ross, md

28

inspirehealth

EMOTIONAL CONNECTION Learn the Language of Your Emotions Emotions are often misunderstood and in many cases either repressed, self-judged or acted out in an unhealthy or uncontrolled way. Learning to feel our

InspireHealth’s Guide to Supportive Cancer Care

“I can’t think of a better place to be for a person with a recent diagnosis of cancer. The emphasis on placing the person at the centre of the healing process is really empowering and hence encourages the acceptance of person responsibility for the outcome of the experience.” inspirehealth member

emotions and how to utilize them as a resource can be a vital and significant part of an individual’s journey toward wholeness and vibrant health.

Emotions manifest in our bodies as physical sensations; for example anxiety about an upcoming event can manifest as a nervous stomach. Rather than habitually avoiding, denying, holding back or viewing our emotions as an inconvenience, we can begin to develop an awareness of our emotions in our bodies and learn to respond in healthy and wise ways.

Observe the Physical Sensations of Emotions We can also practice being curious and patient with our emotions - rather than fearing or judging them and allow them to ‘wash through‘ us without repressing them. As we may do these things we may begin to experience more ease, joy, and freedom in our lives; we are cultivating a deeper and more honest relationship with ourselves.

Our relationships with others then become more authentic. Humans are, by nature, social beings. It is our emotional connection with others, our sense of community and shared humanity that helps to define and sustain us. By connecting with others, we can know ourselves better.

There are many ways to learn how to notice, appreciate, and have compassion for our feelings.

It is a strength to feel, share and express our feelings,

including our most vulnerable ones. At InspireHealth we provide many opportunities to explore the realm of emotions.

Emotional Connection Aids Healing Research from the field of psychoneuroimmunology attests to the important role that emotional connection plays in the healing process.

Studies have shown that the simple act of meeting with others once a week to share emotions and provide mutual support not only improves well-being but can significantly improve the chances of recovery including from life-threatening illnesses such as cancer. For example, cancer researcher Dr. Frank Fawzy found that patients with malignant melanoma who were randomly assigned to participate in a weekly support group for a six week period after diagnosis were much more likely to be alive five years later than those who were not.8 The simple act of sharing emotions with others over a period of six weeks had a very significant impact on the chances of survival five years later.

Express Your Feelings Similarly, Dr. David Spiegel found that women with metastatic breast cancer who attended a weekly support group lived, on average, twice as long as those who did not.9 As Dr. Spiegel wrote, “Patients were encouraged to express their feelings about the 29

Health & Healing

“Surround yourself with people who respect and treat you well.” claudia black

illness and its effect on their lives. Social isolation was countered by developing strong relations among members. Members encouraged one another to be more assertive with doctors.”

A Network of Support Helps Research by Karen Weihs demonstrated that for women diagnosed with breast cancer, a network of supportive friends and relatives was associated with a 60 percent reduction in recurrence and death over seven years compared to women who were socially isolated.10 Emotional connection with oneself and with one’s family, friends and loved ones is important for our health and well-being. Spend time with those you love and tell them how important they are in your life.

Body Image and Sexual Health How you think and feel about your body (your body image) may change when you have cancer. It is common to feel anger, frustration, disappointment, grief and loneliness after cancer surgery or during or after treatment for cancer.

Emotions may arise during cancer or cancer treatments. These may include stress, depression, irritability, anger, confusion, overwhelm, anxiety, grief, loneliness and others. Sometimes emotions are as hard or harder to deal with than the physical changes from having cancer.

Also, the stress of being diagnosed with cancer may affect other areas of your life including your personal and sexual relationships. Some people may experience less sexual pleasure or lose their confidence or desire to be sexually intimate. Or a man or woman without a partner may feel shy or unsure about dating because of having a history of cancer and its effects on his or her body, mind and emotions.

It may be hard to adjust to any of these changes.

If you have stress, concerns or questions about your body image or sexual health, talking to your doctor or other trusted health care professional may help. If your concerns involve your partner, talking openly with your partner may help.

STRESS REDUCTION Some examples of changes that may affect a person’s body image and sexual health include: + Losing a breast because of breast cancer or losing a testicle because of testicular cancer. + Having challenges with erections after prostate cancer treatment. + Not being able to bear children after pelvic cancer treatment. + Living with a colostomy bag, either for a while or permanently, because of colon or rectal cancer surgery. + Losing hair during chemotherapy. + Taking medications that cause changes in your hormones, moods or energy levels. + General pain, fatigue, and discomfort resulting from cancer or cancer treatment. + Scarring from surgeries and other cancer treatments. + Side effects from surgery, chemotherapy, radiation or other medications.

30

inspirehealth

The Stresses of Modern Life There are many sources of personal stress in modern life. Working at a job you don’t like, having unresolved issues in a relationship, being under financial pressure, or feeling ‘trapped’ in a situation you think you can’t control are just some of the common major sources of stress. Most of us can be unaware of the degree to which we are affected by stress, or even unaware of some of the major stressors in our life. Studies have clearly shown that stress decreases immune function.11

Forgiveness Liberates Us In order to optimally support our health, it is important to honestly explore and acknowledge sources of stress in our lives and begin to deal effectively with them.

Unresolved issues, often dating back many years, are a major source of internal stress for many people. These issues are generally unconscious and may be painful to

InspireHealth’s Guide to Supportive Cancer Care

examine. Dealing with them can, in some circumstances, require a substantial shift in perspective, beliefs, lifestyle, relationships, values and goals. Once we begin to accept and let go of experiences from the past, we can live in the moment and see the world, ourselves, and others more clearly and openly. Forgiveness and letting go of the past can be a greater gift to ourselves than to those we forgive. It does not mean condoning the past behaviour of others – it is about forgiving accepting the past as the past. Forgiveness liberates us from the heavy burden of holding onto the past so that we can live more fully in the present with compassion, freedom and gratitude.

can all help to provide this support. Research has shown that psychological support and counseling can significantly improve survival.12,13 InspireHealth physicians and health professionals are also available to support you. In addition, the B.C. Cancer Agency and other cancer and community groups and individual practitioners provide counseling services. Meditation, yoga, exercise and other forms of relaxation can all reduce the physical toll that stress has on the body and all these methods can contribute to greater health and well-being. Sleep, rest, journaling and laughter are also good antidotes to stress. Cultivate an attitude of gratitude by noticing and appreciating all that you have and all that you are.

Be True to Yourself Another source of stress in our lives is the stress created when we think that we ‘should’ do or say something when our inner wisdom is telling us to take our time and/ or to do or say something different. For example, we may think that we ‘should’ do an errand for someone else when what we really want to do is take care of ourselves.

In this way, we take care of another person’s needs instead of our own. For many, this can be a significant source of tension and inner conflict. We can end up feeling resentment towards others when, in reality, it is our responsibility to say ‘yes’ when we mean ‘yes’ and ‘no’ when we mean ‘no’. We may be concerned that, by being true to ourselves, we risk that others may not like our choices or that we may feel abandoned. Our inner critic may tell us that we are being selfish. In reality, learning to take care of ourselves is the best way that we can help not only ourselves but those that we love.

Being true to ourselves takes courage and strength and the willingness to allow ourselves and others to know us and our wants and needs more fully.

Letting Go Sometimes in the midst of what feels like overwhelming stress, it can be helpful to ‘let go’ of having all the answers and being in control of everything. We may feel fear and anxiety about being so vulnerable, yet sometimes ‘letting go’ helps open the door to new possibilities. One potentially liberating and helpful way to deal with stress is to talk with others. Such conversations often enable a shift in perspective, leaving us feeling more empowered and hopeful.

Friends, support groups, and health professionals

Discover Ways to Relax Being diagnosed with cancer is itself a stressful life event. Research has shown that the stress of a cancer diagnosis can suppress immune system function. In order to optimize the healing/recovery process, it can be very helpful to embrace a program of stress reduction and relaxation. By reducing anxiety and stress and facilitating relaxation, we support immune function. In a study of patients with recurrent prostate cancer who participated in a stress reduction program, researchers found a reduction in the rate of rise of their prostate specific antigen tumour marker (PSA), indicating that stress reduction may slow the rate of disease progression.14

Watch For and Minimize External Stressors There are many sources of ‘externally created’ stress in our culture. For example, the mass media - which often uses shock and sensationalism to hold our attention - presents a very distorted image of human nature and society. The news is filled with stories of crime, corruption and war. If we were to base our conception of humankind on this information, we would conclude that humans are selfish, uncaring and destructive. These distorted negative images assault our true values and aspirations and can unconsciously sap our energy, and optimism. Be discerning about the programs you watch and the articles and books you read. Watch programs that inspire you. Read books that celebrate human nature. Spend more time with friends and family that you feel good around. Celebrate their caring, giving and sharing nature and the wonders of the human spirit.

31

Health & Healing

“That which is not good for the bee-hive cannot be good for the bees.” marcus aurelius

REDUCING TOXINS Our world has become an increasingly complex environment in which to live. Rapid social and technological changes have significantly altered our lives and our environment. We are exposed to thousands of human-made chemicals that did not exist prior to the 20th century. Many people wonder about whether exposure to these chemicals is linked to the development of cancer and other illnesses.

Lifestyle Factors While some cancers are inherited, most are caused by outside influences. Lifestyle factors (eg. tobacco and alcohol use, poor nutrition, physical inactivity), and environmental exposures to either naturally occurring substances (eg. UV light, certain viruses, radon gas) or synthetic/human-made substances have all been linked to cancer development.

The causes of cancer are many and teasing out various contributing factors is a matter of ongoing research. Any substance or exposure that causes cancer is called a carcinogen, but the risk that a given carcinogen will cause cancer depends on a variety of factors including length and intensity of exposure and genetics. For example, not all smokers will develop lung or other smoking- related cancers, and some who develop lung cancer have never smoked.

Alcohol is a known carcinogen.15 Research indicates that cancer risk varies depending on cancer type, the amount of alcohol consumed per day, and the addition of other lifestyle factors which may increase risk such as tobacco use. The research linking alcohol and cancer is particularly strong for cancers of the breast, bowel, liver, mouth/throat and esophagus.16,17 The risk of cancer increases with the amount of alcohol consumed per day. Drinking about 3.5 drinks

32

inspirehealth

a day can double to triple the risk of mouth, throat and esophageal cancer. Drinking a similar amount of alcohol increases breast and colon cancer risk by 1.5 times. A study looking at over 150,000 women showed that women who have 2 to 5 alcoholic drinks daily have a higher risk of breast cancer than women who drink only one drink a day or none at all.18 Studies have also found links to lower levels of alcohol use—as little as 3 to 6 glasses of wine per week has been shown to increase breast cancer risk.19 Insomnia is a challenge for many and especially during treatment for cancer. Because alcohol is known to interfere with quality of sleep, InspireHealth recommends limiting or avoiding alcohol during this time. Even small amounts of alcohol can irritate mouth sores caused by some cancer treatments.20 Alcohol can also interact with certain medications used for cancer treatment. If you have questions about your alcohol intake, please speak to your health care provider.

We encourage our members to consider the potential risks of alcohol when making wise and healthy choices for themselves.

Environmental Factors The International Agency for Research on Cancer (IARC) is the specialized Cancer Agency of the World Health Organization. The IARC uses an interdisciplinary approach (laboratory sciences, biostatistics and epidemiology) to identify causes of cancer so efforts to prevent it can be implemented. Since 1971, over 900 agents have been evaluated and 400 of these have been identified as carcinogens, probable carcinogens or possible carcinogens. Evaluating chemical substances for their carcinogenic potential is very complicated and time consuming. Unfortunately chemical substances can be more easily produced than evaluated. Although many are concerned about unhealthy environmental exposures it is possible to stay informed and to make healthier choices that may reduce health risks.

Given the complexity of chemical evaluation it makes sense to follow the “precautionary principle” and minimize or avoid exposure to potentially harmful chemicals when possible. With the growing evidence and concern regarding the effects of human-made chemicals on our health, federal scientists have determined that over 4000 everyday chemicals used in

rely odium sodium de.

Liq i ce uid ca sti Sa le lt so ap So ap gr an O u li v e o le s il W hi te vin W eg as ar hi ng so da

ls

ju

oi m

on

nt ial

Le

Es

se

od ra

x

gs

Bo

k in Ba

explained

a

Ingredients Cuts grease Deodorizes Disinfects Fights mould & mildew Lifts dirt Softens water Whitens

Essential oils are optional; avoid them if you are sensitive to scents. Lemon, lime, grapefruit, tea tree, lemongrass, lavender, and eucalyptus oils have antibacterial, antifungal and/or grease-cutting powers.

More tips and recipes at queenofgreen.ca

r∑x-free liquid dry soap

Powdered l∑undry soap

Courtesy of the David Suzuki Foundation www.davidsuzuki.org and queenofgreen.ca

ound en of endly.

InspireHealth’s Guide to Supportive Cancer Care

Canada pose enough of a risk to human health that they and this interference is thought to be responsible for carcinogenesis. Endocrine disruptors can exert their need to be subjected to in-depth safety assessments effects by turning on or off hormone signals, or by to determine whether or not they should be prohibited Use 1 – 2 tbsp per load modifying signal messages. Hormones are produced from everyday use.21 in endocrine glands such as the ovaries, testes, thyroid, Fortunately there are many ways to keep informed. cup per full load 1 cup soap granules and adrenals. These hormones are secreted into the The Environmental Working Group (ewg.org) provides ½ cup borax blood to send messages to other parts of the body to and current information on how to minimize hot accurate water regulate or avoid potential harmful synthetic chemicals, how ½ cup washing soda the internal balance of our body’s systems. baking soda While to choose the least contaminated produce 10 and skin drops essential oilscientists (optional)have known for some time that cancer liquid castile soap is caused by changes or mutations in our cell’s DNA care products and tips for healthy cleaning. The David coarse salt foundation (davidsuzuki.org) websiteCombine (our genetic there is growing evidence that Suzuki has a link dry ingredients.

Stir inblueprint), essential oil. in addition to causing genetic mutations, endocrine to the Queen of Green blog which is a great resource Tip To soften fabrics, pour 1 cup white vinegar into rinse e dry ingredients in hot water. Add soap and stir. disruptors may also exert their carcinogenic effects for myriad ways to optimize your health and the health cycle (not the wash cycle). by disrupting healthy hormone signals or altering the of the planet. The Canadian and American Cancer ways in which genes express themselves. Endocrine Society’s websites have very good information on notes disruptors have been found in plastics, pesticides, harmful substances and environmental risks (cancer.ca, detergents, cosmetics, fragrances, cleaning supplies cancer.org) and the National Institute of Environmental Health Sciences (niehs.nih.gov) also offers a wide range of information on cancer and the environment.

Over the past several years there has been a growing understanding of the mechanisms More tips and recipes at queenofgreen.ca More tips and recipes at queenofgreen.ca underlying chemical-related cancer development or carcinogenesis. In particular, the role that endocrine (or hormone) disruptors play has been an area of intense research. Both naturally occurring and human-made the buddha chemicals may interfere with our hormone systems, dav i d suzu k i ’ s

dav i d suzu k i ’ s

“Searching all directions with one’s awareness, one finds no one dearer than oneself.”

33

Health & Healing

“What lies behind us and what lies before us are tiny matters, compared to what lies within us.” ralph waldo emerson

and flame retardants. Exposure to these chemicals can occur via skin, air, water and diet.22,23 Some chemicals used in the plastics industry have been shown to act as estrogen-like (female sex hormone) endocrine disruptors.24 We all have many daily encounters with plastics, from plastic bottles and tubes of toiletries to the plastic surfaces and plastic gadgets in our home, office, and car. Many containers used to store water and food are made of plastic. These include plastic bottles and jugs, plastic bags, and the plastic linings of canned foods.

Plastics are made from petroleum-based chemicals and are graded “1” to “7” based on the chemical from which it is manufactured. Plastics graded “1” contain polyethylene terephthalate or PET which is commonly used in water and pop bottles. The linings of many food and beverage cans, thermal paper (ie. receipts), and most polycarbonate plastic bottles (marked “7”) contain the chemical bisphenol A (BPA). Both PET and BPA are considered endocrine disruptors. It is best to avoid storing food and beverages in containers marked with a “1” or a “7” as these containers should only be used once. For the most part, the chemicals in plastics are stable. However, under certain circumstances trace quantities of these chemicals can leach into food or liquid. Especially when it is exposed to heat, plastic can break down, and trace quantities can mix with our food and drink and be ingested. Current recommendations are therefore to avoid heating, microwaving or washing in the dishwasher any type of plastic container.

There are many ways to reduce or eliminate your exposure to potentially harmful chemicals. Containers made of glass, metal, or ceramic provide a safe way to store and carry food or water and by reducing your reliance on plastic, you may help yourself and the environment. Installing good kitchen tap water filters, cooking whole foods from scratch, choosing organic foods and beverages, and pasture-raised meat when possible, choosing personal care products wisely, cleaning with readily available household ingredients, avoiding non-stick cookware and furniture stain coatings, and completely avoiding any exposure (first or second hand) to cigarette smoke are all excellent ways to limit your exposure to harmful chemicals.

34

inspirehealth

Inspirehealth’s Guide to Supportive Cancer Care

SUSTAINABLE SHOPPER’S GUIDE TO A

DIRTY DOZEN Ingredients to Avoid in your Cosmetics and Toiletries BHA and BHT

Parabens

In moisturizers, makeup, etc.

May contribute to cancer risk and interfere with hormone function.

Widely used in makeup, moisturizers, etc. May interfere with hormone function.

Associated with breast cancer.

Coal tar dyes Look for P-PHENYL-ENEDIAMINE in hair dyes, and colours identified as “C.I.” followed by five digits in other products. Potential to increase cancer risk and can be contaminated with heavy metals.

Cyclomethicone and Siloxanes Widely used in moisturizers, makeup, hair products, etc. May interfere with hormone function and liver function.

Parfum Widely used even in some products marketed as “unscented” (often the last ingredient). Mixture of chemicals that can trigger allergies and asthma of which are linked to cancer and neurotoxicity.

PEG Widely used in conditioners, moisturizers, deodorants, etc.

Can be contaminated with 1,4-dioxane, which may increase cancer risk.

DEA, MEA and TEA In creamy and foaming products such as moisturizer, shampoo.

Can react to form cancer-causing nitrosamines.

Dibutyl Phthalate In nail products. May negatively affect reproduction and may interfere with hormone function.

Formaldehyde-releasing preservatives Look for DMDM HYDANTOIN, DIAZOLIDINYL UREA, IMIDAZOLIDINYL UREA, METHENAMINE, or QUARTERNIUM-15.

Widely used in hair products, moisturizers, etc. Formaldehyde is a known carcinogen.

Petrolatum In hair products, lip balm/lipstick, skin care products.

Sodium Laureth Sulfate (Sles) And Sodium Lauryl Sulfate (Sls) In products that foam such as shampoo, cleansers, bubble bath.

SLES can be contaminated with 1,4-dioxane, which may increase cancer risk.

Triclosan in “anti-bacterial” products such as toothpaste, soaps, hand sanitizers.

May interfere with hormone function and contribute to antibiotic-resistant bacteria.

35

Health & Healing

“InspireHealth gave me practical, research-based tools that my family and I can use to live healthier lives.” inspirehealth member

NUTRITION The benefits of healthful nutrition before during and after cancer treatment are far-reaching, time-tested and increasingly supported by medical research (see section on Nutrition at InspireHealth).

Cancer and its treatment can cause changes in digestion and absorption including the extremes of food aversion, nausea, vomiting and significant bowel changes as well as loss of appetite. These symptoms can lead to weight changes, fatigue, wasting and/or weakness resulting in a lack of inspiration and energy to prepare and enjoy meals.

The good news is that preparing and eating whole, natural and unrefined foods does not need to be timeconsuming or labour intensive. With guidance, it can be a simple, inspiring and powerful tool in the recovery process.

Now is the perfect time to adopt a diet - personalized for you and your body’s needs at this time - and to create a healthy, sustainable food shopping, meal preparation and eating plan.

In this context, movement becomes an important aspect of a healing and recovery program. By enhancing energy, increasing strength, balance and range of motion (ROM), as well as improving mood and an overall feeling of confidence and well-being, exercise and movement greatly benefit those living with cancer.

SLEEP, REST AND RELAXATION Sleep, rest and relaxation are all vitally important during the healing process. As our body directs its energies to the healing process, it may be beneficial to slow down our busy schedule and conserve energy. Listen to your body and honour its need for rest. During cancer, its treatments and for weeks to months afterwards, many people report feeling tired. Recognizing the importance of ‘listening’ to their body, they simply surrendered to this feeling and prioritized rest.

Rest and exercise act synergistically so that the benefits of exercise are optimized if your body gets adequate rest. If your energy levels change, adjust your activity level according to the energy you feel.

EXERCISE The benefits of exercise before, during and after cancer treatment are appearing in more and more medical research (see Exercise section in Introduction to Supportive Modalities).

Cancer and its treatment can cause significant changes in the body including fatigue, muscle weakness and wasting, and changes in physical strength and flexibility that can result in normal activities becoming challenging.

36

inspirehealth

Sleep is Vital Fatigue is the most common symptom of people living with cancer. Sleep is of vital importance during the healing process. It is an essential time when our body and brain carry out functions vital to our health.

Turn Off All Bright Lights After Nine There is evidence that light in the bedroom during sleep decreases melatonin. Melatonin is a natural hormone

InspireHealth’s Guide to Supportive Cancer Care

and antioxidant made by the body’s pineal gland, located just below the middle of the brain. The pineal gland produces and secretes increased amounts of melatonin as darkness falls at about 9pm which induces sleepiness.

Supporting our body’s circadian rhythm by paying attention to nature’s day/night cycle optimizes our melatonin levels and healthy sleep. However, exposure to blue light in the evening – from TV, computer screens, handhelds and certain nightlights – may suppress the release of melatonin and interfere with sleep.

Sleep is also extremely important for a healthy emotional and spiritual response to illness. Recent research has revealed that sleep facilitates the learning process, lessens anxiety and lessens the risk of depression.

Relax Before Going to Bed Take time to relax before bedtime and spend at least eight hours in bed each night. Make sure that you don’t watch TV for at least an hour before you go to bed, especially the evening news, since the intense stimulation can make it difficult to fall asleep. Listening to relaxing music, meditating or gentle breathing may help you quiet your mind and fall asleep easily.

Try Meditation or Visualization Relaxation is also of vital importance during the healing/recovery process. We live in such a busy world and many of us don’t give ourselves the opportunity or permission to simply rest and be at peace. Research has shown that the regular practice of a relaxation technique (e.g., meditation, visualization) can significantly enhance the function of the immune system.24 One study of patients with brain tumours found that preoperative relaxation training decreased anxiety, lowered blood pressure, heart rate and respiratory rate, and improved surgical outcomes.25 In order to ensure an optimal recovery program, we recommend that you explore relaxation techniques (e.g., prayer, meditation, yoga, qigong, muscle relaxation, therapeutic touch, visualization, etc.) and incorporate one or more of these healing modalities into your life.

“How beautiful it is to do nothing and then rest afterward.” spanish proverb

I DEAS FOR CR EATI NG A HEALTHY, R EST F UL S L EE P Behaviour

Biochemistry

Environment

+ Exercise regularly + Keep a regular bedtime and

+ Limit caffeine + Limit alcohol + Avoid foods that don’t

+ Sleep in complete darkness

+ + + + + + + +

wakeup time Go to bed by 10 pm Avoid TV, computers and handhelds right before bed Read something calm or peaceful to help you relax Wear socks to bed Spend at least eight hours in bed each night Explore relaxation techniques Keep your bed for sleeping and sex Go to bed when you are tired (don’t let yourself get “a second wind”

agree with you

+ Avoid drinking too many + + + +

fluids before bed Avoid smoking Avoid large meals within 3 hours of bedtime Get outside for some fresh air and natural daylight Talk to your doctor about taking a natural supplement to support sleep

+ + + +

or as close to it as possible (consider blackout blinds or a sleeping mask) Keep your room as quiet as possible - consider ear plugs Remove the clock from view Keep the temperature in the bedroom comfortably cool Avoid computers and television in the bedroom

37

Health & Healing

Supportive Therapies At InspireHealth, optimizing vitamins, minerals and other nutrients through a healthful diet is encouraged and supported through interactive group and individual sessions.

There are certain situations where supplementing the diet with vitamins may be of benefit. For example, illness or recovery after surgery can increase the body’s nutrient demand. People may also experience treatment side effects such as nausea, vomiting and/ or diarrhea which may affect the body’s ability to absorb nutrients from our food. You are welcome to discuss your questions or concerns about supplementation with your InspireHealth medical doctor.

Vitamin D Accumulating evidence demonstrates a link between exposure to solar radiation (UVB rays) and reduced incidence of a number of cancers including those of the breast, colon, prostate, lung, stomach, bladder, pancreas uterus, and ovary.26,28 This association is thought to be mediated by vitamin D which is synthesized in the skin when our skin is exposed to sunlight. The mechanisms by which vitamin D may reduce cancer incidence are not completely understood, but it is known that receptors for vitamin D are located on many cells of the body including those of the breast, colon, lung, prostate, skin, brain, and immune system. Approximately 200 human genes can respond to vitamin D, many of which encode for proteins regulating cell proliferation, differentiation and death (three very important factors in cancer development). Vitamin D has long been known as a regulator of calcium and phosphorus metabolism which is important for bone mineralization.

However, researchers are now studying vitamin D’s many other roles in the healthy functioning of muscles, nerves and immunity, and in the reduction of inflammation.30 Vitamin D insufficiency or deficiency may play a role in the development of many diseases, including cardiovascular disease, diabetes and cancer.29 Vitamin D can be obtained from dietary sources such as salmon (350 IU/3 oz serving), tuna (150 IU/3 oz serving) and egg yolk (40 IU/egg), and fortified foods such as cow/rice milk (100 IU/cup) or orange juice

38

inspirehealth

(125 IU/cup), as well as from sun exposure. However, foods do not generally provide adequate vitamin D and factors such as time of day, cloud cover, use of sunscreen, age, and skin tone can all affect the skin’s ability to produce vitamin D from sunlight. In addition, because of our latitude, Canadians are unable to produce vitamin D during the winter months due to insufficient UV radiation in sunlight. Therefore, many Canadians have low or insufficient vitamin D levels, especially during fall, winter and spring. For these reasons Canadians should consider discussing the use of a vitamin D supplement with their health care providers. Though optimal intakes of recommended daily vitamin D vary, Health Canada’s Dietary Reference Intakes (DRIs) for vitamin D provide a range from 600 to 4000 IU per day for children (age 9 and over) and adults.

Except where advised by a doctor, it is generally considered safe to carefully expose the arms and legs to 10-15 minutes of sunlight each day in the summer months. As Dr. Michael Holick, an international expert on vitamin D has written, “The negative publicity regarding sun exposure during the past 30 years has resulted in a vitamin D deficiency pandemic. The important role that sensible sun exposure has in providing vitamin D for the world’s population needs to be reevaluated.30 Nevertheless, sun exposure must be cautiously considered, due to the risk of skin cancer, especially malignant melanoma. Avoiding UV exposure from tanning beds seems prudent.

Optimal vitamin D levels have been associated with reductions in the risk of developing colon, prostate and breast cancers, and there is evidence that optimal levels of vitamin D may help to control tumour cell growth in these and other cancers.31,32,33 Higher blood levels of vitamin D have been associated with a 50% reduction in the risk of developing colon cancer34 and improved overall survival in those who develop colon cancer.35 Two recent studies (breast cancer and colon cancer) have demonstrated that vitamin D level at the time of diagnosis is correlated with survival;36,37 patients with high levels of vitamin D were half as likely to have a recurrence or to die from their disease compared to patients with low levels. On the other hand, some studies have found an increased risk of developing pancreatic cancer in those with higher vitamin D levels,38 particularly if they are male smokers.39

InspireHealth’s Guide to Supportive Cancer Care

More research is needed to determine if boosting vitamin D levels following a diagnosis of a cancer thought to be associated with low vitamin D levels is associated with improved outcomes.

Because vitamin D is fat soluble, there is potential for toxic levels to accumulate in your body if very high levels are consumed for prolonged periods. In addition, excessive magnesium levels may occur when taking vitamin D together with magnesium supplements or magnesium-containing antacids (eg. Maalox, Diovol, Mylanta), and caution is advised for those taking vitamin D who have been diagnosed with hypercalcemia (high blood calcium levels), sarcoidosis, or tuberculosis.

Again, it is always preferable to discuss the possible risks and benefits of any supplement with your health care provider.

Melatonin Because of its dual roles as hormone (regulator of our sleep-wake cycle) and antioxidant, melatonin has been studied for its potential supportive role during chemotherapy and radiation therapy.

In laboratory studies, melatonin has been found to inhibit cancer cell growth, decrease invasive and metastatic potential and induce cancer cell death.40

Though melatonin has been shown to reduce chemotherapy side effects (eg. fatigue, low platelets and nerve toxicity), boost chemotherapy effectiveness (ie. increase tumour regression rate), and increase survival time in those with certain advanced (metastatic) cancers, the studies have been small and none have used a “placebo melatonin” control group.41,42,43,44 Because placebo treatments are sometimes effective, it’s important to compare “real” treatments to “placebo” treatments to ensure that a given treatment is more effective than a placebo; that is, to establish that a true therapeutic effect exists. Even though the doses of melatonin studied were higher than the usual dose suggested for sleep optimization, there were no significant side effects reported.

Overall, the data collected to date largely supports the notion that melatonin can enhance cancer treatment effects and reduce concerning side effects in the studied populations. However, because the studies are small and lack proper control groups, it is too early to confidently recommend adding melatonin to standard cancer treatment for all patients. It is always important to first discuss the use of any supplement, particularly if undergoing chemotherapy and/or radiation, with your health care provider.

39

4

NUTRITION AT INSPIREHEALTH

Inspiring Food Transformations

“Let food be thy medicine and medicine be thy food.”

Hippocrates

I

nspireHealth’s approach to nutrition is a simple one: enjoy wholesome foods that nature provides, and reduce processed and refined foods. A whole food is one that can be grown, raised, harvested, or hunted.

Whole foods contain the food we need to use most appropriately. The original and preferred sources of nutrients such as vitamins, minerals, phytonutrients, antioxidants, and essential fatty acids are whole foods Cancer and its treatment can cause changes in digestion and absorption leading to symptoms of gas, bloating, constipation, diarrhea, food aversions, nausea and/or loss or gain of appetite and weight. Focusing on healthy eating after a diagnosis of cancer may help to reduce some of the symptoms of cancer and sideeffects of treatment. The good news is that preparing and eating whole, natural, unrefined foods does not need to be time-consuming or labour intensive. With some guidance, cooking whole foods from scratch can be a simple, inspirational practice. Now is the perfect time to adopt or enhance a nourishing diet and create healthy habits in the areas of food shopping, meal preparation and eating.

40

inspirehealth

Inspirehealth’s Guide to Supportive Cancer Care

This book is not intended as a substitute for medical advice. Please consult with your doctor on matters pertaining to health and symptoms that may require diagnosis or medical attention and treatments. Every person is unique, and diagnosis and treatment must be individualized by a doctor.

Nutrition

“One cannot think well, love well, sleep well, if one has not dined well.” virginia woolf

The aim is to migrate away from processed, refined, chemically enhanced, and packaged foods, and towards cooking for ourselves. Be mindful of health claims marketed through food labels and advertising.

There is a difference between a ‘health food’ and a whole food. The idea is to move towards a diet that is based on good quality whole foods.

Be kind to yourself as you transform your diet and eating style. Trying to make many changes at once can be confusing and overwhelming. Start with the food choices you make every day - these changes will have the biggest impact. Use the 80/20 rule as a guideline.

If the majority of your choices are closer to the whole foods option, the part that still remains allow choices that aren’t necessarily health promoting, but that you consciously choose and thoroughly enjoy. Context is also important. We are all unique - what works for someone else may or may not work for you. Listen to your body and its signals to determine your needs during each stage in healing.

In your quest to find the diet that is right for you, you may come across various diet concepts such as low carb, low fat, alkaline, paleo, vegan or raw. Ask yourself: “Do these concepts make sense for me at this time?”, and “Are there aspects of this concept I can add into my whole foods lifestyle?” Be sure to reassess your mood, appetite, bowel function, sleep and energy as you make dietary changes.

We’ve put together our Inspiring Food Transformations as a foundation for your diet evaluation and changes. Be gentle with yourself, make changes at a pace that feels right to you and feel inspired by the many ways in which healthy eating can optimize your overall well-being.

INSPIRING FOOD TRANSFORMATIONS 1. Boost Vegetable and Fruit Intake Plant foods form the foundation of a whole foods diet, and increasing your vegetable and fruit intake is

42

inspirehealth

an easy way to increase your consumption of these foods. Vegetables and fruit are nutrient dense foods that provide us with many of the building blocks we need for a healthy body and immune system.

They are excellent sources of phytonutrients (plantproduced chemicals such as carotenoids, flavonoids and phytoestrogens that protect plants from harm and stress), vitamins, minerals, fibre, and water. Several phytonutrients have been studied for their anti-cancer effects,1 and a lack of plant nutrients may contribute to overall ill health.2 A diet rich in vegetables and fruits can reduce the risk of many illnesses including cardiovascular disease and some cancers.3,4 It makes good sense to ensure that vegetables and fruits are a considerable part of your diet. Current recommendations are to include 8-10 servings of vegetables and fruits per day with a ratio of 2-3 servings of vegetables to 1 serving of fruit. If you are currently having 2 or 3 servings, it’s a great goal to add 1 or 2 servings more in a day. A rainbow of fruits and vegetables ensures a variety of phytonutrients, as many of these compounds produce the vibrant colours in the plant.

There is growing concern about the use of herbicides, pesticides, and fungicides in our food production, some of which are known carcinogens.5,6 As we increase our daily intake of produce, it’s important to be aware of these chemicals and their sources. Every year the Environmental Working Group (EWG.org) from the USA puts together a ‘Shopper’s Guide to Pesticides in Produce’ which lists the Dirty Dozen and Clean Fifteen of the most to least chemically laden produce.7 When possible, choosing the organic version of the more contaminated fruits and vegetables will decrease your exposure to these chemicals. But please remember that it is always better to eat vegetables and fruits even when eating organic is not possible.

Fresh, seasonal and local vegetables and fruits typically provide the best nutrient profiles, but if they aren’t available or are too expensive, consider frozen produce. Commercially canned foods often have added salts, sugars and chemical preservatives and are probably best reduced or avoided.8,9,10,11

InspireHealth’s Guide to Supportive Cancer Care

2. Switch Refined Carbohydrates to Whole Complex Carbohydrates Carbohydrates are an essential part of healthy eating, but not all carbohydrates are created equal.

Carbohydrates are the sugars, starches and fibre found in vegetables, fruits, whole grains, and legumes (e.g., beans, lentils). They are classified as simple versus complex and refined versus unrefined. Carbohydrates are a main source of energy for the body and the preferred source for the brain.12 Sugar can be a confusing topic, as one word has so many meanings. Sugar as glucose in the blood stream is how we produce ATP energy. Sugar as a complex carbohydrate from carrots or rutabaga is a slow release source of this fuel; fruit as a simple carbohydrate has the same role with faster release.13 Molecules ending with –ose (glucose, fructose, sucrose etc.) are all sugars.

But sugar in its refined forms (white sugar, brown sugar, corn syrup, high fructose corn syrup, glucose/fructose, etc) has been stripped of all the nutrients that kept it balanced within a whole food, allowing the sugar to flood our bloodstream at a rate much higher than our

body needs or can optimally process.14,15 Focus on decreasing refined sugars in your diet and replace them with honey, maple syrup, blackstrap molasses, green stevia, coconut sugar, etc - in moderation. Avoid artificial sweeteners as they may cause blood sugar to drop, and increase appetite.16 Refined complex carbohydrates such as white flour, bread, pasta and rice have had much of the fibre, vitamins and minerals removed. Unrefined complex carbohydrate sources such as whole grains, beans and starchy vegetables provide optimal nutritional value and break down slowly in the digestive tract, helping to sustain a full feeling with a slower release of glucose.

Fibre from complex carbohydrates helps to regulate bowel movements, blood sugar levels, and remove toxins, and is important for overall colon health.17,18,19

“Eat food. Not too much.

Mostly plants.” michael pollan

43

Nutrition

A high fibre diet can also decrease the severity of hot flashes in women recently treated for breast cancer.20 When choosing carbohydrates, focus less on total carbohydrate amount and more on carbohydrate quality. Great sources of whole carbohydrates include vegetables (ranging from carrots, beets, and sweet potatoes, to leafy greens, peppers and tomatoes), fruit (such as apples, berries, and grapes), legumes (such as beans, lentils, peas, and chickpeas) and whole grains (such as spelt, barley, amaranth, millet, and oats).

3. Choose Quality Proteins Protein is necessary for building and restoring many components of our bodies including muscles, bones, skin, hair, immune cells, and the lining of our digestive tract. Our protein needs can be higher in times of recovery and rebuilding. Good quality proteins can be obtained from both plant and animal sources. There are differing views about whether to include animal protein in a cancer recovery diet.21 At InspireHealth we recognize that every person is unique: while for some reducing or eliminating animal protein might be appropriate, for others it continues to be an important and supportive food choice.

It is important to consider the quality and source of your protein. If and when you’re choosing animal sources of protein, it’s good to remember that an animal’s diet can influence the nutrient content of its eggs and meat. When choosing animal protein, consider choosing organic, free-range eggs, grassfed or pastured meats and poultry, and wild fish. In comparison to grain-fed beef, grass-fed beef has been shown to have improved beneficial fatty acids and antioxidant content.22 Smaller portions and/ or less frequent consumption may enhance your health and put less strain on your pocket book. Avoid processed and packaged meats such as commercial deli meats which may contain nitrates, nitrites and other chemicals which have been associated with the development of certain cancers.23 Plant-based sources of protein are also an important component of a healthy, balanced diet. Beans, peas, lentils, whole grains, nuts and seeds provide us with protein as well as fibre and phytonutrients. Including whole grains like oats, quinoa, rye, and wheat along with beans, legumes, nuts or seeds can provide a variety of amino acids

44

inspirehealth

“For is there any practice less selfish, any labour less alienated, any time less wasted than preparing something delicious and nourishing for yourself and the people you love?” michael pollan

(the building blocks of protein) for a complete protein.

Avoid processed meat alternatives such as veggie dogs, processed soy products, and other forms of ‘vegetarian junk food’.

4. Emphasize Healthy Fats Fats are an essential part of our diet and body. This macronutrient is required for the building of our cell membranes, hormones, and brain cells.24,25,26,27,28,29 They are also an excellent source of energy and are required to trigger satiety (feeling of being full) signals in our stomach.30,31 They are needed for absorption of vitamins A, D, E and K, and many phytonutrients.32 Like carbohydrates, not all fats are created equally and the type and quality of fat consumed is more important than the quantity.33 The many terms related to fat such as saturated, polyunsaturated, monounsaturated, and trans fats can sometimes be quite confusing. The body has purposes for all types of fats naturally found in whole foods. The more saturated a fat, the more stable it is to heat, light, and oxygen, so being mindful of our storage, preparation, and cooking methods helps to keep these healthy fats healthy. Saturated fats such as those found in butter, ghee, animal fats, and

InspireHealth’s Guide to Supportive Cancer Care

coconut oil are more stable, so are suitable for cooking purposes. Monounsaturated fats can be found in olive oil, avocados and some nuts (e.g., almonds, hazelnuts) and polyunsaturated fats can be found in cold water fish (e.g., salmon, sardines, herring), flax seeds, and walnuts.

These fats are more sensitive and therefore their oils may not be suitable for cooking. Trans fats are most often created with unnatural chemical processes, and can be detrimental to our health and are best avoided.

Two polyunsaturated fats, omega-3’s and omega6’s, are essential parts of our diet as our body cannot synthesize them. The ratio of omega 3:6 fatty acids in our diet is out of balance as we consume far more omega-6 containing grains and oils (corn, soy and canola), the products that contain them, and the food products made from animals that eat them, than we do the omega-3’s found in cold water fish and seeds such as flax, hemp, chia, and pumpkin. Omega-3’s and 6’s can both decrease inflammation, but in excess, omega-6’s can increase inflammation.34 Research has demonstrated that omega-3 fats may have anti-cancer effects for some types of cancers.35,36 Eating ground flax seeds and smaller cold-water fish like salmon,

sardines, mackerel, and anchovies can help to bring this ratio into balance.

To maintain shelf life, packaged foods and baked goods such as crackers, cookies, muffins, cakes and breads almost always contain altered or refined fats, as well as do store bought dressings and dips. Margarine, imitation whipped creams, fried meats, and deep fried foods like fries or chips are also sources of altered oils that are harmful to our body. Decreasing our intake of processed, refined, hydrogenated, fried, and trans fats will help to reduce inflammation and support cellular health in our body.37 It’s important to include good fats with every meal and snack. Eating foods that naturally contain fat, such as nuts and seeds, avocados, organic/free range eggs, cold-water fish, and wild or grass-fed meat, is an easy way to ensure healthy fat intake. When choosing fats for cooking, consider small amounts of heat-stable saturated fats such as organic butter, ghee (clarified butter) or virgin coconut oil. Cold-pressed extra virgin olive oil is suitable for low to mid-range heat, as well as being a wonderful choice for use in dressings and dips.

“This being human is a guest house, every morning a new arrival, a joy, a depression, a meanness, some momentary awareness comes as an unexpected visitor. Welcome and entertain them all. ” rumi

45

Nutrition

5. Eating Seasonal, Local and Organic Factors to Consider Let’s start with where your food is grown. The nutritional content of a food is highest when locally sourced and in season.38,39 A food’s nutritional value may be reduced if picked before it is optimally ripened or if it is shipped long distances. Eat locally and in season by shopping at farmers’ markets, road-side farm stands, and grocery stores that sell local produce. Better yet, grow some of your own food! Leafy greens such as kale come in many varieties and are very easy to grow, even in containers.

Consider choosing organic foods. Eating organic foods may reduce your exposure to chemical pesticides, herbicides and fungicides. When a plant is grown without the use of these synthetic chemicals it must fend for itself. It does this by producing its own natural chemicals called phytonutrients to naturally fight off pests, microbes, and molds, and strengthen its own defenses.40 Four thousand different phytonutrients, such as salvestrols in strawberries, carotenoids in carrots, quercetin in onions, and polyphenols in green tea, are found in nature. Many of these phytonutrients have demonstrated anti-cancer effects in vitro.41,42,43,44,45,46,47

46

inspirehealth

While we are aiming to eat seasonal, local and organic foods, it’s good to keep in mind, however, that just because a chocolate chip cookie is organic doesn’t make it a health food, and eating a banana in Canada in January is still a better choice than eating candy!

6. Consider the Source and Amount of Your Dairy More research is needed to clarify the relationship between dairy and cancer. Studies examining the relationship between dairy consumption and various cancers (primary diagnoses and recurrences) have yielded mixed results. Some studies show an increased risk of ovarian,48 prostate49,50, and liver51 cancer with an increased dairy intake. Another study shows no relation to ovarian cancer.52 Some show an association between a high-fat dairy diet and pre-menopausal breast cancer recurrence, and mortality,53 but a protective factor with low-fat dairy and pre-menopausal breast cancer,54,55 and no association to dairy in any form with post-menopausal breast cancer.56 Some show colorectal cancer protection with dairy intake.57 Many factors may contribute to these diverse findings. Milk and dairy products contain variable amounts of fat, calcium, vitamin D, lactose, protein, and probiotics so it’s hard to know which, if any, of these

InspireHealth’s Guide to Supportive Cancer Care

components together or in isolation may be detrimental or beneficial. A person’s ability to digest lactose, the type and diet of the milked animal, and the amount of processing and additives in the dairy product can all play roles in determining if dairy is healthy, detrimental, or indifferent to an individual’s health.

Dairy farming practices vary between countries and have changed over the years. As mammalian milk is designed for the growth of its infants, it naturally contains hormones for growth such as estrogen and insulin-like growth factor 1 (IGF-1). In the American dairy industry, dairy cattle can be given recombinant bovine growth hormone (rBGH) to increase their milk production. While this hormone is banned from use in Canada, it can enter our food chain through dehydrated forms like ‘milk ingredients’ and ‘concentrated skim milk powder’ in packaged foods. Because cancers such as breast, ovarian, uterine and prostate have a hormonal component, concerns have arisen as to whether or not the hormones contained in milk and dairy products, either added or naturally produced, contribute to cancer development and recurrence.

“In oneself lies the whole world and if you know how to look and learn, the door is there and the key is in your hand.” j. krishnamurti With all of this conflicting data, it’s challenging to know whether or not to consume dairy after a diagnosis of cancer. The diet of the milked animal can affect the nutrient content of its milk. Like meat, dairy from grassfed animals has a healthier nutrient profile. While dairy does contain calcium, so do many other foods, including sesame seeds, almonds, leafy greens and broccoli. For those who have trouble digesting the milk sugar lactose (developing symptoms such as cramping, bloating, and diarrhea), milk substitutes such as unsweetened almond, rice, hemp or coconut milks can be used. You may also consider using fermented milk products such as unsweetened and unflavoured yogurt or kefir that contain gut-healthy bacteria and are often better tolerated.

It may be prudent to decrease dairy intake with any cancer diagnosis. As with all of your health decisions, it’s important to weigh the pros and cons of any choices based on your personal situation, beliefs, philosophy, and health, at that particular time in your life. Using the precautionary principle, it’s reasonable to limit your dairy intake, and if consuming, choose milk and dairy products from grass-fed animals to provide a healthier nutrient profile.

7. Hydrate As much as food is to the structure and function of our body, so are the water and fluids we consume. Over 60 percent of the human body is comprised of water.58 Adequate hydration is needed for every cell, tissue and organ to function properly. Water helps to maintain body temperature, remove wastes, optimize digestion and bowel/bladder elimination, carry nutrients throughout the body, and lubricate joints.

Symptoms of inadequate hydration include sluggishness, constipation, headaches, lightheadedness, hunger, darker urine, and poor concentration. Thirst may be misinterpreted as hunger. Various factors can contribute to water loss including caffeine and alcohol intake, sweating, vomiting and diarrhea, hot weather and medications (e.g. diuretics).

What are the best beverages for hydration? Drinking water is the perfect choice. Though municipally treated water is generally considered very safe, additives such as chlorine and contaminants such as lead and copper from plumbing systems59 or nitrates and pesticides from agricultural run-off may contribute to ill health.

To minimize exposure to these impurities consider a water filtration system appropriate for your needs and water supply. Besides water, many herbal teas, freshly juiced or blended vegetables and fruits, and homemade broths are also hydrating. Enhance your water’s flavour with a slice of lemon, cucumber, berries, mint, or splash of unsweetened juice or tea, or drink it at various temperatures. Note that switching your caffeine, alcohol, or sugary drink to one that contains artificial sweeteners is not recommended.

How much water or other hydrating beverages you need in a day depends on your size, the season, your activity level, and how many veggies, fruit, soups, or smoothies you are consuming. Somewhere between 6 and 12 eight-ounce glasses per day is appropriate for most people.58,60 47

Nutrition

“Put down the weight of your aloneness and ease into the conversation.

The kettle is singing ...The cooking pots have seen the good in you at last ...

Everything is waiting for you.” david whyte

Here are some tips to help you build healthy hydrating habits: + Take water with you wherever you go. You can sip frequently before you get thirsty to avoid dehydration. + Store and drink your water out of glass or stainless steel containers. Avoid refillable or single use plastic bottles. + Keep liquids to a minimum with meals in order to maximize the stomach’s ability to digest that meal. + Drink room temperature or warm beverages, especially if you tend towards being cold and/or are healing and recovering.

8. Balance Blood Sugar through Diet Balancing our blood sugar levels through diet is one way in which we can support our health. Using whole food principles helps to keep blood sugar levels balanced. Start by eating whole foods sources of carbohydrates, proteins, and fats with each meal.

Carbohydrates are the quickest macronutrient for our body to digest. Carbohydrates from refined foods such as white bread or pasta are digested to simple sugars quite quickly whereas the sugars from whole/ complex carbohydrates such as oatmeal or chickpeas are digested and released much more slowly. Proteins take longer to digest, so when eaten together with carbohydrates, they slow down the release of the carbohydrate sugars, allowing more of a slow and steady stream into the blood.61 Fats take even longer to digest and slow down the digestive process and sugar release even more. Including a source of each macronutrient at each meal is a very effective way in which to regulate our blood sugar.

It’s also good to keep blood sugar balanced by eating regularly throughout the day and starting your day with a balanced breakfast. For some people this could mean eating every 2-4 hours. Listen to your body 48

inspirehealth

and your hunger, and don’t get too hungry before eating. Eating a macronutrient-balanced breakfast is a way to let your body know there is no famine after a night of fasting, and allows energy production for all the things we want to do in a day .

9. Develop Healthy Eating Habits Changing a habit and creating a new one can often seem difficult. Sometimes reframing it as a challenge (or better yet, an opportunity!) is quite helpful. The benefit of adopting healthier eating habits is that you typically feel so much better; so it’s motivating to keep that habit going. Here are some healthy eating habits to consider implementing: Determine your habits. Track your food and beverage choices, and notice how your body feels. You may realize that every time you eat chocolate after dinner, you wake up in the middle of the night. This awareness is the first step to meaningful change.

Take baby steps. Work on two or three concepts at a time. It takes about twenty-one days for a habit to form.

Consider aiming for two or three new habits a month.

Upgrade your most frequent choices first. It’s more beneficial to change the white sandwich bread you eat every day to whole grain bread than the chicken wings you eat once a month.

Focus more on adding nutritious foods rather than subtracting less nutritious foods. If we focus on foods to remove from the diet (e.g., pop, sugar, refined foods), we may feel guilty or deprived. Since eating a piece of chocolate cake, for example, does not make you a bad person, focusing on the positives can minimize these negative thoughts. There are so many options

InspireHealth’s Guide to Supportive Cancer Care

of healthful foods to add into our diet. Vegetables, spices, herbs, fruit, nuts, seeds, oils, grains and fish are delicious and nutritious. Focus on ‘fortifying’ your meal. For example, consider fortifying your salmon sandwich by adding onions, peppers, greens, sprouts, avocado or celery, or spicing it up with curry powder, cumin, or paprika. Concentrate on adding goodness to each meal and snack.

Get involved in feeding and nourishing yourself.

Visit a farm, grow something, or try a new recipe.

Shopping, handling, preparing, and cooking our food helps connect us to it. Take a cooking class, read a cooking blog or follow a cookbook recipe and learn to enjoy your food and its preparation.

Plan. Proper meal planning takes some time but is the best way to ensure regular, consistent healthy meals and snacks. People approach planning differently. Some might plan the meals for a week then compile an appropriate grocery list. Others might take stock for the next day when packing up that night’s leftovers. Avoid waiting until it’s time to eat to decide on what to eat.

Planning is also important for snacks and water.

How often does a five minute errand turn into a five hour outing? If we get hungry or thirsty while out and about, we often turn to readily available fast food, and sugary snacks and drinks. Pack some nuts, trail mix, veggies and hummus, fruit, or other portable food, together with a bottle of water or herbal tea.

Consider preserving and freezing food when it is in season and abundant. Cook big batches and store your own homemade ‘convenience’ foods.

Make your home your food oasis.

It’s much easier to choose wisely when eating in your home if it’s not full of food ‘landmines’. Try to fill your fridge and pantry with exclusively healthy food choices. If you truly want a ‘treat’ food, enjoy these outside of your home, or make healthier homemade versions of your favourites.

49

Nutrition

“Tell me, what is it you plan to do with your one wild and precious life?” mary oliver

Focus on eating with intention.

Before eating take a moment to calm yourself, give thanks for your food, and focus solely on the task at hand - eating and digesting. Avoid distractions and multi-tasking. Examine, smell, and salivate over your food. Chew slowly and thoroughly - there are no teeth in the stomach to help with manual digestion. Eating slowly also allows your stomach to send a message to your brain that you are full, before overindulging.

10. Include nutrient-dense ‘superfoods’ The term ‘superfoods’ is often used to describe foods that contain an abundance of healthful nutrients such as antioxidants, vitamins and phytonutrients.

Superfood lists vary from year to year and place to place, but are often whole foods that have long been recognized for their exceptional nutritional profiles.

Including some of the following common superfoods would be a healthy and delicious addition to your daily meal planning. + Cruciferous vegetables - broccoli, cauliflower, kale, Brussels sprouts, kohlrabi, cabbage, collard greens, mustard, watercress, Chinese greens, turnip, rutabaga, and radishes + Alliums – garlic, onions, leeks, shallots, scallions and chives + Berries, nuts and seeds + Carotenoid family- including alpha-carotene (in carrots, pumpkins, etc.), beta-carotene (in dark leafy greens, and red, orange, and yellow fruits and veggies), and lycopene, a carotenoid studied for its prostatecancer decreasing properties (found in tomatoes, watermelons, guavas, and apricots)62 + Dark green vegetables- spinach, kale, lettuces, mustard greens, collard greens, beet greens, and Swiss chard. Raw in a salad, sauteed in a stirfry, juiced,

50

inspirehealth

or blended into a soup or smoothie are all ways to increase your daily leafy green content. + Cold water fish – e.g., salmon, mackerel, sardines Fermented foods- e.g., raw unpasteurized sauerkraut, kombucha, kimchi, miso, tempeh, natto, tamari, kefir, yogurt, and unpasteurized, unfiltered vinegars like apple cider vinegar. In certain circumstances these food would not be advised. Please speak to your physician. + Phytoestrogens-found in flax seeds, soy foods such as tofu, edamame and fermented soy forms like miso and tamari. Processed forms of soy (for example, soy meats or dairy substitutes, soy protein powder, soy flour and soy oil) are not recommended.

Herbs and spices from around the world have been used in part for their healing properties for centuries. In addition to potentially providing health benefits, adding herbs or spices to your food can enhance the flavour and reduce your need for salt.63 Here are a few to consider including: + turmeric, rosemary, cayenne, cinnamon, black pepper, mint, ginger, cilantro Consuming nutrients in their whole foods forms in the context of a whole foods diet allows them to work synergistically. For example, cooking tomatoes together with olive oil can increase the absorption of the carotenoid phytonutrient lycopene in tomatoes.

As you can see, there are many readily available, nutrient-dense and nutritious foods. Though the biochemical mechanisms underlying nutrition as therapy are still only partially understood, it makes sense to eat as healthfully as possible by including foods in their traditional, whole forms.

We invite you to talk to a member of our nutrition team, attend a cooking class and view our recipes online to discover delicious and easy ways to incorporate superfoods into your diet in ways that are right for you.

InspireHealth’s Guide to Supportive Cancer Care

1 Simple Green Smoothie

RECIPES Whether you are using food therapeutically, preventatively, or just because you need to eat, there are a wide variety of recipes out there to choose from. They range from simple to complex, so make sure to find your own personal comfort zone.

Even though in theory a food or meal may be delicious and healthy, it may not be optimal for you at certain times. Surgery, radiation, and chemotherapy can potentially impair digestion, appetite, and taste. In addition, other health conditions affecting digestion can make seemingly healthful foods hard to digest. If digestion is impaired, switching from raw foods to those that are well cooked or blended can work as a form of ‘pre-digestion’, allowing your body to digest the foods more easily. Liquid meals can be helpful when in need of nutrient and calorie dense meals, or when chewing or swallowing is impaired. The following smoothie and juice recipes can be a starting point for at home meal replacements instead of those commercially prepared.

If you are unable to eat solid foods, or digestion is compromised, please consult with both your InspireHealth Nutritionist and your Oncology Dietician to determine what is best for your specific situation. For more recipes visit our website, www.inspirehealth.ca.

Serves 2

Ingredients 1 ripe banana ½ cup blueberries ¾ cup organic, plain, non-homogenized yogurt 1 large handful of spinach ½ - 1 cup water or unsweetened almond milk ½ tsp cardamom

Optional 2-3 dates (pre-soaked) or pinch of stevia 2 Tbsp chia, flax or hemp seeds

Directions + Combine all ingredients in a blender and blend until smooth. + Drink at room temperature.

Variations + Try different chopped greens such as lettuce, spinach, parsley, mint, bok choy, cilantro, cucumber, carrots, celery and kale (remove the leaves from the stems). + Try different fresh or frozen local fruits such as apples, pears, peaches, apricots, plums, blueberries, blackberries, cranberries, strawberries, raspberries, cherries. + More exotic (and sweeter): pineapple, mango, papaya, melons

51

Nutrition

2 Vitality Smoothie (Calorie Dense) Serves 2

Ingredients 2 ripe bananas 2 tsp chlorella powder ½ cup mixed berries ½ cup organic goat or cow’s yogurt, or ¼ cup coconut milk plus ¼ cup water 1 Tbsp nut butter or tahini 1 cup water, green tea, or rooibos tea ¼ cup- ½ cup cooked oatmeal, quinoa or applesauce

3 Joy Juice Serves 1-2

Optional

Ingredients

½ an avocado (this will make it extra creamy and thick!) ½ tsp cinnamon or cardamom powder 1 Tbsp ground flaxseeds

2 lemons peeled 2 tbsp ginger peeled 5 large stalks of celery 3 leaves of Kale 1 green apple

Directions + Add all ingredients to a blender and blend until smooth. + Drink at room temperature for more ease on the body. *Refrigerate unused portions and consume within 12 hours

52

inspirehealth

Optional a pinch of sea salt a pinch of cayenne or turmeric

Directions + Gather all of the ingredients and blend. + Drink immediately.

InspireHealth’s Guide to Supportive Cancer Care

4 Basic Bone Broth Ingredients

barely bubbling. Keep at this temperature for at least 8-12 hours but as long as 72 hours. Foam will collect on the surface, remove as necessary with a spoon.

2-4 pounds mixed bones (chicken or turkey carcass, beef, fish, venison*, etc) 1 carrot 1 onion Splash raw apple cider vinegar 1 litre or more of filtered water Sea salt, peppercorns, bay leaf to taste

+ Strain out the bones and vegetable material and move liquid to storage containers. Feel free to remove the fat from the surface and use for cooking. Bone broth freezes well in ice cube trays as well as larger quart containers. Bone broth can be used as a soup base, as a water substitute in cooking grains, or sipped like tea.

Directions + Place all ingredients in a large stock pot and set out at room temperature for an hour. This begins the process of leaching the minerals from the bones. Move pot to the burner and place over medium heat to create a low simmer, ideally around 180 degrees F, where it’s just

+ Alternatively – place all ingredients in a slow cooker.

Simmer on low for the day. Filter the liquid into jars, then add more water and simmer for another day.

Repeat until the bones are falling apart.

*Be sure to skim all fat off broth if using venison.

53

Nutrition

5 Slow Cooker Winter Squash and Apple Soup Ingredients 3 cups butternut squash, peeled and chopped (or use frozen) 3 cups sweet potato, chopped 3 medium apples, cored and chopped 1 large onion, chopped 3 cups water or veggie stock 3/4 tsp unrefined salt 1 tsp cinnamon Pinch of cayenne

Directions + + + +

Put all ingredients into the slow cooker.

Cook on low for 6 hours or on high for 3 1/2 to 4 hours.

Blend with immersion blender.

Add cayenne pepper to taste.

Optional Garnish with some fresh herbs and toasted pumpkin seeds

54

inspirehealth

InspireHealth’s Guide to Supportive Cancer Care

7 6 Detoxing Cilantro Pesto Ingredients 4 cloves garlic 1/3 cup Brazil nuts 1/3 cup sunflower seeds 1/3 cup pumpkin seeds 2 cups cilantro, or Chinese parsley, packed 2/3 cups extra virgin olive oil 4 Tbsp lemon juice 2 tsp dulse granules or other seaweeds Add Tamari to taste

Inspired Salad Dressing Ingredients If making one salad, mix directly in your salad bowl: 3 Tbsp extra virgin cold-pressed olive oil 1 Tbsp raw unpasteurized apple cider vinegar, or lemon juice ½ clove garlic, minced Pinch of unrefined salt

If making extra, mix in a jar: 3/4 cup extra virgin cold-pressed olive oil 1/4 cup raw unpasteurized apple cider vinegar or lemon juice 1 clove garlic, minced Pinch of unrefined salt

For variety, add to taste: Directions + Process everything in a food processor until blended into a paste. Add a dash of tamari to taste and blend again. Store in dark glass jars if possible. It freezes well, so purchase cilantro in season and fill enough jars to last through the year.

Dijon mustard Raw honey or maple syrup Fresh or dried herbs such as basil, oregano, parsley, cilantro, chives, marjoram, dill and thyme, tahini Lemon, orange or lime juice instead of the vinegar for a refreshing change

55

5

INTRODUCTION TO

Supportive Modalities

Nature does not hurry, yet everything is accomplished.� lao tzu

Y

ou may decide to include supportive modalities in your healing program. There is evidence that some of these mind/body/spirit approaches can play an important role in the healing process. Meditation, for example, produces demonstrable effects on brain and immune function.1 Some of the side effects of standard cancer treatments may be diminished by the integration of appropriate supportive modalities; for example, acupuncture has been shown to relieve chemo-induced nausea.2 Supportive modalities include a wide range of approaches. There are many opportunities to pursue these activities with a health professional and in an InspireHealth class or community class.

56

inspirehealth

Inspirehealth’s Guide to Supportive Cancer Care

57 57

Supportive Modalities

“Leave all the afternoon for exercise and recreation, which are as necessary as reading. I will rather say more necessary because health is worth more than learning.� thomas jefferson

EXERCISE The human body is made to move. However many of us spend hours a day sitting while at home and work and while driving in our cars.This inactivity is increasingly linked to health risks. Research has shown that sitting for more than 11 hours/day, compared to less than 6 hours/day, is associated with significant increases in illnesses such as cardiovascular disease, diabetes and cancer.3,4 Our bodies have an amazing ability to adapt to the situations to which we expose them. For example, sitting on a couch all day will lead to a deconditioned cardiovascular system, loss of muscle mass and increased fat mass. On the contrary, when we exercise our bodies, we strengthen our heart and lungs, build muscle, and create a healthier body composition. The benefits of exercise on the human body are well known and are increasingly supported by scientific research.

A growing body of research focuses on exercise and cancer prevention, treatment, and recovery.

Exercise can play a significant role in the health and conditioning of everyone, not only in those diagnosed with cancer or other illnesses. Engaging in regular exercise can help to maintain or improve physiological factors such as aerobic capacity, muscular strength and endurance, flexibility, and balance. It can also help with psychological factors such as stress, depression, anxiety, overall quality of life, and body image. Exercise can improve energy and sleep. These are important benefits for everyone, especially those who wish to combat possible side effects of cancer treatment. In addition, exercise has been shown to reduce cancer recurrence and cancer-related death in both men and women by as much as 60%.5,6

58

inspirehealth

Exercise and Treatment-Related Side Effects Cancer-related treatments can take a toll on the body.

Engaging in regular exercise both during and following treatments can help to reduce side effects and maintain a strong body and mind.

Physiologically, there are a number of possible side effects that exercise can help to manage.

These include: + Decreased muscular strength: Regular resistance (weight) training can help to maintain, or even improve muscle size and strength throughout chemotherapy and radiation treatments.7,8,9,10 + Decreased aerobic capacity: Chemotherapy and radiation treatments can decrease aerobic capacity by weakening the heart and lungs. Participating in regular cardiovascular exercise (eg. brisk walking, dancing, swimming, cycling) can help to maintain or improve your current aerobic capacity.11 + Increased fat mass and loss of lean muscle mass: Changes in body composition may be partly due to hormonal changes that occur during treatments; however, physical inactivity also plays an important role.12,13 Exercise helps to maintain healthy body composition and fitness levels. + Impaired balance: Changes in balance can occur as a result of peripheral neuropathy, a possible side effect of some chemotherapy drugs or radiation treatments where patients have pins and needles tingling and/ or numbness and/or pain in hands and feet. While exercise may not improve the symptoms of peripheral neuropathy specifically, it can improve balance and increase confidence by training the neuromuscular pathways needed for good balance.14,15 + Decreased bone strength: Strength and resistance training can improve or slow bone density loss, a side effect of certain chemotherapy, radiation, and hormonal treatments.16,17,18

InspireHealth’s Guide to Supportive Cancer Care

+ Lymphedema: Lymphedema results from impaired flow in the lymphatic system. Lymph fluid can accumulate in surrounding tissues, resulting in swelling of the affected limb. This can be related to a cancerous tumour itself or to cancer treatments such as surgery and radiation.19 The lymphatic system relies on the movement of our muscles to pump lymph fluid back throughout our body. Exercise can be beneficial in preventing and reducing cases of lymphedema by providing the pumping action required.

Exercise can also help with some of the psychological side effects of treatment and disease.

These may include: + Depression, despair, and anxiety: Exercise can play an important role in helping to cope with depressive symptoms. Studies have shown that exercise not only helps in this area, but that there is a dose-response relationship; as weekly minutes of aerobic exercise increased, so did a reduction in depressive symptoms.20 Yoga has also been shown to have positive effects on levels of distress, anxiety, and depression in both cancer patients and survivors.21 + Reduced sleep quality and quantity: Sleep patterns can change as a result of increased worry and anxiety, or as a side effect of certain treatments.

Exercise has been shown in numerous studies to reduce sleep disturbances, and increase the amount of restful sleep per night.22 + Body image and self-esteem: Engaging in regular exercise can help to maintain a healthy body composition and physical condition, leading to improved body image and levels of self-esteem.23 + Overall quality of life: Many elements can contribute to overall quality of life, including fatigue and the ability to perform daily activities.

Both aerobic activity and resistance training have been shown to increase quality of life by improving physical functioning.24 59

Supportive Modalities

“Breathing in, I calm body and mind. Breathing out, I smile. Dwelling in the present moment I know this is the only moment.� thich nhat hanh

Cancer-Related Fatigue and Exercise The most noted side effect of cancer treatment is cancer-related fatigue (CRF), which is experienced by up to 90% of those undergoing surgery, chemotherapy, and radiation treatments.25 CRF can be described as an unexpected tiredness that is more intense and more severe than normal fatigue, and is not relieved by sleep or rest.26,20 Although the causes of CRF are not clearly defined within the literature, there are a number of treatment side effects that may contribute such as anemia, cachexia (loss of weight and muscle mass), depression, pain, sleep and appetite disturbances, metabolic disorders, and brain fog.27 Appropriate

60

inspirehealth

exercise can reduce these side effects through various mechanisms. Exercise increases red blood cell production to combat anemia, muscle mass can be maintained or increased to combat cachexia, and levels of depression, pain and sleep disturbance can be reduced.20,25 Exercise also increases blood flow and oxygen to the brain, stimulates metabolism and increases appetite.

A recent review and meta-analysis of published scientific research regarding CRF and exercise found that exercise, regardless of type (i.e. aerobic exercise, strength training, or yoga), resulted in moderate decreases in self-reported CRF. This is beneficial for

InspireHealth’s Guide to Supportive Cancer Care

those patients undergoing treatment, as it suggests that those reluctant to participate in more intense training during treatments may still receive benefits from activities such as yoga and light walking.

Meeting with an Exercise Therapist and Developing a Program Working with an exercise therapist will help to ensure that you exercise safely. An exercise therapist is certified to perform baseline fitness assessments and pre-exercise evaluations that measure cardiovascular fitness, muscular strength and endurance, range of motion, and balance. Any areas of concern, injuries or exercise restrictions will be thoroughly discussed. Based on the initial consultation, the exercise therapist will be able to create an appropriate plan for you based on your goals and current health. Working with an exercise therapist will allow you to make modifications as you progress in your program.

The American College of Sports Medicine Roundtable in 2010 on Cancer and Exercise developed activity guidelines for cancer patients and survivors that include aerobic and resistance training, and the importance of avoiding inactivity. An exercise therapist can help you to create a program that meets these guidelines based on your goals, current fitness levels, fatigue levels, stage of treatment, and preferences.

When tracking your activity levels, please remember that activities of daily living such as gardening, walking the dog, doing housework, and walking up and down stairs all count!

When starting to exercise, one of the most important things you can do is to pick an activity that you enjoy. Choosing something you love will help you to stick with it.28 For example, some people prefer to make exercise a fun and social activity. Joining a group class or going out with friends and family can also help you stick to your plan and make it more enjoyable.

For others, a walk in the woods or on the beach is treasured time alone in nature.

Exercise can help combat fatigue, but it is also important to listen to what your body is telling you.

Starting slowly and building your routine in a progressive way can help to overcome fatigue. Monitoring your energy levels throughout the day can help you to determine the best time for you to exercise. Also, breaking activity into shorter sessions (three

ten-minute sessions of walking per day rather than one thirty-minute session) can help to sustain higher energy levels throughout the day.

The body of research supporting the value of exercise continues to grow rapidly, and there are endless ways of incorporating enjoyable physical activity into your life.

MEDITATION For many of us, our mind is so busy with thoughts that we rarely create the opportunity to simply be at peace, to relax in the present moment, to quiet our minds and to be more aware of the physical sensations in our bodies.

By practicing meditation, which is really just learning to relax and be at peace, we can become more open and attentive to our deeper, intuitive wisdom and the healing potential that lies within us. By invoking the relaxation response, our body moves into the parasympathetic ‘healing’ mode in which physical healing is more optimal.

Meditation is a way of cultivating moment-tomoment awareness, and supports becoming more present to our own experience. To do this requires that we become aware of the constant stream of thoughts and reactions to our inner and outer experiences that we are all normally caught up in. During meditation or contemplation, we discover we are constantly generating thoughts and reactions, and by noticing and focusing on our breath instead, we become more aware of our internal experience, allowing us to experience and even release pent-up anxieties and emotions. With practice we can move towards acceptance and release of stress, limiting beliefs and habitual patterns.

Meditation is a valuable way of reestablishing inner calmness and balance in the face of emotional upset or when you “have a lot on your mind.” When life becomes stressful and out of balance we have all experienced how relaxing it can be to be alone for a few minutes and just breathe, in and out, deeply and quietly. Even such a simple exercise can be very helpful and healthy. Research has shown that meditation can alleviate psychological and physical suffering of persons living with cancer.29 By cultivating clarity and peace in meditation, we become more accepting, less judgmental and happier.

61

Supportive Modalities

While the journey to one’s self can be challenging, regular meditation - slowing down, becoming aware of the present moment and awakening to sensation can provide stepping stones towards experiencing a deeper intimacy with ourselves and the peace, joy and freedom within us all.

Having a safe supportive place to go where you can share what is going on physically, emotionally and spiritually can support your healing, your sense of wholeness and your ability to deal more effectively with the challenges of your illness.

MASSAGE YOGA Gentle yoga is helpful for people dealing with illness, for many reasons. Yoga strengthens the body through movement, supports the mind to return to a calm and naturally focused state, supports the body to return to balance through breath and deepens our connection with ourselves. Research shows that yoga can reduce stress and improve immune function in people diagnosed with cancer.30 Through yoga, you will learn to relax your body and mind. All classes involve simple and achievable yoga movements, focusing on breathing and relaxation.

SUPPORT GROUPS There is growing evidence that psychological support and counseling can significantly improve survival in people diagnosed with cancer. 31,32

62

inspirehealth

Massage is the systematic manipulation of soft tissues of the body to enhance health and healing, and can be used to support relaxation and an improved level of well-being. From a medical or therapeutic perspective, massage can help a person living with a health challenge by reducing pain, anxiety and stress and providing caring touch.

Massaging the tumour itself is not recommended, but people with cancer should not fear that massage in general is contraindicated. In fact, massage can be a very important part of a supportive cancer care program. By adapting techniques and using gentle touch, the benefits of massage can be experienced by all people living with cancer.

There is no evidence to suggest that touch or gentle massage causes metastasis (i.e., spread of cancer), but there is evidence that it greatly benefits many cancer patients, both physically and emotionally. In fact, touch

InspireHealth’s Guide to Supportive Cancer Care

addresses not only physical needs, but emotional, social and spiritual ones as well.

Skilled touch can be beneficial at every stage of cancer treatment and recovery.

Receiving comforting, attentive massage reminds us that the body can be a source of pleasure and influences our ability to enjoy the present moment and feel our aliveness. A massage helps in reuniting body with heart, mind and soul.

Research has shown that massage can positively affect many cancer symptoms and side effects from standard treatment regimens, such as nausea, fatigue, insomnia and pain. Relaxation supports immune function and patients report an increased sense of well-being and a reduction in anxiety and muscle tension.

MANUAL LYMPH DRAINAGE Manual Lymph Drainage (MLD) is a safe, gentle massage technique that is used to treat many health

“When we take the time to breathe, relax and be at peace, we move away from the sympathetic or stress response and towards the parasympatehtic or rest, digest and heal response.”

conditions. It does not treat cancer itself but helps to improve symptoms of cancer treatment, i.e. pain, neuropathies, seromas, lymphedema, scars, and post-surgical swelling. Lymphedema is a condition that occurs in 30% of patients who have had cancer treatment. It is a swelling that occurs most often in the arms or legs.

Lymphedma is a result of an impaired lymphatic system due to chemotherapy, radiation, surgery and/ or removal of lymph nodes. It can be managed or prevented with the timely application of Combined Decongestive Therapy (CDT). This involves 1) skin care, 2) exercise, 3) compression and 4) Manual Lymph Drainage.

ACUPUNCTURE The classical Eastern explanation for how acupuncture works is that channels of energy or Qi (pronounced “chee”) run in regular patterns through the body and over its surface. These channels or meridians are like rivers flowing through the body to nourish the tissues.

There are 14 major acupuncture meridians and each of these is believed to be associated with a particular part of the body.

By inserting needles in certain points, the acupuncturist attempts to bring energy to areas that are lacking or to create flow in areas that are blocked, bringing a sense of balance back to the body. Most people feel very relaxed during and after the treatment.

The National Institute of Health Consensus Statement on Acupuncture concluded that acupuncture has been found to be a promising treatment for postoperative and chemotherapyinduced nausea and vomiting.8

Chemotherapy and Radiotherapy Acupuncture is used to try to counterbalance the potential side effects of chemotherapy and radiation.

Acupuncture treatment may also help to support the immune system and digestive functioning.

In addition to acupuncture, your practitioner may make recommendations on diet, exercise, herbs and lifestyle modifications based on your current state of health and modified as needed.

If you are cancer free, acupuncture may still be beneficial. It may help you to obtain and maintain balance, optimize your health and stay healthy.

63

6

A MESSAGE FROM

InspireHealth

“Ten thousand flowers in the spring, the moon in autumn, a cool breeze in the summer,snow in winter, if your mind isn’t clouded by unnecessary things, this is the best season of your life.” wu-men

A

diagnosis of cancer presents a significant health challenge. It also presents a significant opportunity for learning, growth and change. We can all play an important role in our health, quality of life and well-being.

At InspireHealth, we support you and connect with your health and take charge of your health in ways that feel exactly right for you.

64

inspirehealth

Inspirehealth’s Guide to Supportive Cancer Care InspireHealth’

65 65

Notes

66

inspirehealth

InspireHealth’s Guide to Supportive Cancer Care

67

Notes

68

inspirehealth

InspireHealth’s Guide to Supportive Cancer Care

69

Notes

70

inspirehealth

InspireHealth’s Guide to Supportive Cancer Care

71

Notes

72

inspirehealth

InspireHealth’s Guide to Supportive Cancer Care

73

Bibliography

2. The InspireHealth Philosophy 1.

2.

3.

4.

Astin JA, Shapiro SL, et al. Mind-body medicine: State of the science, implications for practice. J Am Board Fam Med. 2003 Mar;16(2):131-147.

Ornish D, Magbanua MJ et al Changes in Prostate Gene Expression in Men Undergoing and Intensive Nutrition and Lifestyle Intervention.

Proceeding of the National Academy of Science USA. 2008, Jun 17 Dusek JA, Hasan H et al Genomic Counter-Stress Changes Induced by the Relaxation Response Traka, M, Amy V. Gasper, Antonietta Melchini, et al. Broccoli Consumption Interacts with GSTM1 to Perturb Oncogenic Signalling Pathways in the Prostate PLoS ONE. 2008 July 3(7): - e2568.

3. The Foundation of Health and Healing 5.

6.

7.

8.

9.

10.

11.

12.

74

inspirehealth

Berk LS, Felten DL, Tan SA, et al. Modulation of neuroimmune parameters during the eustress of humor-associated mirthful laughter. Altern Ther Health Med 2001;7(2):62-76.

Christie W, Moore C. The impact of humor on patients with cancer. J Clin Oncol Nurs 2005;9(2):211-18.

Svebak S. Sense of humor and mortality: a seven-year prospective study of an unselected adult county population and a sub-population diagnosed with cancer. The Hunt Study. American Psychosomatic Society 65th Annual Meeting, March 7-10, 2007.

Cunningham AJ. Adjuvant psychological therapy for cancer patients: putting it on the same footing as adjunctive medical therapies. Psychooncol 2000;9:367-71.

Davidson RJ, et al. Alterations in brain and immune function produced by mindfulness meditation.

Psychosom Med 2003;65:564-70.

Ranganathan VK, Siemionow V, Liu JZ, et al.

From mental power to muscle power-gaining strength by using the mind. Neuropsychologia 2004;42(7):944-56.

Crum AJ, Langer EJ. Mind-set matters: exercise and the placebo effect. Psychol Sci 2007;18(2):165-71.

Fawzy F.I. et al Malignant melanoma: effects of an

early structured psychiatric intervention, coping and affective state on recurrence and survival 6 years later. Arch Gen Psych 1993;50, 681-9.

13. Spiegel D, Bloom JR, Kraemer HC, Gotthiel E. Effect of psychosocial treatment on survival of patients with metastatic breast cancer. Lancet 1989;2(8668):888-91.

14. Weihs K. George Washington University Medical Center. Presentation to the American Psychosomatic Society. March 2001.

15. Andersen BL, Farrar WB, Golden-Kreutz D, et al. Stress and immune responses after surgical treatment for regional breast cancer. J Natl Cancer Inst 1998;90(1):30-6.

16. Kuchler T, Bestmann B, Rappat S, et al. Impact of psychotherapeutic support for patients with gastrointestinal cancer undergoing surgery: 10year survival results of a randomized trial. J Clin Oncol 2007;25(19):2702-8.

17. Weihs KL, Simmens SJ, Mizrahi J, et al.

Dependable social relationships predict overall survival in Stages II and III breast carcinoma patients. J Psychosom Res 2005;59(5):299-306.

18. Saxe, GA, J.M. Major, J.Y. Nguyen, K.M. Freeman, T.M. Downs and C.E. Salem. Potential Attenuation of Disease Progression in Rucurrent Prostate Cancer with Plant-Based Diet and Stress Reduction Integr Cancer Ther. 2006 Sep:53:206-213.

19. Canadian Cancer Society website. http://www. cancer.ca/en/cancer-information/cancer-101/ what-is-a-risk-factor/alcohol/?region=bc.

Accessed on September 10, 2015.

20. Doyle, C., Kushi, L.H., Byers, T. (2006). Nutrition and physical activity during and after cancer treatment: An American Cancer Society guide for informed choices. CA: A Cancer Journal for Clinicians, 56, 323-353.

21. Pelucchi, C., Tramacere, I., Boffetta, P., et al. (2011).

Alcohol consumption and cancer risk. Nutrition and Cancer, 63(7), 983-990.

22. Hamajima, N., Hirose, K., Tajima, K., et al.

(2002). Alcohol, tobacco and breast cancer-collaborative reanalysis of individual data from 53 epidemiological studies, including 58,515 women with breast cancer and 95,067 women without the

InspireHealth’s Guide to Supportive Cancer Care

23.

24.

25.

26.

27.

28.

29.

30.

31.

32.

33.

34.

disease. British Journal of Cancer, 87(11):1234-1245.

Chen, W.Y., Rosner, B., Hankinson, S.E., Colditz, G.A., Willett, W.C. (2011). Moderate alcohol consumption during adult life, drinking patterns, and breast cancer risk. JAMA, 306(17):1884-1890.

Ecological Categorization of Substances on the Domestic Substances List (DSL). Health CanadaEnvironment Canada. Available from: http://www. ec.gc.ca/substances/ese/eng/ dsl/cat_index. cfm. (Accessed 14 February 2007).

Ferreira LL et al. Bisphenol A as epigenetic modulator: Setting the Stage for carcinogenesis?

European J of Clinical Investigation; 2015; 45(S1): 32-36 Gore AC et al. Endocrine Disruption for Endocrinologists (and others). Endocrinology 2006 Crews D, McLachlan JA. Epigenetics, Evolution, Endocrine Disruption, Health and Disease.

Endocrinology 2006; 147(6): S4-10 Hall HR, Minnes L, Tosi M, Olness K. Voluntary modulation of neutrophil adhesiveness using a cyberphysiologic strategy. Int J Neurosci 1992;63:287-97.

Zheng Z-H, Deng Q-R, Xu Z-Y. Preoperative relaxation training of patients with intracranial tumor. Zhongguo Linchuang Kangfu 2006;10(24):52-4.

Palmieri C, MacGregor T, et al. Serum 25-hydroxyvitamin D levels in early and advanced breast cancer. J Clin Pathol 2006;59(12):1334-6.

Holick MF. High Prevalence of Vitamin D Inadequacy and Implications for Health. Mayo Clin Proc 2006;81(3):353-373 Ontario Medical Advisory Secretariat, Ministry of Health and Long-term Care. Clinical utility of vitamin D: an evidence-based analysis. Ontario Health Technology Assessment Series. 2009 Holick MF. Vitamin D: Importance in the prevention of cancers, type 1 diabetes, heart disease and osteoporosis. Am J Clin Nutr 2004; 79:362-371.

Holick MF. Sunlight and vitamin D for bone health and prevention of autoimune diseases, cancers, and cardiovascular disease. Presented at “Vitamin D and health in the 21st century: bone and beyond.” Bethesda, MD, Oct 9-10, 2003.

35. Garland CF, Garland FC, Gorham ED. Calcium and vitamin D: their potential roles in colon and breast cancer prevention. Ann NY Acad Sci 1999;889:107-19.

36. Giovannucci E. The epidemiology of vitamin D and cancer incidence and mortality: a review (United States). Cancer Causes Control 2005;16(2):83-95.

37. Gorham ED, Garland CF, Garland FC, Grant WB, et al. Optimal vitamin D status for colorectal cancer prevention: a quantitative meta analysis. Am J Prev Med 2007; 32(3):210-6.

38. In a recent study on patients with colorectal cancer, higher pre-diagnosis blood Vitamin D levels were associated with a significant improvement in overall survival. Ng, K, J.A. Meyerhardt, K. Wu, et al. Circulating 25-Hydroxyvitamin d Levels and Survival in Patients with Colorectal Cancer. Journal of Clinical Oncology. 2008 Jun 20; 2618-2991.

39. Ng, K, J. A. Meyerhardt, K. Wu, et al. Circulating 25-Hydroxyvitamin d Levels and Survival in Patients with Colorectal Cancer Journal of Clinical Oncology. 2008 Jun 20; 2618: 2984-2991.

40. Palmieri, C, T. MacGregor, S. Girgis and D. Vigushin.

Serum 25-Hydroxyvitamin D Levels in Early and Advanced Breast Cancer J Clin Pathol. 2006 Dec; 5912:1334-1336.

41. Kathy J. Helzlsouer for the VDPP Steering Committee. Overview of the Cohort Consortium Vitamin D Pooling Project of Rarer Cancers. Am J Epidemiology 2010;172:4-9.

42. Stolzenberg-Solomon RZ, et al. A prospective nested case-control study of vitamin D status and pancreatic cancer risk in male smokers. Cancer Res 2006;66:10213-9.

43. Blask DE, Sauer LA, Dauchy RT. Melatonin as a chronobiotic/anticancer agent: cellular, biochemical and molecular mechanisms of action and their implications for circadian- based cancer therapy. Curr Top Med Chem 2002;2(2):113-32.

44. Lissoni, P, S. Barni, M. Mandala, et al. Decreased Toxicity and Increased Efficacy of Cancer Chemotherapy using the Pineal Hormone Melatonin in Metastatic Solid Tumour Patients with Poor Clinical Status Eur J Cancer. 1999 Nov; 3512: 45. Lissoni, P Biochemotherapy with Standard

75

Bibliography

Chemotherapies Plus the Pineal Hormone Melatonin in the Treatment of Advanced Solid Neoplasms. Pathologie Biologie. 2007 Apr- May; 553-4: 201-204. 1688-1692.

46. Lissoni P, Barni G, Tancini A, Ardizzoia A, et al. A randomized study with subcutaneous low-dose interleukin 2 alone vs. interleukin 2 plus the pineal neurohormone melatonin in advanced solid neoplasms other than renal cancer and melanoma.

Br J Cancer 1994;69:196-9.

47. Lissoni P et al. A randomized study of chemotherapy with cisplatin and etopisode versus chemoendocrine therapy with cisplatin, etoposide and the pineal hormone melatonin as a first-line treatment of advanced non-small cell lung cancer patients. J Pineal Res 1997;23(1): 15-9.

48. Lissoni P, Meregalli S, Nosetto L et al. Increased survival time in brain glioblastomas with use of a radioneuroendocrine strategy with radiotherapy plus melatonin compared to radiotherapy alone.

Oncology 1996:53:43-6.

4. Nutrition at InspireHealth 49. Gupta C and Prakash D. Phytonutrients as therapeutic agents. Journal of Complementary and Integrative Medicine. Sep 2014;11(3);151-169.

50. Slavin JL and Lloyd B. Health Benefits of Fruits and Vegetables. Advances in Nutrition.

2012;3:506-516.

51. Health Canada (2007), (HC PUB.: 4651). Ottawa: Queen’s Printer.

52. Hung et al. Fruit and vegetable intake and risk of major chronic disease. Journal of the National Cancer Institute 2004;96:1577-84.

53. Collota M, Bertazzi PA and Bollati V. Epigenetics and Pesticides. Toxicology. May 2013;307:35-41.

54. Alavanja MCR, Ross MK and Bonner MR. Increased cancer burden among pesticide applicators and others due to pesticide exposure. CA: A Cancer Journal for Clinicians. March/April 2013;63(2):120-142.

55. Environmental Working Group. All 48 fruits and vegetables with pesticide data. 2014. internet site: http://www.ewg.org/foodnews/list.php, consulted on Jan 2015.

76

inspirehealth

56. Nursal B and Yucecan S. Vitamin C losses in some frozen vegetables due to various cooking methods. Molecular Nutrition and Food Research.

December 2000;44(6):451-453.

57. Rickman JC, Bruhn CM Barrett DM. Nutritional comparison of fresh, frozen, and canned fruits and vegetables II. Vitamin A and carotenoids, vitamin E, minerals and fiber. Journal of the Science of Food and Agriculture. Mar 2007;87(7):1185-1196.

58. Rickman JC, Bruhn CM Barrett DM. Nutritional comparison of fresh, frozen and canned fruits and vegetables. Part 1. Vitamins C and B and phenolic compounds. Journal of the Science and Food Agriculture. April 2007;87(6):930-944.

59. Lorber M, Schecter A and Paepke O et al. Exposure assessment of adult intake of bisphenol A (BPA) with emphasis on canned food dietary exposures.

Environment International. Jan 2015;77:55-62.

60. Jequier E. Carbohydrates as a source of energy.

The American Journal of Clinical Nutrition.

1994;59(3):682S-685S. 61. Augustin LS, Franceschi S and Jenkins DJ et al. Glycemic index in chronic disease: a review. European Journal of Clinical Nutrition.

2002;56(11):1049-1071.

62. Schwingshackl L and Hoffmann G. Long-term effects of low glycemic index/load vs. high glycemic index/load diets on parameters of obesity and obesity-associated risks: A systematic review and meta-analysis. August 2013;23(8):699706.

63. Bessesen DH. The role of carbohydrates in insulin resistance. The Journal of Nutrition. Oct 2001;131(10):2783S-2786S. 64. Augustin LS, Franceschi S and Jenkins DJ et al. Glycemic index in chronic disease: a review. European Journal of Clinical Nutrition.

2002;56(11):1049-1071.

65. Rose DJ, DeMeo MT and Keshavarzian A et al. Influence of Dietary Fiber on Inflammatory Bowel Disease and Colon Cancer: Importance of Fermentation Pattern. Nutrition Reviews. Feb 2007;65(2):51-62.

66. Kranz S, Brauchla M and Slavin JL et al. What Do We Know about Dietary Fiber Intake in Children

InspireHealth’s Guide to Supportive Cancer Care

67.

68.

69.

70.

71.

72.

73.

74.

75.

76.

77.

and Health? The Effects of Fiber Intake on Constipation, Obesity, and Diabetes in Children.

Advances in Nutrition. Jan 2012;3:47-53.

De Natale C, Annuzzi G and Bozzetto L et al.

Effects of a Plant-Based High-Carbohydrate/ High-Fiber Diet Versus High–Monounsaturated Fat/Low-Carbohydrate Diet on Postprandial Lipids in Type 2 Diabetic Patients. Diabetes Care. Dec 2009;32(12):2168-2173.

Gold EB, Flatt SW and Pierce JP et al. Dietary factors and Vasometer Symptoms in Breast Cancer Survivors. Women’s Healthy Eating and Living study (WHEL). Menopause. May-Jun 2006;133:423-433.

Donaldson MS. Nutrition and cancer: A review of the evidence for an anti-cancer diet. Nutrition Journal. October 2004; 3(19):1-19.

Daley CA, et al. A review of fatty acid profiles and antioxidant content in grass-fed and grain-fed beef. Nutrition Journal 2010; 9:10 World Cancer Research Fund. Summary. Food, Nutrition, Physical Activity and the Prevention of Cancer: A global perspective. 2007.

Ostroumova OS, Efimova SS and Malev VV. Modifiers of membrane dipole potentials as tools for investigating ion channel formation and functioning. International Review of Cell and Molecular Biology. 2015;315:245-297.

Otero M, Lago R and Gomez R et al. Changes in plasma levels of fat-derived hormones adiponectin, leptin, resistin and visfatin in patients with rheumatoid arthritis. Annals of the Rheumatic Disease. 2006;65:1198-1201.

Payne AH and Hales DB. Overview of Steroidogenic Enzymes in the Pathway from Cholesterol to Active Steroid Hormones. Endocrine Reviews. July 2013;25(6):947-970.

Tabas I. Cholesterol in health and disease.

The Journal of Clinical Investigation. sept 2002;110(5):583-590.

Haag M. Essential Fatty Acids and the Brain.

Canadian Journal of Psychiatry. 2003;48(3):195-203.

Innis SM. Dietary (n-3) Fatty Acids and Brain Development. The Journal of Nutrition.

2007;137(4):855-859.

78. Parra D, Ramel A and Bandarra N et al. A diet rich in long chain omega-3 fatty acids modulates satiety in overweight and obese volunteers during weight loss. Appetite. November 2008;51(3):676-680.

79. Lawton CL, Delargy HJ and Brockman J et al. The degree of saturation of fatty acids influences postingestive satiety. British Journal of Nutrition. May 200;83(5):473-482.

80. Slater GH, Ren CJ and Siegel N et al. Serum fatsoluble vitamin deficiency and abnormal calcium metabolism after malabsorptive bariatric surgery. Journal of Gastrointestinal Research.

2004;8(1):48-55.

81. Lawton CL, Delargy HJ and Brockman J et al. The degree of saturation of fatty acids influences postingestive satiety. British Journal of Nutrition. May 200;83(5):473-482.

82. Simopoulos AP. The importance of the ratio of omega-6/omega-3 essential fatty acids.

Biomedicine and Pharmacotherapy. October 2002;56(8):365-379.

83. World Cancer Research Fund. Summary. Food, Nutrition, Physical Activity and the Prevention of Cancer: A global perspective. 2007.

84. Larsson SC, Kumlin M and Ingelman-Sundberg M et al. Dietary long-chain n3 fatty acids for the prevention of cancer: a review of potential mechanisms. The American journal of Nutrition.

June 2004;79(6):935-945.

85. Calder PC. n-3 Polyunsaturated fatty acids, inflammation and inflammatory diseases. The American Journal of Clinical Nutrition. June 2006;83(6):1505S-9S. 86. The World’s Healthiest Foods. Healthy eating with the seasons. internet site: http://www. whfoods.com/genpage.php?tname=faq&dbid=28, consulted on Feb 2015.

87. Seyfang G. Ecological citizenship and sustainable consumption: Examining local organic food networks. Journal of Rural Studies. October 2006;22(4):383-395.

88. Drewnowski A and Gomez-Carneros C. Bitter taste, phytonutrients, and the consumer: a review. The American Journal of Clinical Nutrition.

2000;72(6):1424-1435.

77

Bibliography

89. Rao AV and Rao LG. Caretenoids and human health. Pharmacological Research. March 2007;55(3):207-216.

90. Potter GA and Burke MD et al. Salvestrols–Natural Products with Tumour Selective Activity. Journal of Orthomolecular Medicine. 2006;21(1):34-36.

91. Ware WR. Salvestrol: a natural, targeted approach to preventing and treating cancer.

Integrated Healthcare Practicioners (IHP) magazine. November/December 2012. internet site: http://ihpmagazine.com/wp-content/ uploads/2014/11/Feature-Ware.pdf, consulted on Jan 2015.

92. Rotches-Ribalta M, Andres-Lacueva C and Estruch R et al. Pharmacokinetics of resveratrol metabolic profile in healthy humans after moderate consumption of red wine and grape extract tablets. Pharmacological Research. November 2012;66(5):375-382.

93. Graefe EU, Wittig J and Mueller S et al.

Pharmacokinetics and Bioavailability of Quercetin Glycosides in Humans. The Journal of Clinical Pharmacology. May 2001;41(5):492-499.

94. Havsteen BH. The biochemistry and medical significance of the flavonoids. Pharmacology and Therapeutics. 2002;96(2-3):67-202.

95. Manach C, Scalbert A and Morand C et al.

Polyphenols: food sources and bioavailability.

The American Journal of Clinical Nutrition. May 2004;79(5):727-747.

96. Larsson SC et al. Milk, milk products and lactose intake and ovarian cancer risk: a meta-analysis of epidemiological studies. Int J Cancer 2006; 118:431.

97. Raimondi S, et al, Diet and prostate cancer risk with specific focus on dairy products and dietary calcium: a case-control study. Prostate 2010; 70(10): 1054-65 98. Chan JM, et al. Dairy products, calcium and prostate cancer risk in the Physicians’ Health Study.

Am J ClinNutr 2001; 74:549 99. Duarte-Salles T, et al. Dairy products and risk of hepatocellular carcinoma: the European prospective investigation into cancer and nutrition (EPIC). Int J Cancer 2014. 135:7

78

inspirehealth

100. Genkinger JM, et al. Dairy products and ovarian cancer: a pooled analysis of 12 cohort studies.

Cancer Epidemiol Biomarkers Prev 2005; 14:13.

101. Kroenke CH, et al. High- and low-fat dairy intake, recurrence, and mortality after breast cancer diagnosis. JNCI March 2013 102. Shin MH, et al. Intake of dairy products, calcium, and vitamin d and risk of breast cancer J Natl Cancer Inst 2002; 94:1301 103. Lin J, et al. Intakes of calcium and vitamin D and breast cancer risk in women. Arch Intern Med 2007; 167:1050 104. Missmer SA, et al. Meat and dairy food consumption and breast cancer: a pooled analysis of cohort studies. Int J Epidemiol 2002; 31:78 105. Murphy N, et al. Consumption of dairy products and colorectal cancer in the European prospective investigation into cancer and nutrition (EPIC). PLoS One 2013; 8:9 106. Perrier A, Agnès Demazières, Nicolas Girard et al. Circadian variation and responsiveness of hydration biomarkers to changes in daily water intake. European Journal of Applied Physiology.

August 2013;113(8):2143-2151.

107. King WD, Marrett LD Case-control study of bladder cancer and chlorination by-products in treated water (Ontario, Canada). Cancer Causes Control 1996:7 (6):596-604.

108. Parajuli KP, Chaulagain DD and Singh G et al. The Microbial Invasion of Gastro Intestianal Tract and Habit of Drinking Water Immediately after Meals.

Journal of Nobel Medical College. 2014;3(1):58-61.

109. Cannon MC, Nuttall FQ and Saeed A et al. An increase in dietary protein improves the blood glucose response in persons with type 2 diabetes.

The American Journal of Clinical Nutrition. October 2003;78(4):734-741.

110. Masterjohn C. 2005. Coenzyme Q10 (Ubiquinone): statins inhibit coenzyme Q10 synthesis. http:// www.cholesterol-and-health.com/Coenzyme-Q10. html#Table. Accessed 11 111. January 2007.

112. Shan B, et al. Antioxidant capacity of 26 spice extracts and charcterization of their phenolic

InspireHealth’s Guide to Supportive Cancer Care

123. Schmitz, K.H., Courneya, K.S., Matthews, C., Demark-Wahnefried, W., Galvao, D.A., Pinto, B.M., et al. (2010). American College of Sports Medicine roundtable on exercise guidelines for cancer 5. Introduction to Supportive Modalities survivors. Med Sci Sports and Exercise, 42(7), 113. Davidon RJ, Zabat-Kinn J, Schumacher J, et 1409-1426. al. Alterations in Brain and Immune Function Produced by Mindfulness Meditation. Psychosom 124. Ingram, C., & Brown, J.K. (2004). Patterns of weight and body composition change in Med 2003;65:564-70. premenopausal women with early stage breast 114. Reindl TK, Geilen W, et al. Acupuncture against cancer: Has weight been overestimated? Cancer chemotherapy-induced nausea and vomiting Nursing, 27(6), 483-490. in pediatric oncology. Interim results of a multicenter crossover study. Support Care Cancer 125. Harle, L.K., Maggio, M., Shahani, S., Braga-Basaria, M., Basaria, S. (2006). Endocrine complications of 2006;14(2):172-6. androgen-deprivation therapy in men with prostate 115. Seguin R. et al. Sedentary Behavior and Physical cancer. Clinical Advances in Hematology and Function Decline in Older Women: Findings from Oncology, 4(9), 687-696. the Women’s Health Initiative. Journal of Aging 126. Rock, C.L., Doyle, C., Denmark-Wahnefried, W., et Research. Volume 2012 (2012), article ID 271589. al. (2012). Nutrition and physical activity guidelines 116. van der Ploeg H.P. et al. Sitting Time and All-Cause for cancer survivors. CA: A Cancer Journal for Mortality Risk in 222,497 Australian Adults. Arch Clinicians, 62(4), 243-274.

Intern Med. 2012; 172(6): 494-500) 127. Winters-Stone, K.M., Dobek, J., Bennet, J.A., et 117. Holmes, M.D., et al. (2005). Physical activity and al. (2012). The effect of resistance training on survival after breast cancer diagnosis. Journal of the muscle strength and physical function in older, American Medical Association, 293(20): 2479-86. postmenopausal breast cancer survivors: A 118. Kenfield, S.A., et al (2011). Physical activity and randomized controlled trial. Journal of Cancer survival after prostate cancer diagnosis in the health Survivorship, 6(2), 189-199. professionals follow-up study. Journal of Clinical 128. Rock, C.L., Doyle, C., Denmark-Wahnefried, W., et Oncology, 29: 726-32. al. (2012). Nutrition and physical activity guidelines 119. Rock, C.L., Doyle, C., Denmark-Wahnefried, W., et for cancer survivors. CA: A Cancer Journal for al. (2012). Nutrition and physical activity guidelines Clinicians, 62(4), 243-274. for cancer survivors. CA: A Cancer Journal for 129. Hayes, S.C., Spence, R.R., Galvao, D.A., et al.

Clinicians, 62(4), 243-274.

(2009). Australian Association for Exercise and 120. Hayes, S.C., Spence, R.R., Galvao, D.A., et al.

Sport Science position stand: Optimising cancer (2009). Australian Association for Exercise and outcomes through exercise. Journal of Science Sport Science position stand: Optimising cancer and Medicine in Sport, 12(4), 428-434. outcomes through exercise. Journal of Science and 130. Winters-Stone, K.M., Dobek, J., Nail, L.M., et Medicine in Sport, 12(4), 428-434. al. (2013). Impact and resistance training 121. Winters-Stone, K.M., Schwartz, A.L., Hayes, S.C, et improves bone health and body composition in al. (2012). A prospective model of care for breast prematurely menopausal breast cancer survivors: cancer rehabilitation: Bone health and arthralgias.

A randomized controlled trial. Osteoporosis Cancer, 118(8 suppl), 2288-2299.

International, 24(5), 1637-1646.

122. De Backer, I.C., Schep, G., Backx, F.J., Vreugdenhil, G., Kuipers, H. (2009). Resistance training in cancer 131. Schmitz, K.H., Courneya, K.S., Matthews, C., Demark-Wahnefried, W., Galvao, D.A., Pinto, B.M., survivors: A systematic review. International Journal et al. (2010). American College of Sports Medicine of Sports Medicine, 30(10), 703-712. constituents. J Agric Food Chem 2005; 53(20): 7749-7759)

79

Bibliography

132.

133.

134.

135.

136.

137.

138.

139.

140.

80

inspirehealth

roundtable on exercise guidelines for cancer survivors. Med Sci Sports and Exercise, 42(7), 1409-1426.

Brown, J.C., Huedo-Medina, T.B., Pestcatello, L.S., Ryan, S.M., Pescatello, S.M., Moker, E., et al. (2012).

The efficacy of exercise in reducing depressive symptoms among cancer survivors: A metaanalysis. PloS ONE, 7(1): e30955. Doi: 10.1371/ journal.pone.0030955.

Buffart, L.M., van Uffeleln, J.G.Z., Riphagen, I.I., Brug, J., van Mechelen, W., Brown, W., & Chinapaw, M.J.M. (2012). Physical and psychosocial benefits of yoga in cancer patients and survivors, a systematic review and meta-analysis of randomized controlled trials. BMC Cancer, 12: 559.

Tomlinson, D., Diorio, C., Beyene, J., & Sung, L. (2014). Effect of exercise on cancer-related fatigue: A meta-analysis. American Journal of Physical Medicine & Rehabilitation. 93, 675-686.

Courneya, K.S., Segal, R.J., Mackey, J.R., Gelmon, K., Reid, R.D., Friedenreich, C.M., Ladha, A.B., Proulx, C., et al. (2007). Effects of aerobic and resistance exercise in breast cancer patients receiving adjuvant chemotherapy: a multicenter randomized controlled trial. Journal of Clinical Oncology, 25(28), 4396-4404.

Segal, R.J., Reid, R.D., Courneya, K.S., Sigal, R.J., Kenny, G.P., Prud’Homme, D.G., et al. (2009).

Randomized controlled trial of resistance or aerobic exercise in men receiving radiation therapy for prostate cancer. Journal of Clinical Oncology, 27(3), 344-351.

Hofman, M., Ryan, J.L., Figueroa-Moseley, C.D., et al.(2007). Cancer-related fatigue: The scale of the problem, Oncologist, 12(suppl 1), 4-10.

Holley, S. (2000). Cancer-related fatigue: Suffering a different fatigue. Cancer Practice, 8, 87-95.

Ryan, J.L., Carroll, J.K., Ryan, E.P., Mustian, K.M., Fiscella, K., & Morrow, G.R. (2007). Mechanisms of cancer-related fatigue. The Oncologist, 12, 22-34.

Rhodes, R.E., Fiala, B., & Conner, M. (2009). A review and meta-analysis of affective judgments and physical activity in adult populations. Annals of Behavioral Medicine, 38, 180-204.

141. Ott MJ, Norris RL, Bauer-Wu SM. Mindfulness meditation for oncology patients: a discussion and critical review. Integr Cancer Ther 2006;5(2):98-108.

142. Schultz PE, Haberman M, Nichols J, et al. Downregulated lymphocyte NF-kB activation in breast cancer survivors following yoga participation.

FASEB 2007;21:765-7.

143. Kuchler T, Bestmann B, Rappat S, et al. Impact of psychotherapeutic support for patients with gastrointestinal cancer undergoing surgery: 10year survival results of a randomized trial. J Clin Oncol 2007;25(19):2702-8.

144. Weihs KL, Simmens SJ, Mizrahi J, et al.

Dependable social relationships predict overall survival in Stages II and III breast carcinoma patients. J Psychosom Res 2005;59(5):299-306.

InspireHealth’s Guide to Supportive Cancer Care

“There are only two ways to live your life.

One is as though nothing is a miracle.

The other is as though everything is a miracle.” albert einstein

81

inspirehealth’s guide to

Supportive Cancer Care

A resource for people living with cancer and their families.

Stay in touch 1.888.734.7125

LOWER MAINLAND VANCOUVER 604.734.7125 #200 - 1330 West 8th Ave

SOUTHERN INTERIOR KELOWNA 250.861.7125 #123 - 525 Bernard Ave

VANCOUVER ISLAND VICTORIA 250.595.7125 #212 - 2187 Oak Bay Ave

INSPIRELIFE CANADA VIRTUAL CENTRE inspirehealth.ca/ inspirelifecanada

The InspireHealth Guide was printed in part through a generous donation sponsorship by Finlandia Pharmacy. finlandiapharmacy.com | 1.800.363.4372

inspirehealth.ca 2

inspirehealth