New England Journal of Medicine: Going Nuts for Nuts: Another Break from CLL, but for Healthy Reasons

Any casual reader of my blog knows that I am a committed vegan.

I love what I eat. Often only raw veggies, but sometimes a plain salad just isn't deeply satisfying. But add some nuts and I get some crunch, some grit, some surprises and some increased nutrition to boot.

Nuts are my "meat".

I just bought 20 pounds of raw organic nuts: cashews, brazil nuts, pistachios, walnuts, pecans, hazelnuts, macadamia, and pine nuts which are really seeds. Actually all nuts are fruits that have a hard shell and a seed.

Though they vary from nut to nut, most are rich in an antioxidants and other nutrients. Walnuts are especially high in the healthy omega-3 and have been shown to lower our LDL cholesterol. Pistachios are full of lutein and zeaxanthin that may help prevent age related macular degeneration.  Each one has its set of particular nutritional assets, and mixed together are delicious.

See this sweet article for a review of some of the nutritions in a few common varieties.

A special shout out and warning to fans like me of brazil nuts ( BTW, more come from Bolivia than Brazil). The USDA National Nutrient Database for Standard Reference, Release 25 tells that as few as 6-8 brazil nuts may contain as much as 10 times the daily recommended dose of selenium, though the amount may vary widely. Getting the right amount of selenium is healthful and I believe may lower cancer risk, but my levels were toxic when I was eating too many tasty brazil nuts. I now restrict myself to 5 or less a day and occasionally check my blood selenium level.

I try to eat only raw nuts because they generally have better nutritional profiles, especially in regard to their fatty acid contents. (Except for chestnuts that only I eat when singing Christmas carols and after they have been roasting in an open fire.)

And I choose organic when possible. And never salted or honey coated or spiced or anything. Just raw organic nuts.

I avoid peanuts (not actually a nut but a legume and schizocarpic to boot as I recall from high school biology) because the raw ones are at risk for aflotoxin, a potent poison from the mold aspergilllus flavus that likes to grow on peanuts if they are not properly stored.

I also avoid raw almonds. "Raw" farmed almonds in California may not be actually raw but "pasteurized" usually with the toxic propylene oxide or PPO to prevent a recurrence of the past Salmonella outbreaks. And besides too many of the raw almonds taste awful with a sickly bittersweet aftertaste that I have heard described as "Amaretto gone bad".  Not sure why, but spitting out a foul mouthful of nuts is not always possible and is never pleasant, so I sadly just skip them.

The remaining members of the nut are my boon companions when I wander, mixed and packed with great care right next to my other precious travel commodities including my medications and my organic green teabags in my carry-on. I would be lost or more actually hungry without them, especially in the southern US where being a vegan is pretty similar to being some exotic visitor from a faraway planet.

There are too often my breakfast and lunch and late snack snack when I am far from home. They are my manna.

So I was very pleased when the prestigious and very conservative New England Journal of Medicine published this:

Association of Nut Consumptionwith Total and Cause-Specific Mortality 

concluding:

"In two large, independent cohorts of nurses and other health professionals, the frequency of nut consumption was inversely associated with total and cause-specific mortality, independently of other predictors of death."

Read the whole article here.

The news about reducing vascular disease was not a surprise, but the lower risk of cancer and all cause mortality was a happy finding.

As with all retrospective studies, there is the potential for many confounders. Do nuts eaters tend to avoid more junk food, do they make better health and food choices overall and that is the reason for their improved survival?

The researchers tried to control for some of that Again, quoting from the research:

"Multivariate analyses were adjusted for age; race; body-mass index; level of physical activity; status with regard to smoking, whether a physical examination was performed for screening purposes, current multivitamin use, and current aspirin use; status with regard to a family history of diabetes mellitus, myocardial infarction, or cancer; status with regard to a history of diabetes mellitus, hypertension, or hypercholesterolemia; intake of total energy, alcohol, red or processed meat, fruits, and vegetables; and, in women, menopausal status and hormone use. "

Moreover, the fact that there was a linear inverse relation between nut consumption and mortality indicates that it is a valid correlation, if not necessarily a cause and effect.

The numbers were significant too.

The hazard ratio for those us eating nuts 5 x a week was 0.83 compared to those who never had a tasty nut touch their palate. That means almost a reduction of 1/5 in the chance of dying during the study period.

The reductions for heart disease was even bigger, 29% and for kidney disease it was a whopping 39%. Cancer deaths were cut by respectable 11%.

I fully expect that soon we will be able to buy nut extracts to add to our juices or cereals. Or nut pills to avoid all the hard work of buying and chewing those delicious seeds.

Don't fall for it. We have proved over and over again that there a huge danger in assuming that eating the essence or extract of a particular food is the same as eating the food itself.

A de-orderized garlic capsule is not garlic.

Vitamin C is not OJ is not an orange.

Nut extracts are not nuts.

Remember my mantra. Stay close to the soil. The more packaged and processed, the worse it is for you.

Enjoy your simple raw nuts, guilt free

I sure do.

As I have said before, I don't for a minute believe eating nuts or any particular diet will cure me or anyone else of cancer, but I do believe that conscious eating can keep us all stronger for the health challenges we face.

Live from the Infusion Center: Anemic Again

My blood draw at the cancer center for my IVIG infusion showed that I am mildly anemic again. Hgb was only 13.2 which is the lowest it has been since last August. 

This almost certainly not a big deal unless my counts continue to fall. 13.2 is a value many with CLL aspire to reach.

The white count, neutrophils and lymphocytes were all fine and platelets were 381,000.

However, I am clearly iron deficient based on lack of iron stores seen on my bone marrow biopsy, a low iron saturation of 14% and a borderline ferritin of 22.

My marrow was making adequate red cells so that is not the issue, and there is nothing clinically or in my lab to suggest an auto-immune problem (AIHA), so the nutritional deficit is the likely culprit. B12 is fine, daily I eat a ton of leafy greens with high levels of foods with folate, so that leaves the finger pointing at iron. 

Doctors Kipps and Forman agreed that there was no need for iron replacement a few weeks ago as I was not anemic when my blood was last checked a month ago, but the sharp eyed Dr. Kipps did notice that my MCV, a measure of the red blood cell size, was drifting down. My erythrocytes tend to be too big and funny looking due my splenectomy, but lately they have been more normal size, consistent  with a mixed picture of multiple influences on their size and shape, as low iron stores will shrink cell size.

Vegan like me are at higher risk for iron deficient anemia as the iron found in veggies is not as easily absorbed as the iron in blood. There is some controversy on this, but it makes sense. Heme iron is found in animal proteins, while non-heme iron is found in plant-based foods and has a different molecular structure than heme iron.

All the green tea I drink doesn't help either, as it interferes with absorption.

I am not too worried about a GI bleed as my last colonoscopy was only 3 1/2 years ago.

So why not take iron?

First iron overload is a much bigger problem and harder to remedy down the line in blood cancers.

Second, there is some controversial data (in dialysis patients) suggesting that iron supplementation may be associated with increased infection risks and low iron may be protective. Again, there is conflicting data.

Finally iron is constipating and can cause other GI issues.

I think I will just start taking more blackstrap molasses. And check for my stool for blood. And watch the trend. 

All in all, not a bad picture. Much better than the numbers that too many friends need to contend with.

Still one time, I would love to have a blood count with no numbers in the red. I haven't seen that in 8 years. Not once since I was diagnosed.

BP is 107/68 and I need a nap.

Growing our Own: Family, Friends, Ibrutinib and Green Tea: Many Reasons to Give Thanks

Our flushing Camellia Sinensis (tea trees)

I have many reasons to celebrate my favorite secular holiday of the year, Thanksgiving. It is a good time to pause with family and friends, perhaps before the festive meal begins, and go around the table and have everyone reflect on all that brings us joy and purpose, all that makes us thankful.

I am blessed with a close and loving and expanding (through marriage and babies) family, amazing friends nearby and on the other side of the world, meaningful and rewarding work, year round access to, and better yet, the ability to grow our own tasty local organic vegan food (and soon make meaningful amounts of my own delicious green tea), the chance to travel and lecture in supposedly pedestrian towns that always turn out to be full of new experiences and friends, teachers and cultural opportunities that expand my vision, and maybe, just maybe, getting my health back, my chance to keep going, to do more, and to grow old.

I am so grateful for the opportunity to be a lab rat. Yes, I complain about the CT scans and all the travel, but honestly because of Clinical Trial NCT01217749 that gave me access to ibrutinib, I am here and well and celebrating with a mind that is not convulsed about my next treatment choice or about a looming unexpected twist in my health. I have a real shot at physical redemption. I am thankful for all the help I got from my case managers and my medical group (St Jude Heritage Medical Group), the entire medical and trial team at OSU, and my family, especially my wife for making this all  happen. 

It is possible to live in gratitude and sickness at once. Some of us with cancer must do this for long chunks of our lives, but it never easy and never the most desirable. Ghandi simply said: It is health that is real wealth and not pieces of gold and silver. While I have posted extensively on living with bad news and sickness, it has always been with an eye on the prize of getting better, of being well.

My next post will discuss the risks and benefits of clinical trials, both from my personal perspective and from what I learned at the Manhattan Beach Lymphoma Research Foundation Meeting a few weeks ago.

But first, I will enjoy a down day of turkey less vegan feasting with my family.

Back from Ohio

To start, they know what a vegan is in Columbus and they actually know how to feed and nurture one, which is good thing, because it looks like I am going to staying there for the better part of three months starting sometime in February.

Yes, I was accepted in the trial of PCI-32765 and ofatumumab pending the insurance OK and the intake screening. That will happen sometime in the next few weeks, and the

I was very impressed with Dr. John Byrd and his team at OSU. Thorough, prepared, caring, smart and humane.

I must review pages of notes taken by my daughter, Heather who flew down from Chicago and her studying for the bar in Illinois (she is already licensed to practice law in NY) to be my scribe, second set of ears, and moral support for the whirlwind tour of this cold and windy central Ohio college town.

Over the next week, I will share what I learned, my decision process, and the next steps to get things going.

Right now I am still recuperating from the sleep deprivation of an alarm ringing before 4AM (1 AM Pacific time) to get to the airport on time for our flight home.

But it all going to be OK. They have good vegan food, a new drug that could save my life, and an NHL hockey team.

What more could I need?

Why I am vegan, revisited

Dr Hamblin recently posted on alternative therapies for CLL on his blog and discussed the lack of evidence that diets are any help. He is right of course.

Here is how I responded to his post:

I am vegan, mostly raw, mostly organic. I have no fantasy that this will cure me and even less impulse to convert anyone else to my diet. And I am not fanatical. I cheat when I travel and eat egg and dairy.

I do it because I believe a plant based diet is the healthiest diet for me (with a B12 supplement), and I already have CLL, so I don't need anymore problems.

I do it because I believe it is more sustainable for the planet and is clearly better for the animals. And it supports the local organic farmers' co-operative.

I do it because it makes my GI tract feel the best it has ever felt.

I do it because because I love the taste of fresh local organic fruits and vegetables. It helps to live in southern California

And I do it because it is a form of discipline that I enjoy in my otherwise mostly undisciplined life.