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Greenville Health System (GHS) has been advancing health care for generations. The stories below provide an inside look into GHS and how we’re transforming health care for the benefit of the people and communities we serve.
Greenville Health System (GHS) has been advancing health care for generations. The stories below provide an inside look into GHS and how we’re transforming health care for the benefit of the people and communities we serve.
We’ve seen some big news recently about the treatment of breast cancer and it has sparked a national discussion among cancer specialists, patient advocates and cancer survivors. The controversy is about the treatment of a form of breast cancer called “ductal carcinoma in situ.” The acronym is DCIS. It accounts for about 25 percent of all breast cancer diagnoses. DCIS has been considered to be a very early stage of breast cancer. It is called stage 0 to separate it from the more advanced and more dangerous “invasive ductal carcinoma,” ranging from stages 1-4.
On August 20, 2015, a study in JAMA Oncology was reported online. It described an observational study of more than 100,000 women with DCIS in a large national cancer database called Surveillance, Epidemiology and End Results (SEER). Virtually all of the women in the study had lumpectomy or mastectomy and some had double mastectomy. Many received radiation therapy and endocrine therapy like tamoxifen. The study estimated the 10-year breast cancer-specific mortality rate after a diagnosis of DCIS to be 1.1 percent and the rate at 20 years to be 3.3 percent. It turns out that this low risk of dying from breast cancer for women is about the same as the risk of dying from breast cancer for women in an American Cancer Society database, who were not diagnosed with DCIS. In other words, women diagnosed with DCIS, that is, stage 0 breast cancer, have a very low risk of death due to breast cancer that is no higher than the general female population.
The conclusion of many experts is that DCIS is not very dangerous at all and the vast majority of women diagnosed with breast DCIS do not need lumpectomy and radiation therapy, mastectomy or double mastectomy. The further conclusion is that most women with DCIS receive more treatment than they need and the standard of care for treatment of DCIS should change. In a recent New York Times article, some prominent breast cancer experts said that the best way to treat DCIS is to do nothing at all. Other experts said that DCIS should still be considered as a precursor to invasive breast cancer and be treated with lumpectomy or mastectomy. It is rare for oncology experts to be so divided.
What should we make of this controversy? What does this mean to women newly diagnosed with DCIS? I have a few observations. First, all DCIS is not the same. The study indicated that DCIS has a definitely higher risk of invasive cancer and death in certain subsets of women, including women less than age 40, African American women and women with known genetic mutations. The experts agree that these groups should be treated with the current standards. However, it is important to know the specifics of the DCIS before making treatment decisions.
Second, the vast majority of DCIS is truly much less dangerous than invasive breast cancer. The difference is so great that some experts have suggested changing the name of DCIS to something without the word cancer. I offer the following analogies. If invasive breast cancer is a watermelon, DCIS is a plum. If invasive breast cancer is a dandelion, DCIS is a seed that has not sprouted and hopefully never sprouts. If invasive breast cancer is social media, DCIS is snail mail.
Third, a woman newly diagnosed with DCIS benefits from a thorough evaluation by multiple cancer specialists. In the Breast Cancer Multidisciplinary Clinic (MDC) at the GHS Cancer Institute, a woman with a new diagnosis of breast cancer is evaluated in the same visit by the surgical oncologist, the radiation oncologist and the medical oncologist. At this lengthy visit, the breast radiologist and breast pathologist review the specific features of that breast cancer. This systematic and thorough MDC approach has been recognized as a national best practice for breast cancer care.
When a woman is diagnosed with breast cancer, a first impulse might be to “get this off of me now.” I would advise taking a few weeks to think about it, to get a thorough evaluation in a multidisciplinary, real time clinic, and/or to consider getting a second opinion. You are worth the extra effort.
For more information about breast cancer and the GHS Cancer Institute Breast Cancer Multidisciplinary Clinic (MDC), contact the GHS Breast Health Center at (864) 454-2224.
Breast Nurse Navigator Jo Maria Weathers and Genetic Counselor LeDare Finley contributed to this blog post.
When I received my September issue of Consumer Reports and saw the article about “healthiest snack bars,” I was curious about the criteria Consumer Reports would use to decide that one snack is better than another. To me, it brings up the question of what one wants from a snack and what one should want from a snack. Readers of the Survive and Thrive blog are well aware of our advocacy of a plant-based diet with five servings of fruits and vegetables per day, limited added sugars, whole grain foods and limited red and processed meats. Our readers are also well aware of the need for calorie control and the link between excess weight and cancer. To add to the discussion, I will say that the Center for Integrative Oncology and Survivorship (CIOS) is paying more and more attention to how we avoid bad eating habits, create good habits and maintain good habits. So, what do we really want from a snack? What would make a snack healthy?
The question is important because we are bombarded with advertisements for more food than we need or should eat. The Consumer Reports article points out that 90 percent of pharmacies and gas stations have candy, sugary drinks and salty snacks at the checkout. Clearly candy bars and full-calorie sodas are not healthy. I like to refer to them as “weapons of mass destruction” for what they do to our bodies through excess calories, excess inflammation and immune suppression.
So, if a snack should not contain added sugar, what should it contain? That may depend on your reason for eating a snack. If it is before exercise, you should include a healthy carbohydrate like fruit (natural sugar) or whole grains (without added sugar) paired with a plant-based protein such as peanut butter. If it is simply to hold you over until the next meal, try a non-starchy vegetable that you can eat a larger volume of with fewer calories and pair it with a protein. For instance, carrots and hummus make a great snack. If you are eating just for a sweet taste, try a convenient fruit such as grapes or dried fruit to satisfy your sweet tooth.
I propose that the best purpose of a snack is to satisfy one’s appetite until the next meal. This may not be everyone’s definition, but it is a good one. In this regard, protein and fats are better at satisfying hunger than carbohydrates like breads, foods with added sugar, and candy. One of my favorite snacks is a serving (enough to fill the palm of your hand) of almonds. It has some fat and some protein, but it is tasty and more likely to tide me over to the next meal versus a chocolate chip cookie.
The Consumer Reports article lists berry and nut bars as well as chocolate bars, while rating some as top picks on the basis of less added sugar and protein coming naturally from the fruits or nuts. The snack bars listed as bottom rated tend to have processed protein or fiber in the form of soy-protein isolate or chicory root (this is an added fiber). I will not name names, but I will suggest that you pay attention to grams of added sugar. Bars with less than 10 grams of sugar each are a better choice than bars with 15-20 grams of added sugar each. Remember that the recommended limit for added sugars in our diet is 25 grams per day, which is equal to about six teaspoons of sugar.
In summary, I suggest that you treat a snack as something healthy to get you through to a healthy meal later on. For this, I recommend fruits and nuts. Snack bars are appealing, but they may have more added sugar, more calories or more trans fats than meet the eye. As an alternative to commercial snack bars, I recommend something like this recipe that was given to me by my sister-in-law, Evie O’Kale.
Here’s a yummy treat that will fuel you with wholesome and real food ingredients. It combines healthy fats, carbs and protein to provide an energy boost any time of day!
– 3/4 (loosely filled) cup of medjool dates, pitted
– 1/2 cup of raw almonds
– 1/2 cup raw walnuts
– 2 tablespoons unsweetened shredded coconut
– 2 tablespoons dried goji berries
– 1 tablespoon chia seeds
– 1 tablespoon of almond or cashew butter
– 1 tablespoon raw cacao nibs
– 1/4 teaspoon ground cinnamon
Makes approximately 15 servings (~1 inch balls).
If desired, you may use unsweetened carob powder, hemp seeds or the shredded coconut as a coating.
Place the nuts into a food processor; blend until finely crushed. Then add the dates, pulsing processor until mixture begins to stick together, scraping down sides as needed. Add the rest of the ingredients to the processor, pulsing until well incorporated.
Roll the mixture into small bite-size balls, about an inch in diameter. If you like, roll balls in a small bowl with the coating of your choice. Place them in the freezer on a parchment lined sheet for an hour or two to set; then store in the fridge.
These will keep about a week in the fridge in a glass covered container. Enjoy!
Registered dietitian Jessica Menig contributed to this blog.
Big news! Pepsi Co. recently announced that it will stop using aspartame in Diet Pepsi. The new soda cans will say “Now Aspartame Free” on the label. The reason given is not health or safety issues but rather consumer demand. That is, Pepsi is dropping aspartame after more than 20 years because its customers are uncomfortable with aspartame. Interestingly, Diet Coke and Diet Dr. Pepper use aspartame as their sweeter and will continue to do so, although Diet Coke does have a formula that uses Splenda.
A Gallup poll published in July indicated just how uncomfortable Americans are with artificial sweeteners in diet soft drinks. When asked what foods they include or avoid in their diets, 62 percent said that they avoid diet soda, compared to 61 percent for regular soda, 50 percent for sugar, 47 percent for fat and 39 percent for salt. I am surprised that more Americans avoid diet soda than regular soda. So, are artificial sweeteners that bad? Is aspartame, in particular, that bad?
Health risks for aspartame have been studied extensively. Neither animal studies nor human studies have demonstrated any cancer or other health risk. The Food and Drug Administration (FDA) and the European Food Safety Authority (EFSA) have both pronounced aspartame safe as a general sweetener for food. There is a good discussion of this on the American Cancer Society website. As a physician who practices integrative medicine, I add evidence-based concerns about our mind and body health to conventional medicine. I find no evidence that aspartame is bad. Therefore, I use artificial sweeteners occasionally to help me avoid added sugars. The label “now aspartame free” does not impress me.
Similarly, I have found no evidence that other artificial sweeteners, such as Splenda (sucralose), Sweet ‘N Low (saccharin) and Truvia (stevia), are health risks. In fact, a previous Survive and Thrive blog explains that saccharin is definitely not harmful and may have an anti-cancer effect. (Read that blog post here.) On the other hand, added sugar in soft drinks is a huge health risk. This has also been discussed in prior Survive and Thrive blogs. It is fine to avoid diet soda because we don’t need extra artificial chemicals in our bodies, but it is much more important to avoid sodas containing added sugar. Note that a 20 ounce Pepsi contains 69 grams of added sugar compared to the recommended 25-35 grams of added sugar per day. We definitely don’t want the calories, the inflammation, the diabetes, the heart disease or the cancer. Let not the mouse distract us from the elephant.
At the Center for Integrative Oncology and Survivorship (CIOS), we pay a lot of attention to nutrition and diet. If you would like to learn more about healthy food and drink choices for cancer survivors, call (864) 455-1346. We can provide information about classes and activities or schedule an appointment with our integrative oncology nutritionist. You can also find us online at ghs.org/cios.
Going back to school is such an exciting time, but after a summer of fun it can sometimes be hard to get back on a schedule.
Parents have to readjust to the daily activity of packing school lunches. As a parent, you want to make sure that your children are eating not only a healthy lunch but a safe one as well.
Food safety and good health start at home.
Always make sure to wash your hands prior to prepping or packing any food. Ensure that fruits and vegetables are safe by washing and drying them thoroughly before packing them. Always keep raw foods away from cooked or ready to eat foods to prevent cross-contamination. If you are cooking food, make sure it is cooked to the proper internal temperature. For example, chicken should be cooked to 165 degrees fahrenheit.
To ensure that foods stay at the right temperature by lunch time, buy an insulated lunch box.
When packing food, use baggies and containers that can seal completely. To keep cold foods cold you can use ice packs or even frozen water bottles for dual purpose. For hot items, like spaghetti or soup it is helpful to use a thermos to maintain temperature. It’s also a good idea to use as many non-perishable items as possible so that temperature control isn’t an issue.
A great way to make healthy packed lunches fun is to involve the kids in the process.
They are a lot more likely to eat what you give them if they have a say in what they are given. Let them help you clean and cut up fruits and vegetables and put them in containers for the week and then day to day they can pick an option. You can also keep a bin of healthy non-perishable snacks they can pick from day to day. General recommendations would be: fruit leather, seed and nut packs, unsweetened applesauce, multigrain crackers, granola bars, veggie straws, and banana or apple chips.
Getting creative with main meals everyday can get tough, especially with picky eaters as well as food restrictions.
A lot of schools now do not allow certain foods like peanut butter or nuts due to prevalent food allergies. A good alternative to the classic peanut butter sandwich could be hummus and pita bread or chips. You could also offer a homemade fruit smoothie in a thermos for a yummy treat to break up the sandwich monotony. Homemade soups are a healthier option for cold winter months and will stay warm in a thermos. If you do offer your children deli meat sandwiches, keep condiments on the side and use an ice pack in the lunch box. Sometimes sandwiches will get squished from the pack, so try using whole wheat pita pockets for deli meat sandwiches that hold up better than bread.
The bottom line is to use lunch packing as a learning opportunity with your kids. It can help them learn not only about making daily healthy choices but also food safety!
Our bodies do wonderful things to keep us alive while we go about living our daily lives. Our immune system is constantly seeking out and eliminating infection and cancer from every corner of our body. Our heart pumps the blood through arteries that deliver anti-inflammatory phytochemicals from our diet to every part of our body. Our liver filters the returning blood and removes toxins and waste products, causing them to be passed out of the body in the urine and stool. Our liver has an enormous capacity to adapt to stress and illness, but it is susceptible to injury from illness, medications, environmental toxins, diet, alcohol and stress. Accordingly, we want to do whatever we can to keep our livers healthy, especially when living with a chronic illness like cancer. In this post we’ll explore how the liver works and how we can detox when it becomes overwhelmed.
The liver eliminates toxins from our bodies using specialized enzymes in the cells called hepatocytes. The enzyme reactions inside the hepatocytes can be divided into two phases, conveniently called phase 1 and phase 2. Think of it like painting a car: phase 1 is the primer coat and phase 2 is the final coat. So it is in the liver with the two phases. In chemical terms, phase 1 involves cytochrome P450 enzymes and phase 2 involves enzyme pathways that change the intermediate metabolites in a process called conjugation.
Both phase 1 and phase 2 require nutrients, called cofactors, that come from our diet. For phase 1, the required nutrients are B vitamins, folic acid, glutathione, antioxidants, carotenoids, vitamin E and vitamin C. The best source of these nutrients is a diet with a variety of fruits and vegetables, especially green leafy vegetables. It turns out that supplements like vitamin E are not helpful, but rather harmful. Studies have shown that vitamin E actually increases the risk of cancer. For phase 1, most practitioners of integrative medicine recommend five servings of fruits and vegetables daily. I personally try to bring vegetable juices, almonds and a fresh fruit in my lunch every day. I encourage a similar strategy for most people.
For phase 2, the required nutrients include amino acids, like glutamine, glycine, taurine and cysteine. These are found in proteins. Here, most practitioners of integrative medicine recommend plant-based proteins like beans, lentils, nuts and whole grains. Another required nutrient for phase 2 is sulphated phytochemicals, which are found in abundance in garlic and cruciferous vegetables like broccoli and cauliflower. This is a great reason to add liberal amounts of garlic to our food.
At the Center for Integrative Oncology and Survivorship (CIOS), nutritionist Jessica Menig recommends the following for liver detoxification. First, drink eight to 10 cups of fluids per day, focusing on water (lemon water is okay), green tea or milk. Second, increase plant-based protein sources as well as fruits and vegetables in your diet. Third, choose heart-healthy fats such as avocado, flax seed, salmon, nuts, seeds and olive oil. Fourth, avoid alcohol. Fifth, avoid processed red meats and fatty foods.
Finally, at CIOS, we do not recommend the use of liver detoxification supplements. Such supplements may not be effective and may backfire or cause unintended consequences. For example, milk thistle (silymarin) may be good for phase 1 liver enzymes, but it may overstimulate the phase 1 enzymes and lead to side effects from other drugs you are taking.
In summary, the best way to detoxify the liver is to follow Jessica’s steps above to hydrate well and enjoy a plant-based diet. When it comes to liver health, use foods like onions, shallots and garlic. Let your kitchen be your medicine cabinet. For more information or to make a nutrition appointment at CIOS, call 455-1346.
Not all news about American eating habits is bad. Indeed, there has been a slight but definite decrease in the average number of calories consumed each day by American adults. The data comes from the National Health and Nutrition Survey (NHANES) comparing 2003-2004 and 2009-2010. For children, two to 18 years old, total calories per day decreased 10 percent to 1908 calories. For adults, total calories per day decreased four percent to 2134 calories. The drop in calories from beverages, mostly sugary sodas, was more striking. For children, average daily calories from beverages dropped 24 percent to 382 calories. For adults, the drop was 10 percent to 419 cal. Dr. Barry Popkin of the University of North Carolina Chapel Hill Food Research Program was recently quoted in The New York Times saying that these data, “along with the flattening of the national obesity rate, have convinced many public health researchers that the changes are meaningful.”
One reason for the decrease in calories consumed includes reports of scientific research that show the harms of obesity and added sugars in the diet. Public health campaigns that resulted in chain restaurants posting nutritional content, various taxes and limitations on sugar-sweetened beverages also contributed to the culture shift. The drop in consumption of full-calorie sodas is particularly noteworthy given the negative publicity that full-calorie sodas and added-sugar drinks have received. On average, Americans purchased 30 gallons of full-calorie soft drinks per year in 2014, compared to 40 gallons in 1998. It encourages me to see that the public at large has begun to “get it” with regard to the harms of excess calories and added sugars in our diets.
The news about cancer and calories continues to progress, indicating that excess calories is an increasingly common cause of cancer. A study recently reported in JAMA Oncology indicated that obesity with BMI greater than 35 is a risk factor for prostate cancer among African American men, an increased risk of 50 percent compared to normal BMI (less than 25). Another study recently reported in JAMA Oncology indicated that obesity with a BMI greater than 35 increases a woman’s chance for estrogen positive breast cancer by 50 percent compared to normal BMI (less than 25). As a cancer specialist, I see weight control as an important strategy to reduce the risks of prostate and breast cancer for us and for our children. As a society, our eating and drinking habits are getting better, but we still need a lot of improvement. I encourage you to keep saying no to full-calorie sodas and keep watching the calories.
The GHS Cancer Institute’s Center for Integrative Oncology and Survivorship is dedicated to healthy nutrition and weight loss counseling for people living with cancer and hoping to prevent cancer. To learn about nutrition classes, programs and individual counseling, contact CIOS at 455-4399 or click here to learn more.
There is a growing amount of medical evidence to indicate that stress affects us in ways that we can feel and notice, but also in silent ways that we neither immediately feel nor notice. That silent stress causes inflammation at the individual cell level and stimulates the body’s nervous system in unhealthy ways. Specifically, it stimulates the sympathetic nervous system and causes imbalance with the parasympathetic nervous system. These effects alter the immune system, making us more susceptible to a variety of illnesses, including cancer. Drinking a Coca-Cola seems harmless enough, but it sets off an unhealthy chain of events in the body.
The connection between diet, stress and inflammation was the subject of a recent article in Science News. It turns out that many processed foods with added sugars, high salt concentrations and high saturated fat content tend to disrupt the body’s natural defenses and immune system. On the other hand, foods with fiber and the complex carbohydrates found in whole grains do the opposite. They reduce inflammation and improve the body’s natural defenses and immune system.
How does this work? The answer may be found in how different foods affect the bacteria that normally live in the intestinal tract. Pro-inflammatory foods like sugary soft drinks irritate our body’s intestinal bacteria, resulting in release of inflammatory chemicals to the bloodstream and negative messages to the immune system. Anti-inflammatory foods like the fruits and nuts we should be packing in our lunch every day do not irritate the normal healthy bacteria, such that inflammation and negative messages to the immune system do not occur.
Our body has an extraordinary amount of bacteria distributed throughout our digestive tracts, glands and skin. They have many different effects on digestion, immune function and normal body processes. The sum total of all of the bacteria and fungus is called the human microbiota. Good nutrition is important because the human microbiota is very sensitive to the kind of food we feed it. The kind of food we eat can change the microbiota balance in a matter of weeks.
This is why integrative physicians in particular and doctors in general recommend that our diet include five servings of fruits and vegetables a day, whole grains (whole wheat bread, not white), limited saturated fats and high fiber. The effect of added sugars, highly salted foods and foods high in saturated fat is silent but real. I encourage everyone to become conscious of the content of the food you are eating and to choose wisely. Look at the nutrition labels on foods and note the amount of sugar per serving. Your health is worth it.
Do you wash your fruits and vegetables with dish detergent? What about baking soda or vinegar? Have you ever thought about the best way to wash your fruits and vegetables? The more we learn about pesticide residues and food-borne illness from raw produce, many may question the most effective method to clean produce before consuming. I personally use cold, running water and rinse well. However, if the produce has a hard skin or rind, I will give it a good scrub.
The first important thing to note is that all produce, organic or conventionally grown, needs to be washed before eating, unless it has been pre-washed and packaged. Also, be sure to wash your hands with soap and water prior to cleaning and cooking produce to prevent the transfer of naturally occurring bacteria from your hands to your food.
Let’s look at the Dos and Don’ts that help reduce bacteria and pesticide residue found on fresh fruits and vegetables.
Long story short, the best way to clean produce is with clean, cold water following the specific guidelines above. While you are thinking of washing your produce, don’t forget to consume your five cups of fruits and vegetables daily!
For many women with breast cancer, the treatment includes taking a tablet that blocks estrogen in the body. Some of these are in a group called aromatase inhibitors. They include anastrazole (Arimidex), letrazole (Femara), and exemestane (Aromasin). One common side effect is hot flashes. Another more common side effect is achiness in the muscles and joints. This is called aromatase inhibitor musculoskeletal syndrome (AIMS).
The range of symptoms of AIMS includes arthritis (inflammation in the joint), arthralgia (pain in the joint), myalgia (pain in the muscle), carpal tunnel syndrome (pain in the wrist and hand), joint stiffness, and paresthesia (abnormal sensation over the skin). When AIMS occurs, it usually does so in the first two months. It frequently gets better after three months or so, but it can persist for years.
In a study presented at the 2014 San Antonio Breast Cancer Symposium by Dr. Janine Lombard, 81% of 370 women who were taking aromatase inhibitors reported joints symptoms, most often in the feet (68%), hands or wrists (65%), knees (62%), hips (56%), shoulders or elbows (49%), and back (46%). For the 27% of women in the study who stopped taking the aromatase inhibitor early, symptoms of AIMS were the most common reason.
Usually, the first treatment for AIMS is an over-the-counter medication, such as acetaminophen (Tylenol), or non-steroid anti-inflammatory drug (NSAID), such as ibuprofen (Advil) or naproxen (Aleve). Commonly used prescription drugs include NSAIDs such as diclofenec (Voltaren) or meloxicam (Mobic). These medications give some relief some of the time, but there remains a need for more effective treatments for AIMS. For people who do not tolerate NSAIDs, I have found that curcumin, available in health food stores, is comparable to NSAIDs when taken as 2000 mg daily. Another strategy worth a try is glucosamine (without chondroitin) at 500 mg three times daily.
At the GHS Center for Integrative Oncology and Survivorship, we have seen success with exercise, yoga, massage and acupuncture. We are currently conducting a clinical trial of heart rate variability (HRV) biofeedback. Exercise deserves particular mention because it also helps with hot flashes, and it is so good for our mental and physical health overall.
A study recently reported in the Journal of Clinical Oncology by Dr. Melinda L. Irwin demonstrated the benefits of exercise for reducing the pain of AIMS. The study involved 121 breast cancer survivors taking aromatase inhibitors. Half did aerobic exercise 150 minutes per week and supervised strength training two days per week, while half followed their usual routine. The exercise group reported less pain and more mobility after three months and even more after 12 months. This study is consistent with our experience at the Center for Integrative Oncology and Survivorship. Exercise helps many things, and it is especially helpful for breast cancer survivors taking aromatase inhibitor drugs.
If you are a breast cancer survivor taking an aromatase inhibitor and experiencing hot flashes and achiness in the joints, I encourage you to have a talk with your oncologist or nurse. There are good strategies available to get relief from these symptoms.
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