Recipe - Healthy Pumpkin Muffins

Healthy Pumpkin Muffins

• 3/4 cup all purpose flour
• 1/4 cup soy flour
• 3/4 cup whole wheat flour
• 1/4 tsp. Baking powder
• 1 tsp. Baking soda
• 1 cup sugar (I will try to cut this down even more the next time I make these)
• 1/4 cup ground flaxseed
• 1/2 tsp. Salt
• 1/4 tsp. Ground cloves
• 1/2 tsp. Nutmeg
• 1 tsp. Cinnamon
• 2 large eggs, beaten slightly (I use eggs with increased amounts of omega-3 fatty acids)
• 1 cup pumpkin puree
• 1/2 cup plain low-fat yogurt
• 1/3 cup water
• 1/2 cup dried fruit of your choice (cranberries are delicious!)
• 1/2 cup chopped nuts

Add all dry ingredients to a large bowl. Mix well with a fork or wire whisk.

In a smaller bowl, mix eggs, pumpkin, yogurt, and water until well blended.

Stir wet ingredients into dry ingredients by hand - mix well.

Add fruit and nuts and gently blend well.

Spray a muffin-baking pan with non-stick spray. This recipe makes 15-18 normal size muffins, filling each muffin cup ~2/3 full, or alternatively, it makes 12 normal size and 12 mini-size muffins. (special note: if you use muffin cups, give them a quick spray with a non-stick oil before putting in the batter)

Bake at 350 F. for ~20 minutes or until done (insert a toothpick into center of one – should come out clean).

FAQ #10 - Specialized diet after a Whipple surgery for pancreatic cancer?

Is there any specialized diet for people who have had the Whipple procedure for pancreatic cancer? What dietary suggestions would you make? 
 
Thank you for visiting my web site. It is very difficult to make generalized dietary recommendations for people who have had a Whipple procedure for pancreatic cancer because nutritional status prior to the surgery and then both tolerance and the potential for long-term complications after the surgery will vary significantly from individual to individual. 

The primary concern after this surgery is malabsorption of fats (resulting in weight loss), plus malabsorption of fat-soluble vitamins, some minerals, and many phytochemicals that are also fat-soluble. Sometimes these problems can even happen with minimal GI distress. Malabsorption secondary to this surgery is usually treated with high doses of oral pancreatic enzymes for which (1) an individual's response to a particular brand and dosing of these enzymes needs to be assessed and (2) the person needs to be taught how to titrate the dose taken to the exact amount of fat contained in each meal and snack. Some people may additionally develop diabetes after this procedure, although this is not universal.

I highly recommend obtaining the professional expertise of a Registered
Dietitian (RD) at your local cancer treatment facility, medical center outpatient department, or private practice in your locality. The RD, working with your full medical team, can assess your current nutritional needs, develop and prioritize individualized goals taking your entire medical history and any on-going therapies into account, help you and your family develop a realistic plan for achieving these goals, and then be available for monitoring and answering questions and concerns that develop during your recovery path.

If an RD in private practice is needed, you may locate one by going to the
web site for the American Dietetic Association, click on Find A Nutrition Professional, click Yes on the agreement page, and then type in your zip code. Look for an RD with experience in oncology.

Here is a web site that explains the Whipple procedure and potential complications very well.

I send all my best wishes for health, healing, and hope!


Diana Dyer, MS, RD

FAQ #9 - Pros and Cons of a "G-Tube"

I have head and neck cancer. My doctor is recommending a gastrostomy feeding tube (G-tube). Can you elaborate on some pros and cons of having a feeding tube placed to help with nutritional intake during radiation therapy for head and neck cancer?

 

Having a gastrostomy tube place proactively in order to maintain optimal nutritional intake is commonly done now for patients receiving radiation in the head and neck area, rather than waiting to see if they will lose weight. 

Please be sure to request both initial and ongoing consults with the Registered Dietitian (RD) at your cancer treatment facility so that the formula chosen will meet your nutritional needs and any adjustments can be made in light of your tolerance and requirements.

I highly recommend reading the following essay written by Harland Johnson, a cancer survivor who has used a gastrostomy feeding tube, for a patient's viewpoint of the pros and cons for this life-sustaining experience.

"Happy G-tubing: from the Perspective of a Cancer Survivor"
(reprinted with permission from Harland Johnson)

After six years with a G-tube, I feel semi-qualified to give advice, particularly to those who have just had one placed, or are about to. And especially to those who are worried or depressed about the prospect. This message is for those who will or do rely totally or partially on nutrition by means of a G-tube or G-button. It's obviously from a patient perspective and not to be construed as medical advice (i.e. don't sue me or the publishers of this newsletter). 

I don't know all of the answers but I have some definite opinions and several "tricks" on living with tube feeding. 

And I mean LIVING. My strongest opinion is that unless you have other medical problems, tube feeding should not change or interfere with your lifestyle. It's a minor inconvenience at times, but so is getting up and going to work, so don't be downhearted about the prospect. There are actually some advantages; the greatest one being that tube feeding is a very convenient and relatively worry-free way to maintain your nutrition and hydration, which is especially important if you are facing radiation treatment or further surgery. Or, if for whatever reason you are facing an indefinite duration with a tube, it is essential to your wellbeing. 

I can honestly say that after the first period of learning the tricks and getting adapted to the new procedures, the G-tube hasn't had much effect on what I, or my family (wife and teenage daughter), does. We still dine in or out with friends and guests. We travel a lot, both domestically and internationally. 

I used to swim in the Gulf of Mexico when we lived on the beach. I exercise and work in the yard. Tube feeding should not interfere with most sports (tackle football or wrestling may be an exception!), with intimacy, and with participation in all of the hobbies and recreational activities that you enjoyed prior to the tube. 

Have you ever considered the advantages of tube feeding? I can work on the computer while I feed, or play the piano, or work at my desk (before I retired I would have meetings in my office while I was feeding), or read, or even nap (but you should keep your upper body at least at a thirty degree angle to avoid reflux). I get all of the right vitamins and minerals and calories to keep my weight where it should be, my cholesterol is way down, I get no overdoses of nasty caffeine or chocolate or alcohol, I don't have to worry about grocery shopping, I have my food delivered to my door, and insurance pays for 80% -- what a deal! 

In my opinion, the first and biggest step to successful G-tube living is mental: DO NOT consider tube feeding as a medical procedure. It's a shortcut way to get food into your stomach. It's just another way of eating, for goodness sake. It's not a blood transfusion or an IV. It doesn't require any higher level of hygiene than you use for normal eating. The location where the tube penetrates the abdominal wall (the stoma site) is not a sterile site. It needs to be kept reasonably clean and dry to avoid irritation and bumpy tissue growth (called granulation tissue) but you don't need a mask and gloves! And there are creams, ointments, and powders to help with site maintenance. 

You don't need an IV pole on which to hang your feeding bag (if you feed by gravity). When I travel I carry several "over-the-door" plastic hooks in my feeding supplies backpack to hang over pictures in hotel rooms or at rest stops or to hang from the rear hatch of our minivan. At home I use the same hooks or a handy nail at one or two spots where I typically eat. And if I can't find a place to hang the bag I use my 60-cc syringe to inject the formula into my tube. 

The second most important principle is to be self-reliant. Whether you keep your feeding supplies in the kitchen, bedroom or bathroom, look after them yourself. Unless you are physically unable to do so, take care of your own feeding. It's very natural for a spouse to want to help, but it isn't necessary. My wife is a nurse who would and could help if necessary, but I prefer to be independent, and I wouldn't think of getting her involved anymore than I would think of having her spoon-feed me if I were eating "normally." Her typical level of participation is to ask, "Have you eaten supper yet?" when we're sitting in front of the TV. Yes, you will get hungry or not get hungry just as you always have, and sometimes you'll forget it's mealtime. 

Plan ahead: If you're going out with friends for dinner, eat ahead of time. If you're going on a shopping trip, throw your backpack and a few extra cans of food in the car just in case you stay beyond mealtimes. Ditto for long distance travel. Take a few extra cans on the plane just in case. 

Use humor: If you're dining out with guests, and you've already eaten, you can dominate the conversation (!!) while everyone else has their mouth full. Tell the waiter, "Nothing for me thanks. I'm just here to watch and pay." Or order a glass of wine to have something in front of you, and wet your lips and savor the aroma during the meal. If you're able, sneak tastes from your wife's dish, and discreetly spit it out in a napkin if you can't swallow at all. If you're at a banquet, don't make a big deal out of not eating. Let them serve you. Push the food around if necessary. Whether you tell your tablemates about your feeding habits depends on you and whether anyone notices. You may be surprised how few do. 

Join in support or discussion groups to ask questions, exchange ideas and tips. It has become obvious to me that most caregivers do not give new G-tubers adequate instruction, and most physicians are woefully uninformed about the ins and outs of enteral feeding. A good source for information is the Oley Foundation, which is a support organization for enteral and parenteral feeding. Professionals can find information on ASPEN's website (American Society for Parenteral and Enteral Nutrition.


Finally, consider how wonderful it is that we have the opportunity to continue our lives in an almost-normal fashion because of enteral feeding. The G-tube is simple in concept, and easy to use, and I thank God for this low-tech procedure. The alternative is not nearly as appealing! 

-- Harland Johnson, adult G-tuber
***************

I hope this information is helpful to you!

Diana Dyer, MS, RD 

FAQ #8 - Dumping Syndrome Problems after Stomach Cancer Surgery

Do you know of any research, findings, suggestions, specific diets, etc. for stomach cancer patients that have had a gastrectomy and who are consequentially having symptoms of dumping syndrome?

Thanks for writing and asking your very good question. I am referring you to the following web site at The University of Virginia, which has very good accurate information about dumping syndrome, specifically geared to complications following a gastrectomy.

In addition, I strongly recommend an appointment with the Registered Dietitian (RD) at your cancer center who can assess your nutritional status, nutritional requirements, devise a nutrition plan to meet your goals, monitor your responses and modify it as necessary to help you achieve optimal health. 

Most importantly, the RD will have access to your medical records and other medical team members to obtain as much information a possible to design a nutritional plan that meets all of your individual and unique medical needs. 

I send all my best wishes for health, healing, and hope!

Diana Dyer, MS, RD

FAQ #7 - Ideas for relieving bloating associated w/ abdominal radiation therapy?

I am presently undergoing radiation for endometrial cancer and I am encountering bloating after my meals. Do you have any suggestions to relieve this discomfort so that I still take a well balanced diet without fearing this bloating feeling?

I consulted with Suzanne Dixon, MS, MPH, RD former oncology nutrition specialist for the University of Michigan Comprehensive Cancer Center who has developed all the nutrition material for the excellent web site www.caring4cancer.com to help me answer your question. Here is her response along with some suggestions.

******************** 

Bloating is a very common side effect with the radiation for endometrial and ovarian cancer treatments. There isn't research in this area, but in my experience, diet changes help sometimes, and other times they don't make much of a difference. It's certainly worth a try to see if some of these changes might relieve some of the bloating.

Omitting 'gas producing' foods is one thing to try. It's the obvious stuff, which I'm sure you're familiar with: beans, peas, corn, cabbage, broccoli, cabbage, green leafies, etc. Unfortunately, it's a lot of the 'good stuff' people want to try to eat. But, temporarily omitting these foods may help. Also, avoiding carbonated drinks, talking when eating (which causes more air swallowing), and avoiding use of straws can help.

Glutamine sometimes helps, because the gut damage that is leading to the bloating can sometimes be improved/healed with glutamine and this alleviates gas. Starting dose of 3-4 grams 3x/day and going up to 10 grams 3x/day is worth trying. If there is no improvement within a week or so after reaching final dose, then it's probably not going to help and you could discontinue to avoid wasting money. Also, some patients complain glutamine actually causes bloating, so if you try it and get worsening of symptoms, I wouldn't even bother going up to the full dose.

Digestive enzymes may help. Something like pancrease or ultrase. These require a prescription, but you could ask your doctor.

Or, you could try supplemental, food-derived enzymes. Bromelain is a good one, and it may have anti-cancer activities too, so that's a bonus. Selecting bromelain is tricky, because there is both the 'dose' (mg) and the 'strength' (often referred to as GDU or gelatin digesting units). If the supplement is not sufficient 'strength' or GDU, then it won't do much. One with a GDU of at least 1500-2000 GDU per gram is good. Solgar Bromelain in 500 mg tablets is a good one. You could try 3-6 capsules per meal/snack. It's derived from pineapple so do not use if you possibly have a pineapple allergy.

Sometimes avoiding dairy, or using lactase or 'lactaid' products can help. Some people get temporary disruption in endogenous production of lactase (the enzyme that breaks down the milk sugar called lactose), so dairy can be a problem until lactase production returns to normal.

Adding in other 'digestive' aid type herbs may help, such as fennel, ginger, peppermint (if no gastro-esophageal reflux disorder). These are worth trying. All come in tea or capsule form. I think the teas are nice to try.

********************

I hope some of these ideas are helpful. Please be sure to ask for a consultation with the Registered Dietitian at your own cancer center for more individualized advice and follow-up.

Best wishes to you for health, healing, and hope!

Diana Dyer, MS, RD

FAQ #6 - Ideas for resolving diarrhea after radiation therapy?

Do you have diet suggestions for someone who has diarrhea after radiation therapy for rectal cancer?

 

I recently had several people write me with this same question. Chronic radiation enteritis after radiation treatments for rectal cancer (or other cancers that have been treated with radiation to the abdominal area) can produce side effects like long-standing diarrhea, bowel urgency, and incontinence. Sometimes these side effects can even occur a year after therapy has been completed.

I asked Registered Dietitians (RD) from the Oncology Nutrition Dietetic Practice Group of the American Dietetic Association who have helped many other patients with such side effects for their best "tricks of the trade." I thank them for their advice. Here is a compilation of what they had to say:

1) I always assume that something can be changed to reduce or eliminate the diarrhea, even if the doctors seem to think the diarrhea is a "given".

2) Try to change only one aspect of treatment or care at a time to evaluate what works and what doesn't.

3) As the patient's RD, I always try to work with the patient and his/her doctor to determine if there are any medications that might be helpful, i.e., H2 blockers, anti-motility agents, and bile acid sequestrants.

4) I ask patients to keep a detailed diet diary (all foods and beverages), what food is eaten, portion sizes, if foods are hot or cold, are foods eaten in a restaurant, take out food, or home made, time of day food is eaten, and also a detailed symptom diary. Discuss the food and symptom diary with the RD who will try to determine if the symptoms are related to the food intake or even the timing of the food consumption. This process may take several weeks to evaluate and see patterns!

5) Never assume what bothers one person will bother the next person. Everyone is soooo different! Example: One of my patients could not tolerate any leftover foods or foods served from a salad bar. I think this might be due to higher bacterial contents of these foods.

6) If a patient cannot tolerate whole fruits and vegetables, try either baby foods (can even buy organic baby foods) or juicing.

7) One caveat, avoid "gassy" vegetables at all times, even when juicing (i.e., all members of the broccoli family, onions).

8) Encourage intake of yogurt with active cultures or kefir - approximately 8 ounces per day. Use a lactase tablet. Also consume lactase treated milk and use lactase tablets for other dairy products.

9) Consider use of a probiotic supplement. (Probiotics and benefits with radiation diarrhea. Eur J Gastroenterol Hepatol 2001; 13: 391-396) One supplement of this type is called Culturell. Take 2 capsules twice daily for a month (available over the counter at most pharmacies).

10) Start psyllium three times/day or Benefiber right from the start.

11) Use soluble fiber foods like oatmeal or oat bran bread while avoiding insoluble fiber foods like whole wheat, whole rye products or other whole grains.

12) Avoid hard-to-digest foods like corn, gassy vegetables like Brussels sprouts and other cabbage family foods, all fatty foods, caffeine, alcohol, and spicy foods.

13) Some patients will have diarrhea no matter what fruits, vegetables, and other foods are eliminated. Patients may find the use of Imodium will control the diarrhea without needing to be so restrictive with the diet.

14) Review all herbs and other dietary supplements with your RD for possible side effects like diarrhea. One case report in the medical literature has shown that unexplained diarrhea resolved upon discontinuing the herb milk thistle (Adverse Drug Reactions Advisory Committee. An adverse reaction to the herbal medication milk thistle (Silybum marianum). Med J Aust 1999;170:218-9.)

15) Avoid foods high in in-soluble fiber, which are foods made from whole grains. Also avoid raw whole fruits and vegetables, nuts, beans and legumes.

16) Consider adding 400 IU of vitamin E and 500 mg vitamin C three times daily. ("Successful and sustained treatment of chronic radiation proctitis with antioxidant vitamins E and C", Kennedy M, et al. Am J of Gastroenterology 2001;96:1080-1084) Try for 8 weeks to see if diarrhea is reduced or eliminated. (This study used these anti-oxidant supplements after radiation was completed, not during therapy.)

17) "Rice Congee" may really help! Combine 1 cup long-cooking WHITE rice with 6-7 cups of water and one-tablespoon of salt; cook this according to package directions (usually ~ 40 minutes); this will be a 'sticky, soupy' mixture; eat and drink mixture. If broth is used instead of water, omit the salt.

18) Many RD's recommend glutamine therapy to help those people with chronic diarrhea that does not resolve with other dietary changes. Use 10 gm three times per day mixed with clear juice or water. (Do not use without consulting your RD or MD. Do not use if you have decreased liver or kidney function.) If glutamine is going to work, you should see results in three days. Two brands that have been used in research studies are:

(a) Cambridge Sympt-X marketed by Baxter
(b) GlutaSolve by Novartis.

19) Be sure to have "C. diff" (clostridium difficiles) ruled out. C. diff is an overgrowth of normally present GI bacteria that can produce loose and crampy stools.

20) To compensate for any possible vitamin and mineral malabsorption due to the diarrhea, one RD recommends a Flintstones Chewable complete vitamin twice daily for a month then go to one daily or switch to a Centrum Silver type if the diarrhea has lessened or stopped.

21) Have your doctor and dietitian order blood work to evaluate levels of fat-soluble vitamins and vitamin B12. In addition, a stool sample should be checked for bile salt malabsorption with a bile acid sequestrant like cholestyramine added if needed.

22) See the following web site for even more additional helpful information regarding management of diarrhea. www.cancernutritioninfo.com, click on Treatment Symptom Management, then click on diarrhea.

23) I have heard of several recently reported cases of patients developing intractable diarrhea after cancer therapy who were finally tested and found to have previously undiagnosed celiac disease (gluten intolerance).

Counseling from a Registered Dietitian and adherence to a strict gluten-free diet completely eliminated the chronic diarrhea.

24) Some RDs are reporting that a few patients have had successful resolution of long-standing diarrhea by the use of either acupuncture or massage.

25) Words of wisdom from a very experienced dietitian:

For one specific patient, it helped her just to have the knowledge of what she could and could not tolerate. Prior to working with her, she felt completely out of control, not knowing if eating would precipitate diarrhea or not. This knowledge was empowering in and of itself. Although she has to avoid some foods high in insoluble fiber, she was able to systematically try different foods to learn her own tolerances.

26) Lastly, if all of these efforts fail, consider the observation of another very experienced dietitian:

I have had several patients with long standing diarrhea, bowel urgency and incontinence after treatment. I tried everything from glutamine, paregoric, high soluble fiber, and anything else that the MD would agree to try. I kept coming across a common problem; they had very low re-anastamosis surgeries. There was a surgeon in town that tried to save many patients from the humiliation of a colostomy by "doing them a favor" and reattaching them even if there was precious little rectum or sphincter tone. All of our patients regained a normal life after getting an ostomy. I know that this is not the answer many patients are looking for, but these people were truly happy with the results and not having to wear diapers or being afraid of having an accident.

I hope some of these ideas are helpful to you, as you try to regain a sense of control and also normalcy during your cancer recovery journey. 

Be sure to discuss all of these concerns and possible solutions with both your doctor and dietitian. I have heard of one oncologist who says that since hiring a dietitian for his practice, he no longer needs to spend one single minute of his precious face-to-face time discussing diarrhea with his patients. Now that is one terrific example of teamwork and true comprehensive cancer care!

I send all my best wishes for health, healing, and hope!


Diana Dyer, MS, RD

FAQ #5 - Do you have advice about nutrition for childhood cancers?

Does your book cover nutritional recommendations for children with cancer? My child has been diagnosed with __________ cancer and I don't know where to turn for good advice about nutrition and herbal supplements to help optimize the chances for survival.

Thanks for writing. My book does not address nutritional requirements for children with cancer. That knowledge is a sub-specialty for which I have no training or experience.

I strongly recommend requesting a consult with the Registered Dietitian (RD) at your child's cancer treatment facility. I think that would be very important to make sure that your child is receiving the best possible nutrition not only to optimize the cancer treatments but also to optimize your child's growth and development potential. 

If your cancer center does not have an RD, please advocate for your child (and others) by asking why not! Then find one in private practice in your location either by (1) using the Yellow Pages (look for the credentials RD after the name of those listed under Dietitian and/or Nutritionist), (2) calling your local hospital's nutrition department and asking for recommendations from the chief clinical dietitian, or (3) by going to the web site for the American Dietetic Association at www.eatright.org.

For general info about handling side effects of cancer treatments in children that are related to eating, visit the web site for the American Cancer Society. 

For general info about pediatric integrative cancer therapy, including herbs and other dietary supplements, an informative web site is: Integrative Therapies Program for Children with Cancer at Columbia University in New York City.

Please remember that, unfortunately, almost no herbs or dietary supplements have been evaluated for benefit or safety in children. I strongly urge you to discuss both your concerns and ideas about nutrition and/or supplements with your child's oncologist and request (insist if you have to) a referral to an RD with expertise in pediatric oncology nutrition.

Hope is so much more realistic for children diagnosed with cancer now than when I was in 1950. :-)

I send my very best wishes to your child plus you and your family for good health, healing, and continued hope!

Diana Dyer, MS, RD

FAQ #4 - I have just discovered a lump in my breast. Do you have any pearls of wisdom for me during this difficult time?

I have just discovered a lump in my breast. Do you have any pearls of wisdom to help me during this difficult time? 
 
I will guess that (1) your head is spinning right now working through the logistics of what comes next and (2) you are also trying not to panic. 

Although I have had 2 breast cancer diagnoses, I do know that the vast majority of lumps and biopsies are negative, meaning they are free of cancer. You have every reason to hang on to the hope that you will be in that majority until you hear otherwise. 

I have tried hard to handle the many insecurities about my health during my lifetime by (1) choosing to focus on what I know right now, (2) what needs to be known next, and then (3) what needs to be done right now, instead of all the what ifs and/or the worst case scenarios, which are only conjecture at that point and cause energy to go to worry instead of healing. 

I know that is all much easier to say than to do, but that has been my goal. :-) For the most part that approach has worked, along with taking lots and lots of deep breaths, lots and lots of prayer to God and the universe with the following affirmation: "I know in the ultimate flow of life, the seen and the unseen, that I am safe." I have also opened myself up to multiple support systems to permit additional healing energy into my circle. 

There are many good resources available to help a person without an extensive medical background learn about diagnosis and treatment of breast lumps and breast cancer. Dr. Susan Love's Breast Book is considered the classic book. The website www.breastcancer.org is also very extensive and helpful. Knowledge is power. Use that knowledge to become an informed and equal partner in your medical care. 

I do hope your lump is benign. However, if it is not, you will have many role models to follow in this club of cancer survivors who will offer you support during this new challenge in life, that of a cancer recovery journey. 

I send you my best wishes and prayers for health, healing, and hope. 

Diana Dyer, MS, RD

FAQ #3 - How do I start on this cancer recovery journey?

I have read everything in your book. I want to do everything you suggest, but I am so overwhelmed. How do I start on this cancer recovery journey?

 

Thank you for writing and sharing your thoughts and concerns. I commend you for trying to do 'everything'. I can certainly understand your feeling of being overwhelmed, as I have 'been there' myself. 

If you have not done so already, read the answer to FAQ #2 on my blog's FAQ page about 'first steps'.  

In addition, I think the most important thing to remember is that no one (and I mean this sincerely - no one) yet knows the complete answer to how to keep me or you or anyone else 100% cancer-free (please read a post I have written about 'choices' at my dianadyer.com blog here). So pick and choose strategies from my book that seem reasonable, manageable, and affordable for you to implement. Anything is likely better than nothing. As you get one thing under control and implemented, then you may wish to pick another. 

When you have done what you can do, what feels right to you, then let the rest go. That's also where the expression 'Let go and let God' comes in. I hope you find some helpful thoughts here. 

I send all my best wishes for your health, healing of your spirit, and continued hope. 

Diana Dyer, MS, RD

Recipe - Fish Stew with Collard Greens

This is inspired by the recipe on the back of the package of CutNClean Collard Greens.

• 1/2 package of 1# bag of CutNClean collard greens (well rinsed and spun dry) - if using fresh collard greens, rinse well, pat dry, and cut into thin strips to measure about 6 cups
• 1 medium onion,medium dice
• 1 sweet red pepper - medium dice
• 1-2 cloves fresh garlic - finely chopped or smashed
• 1/8 teaspoon crushed red pepper flakes
• 1/2 Tbsp. cajun seasoning (I used some *seafood* seasoning instead)
• 1 Tbsp. Dijon mustard
• 1-2 Tbsp. extra-virgin olive oil
• 16 oz. can fire-roasted crushed tomatoes (by Muir Glen) - plain diced or crushed canned tomatoes could also be used but the extra flavor from the fire-roasted variety is worth seeking them out
• 1 quart water
• 4 ounces clam juice
• 1# cod (or any firm fish of your choice) - cut into generous 1 inch cubes.
• 1/4 teaspoon paprika salt and pepper to taste

Directions:

• Cook onions, red pepper, garlic, and crushed red pepper in the olive oil until softened (3-4 minutes - do not burn) in a large soup pot.
• Add collards and water. Bring to a boil, cover, and simmer gently 25 minutes.
• Add fish to pot.
• Pour in tomatoes and other ingredients.
• Cook until fish is done (flakes with a fork). About 10-15 minutes.

Makes 6 generous servings. Serve with any muffins or whole grain breads of your choice and some fresh fruit. Recipe can easily be doubled. Be sure to make enough for at least two meals.

Recipe - Fish Poached in Mediterranean Sauce

I created this recipe to duplicate a delicious dish I had at a local restaurant we return to time and again because of their beautiful salads, generous use of fruit and vegetable garnishes, and the fact that they nearly always have Alaskan salmon on their menu. I used bits and pieces of vegetable that I had on hand. Feel free to omit or add your own ingredients, even changing the amounts based on what you find in your refrigerator. However, my husband, older son and his girlfriend (now his wife!) all think this recipe is a keeper! 
 
1# mildly flavored fish (I used Alaskan cod)


Sauté together gently in a saucepan with a lid:

• 2 Tbsp. olive oil
• 1 bunch green onions, sliced (both white and green parts) - save the green parts to add at the end
• 3-4 large garlic cloves, minced (~1 tbsp. chopped)
• 2 Tbsp. capers
• 3-4 chunks roasted red pepper, drain, rinse and slice into small pieces 
• 1 can artichoke hearts, quartered 
• 1/2 package frozen mushrooms, drain and rinse (can substitute sliced 4-8 oz fresh any variety) 
•  1/2 cup pitted kalamata olives, sliced
•  1 cup mild salsa (could substitute 8 oz can diced tomatoes)
  

Directions:

• Place cod on top of vegetables.
• Cover and cook over medium heat until fish is tender and flaky (~10-15 minutes)

Add the following ingredients, cover, and heat another few minutes until all is heated through:

• 1/2 package of frozen spinach (about 8 oz)
• Green onion slices from above

I served this with baked potatoes and steamed fresh broccoli. Yum, yum! 


Serves 4 easily. Could use more fish for larger portions or more servings.

Recipe - Turkey Divan

A very traditional recipe that is *Soy Delicious*!
 
"Do I ever eat chicken or turkey?" is a question I get frequently when speaking. Only rarely, and this recipe is for one of those rare occasions. Some of my most creative recipes get made when winter storms hit and I don't want to risk going to the store for ingredients. So supper gets made from what I have on hand in the pantry and freezer. Thus the creation of this recipe during our first big storm of Winter 2001-2, which finally came at the end of January (weird weather this year!). 
 
Yes, it is turkey, but it is also a soy recipe (soy milk, soy cheese, and miso) and filled with many other foods that have anti-cancer phytochemicals.

• 2 Tbsp. olive oil
• 1/2 cup coarsely chopped white section of leeks (or chopped onions)
• Chopped red stems from a bunch of Swiss chard (I had used the leaves for a recipe earlier in the week - could omit or substitute red sweet pepper here or even celery but that would be less colorful and healthful)
• 2 Tbsp. whole wheat flour
• 2 teaspoons miso
• 2 cups unflavored soy milk
• 1 Tbsp Dijon mustard
• 1 cup shredded soy cheddar cheese
• 1-2 ounces shredded low-fat cheddar cheese (I threw this in for extra flavor)
• 1 lb. frozen broccoli spears, thawed
• 3 cups cooked chicken or turkey (finally used up the remainder of the Thanksgiving turkey)
• 1/3 cup bread crumbs (made from dry whole grain bread)
• 1/2 teaspoon Italian seasoning

Directions:

• Heat the olive oil and slightly cook the leeks and chard. Add the flour and stir a few minutes to lightly toast the flour. Add the mustard and miso to the milk, whisk to mix thoroughly and then slowly add milk mixture to veggies, stirring constantly as mixture thickens slightly. Add the cheeses, stirring until melted.

• In 9x13 baking dish, slightly spray with Pam. Spread out broccoli and turkey in dish. Pour cheese/veggie sauce over the turkey and broccoli. Top with bread crumbs and seasoning. Bake in oven at 350 (325 if using a glass dish) for 30-40 minutes until hot and bubbly.

Can be served with fruit, a salad, and whole grain bread for a complete meal. (You can even exercise while the meal is cooking in the oven!). 

Yield:  Makes 4- 6 generous servings.

Recipe - Chicken Salad Roll-ups

"The following recipe for Chicken Salad Roll-ups gives you an example of how I include organic chicken in my diet. (I modified this recipe from one similar in the Sept 2002 issue of Prevention Magazine)

• 1 cup finely chopped or shredded cooked skinless chicken breast
  (about 1 medium sized piece) - chilled
• 1 cup drained and rinsed black beans
• 1/2 cup chopped celery
• 1 cup seedless red grapes (cut in half or quarters if they are huge)
• 1/2 cup hummus (any flavor will do)
• 1 to 2 teaspoon curry powder (depends on how much curry you like)
• 1/2 teaspoon roasted red chili paste (I use a brand by Thai Kitchen found in the Thai foods section of my regular grocery store)
• whole wheat bread (I use whole wheat pita bread by Pita Gourmet™)

Directions:

• Mix all ingredients together.
• Spread on bread for sandwiches.

I served it with a large green salad, fresh fruit, and steamed green beans, fresh from the garden. Ingredients could easily be added or increased to make enough to serve more people. 

My husband commented on how good this was at least 3 times during dinner. That is a sign of a recipe to keep and repeat again some day soon!
 
Servings: Makes about 2 large dinner sandwiches and enough leftover for one lunch.

Recipe - Crockpot Chicken with Prunes, Sweet Potatoes, and Apples

Adapted from the University of California Cooperative
Extension-Nutrition, Family, and Consumer Science Program.

• 2-3 chicken breasts (skinless, boneless)
• 2 small apples, cored and sliced (leave peels on)
• 1 cup celery, sliced in 1/2 inch pieces
• 1 cup onion, coarsely chopped
• 1 cup black beans, rinsed (look for black soybeans)
• 2 Tbsp. whole wheat flour
• 2 cups chicken or vegetable broth (may also use miso broth)
• 2 sweet potatoes, cooked, peeled and sliced into large chunks (cook in microwave or use left over from previous day or may use canned yams)
• 10-15 prunes, pitted (cherry essense flavor is very nice)
• parsley for garnish
  

Directions:

• Spray frying pan with non-stick cooking spray or use a small amount of olive oil.
• Brown chicken well on both sides. Remove from pan.
• Arrange apples, celery, onions, beans, in crock-pot. Sprinkle with flour. Pour broth over vegetables. Place browned chicken pieces over veggies. (I cut them into thick slices). Place sweet potatoes and prunes over chicken pieces.
• Cover crockpot, cook on high for 4-5 hours.

Serve over whole wheat cous-cous (follow directions on the box - this takes about 5 minutes to prepare). Sprinkle with chopped parsley for garnish. Serve with whole grain bread, green salad and fresh fruit.

 

Easy, quick to throw together, yummy meal filled with cancer fighting ingredients.

Makes 4 generous servings.

Recipe - Crispy Chicken or Tofu

• 3/4c. dry unseasoned bread crumbs
• 1/3 c. Dijon mustard
• 1 T. olive oil
• 4 (4 oz. each) boneless skinless chicken breast (halves)
• 1/2 lb. extra firm tofu, cut into 4" slabs

Directions:

• Take out two cereal bowls and place the bread crumbs in one, the mustard in the other:
• Heat the olive oil over medium heat in a non-stick skillet.
• Dip chicken and/or tofu in mustard, then roll in the crumbs.  Brown each side in the skillet for 4 - 5 minutes.

Serving suggestion:  I cook the chicken and tofu together, which makes enough for 2-3 meals for us.  Other components of a typical meal for my family, such as herbed brown rice, baked sweet potatoes, fresh steamed broccoli, and fruit salad, are the same for all of us.

Recipe - Chicken Pot Pie

I recently have added small amounts of organic, skinless, boneless chicken back into my diet. However, I love to adapt recipes so I still consume beans and some soy at each meal. Here is a favorite - chicken pot pie - with many added ingredients that have cancer-fighting activity.

• 2 Tbsp. olive oil + 1 tsp. olive oil
• 3 Tbsp. whole wheat pastry flour
• 1 can (14 oz) veggie broth (if using homemade veggie stock, may need to add salt to taste)
• 1/2 teaspoon turmeric
• 2-3 teaspoon fresh rosemary
• 12 oz. soy milk (unflavored)
• 1 medium yellow onion, sliced
• 16 ounce bag mixed frozen veggies, thawed and drained
• 1/2 -16 ounce can of beans (I used Adzuki beans - save the other half to add on top of a homemade pizza later in the week or add to a can of ready-to-eat soup)
• Tabasco sauce - just a few drops is enough for a slight kick
• 1 whole chicken breast (~3/4 pound), roasted and cut into cubes (can use leftovers)
• 2-3 sheets of phyllo dough (thawed- I was lucky - I had some thawed in my refrig that I had not used during the holidays. Otherwise, pull it out of the freezer before you go to work in the morning.)
• 1 egg white, slightly beaten

Directions:

• Start by roasting chicken breast if not using left-overs. I simply sprinkled the chicken with dried Italian herbs and baked for ~ 30 minutes at 350 degrees, cooled, and then cut into cubes.
• Increase oven to 400 degrees after the chicken is done cooking.
• In a large saucepan, heat olive oil over medium high heat. Add flour, stirring with a whisk to make a paste. Stir for a minute or two to toast the flour.
• Mix in the broth, a quarter cup at a time, until smooth.
• Whisk in the rosemary, turmeric, and salt (if using salt, start with only 1/4 teaspoon, add more to taste after sauce is done cooking). Continue whisking after broth is added for an additional 5-7 minutes until sauce is starting to thicken.
• Add soymilk and continue cooking with occasional stirring for 5-7 more minutes. Reduce heat slightly if boiling too rapidly. The sauce will be a beautiful golden yellow.
• Heat the additional teaspoon of olive oil in a non-stick skillet. Add the onions and heat over medium heat until caramelized (10-15 minutes). Add drained veggies and beans along with the hot sauce. Stir together.
• Spray a 9x9 baking dish with non-stick spray. Place chicken and veggie mixture into dish and then add the sauce over all. The dish will be nearly full.
• Simply put 2-3 sheets of the phyllo dough (see directions on box for how to handle so they do not dry out) over the dish, tucking in the edges. Brush the top of the dough with the egg whites. Cut a few slits into the top of the dough.
• Bake at 400 degrees for 35 minutes or until crust is golden and the dish is piping hot. I baked it on a cookie sheet, just in case the filling spilled over the sides (it did not).

I served this over whole wheat cous-cous with fresh fruit and a green salad. Nothing else was needed. 4 generous servings.

Recipe - My Granola

When I was in graduate school during the mid-1970’s, I made a granola recipe that I ate for breakfast nearly every day for five years, maybe longer. Somewhere along the way I got out of the habit of making my own, but recently I have gotten tired of trying brand after brand and finding them all too sweet and all too expensive. So I started on a quest for my old recipe, which I could not find. So after looking in all my old cookbooks and all my new cookbooks, I cobbled together many ideas combining what I wanted for both tasty and healthy ingredients.

Here is my new up to date recipe:

• 3 cups rolled oats
• 1/2 cup wheat germ, untoasted
• 1/2 cup ground flaxseed
• 1/2 cup soy nuts (unsalted)
• 1 cup dry textured soy protein (I bought textured vegetable protein, TVP, by Bob’s Red Mill, which is simply defatted soy flour)
• 1 cup chopped walnuts
• 1/4 cup honey (or maple syrup)
• 1/4 cup apple cider (use any kind of juice or juice concentrate if a stronger flavor is desired)
• 1/2 teaspoon pumpkin pie spice (or 1/4 tsp. Cinnamon, 1/8 tsp. Nutmeg, 1/8 tsp. Ginger)
• 2 Tbsp. Canola oil (measure before honey, then honey should slide right out of your measuring cup)

Directions:

• Mix all dry ingredients together in large oven proof baking dish (I use the bottom half of a medium sized Dutch oven) or baking sheet with raised edges. Mix remaining ingredients in small bowl and then pour over oat mixture. Stir to thoroughly mix.
• Bake at a slow 250 degree oven until golden brown, stirring every 20-30 minutes. This may take 2-3 hours depending on the size of the pan or baking sheet. Be careful not to burn.

When there is ~30 more minutes of baking left , I stir in 1 cup of dried fruit like dates, cherries, blueberries, apples, apricots, or raisins, all cut into raisin size pieces.

(Guess what? My sister-in-law found her copy of my old recipe and (except for the flax seeds) it is remarkably similar to what I am doing now. I guess I must have remembered the great taste!)

Makes 7-8 cups, approximately 15-1/2 cup servings.

Recipe - Canadian Breakfast

On days that I don't make a shake, I have a breakfast that is commonly enjoyed in Canada:

• Pour into a nice-sized cereal or soup bowl ~1/2 cup of granola or museli.
• Sprinkle ~1 tablespoon of ground flax seeds on top of the cereal .
• Top with ~1/2 cup low-fat yogurt (any flavor will do - unflavored was used in Canada).
• Top with ~3/4 cup fresh or frozen fruit.

This is similar to the portion sizes I had when on vacation in Canada several years ago and lasted me ALL morning.

FAQ #2 - I have just been diagnosed with cancer. What steps do you suggest I take?

I have just been diagnosed with cancer. What steps do you suggest I take?
 
1) First have a good cry with a close friend or family member. There is even a book with this title; First you Cry by Betty Rollins, perhaps the first published personal account of surviving a disease that wasn't talked about at that time. Ms. Rollins is still alive, 20+ years after her first diagnosis, and her book has now been re-published. 

2) Then remember that someone somewhere has survived your type and stage of cancer. Read the book 50 Essential Things to do when the Doctor says "It's Cancer!" by Greg Anderson, who was told he has 30 days to live after a lung cancer diagnosis over two decades ago! 

3) Choose *active hope*. Surviving this disease may be the "biggest project of your life, for your life". I cannot over-emphasize this. Ask yourself and your medical team members "What can I do to help myself?" Even if you only change the odds 2% by being an equal partner in your care, you might be tipping the scale from 49% to 51% for long-term survival. Think of the psychological power that comes from being part of the majority! 

4) Put together your whole support team and delegate what needs to be done (from taking the kids to after-school activities, meals, to finding a doctor). This is not the time to be shy. People really want to help you, but they may need to take direction from you. Read Amy Harwell's book When Your Friend (or Relative) gets Cancer. Another book by a cancer survivor who beat slim odds for survival that gives you hundreds of ideas how to have friends be helpful.

5) Get as many medical opinions as you need to make an informed decision about the choices you have for treatment - don't be shy about this! There are very few *gold standards* in cancer therapy. Make sure your additional opinions are from doctors who did their oncology training at different medical centers. Read the Cancer Survival Toolbox Kit from the National Coalition of Cancer Survivorship.

6) Choose a doctor(s) who is truly supportive of your goals and gives you hope. I cannot overemphasize this enough! Read this link about the importance of hope.

7) There is increasing scientific evidence that what you bring to the equation can help you survive longer and at the very least improve your quality of life. No one knows the complete answer to how to survive cancer, but activities such as participating in support groups, prayer, meditation, nutrition, exercise, and laughter (as a starting points) all may contribute their share to increasing your odds for long-term survival. There is not a *magic bullet* (not any conventional therapy nor any dietary supplement) for full recovery from cancer. It requires a comprehensive or *holistic* approach to achieve full physical, emotional, mental, and spiritual recovery. 

8) After you have chosen your treatment goals and path, believe in your choice with 1000% conviction!! Again, I cannot overemphasize the power of belief. Do not worry that that your path is very different from the next person's. You both can achieve success. Recovery paths will be unique, just as you are unique. In addition to different conventional therapies (such as surgery, chemotherapy, or radiation), you may feel that certain teas and yoga are *right* for you, but the next person may choose Tai Chi and meditation to supplement their conventional cancer therapy . There is more than one path to the mountain top!

9) When friends and relatives bring you information about *alternative* treatments for cancer (and they will - I have grocery bags full of audio tapes and literature that people sent or brought me), first thank them for caring so deeply for you. Then tell them you will call them if you want more details about the particular product or treatment about which they brought you information. These choices are yours and yours alone to make - don't permit yourself to be pressured. My first choice in books is still Michael Lerner's Choices in Healing. The entire book is on the Internet. 

10) Read, read, read and be the patient with 10,000 questions (this is true for both conventional and alternative cancer therapies). Don't take any one source of information as the *gospel truth*, particularly if that source has a financial interest in the product or procedure. 

11) You will finally reach a point where you don't want or need any more information. That's ok! Then it's time to feel comfortable with the choices you have made for your recovery efforts and turn the outcome over to your faith. If I die from cancer, I will do so at peace knowing that I gave it my all; I looked under every stone and tried everything that made sense to me. In the meantime, I sleep well at night knowing that I am trying to help someone else have an easier cancer journey than I had. 

Best wishes for health, healing of the spirit, and hope! 

Diana Dyer, MS, RD