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.

Another boring bone marrow biopsy and aspiration

When asked if I had had this procedure before, I just smiled my yes.

When asked how many times, I didn't know.

Becky, Dr. Kipps' NP was great, the pain was minimal during and after, though my blood pressure did shoot up a bit. I am convinced it more a matter of technique than strength, though I know this experienced oncology nurse worked hard to get the specimen. Thanks to G-d for lidocaine.

You want your bone marrow biopsy to be routine. Results in two weeks. That is the part that is hardest for me.

With no meds for pain, I was well enough to stop at my new favorite raw restaurant, Peace Pies in my old haunt, Leucadia. These guys are amazing and committed. Great introduction to raw food. And I love that old beachy still slightly hippy feeling of that stretch of Pacific Coast Highway.

Back home, after a desperately needed nap, I am back to the grind and cleaning up the house before my wife comes back tomorrow.

Making good progress on my to do list for the CLL but nothing is "completed" yet and life has a way of disrupting my plans. That's OK. It reflects an active engagement with the world.

Though the cat is fine company, I miss my wife who is out of town helping out with our 6 month old granddaughter. Amira's blog is much more more exciting and certainly more fun to look at than mine.

My most brilliant move today was to pick up "to go" a raw organic vegan "tuna sandwich" and a slice of "apple pie" for my dinner, so life is sweet.

A good day. Another ho-hum bone marrow biopsy and drive along the amazing California coast.

What's New

Patty is out of town for Will's graduation from MICA in Baltimore. Today he received his BFA magna cum laude at the ripe old age of 20.

On the side bar are his old http://killmecomix.com/ and his new Candy for your Eyes web pages. They are wonderful. Patty and I are so proud.

With Ben's graduation from Art Center, Pasadena in film direction last month, all our kids are through college (at least for now).

So if you need someone to help with a film or commercial, especially a documentary, contact Ben http://www.bkoffmanart.com/ and if you need any illustration contact Will. You won't be disappointed.

So now that I am finished shamelessly kwelling (Kvell, a Yiddish term, means 'to be bursting with pride; boast; gloat', and is usually used with the connotation that one is delighted with the accomplishments of one's children) and promoting my sons, let me kvetch ( this Yiddish word means grumble or complain) for a minute. I am getting tired of my own food prep (remember I eat no cooked food) and more tired of just being alone. The cat and dog help, but I get pensive and moody when I am alone for several days at home.

Today I made a raw organic broccoli-avocado-tomato-squash-brazil nut-coconut milk soup. It wasn't that great but I ate it all for lunch and dinner. I sure don't want to face any more of it left over tomorrow.

And the 4.7 earthquake didn't help my mood.

Nuff of this pity party.

I saw the new Star Trek movie at the local IMAX with my son. Dazzling.  Must see for any fans. The best in many years. I hear the Trekkers are complaining that there is so little to complain about.

Heard some great jazz last night at Jack Prather's CD release party. Listen to some of the material @ http://www.myspace.com/jackprathermusic 

Live jazz is hard to beat. My friends Leonard Thompson on keyboards and Dewey Ernie on vocals were there which made it extra sweet.

The ASCO (American Society of Clinical Oncology) meeting is starting. I have been reviewing the abstracts on CLL and transplant.

I wish there was some great breakthrough to report, but I was underwhelmed.  An interesting and important paper on VRE (Vancomycin resistant enterococci) post transplant, a new dosing schedule for OFAR, new monoclonals in the pipeline.

Time to refocus.

A demain

Dr. Forman April 16, 2009, my diet and supplements, and my comedy routine in Niagara Falls

Much to share:

Let me start with my appointment with Dr. Forman last week.

All my lab remains normal and I have no evidence from lab tests of the dangerous post transplant lympho-proliferative disorder (PTLD). No active EBV in my blood to be found.

My B cells are only about 1% of my lymphs and my T cells are normal with healthy CD4/CD8 ratios.

I am realizing that my doctors’ appointments are become less important, less dramatic, and less frequent. And I don’t post on them, as I walk out the door.

Maybe the rest of my life is just getting busier.

I don’t see my doctor for over 2 months now.

The question is no longer whether my nodes have grown or not. My radiologist friend from France is the latest doctor to confirm the growth. My mesenteric nodes are more bulky. The rest are stable. That’s undeniable now. Four different readings: one conclusion. They're bigger.

What does it mean?

There is still some question as to whether the growth is a sign of relapse though I would say if they shrink it was a sign of remission. Either way I would be happy.

Biopsy is way too dangerous and really an overreaction.

So the question is when to repeat the scan. The range of medical advice is from 3 months to until there is a clear indication.

I am thinking the middle road. No need to rush into a life threatening second transplant, but you don’t want to wait too long, when the disease may be harder to control, bulky or worse yet, undergone clonal evolution. 

6-12 months makes sense. That's Dr. Forman's plan. A minimum of once a year. CT is cancelled for June.

I suspect this is all moot. The disease will decide. I doubt I will grow massive gut nodes without something popping up somewhere else or my lab showing subtle signs of recurrence.

The real question is what to do about the growing nodes seen only on CT scan. Do we jump it and hit the cancer when the tumor burden is low? Bexxar to deliver a toxic radioactive payload to my nodes while my bone marrow is clean? That might make sense. The NK study to immunologically mop up the remains of the Amalakites?  Revlimid to increase the immune surveillance? 

I am revisiting old battlefields in my head.

Dr Rai says let someone else worry about your nodes. He says my loss of the graft is bad news, but not a death sentence. He says specifically no Bexxar or Revlimid.

He says I have gotten quite well, and done it while staying remarkably unscathed from treatment. And the next steps could be most dangerous and I may not miss the minefields a second time.

So best to just forget about it.

Or try something different. If they are all gut nodes, let me target the gut. For me that means the organic vegan low glycemic index diet. To you that means raw green vegies and raw nuts and seeds. Oh, they can be dehydrated or blended or juiced, but that’s about it.

This diet is nearly impossible when you travel (although Toronto had a great raw restaurant-LIVE- check it out), and hard when you are at home. You spend a lot of time chewing. You spend a lot of time eating. And what goes in, come out, so you spend a lot of time indisposed.  The term bulky does not only refer to lymph nodes.

Let me be clear there is no evidence that it works. In fact, on a similar diet, my CLL got worse about 2 years ago. This time I am stricter and avoiding the sugars in fruits and carrots and beets.  It is based on the rainbow green cuisine writings of Dr Gabriel Cousens.

It is pretty far out.

People ask me how I can stay on this diet.

One: It’s delish

Two: It’s healthy

Three: I am fighting for my life

Four: I’m no saint, I cheat a little

Five: When I am cured, or if there if no benefit, I will definitely loosen up.

While on that strict diet, I continue with my zinc and Vitamin D3 (6000 IU) a day unless I walk shirtless on the beach). I still drink three pots of organic Japanese green tea, and I have added vegetable source digestive enzymes and an organic source of Vitamin C. And I thought adding 2 Teavigo green tea extract with all that EGCG might make the nodes a bit less hospitable for my cancer bad boys.

Add to those 1-2 tablespoons of organic cold pressed flaxseed oil (fancy linseed oil commonly used to thin paints) and EFA (Essential Fatty acids) and vitamin mix that are part of the Budwig diet. Check it out.

Further out you say.

I am not done yet.

I am even considering (all my hard core medical readers are running for the doors now) the infamous “detoxifying” Zeolite of MLM (multi-level marketing) disgrace, though I see no reason not to buy the cheapest stuff I can find. This MLM stuff is pretty nasty and turns be off the whole business,  and it smells of pseudo-science to me, but MDs I respect have recommended it.

Remember, none of this is of any proven value (except the green tea),

The good news is that also none of this is too pricey (well maybe the Zeolite), and all of it pretty healthy and safe.

So when my next CT shows my guts nodes have shrunk, my doctors will say: See Brian, you worried for nothing. But you and I will know that it was my diet and supplements that righted the ship.

And if those nodes, and this is most unlikely, have grown, I am not going to eat a steak, or even a smoked meat sandwich, but I might order some sushi or have a thick wedge of sharp cheddar cheese on a piece of home baked apple pie. Organic, of course.

Have you lost all respect for me, my hard nosed colleagues? Remember I am the one who tried and rejected Chinese medicine when it did not work, and embraced the most aggressive intervention in Western medicine: a stem cell transplant. The jury is still out on that, but it sure benefited  much more than all my alternative treatments.

But I am still looking, refining, guessing, experimenting, and trying not to be stupid.

Last thing:

The CLL-PAG conference at Niagara Falls was very special. More later. I did my comedy routine.  I won't be self-deprecating. I killed them. It was a smashing success. It helps that I had such a generous and kind hearted audience. And they all had CLl, or doctored or cared for someone with CLL.

I had such fun. Little is better in life than making people laugh at their predicament. Except maybe making their doctors laugh at themselves.