Cancer Treatments In Canada

hello everybody. i think we will get startednow. welcome to our lunch and learn. my name is michelle snow and i am patient educationlibrarian here at princess margaret cancer center and i will be introducing our speakertoday. jean lamantia is a registered dietitian, cancer survivor and best-selling author ofthe book: “the essential cancer treatment nutrition guide and cookbook”. jean alsowrites a monthly blog called “cancer bites” and you can subscribe to the blog at www.jeanlamantia.com.i believe it is on the first slide on the bottom. jean provides peace of mind throughone on one and group mentorship to cancer patients, survivors and people in high riskfor cancer. so please join me in welcoming jean lamantia.

jean lamantia: thank you michelle. i wantto thank michelle and her team for inviting me here today. i just want to tell you mystory. when i was 27 years old, something happened to me that really changed my life.at the time i felt like the rug was pulled from under me and i was not sure if i wasgoing to survive. with time i began to see the experience as a gift because it reallyhas shaped my career. when i was 27 years old i was diagnosed with hodgkin’s lymphomastage 2b. i had massive lumps in my neck, under my arms and i had a tumour the sizeof a small grapefruit growing in the middle of my chest. by the time i reached the cancercentre my lungs were so full of lymphatic fluid that it felt like i was drowning. ireceived my diagnosis and i started 6 months

of chemotherapy followed by 1 month of dailyradiation. it was really a turning point for me at theend of my treatment. this is what i thought; when it was my very last day of radiationi actually thought my radiation oncologist was going to meet me there at the radiationsuite and was going to shake my hand and say “you did it. you finished your treatment,your cancer is gone. you are cured.” most of you probably know that it doesn’t workthat way. there was no fanfare, no doctor, and no special treatment from the radiationtechs. all i had was my appointment card. so i thought, ok that’s when the doctoris going to tell me. so i go to the three month appointment, they took a chest x-ray,they did bloodwork, they weighed me, they

did the physical exam and said ok see youback in three months. this began a real rollercoaster cycle for me. relief that i didn’t havecancer that day but a gradual buildup of anxiety and fear before my next three month followup because i thought they could say today its back. what occurred to me during thistime is that my medical team is expert at treating my cancer and they were expert atdetecting my cancer. but they were not experts in helping me reduce my risk of recurrenceof my hodgkin’s and reduce my risk, the cancers that they told me in my case, lungcancer and breast cancer, that now i was at high risk for. if i was doing something tohelp myself, i didn’t know what it was. so in that way it didn’t help with my fear.this fear really reached a peak and that peak

happened actually as i was trying to get mylife back on track. and when you’re 20 something you go out with your friend and have a drink.so i had my first drink of alcohol since my diagnosis and treatment and i got a headache.now this may not seem like a big deal but let me backtrack for you a year and a halfbefore. my cancer started as a pain in the neck. that’s all it was. felt like a stiffneck. but the interesting thing about this stiff neck was whenever i had alcohol thepain in my neck would increase and radiate down my arm into my hand. and at the time,i was actually working at a diabetes education centre and another dietitian i used to goout with and shoot pool and drink beer with. so there goes the little secret, dietitiansshoot pool and drink beer. when i was finally

diagnosed 7 months later and i started researchingmy type of cancer, one thing caught my eye, this cancer sometimes reacts to alcohol andi knew exactly what that was because i experienced that pain shooting down my arm into my hand.now fast forward to the place i was having my first drink of alcohol after my cancertreatment finished, having a headache, spiraling in fear and anxiety, where does that leadme? oh my god i have brain mets. that’s where i went with that. so i was so convincedthat i had brain mets, i called the cancer centre where i had my treatment and i askedif they could page the oncology nurse on call and i tearfully explained; i’m a hodgkin’spatient i’ve finished my treatment, i just had my first drink of alcohol and now i havea headache, i think have brain mets. he laughed

at me and it was deeply humiliating.the fact that my fear was not listened to and heard really hurt. at the same time itwas one of those moments where you look in the mirror and you see yourself and in mymoment i said jean you’ve got to get a grip. i recognized that my fear was out of controland my anxiety was out of control and i had to do something. my medical team, i couldsee their expertise, as i said, was in treating my cancer and detecting my cancer. it wasnot in helping me reduce my risk. my medical oncologists told me just eat a healthy diet.i knew what that was because i was already a dietitian and of course this flashed intomy mind; canada’s food guide. i learned from this in my first year of university butwhat i know about this is this a tool for

the general healthy population. thinking ofthis did not reduce my fear because i thought: i need to do more than that. i’ve alreadyhad cancer once and i am at a high risk for two other types of cancer. it just didn’tfeel like enough and that it was not going to do anything to break through my fear andanxiety that i was having. in that moment of humiliation i kind of talked to myselfand you know…i feel like i have to figure this out, i have to do something to help myselfto get out of this situation. to be honest i didn’t have to look too far because hereis my degree from the university of guelph; i graduated with applied human nutrition andi had a clinical dietetic internship from the toronto western hospital. if you’regoing to pick someone who is going to be qualified

to be a cancer patient it was me right? soi started looking at the research. i had stopped since and i’m going to distill that informationnow for you today into 3 keys that i think you should focus on as someone who has beenthrough cancer treatment and want to reduce your risk. i can’t share everything i havelearned over the years but i’ll do my best to give you some real tools you can implementtoday. if you want more there are plenty of ways to get in touch with me and work withme either one on one, group or online. it’s important, you might think that it’s justfear or anxiety, but think about it this way your fear can actually compromise your immunesystem. your immune system is one of the things that can help protect your from cancer. sothe very thing that you fear, you are actually

creating an environment that will allow thatto take hold. the other thing that way happening in my case, the night before one of these3 month follow-up appointments; i had a migraine. i’ve never had a migraine before. i feltthe migraine because i was so afraid that when i go back to the follow up appointmentmy doctor was going to tell me my cancer was back.now not everyone gets migraine headaches from their fear and their anxiety and their stresslevel. some people develop high blood pressure, some develop angina, some have heartburn,some have irritable bowel symptoms like diarrhea, constipation or bloating, some have skin problemslike eczema or rashes. so my fear was so out of control that i was this hyper vigilantperson thinking that every headache was a

cancer spreading and i was also creating newillness, in my case it was migraine headaches that i’ve never had before. it was reallystarting to affect my health. here are the 3 keys that i want you to hold onto and rememberthat these are your tools that you can use and when you implement these my wish is thatthe fear and anxiety about recurrence and a new cancer will start to diminish becauseyou will realize there’s evidence that these things can help you.the 3 keys are: first is to support the immune system and i’m going to tell you how todo that. the 2nd one is to reduce chronic inflammation and the 3rd one is to eat thefoods and nutrients that act on cancer cells directly. let start with the first one: supportthe immune system. now nutrition can do this,

i wrote a whole 6 part blog series on thenutrients that can help support the immune system. vitamin b6 is one, vitamin e is another,beta glucan, and isoflavones found in soy. i only have a limited time here today so iwon’t go into detail but you can please read them on my blog. the first one i wantto talk about and you kind of get an idea of it; and that is stress management.so last year we were in the us on vacation and checking out at the grocery store, mydaughter sees this magazine and she asked me “mommy can we get this” so i said ok.popular science magazine for a seven year old but any ways. of course you can see whyshe wanted to get it because she thought it was all about lego. so we get the magazineand it’s all about stress and you know i

just want to say when i’m putting my informationtogether it is all evidence based and i get that from the published medical literature.not always from popular science. one thing i wanted to point out, it says chronic stresshas been linked to illnesses such as cancer and diabetes and the medical literature supportsthis too. there is definitely a link between stress and cancer. then a few pages in i thinkthe magazine got it wrong. let me read you what it says in here. so they’re profilinga comedian by the name of tig notaro. it said that tig notaro had a famously stressful yearin 2012. within months she got pneumonia, and intestinal infection, went through a breakup, her mom died unexpectedly and she was diagnosed with breast cancer. i would writethat differently, i would say comedian tig

notaro had a famously stressful year in 2012.within months she got pneumonia, got an intestinal infection, went through a breakup, her momdied unexpectedly and because of the stress from all these things, the individual cancercells found in her body were allowed to grow into the size of a mass that was actuallydetectable because of her compromised immune system due to her high stress levels. maybethe editor would have to make that sound a little better but we have heard the expressionit never rains but it pours and maybe in your experience with cancer you’ve had this ormaybe you know someone. it’s not uncommon to have something from that persons list;a divorce, a breakup, the death of someone close, maybe a pet or family member, forcedretirement. all kinds of things can precede

the diagnosis of cancer. let’s not underestimatethe effect that stress has on the immune system and what a great partner the immune systemcan be with helping to protect us from cancer. so it’s not surprising that one of the waysto support the immune system is to do regular stress management. this does not prevent yourstress levels, your fight of flight reaction from occurring when one of life’s stressfulevents happen, but when you are practicing regular stress reduction you’re more likelyto go to that. if you are used to going to yoga a couple of times per week or if youare used to exercise or meditation you’re going to have that tool and you are goingto know how to use it. not to mention it’s good for just the stress that comes with aregular boring old week. stress management

is one of the keys, another one is physicalactivity. not all types of physical activities actually support the immune system some actuallycompromise it. i’ll give you my own personal experience with this. when i was finishedmy cancer treatment, i was very out of shape. i had spent the first 3 months of my chemojust vomiting and i had lost a lot of muscle and so several months after my treatment ithought i’m going to get back in shape. i went to the track at u of t, inside trackand i could run half way around, that’s it. so i just kept going and kept going. eventuallyi found myself at the starting line of my first half marathon. i made all the rookiemistakes, i didn’t fuel properly the night before, and i didn’t hydrate enough duringthe race, i started off too fast. by the end

i was having chills, i was dehydrated andit was everything i could do to just push myself to get across the finish line. whathappened to me the next day? i got sick. that type of really high intensity exercise whereyou are not listening to your body is compromising the immune system. the type that supportsthe immune system is regular, moderate physical activity and you want to be doing this everyday if you can. another one is being out in nature. as i saidall of the information i am giving you today is evidence based, but i’ll tell you thatwith this information there’s only a handful of studies and they all come from japan. andin japan they have a practice called forest bathing where they go into the forest andin these studies they measure people’s natural

killer cells which are certain cells thatare part of the immune system before and after they are in the forest. so the level of thesecells goes up. what they believe is happening here is that the trees are giving off a naturalwood aroma therapy that’s affecting the immune system in a positive way. i think that’sreally nice if you tie those three together; stress reduction, physical activity and beingoutside, being around trees. to know also, that these are supportive of the immune system.now you might be doing this stuff already but again knowing that it helps is what’sgoing to help reduce your fear. otherwise you might be thinking there’s nothing ican do, i’m just randomly waiting for this, to know if this cancer is coming back or not.another thing that can support the immune

system is laughter. in the research on thisthey’ll have people read a funny story or watch a funny movie and they measure the effecton the immune system and there’s a positive effect. but you know what, even if you laughand there’s nothing funny about it, it still has a positive effect on the immune system.who would laugh if there’s nothing funny to laugh at? people who go to laughter yoga,have you heard of this? so nothing funny about it, you go to a regular yoga class and atsome point the instructor will ask you “take a deep breath and let’s do a big belly laugh…ha ha ha. to some it feels pretty ridiculous to be honest at the beginning then it takeson a life of its own and starts laughing. even this kind of laughter is supportive ofthe immune system.

another one i’ll give you today and thatis sleep. no surprise sleep is very restorative to the immune system like it is to the musculoskeletalsystem, the neuroendocrine system but there are a couple of keys to pay attention to andthat is the amount of sleep. between 7-8 hours of sleep is ideal but also the time at whichyou go to sleep and if you can be asleep between 11 pm and 3am, that sort of magic window isespecially supportive of the immune system. so if you are pulling an all-nighter and youthink i’m just going to sleep 8 hours now and sleep until 11, that’s not the samething. it’s not just the number of hours it’s the time that you go to sleep. so that’sthe first key, supporting the immune system. those are just an overview of some of thetools to help you do that.

the next one i want to talk about is reducingchronic inflammation and people can think about inflammation as you know, i’ve gottonsillitis, any time you have ‘itis’ on the end of the term or appendicitis, gastritis.but the kind of inflammation i’m talking about here you may not even know if you haveit in your body. now there are ways to tell if you have it and you can measure it in ablood test one of them for example is called crp c reactive protein, another is calledil6. let me share with you an analogy i’ve developed to help you understand what chronicinflammation is. let’s say you get up in the morning and you look out and you havea view of the street and you see there is a car accident in front of your house. you’llpick up the phone and call 911. what’s going

to happen, the first responders are goingto show up. so the ambulance attendants are going to help people that are injured thepolice are going to order the tow truck to get traffic moving again, the fire truckerwill clean up any fuel spill put out any fire and then they are going to leave. then youlook out on the street a couple hours later and you won’t be able to tell that therewas any problem there. think of that as an acute inflammation acute meaning short term.you cut your finger it’s like dialing cellular 911. first responders come and these are specializedcells that fix the problem and then everything gets back to normal. one problem in that analogy,when you call 911 and those first responders come to the car accident but they don’tleave. then what happens, the injured patient

is not going to get to the hospital or wherethey need, so there will be a lot of bystanders asking “what’s going on” it’s goingto be hard for me to get down the sidewalk as there will be people trying to figure outwhat’s happening. then traffic is going to get backed up and cars are not going toget down the street and then garbage day; well garbage is going to start to pile upand then what was once a very functional healthy system has now created all kinds of dysfunctionand disease. so you create all new problems you know… there’s going to be rats, there’sgoing to be more car accidents, the street won’t be able to be usable anymore. thinkof that as chronic inflammation. what once was a very healthy cellular reaction insideyour body meant to either get rid of a foreign

body or deal with a virus or bacteria or heala sunburn or heal some other infection. if those cellular 911 first responders don’tleave it’s creating dysfunction and within that dysfunction it’s allowing the creationof a cancer cell. one cell. that’s all it takes to start this process.a tool in your tool box is to reduce chronic inflammation. so how do we do that? i’vetold you to have a blood test and there’s no point to test your blood unless you knowyou can do something about it, unless you can track that and 3 or 6 months later you’llsee that number come down. there are things that you can do about it. number 1 of coursebecause i’m a dietitian i’ll tell you about the diet stuff. there are foods thatare anti-inflammatory. there is a study published

several years ago where the researchers lookedat 40 different components of food, micro nutrients, macro nutrients, vitamins, herbsand spices and they raked them. which is the most anti-inflammatory any guesses? omega3 fatty acids. what do most people think of when they hear of omega 3 fatty acids? coldwater fish, salmon, sardines, herring, macrel, anchovies. also maybe not the first thingthat comes to mind, but ground flax seeds, flax oil, walnuts. there are not a lot ofdietary sources of omega3 fatty acids so you really have to pay attention to your dietto make sure you are including those. the number 2 anti-inflammatory; turmeric,that yellow spice. that’s why you hear so much about turmeric. and you can find thatin yellow curry but it’s quite likely that

that has a lot do with why people in southasian countries that use turmeric on a regular basis have lower rates of the cancers thatare so prevalent in north america. number 3,4 and 5 garlic, ginger and tea. green tea,black tea doesn’t matter. those are just the top 5 anti-inflammatories and you wantto make sure that you are including these in your diet.the other thing to pay attention to though the fact that you can get too much of a goodthing. even if your diet is healthy, if you are overeating that can be an inflammatorysituation. so you would want to find the portions that work for you. so that you can be lean.now how lean? the american institute for cancer research says that you should be as lean aspossible without being underweight. getting

back to the lean bit. one of the reasons forthat is that there are several types of fat that we carry in our bodies. two main ones;on is called subcutaneous fat. if you have ever had an injection call sub q that standsfor subcutaneous. that’s the kind of fat that’s in our arms on our thighs on thebuttocks. then there is visceral fat. visceral fat is the type of fat that is packed in theabdominal cavity between the organs. that’s why you may have come across in the researchthat you are doing that waist circumference is a risk factor because when we measure thewaist circumference with a tape measure, you’re getting an indication of how much visceralfat you have in your body. visceral fat is dangerous because it produces inflammatorycytokines. in other words, inflammatory messengers.

it creates… it’s a source of inflammationin the body as well it can produce hormones like estrogen. so you want to include theanti-inflammatory foods but in the right portions so that you are getting lean. particularlyif where you are carrying your body fat is in the lower abdominal region. you also wantto participate in regular or moderate physical activity to support the immune system. sowe have talked about 2 of the keys 1 support the immune system. 2 reduce chronic inflammation.i want to talk to you about the 3rd key and i’m going to switch over to the slides. this is the life cycle of a cancer cell. itbegins here with inflammation, remember i said? chronic inflammation creates that reallybad neighborhood. that neighborhood that allows

that cancer cell to come into existence becausepart of what these cellular first responders are doing is saying you’re damaged, getout of here. you need to replicate yourself to create a new cell to replace this damagedcell. when there is a high turnover like that more new cells coming into existence, it’sjust a greater statistical likelihood that one is going to come into existence that hasa defect. and that defect is going to allow it also to survive where a normal cell shouldjust have a certain lifespan and then die off and replace itself. so this damaged cellnow, this cancer cell is going to survive, it’s going to proliferate, it’s goingto invade the tissue that really gets rolling here in angiogenesis and is going to createits own blood signal and then metastasis or

spread. now there is one thing i’m goingto put in the middle here, that can help in the early stages and that is nutraceuticals.you may not have heard of this word but you can probably figure out what that means. itcomes from the word nutrition and pharmaceutical. so they are food or food components that havea pharmaceutical action and i’m going to introduce you to 3 of them today.the first one; garlic. i’ve even brought some with me. now i’m going to give youa little chemistry lesson. this garlic doesn’t smell like garlic. when does the garlic smelllike garlic? it’s not until after you put it through your crusher or until you chopit up, smash it on the cutting board. that’s because the compound that creates the garlicsmell is not in there. there is an enzyme

that is in one little cell membrane or areaand a naturally present precursor. and when you crush it or break it apart, these twocomponents can react because before that they were in their own little area. they can createa new component. it’s allicin that has the aromatic qualities that we associate withgarlic and then that breaks down into other compounds and these are the ones that actuallyhave an effect on cancer cells. what effect do they have? to maximize that reaction, thereis a researcher in the us that found that when you crush it or break open that garlic,you’ll want to leave it for 10 minutes before you eat it or you cook it to maximize thatchemical reaction. just set it aside on you cutting board and cut up your onion or celeryor whatever else you’re putting into your

recipe and then you put it in the pot. rememberthat lifecycle of the cancer cell that i showed you? so the researchers that do work on this,what they do is they have a petri dish with lung cancer cells or breast cancer cells orcolon cancer cells in it and they put in extract of garlic or they maybe even isolate specificallyfor what they think is an active ingredient, allicin or some of the other active compounds.then they watch what is happening to this cancer cell. will the garlic stop the inflammation?it’s stopping the invasion and stopping the angiogenesis. so there are three placeson the life cycle of the cancer cell where the garlic cell is interfering. just becausethis happens in a petri dish or laboratory, we can’t say for sure that this is happeningin our body. but what are the down sides of

acting on this information besides bad breath?you always have to weigh your cost/benefit ratio. i think the potential benefit hereis pretty good, if this is doing this. and we do have support from other areas of researchbecause we do have trials where we have put people on the mediterranean diet, traditionalmediterranean diet which is going to include garlic every day. we know that the mediterraneandiet that can reduce cancer risk. so we have evidence from two sides of the spectrum. wedon’t have a clinical trial where they put half the people on garlic every day and halfthe people without it and follow them for five years or ten years and see what happensbut we have good laboratory work. the next one i want to talk to you is thisone. what is that? ginger. now look at this!

so we already know its anti-inflammatory.it can also stop cell proliferation, invasion, angiogenesis and spread or metastasis. peopleoften ask how i would include ginger in my diet because i didn’t grow up on that. asimple way of doing that is to drink ginger tea. you can even peel it with a spoon, makesome rough chunks, put it in a mug and add some boiling water and drink it. you can alsojulienne a ginger, fry it and it makes a nice topping on salads or stews, things like that. the third group, this is a whole family calledthe cruciferous family, also called the mustard family. there is another chemistry lesson.a little more complicated than the garlic but the same kind of idea. the cancer fightingingredient, let’s use broccoli as an example,

it’s not in that bunch of broccoli but whenyou snap off your piece of broccoli you are breaking those membranes and allowing an enzymein this case i’d say myrosinase to meet up with a group of compounds. now this isdifferent depending on what you’re eating, cabbage, brussel sprouts or cauliflower. itcreates an end product and in the case of broccoli the end product is called sulforaphane.and i’m not sure if you are familiar with dr. richard beliveau from the university ofquebec. he published a very good book called “foods that fight cancer”. he calls sulforaphanethe most important nutrient in the fight against cancer and by extension broccoli, the mostimportant food in the fight against cancer. so this is some pretty important stuff. nowthere is another reaction that can take place

when you cut that broccoli and that is theenzyme myrosinase can meet up with a protein and that can create and inert compound, useless.so we go from this reaction where we create the most powerful cancer fighting compoundto this where we create a dud. so how do we get rid of this protein but keep the myrosinaseenzyme? the answer is you cook it and i know this is contrary to people who support thatraw food is the only way to go and any time you cook your food you’re making it lessnutritious. we know that’s not true from lycopene in tomato products because the recommendationis always to have processed tomato products, like tomato sauce or tomato soup. now we canadd the cruciferous family to that list of foods that are actually better cooked. thereis a researcher who studies broccoli and what

she discovered is that to destroy the proteinthat’s going to take it an inert end product you need to either boil it for 30 secondsor steam it for 3 minutes, that’s it. that’s all it takes. if you do that, if you steamyour broccoli for 3 minutes and you still put it out on the table, it’s going to benice and green and crispy, it’s not going to be soggy. how much is too much? we don’twant to destroy myrosinase enzyme. you’ll want to boil it for no more than 1 minute,steam it for no more than 5. if you’re boiling the window is between 30 seconds and a minute.it’s hardly worth getting the pot out for. steam it for between 3 and 5 minutes. that’syour magic window. let’s say i have overcooked it, is there any nutrition left in here? whatyou’ve done is you’ve destroyed the enzyme

but guess what? that enzyme is in other foodsthat belong to that family. open up your fridge and get out the mustard, wasabi mustard orgrainy mustard or get out your keen’s mustard powder from the spice cupboard. that containsthe enzyme. if you have another broccoli in the fridge or a piece of cabbage or kale,you break a piece of that off, if you eat it when you eat your overcooked broccoli,because that is the enzyme that you destroyed from overcooking. who thought science couldbe so practical? why is this worth doing? check this out! every single stage in thelifecycle of the cancer cell can be interrupted by the nutraceuticals found in the cruciferousfamily. it’s very powerful. if you’re experiencing a lot of fear, anxiety i wantyou to know that there are tools that you

can use to help you feel that you’re doingsomething to help reduce your risk. and you can support the immune system, you can reducechronic inflammation, you can act on cancer cells directly by changes you can make inyour lifestyle and by changes you make in your diet. so now i’ll take any other questions.there is another group coming in here but i want to thank you for coming.