How To Help A Friend With Cancer

These are three of the most frightening words in the English language.  “You have cancer.”

My dear friend was just diagnosed with cancer.  As you can imagine, this is overwhelming and confusing.  In most situations, friends and family desperately want to help but it’s hard to find the balance between helping and hovering.

When my husband was first diagnosed with cancer, I was asked over and over, “How can I help?”  It’s difficult to know how to help a friend with cancer.

For those with cancer and their loved ones, it’s important to remember that they are too busy with doctor’s appointments, treatment options, financial worries and sleepless nights to think “Hey, I can ask Karen to bring dinner over,” or “I wonder if Tom could pick up the kids from practice tonight.”

No one WANTS to need help.   Most of us resist asking for help fiercely.  So if you have a friend that’s newly diagnosed with cancer, they need YOU to reach out and offer.  Here are a few suggestions from our experience.

FOOD

If your friend is undergoing chemo, healthy nutritious food is often just too much trouble.  Offering to bring dinner is an incredibly kind way to take a small weight off.

For a cancer patient undergoing chemo, the sense of taste is often disrupted.  Food doesn’t taste good and nausea can be a big problem.  Simple nutritious foods, lightly flavored and spiced, are the best.

If you know your friend well and understand his or her food preferences, feel free to choose for him.  Otherwise it’s best to offer a small number of options.  “Hey Sharon, I’m going to bring dinner over for you tomorrow night.  I know chemo sucks and I’m not sure how your stomach is feeling.  Would you like some of my black bean soup and a salad, or maybe a pasta dish with chicken?”

ERRANDS AND HOUSEHOLD CHORES

All the little things that go into running a household are ten times harder to accomplish while undergoing cancer treatment.  Everyone can use help with cleaning, laundry, shopping and running the kids to and from their activities.

Again, remember that your friend is not likely to reach out and ask for help.  It’s up to you to offer.

PRAYER

One of the most important services you can provide for any cancer patient is prayer.  Studies have shown that third-party prayer improves health care outcomes.  No matter what your faith, prayer works and will help.

Encourage the cancer patient to stay active in their faith.  Offer to pick them up for services or reach out to the clergy at their congregation and ask for in-home ministry.  If your friend is hospitalized be sure to notify their congregation and let the nursing staff know to alert the hospital’s pastoral ministry department.  I know from personal experience how comforting it is to have a visit from a clergy member or lay minister while hospitalized.

If your family member or friend is diagnosed with cancer, it can be overwhelming to know what to do to help.  There are a number of simple, concrete things you can do to help a friend with cancer.  And remember to stay in touch.  Short phone calls can help reduce the isolation that cancer patients feel and remind them that they are loved.

QUESTION: Have you had trouble knowing how to help a loved one with cancer?  What was your experience?

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Mental Health Care For Diabetics

Someone very dear to me has diabetes.  She has also been dealing with a lot of stress over the last year or so, and struggles with depression.  While her doctor has been trying to help her, there really aren’t a lot of resources available that specifically provide mental health care for diabetics.

Do you know anyone with diabetes?  Do they struggle sometimes with their mood?  If they seem depressed and anxious, they’re certainly not alone.  Up to 30% of diabetics are depressed at any given time, depending on how it is assessed.

Credit: steptohealth.com

Depression is a big deal for those with chronic illness.  Not only does it steal the fun out of life, but it plays havoc with motivation to keep up with behavior change.  Depression makes it really hard to eat right, to exercise, to take medication properly.

If a diabetic is struggling with depression there is definitely treatment available.  However, that treatment may be hard to find.  Ideally, the person or group treating the diabetes will be able to direct treatment for diabetes.

A group at the University of Massachusetts Medical School just published a study that showed that a lot of diabetes care clinics don’t have good access to mental health services.  Even the highest-ranked care centers didn’t have mental health professionals on staff.

Why is this?  The biggest reason is probably money.  Mental health services in this country are NOT a priority for insurance companies or the government.  Coverage is spotty and there are limits on the number of visits covered.

For a very common problem that has a huge impact on quality of life, limiting treatment is very shortsighted.  Depression impacts diabetics’ health in a number of ways.  For instance, diabetics suffering from depression have more complications, have a harder time controlling their blood sugars, are not as likely to take their medications properly and are more likely to die.

If you know and love a diabetic, make sure to keep an eye on their mood.  If they seem depressed, encourage them to talk to their doctor about it.  See if your loved one will let you go to a doctor’s visit with them.  This will give you an opportunity to talk directly to the doctor about your concerns.

If your loved one needs mental health services, the American Diabetic Association just launched a directory which you can access at this link: https://professional.diabetes.org/mhp_listing.  This link is a searchable directory of mental health providers with experience in treating diabetics.

This directory is brand new and doesn’t contain a lot of names.  The nearest provider to where I practice outside Cleveland is 100 miles away :-/  But hopefully it will grow!

Be persistent in seeking treatment for depression and anxiety.  If you or a loved one has diabetes, treatment will certainly improve quality of life.  It may be the difference between life and death!

QUESTION: Is there a diabetic in your life suffering with depression?  What has been your experience in seeking treatment?

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Fish Oil And Inflammation

Fish.  Everyone knows they should eat more fish, right?  Why is that?  Fish is good for your heart, but why?  And what kind of fish? Turns out FATTY fish intake reduces cholesterol and, more importantly, there is a strong link between fish oil and inflammation.

Seems I have been talking to EVERYONE this week about fish oil, diet and inflammation.  When a patient’s cholesterol is high I often check a profile called an essential fatty acid (EFA) panel which gives a nice peek into their diet.  Often I just get confirmation of what I already know – their diet stinks and we need to get to work ASAP!

Ultimately I really don’t care about an individual’s cholesterol.  I really don’t.  High cholesterol in and of itself is not a disease.  I care about their risk of OTHER diseases either directly related to the high cholesterol levels (like pancreatitis from super-high triglycerides) or for which high cholesterol is a marker (like heart disease).

High cholesterol is like the fire alarm going off.  When the fire alarm goes off, do you just go turn it off and go back to bed?  No, of course not, you go figure out what made it go off in the first place.  Find the fire, right?  When a person’s cholesterol is high, that means we need to go search for the fire, and an EFA panel is one of my first steps in hunting for the fire.

One of the calculations I can make based on the EFA panel is a quick-and-dirty check of overall inflammation levels in the body.  The ratio of arachidonic acid (AA) to eicosapentaenoic acid (EPA) is directly tied to inflammation in the body.  The higher the ratio, the higher the levels of inflammation.

Why do we care so much about this ratio?  Higher ratios are also associated with higher risk of heart disease, as reported in the Journal of Cardiology.

I tell patients (and my students) that over the next 10 years I believe we’re going to be paying much less attention to cholesterol and much more attention to inflammation.  Inflammation hurts the cardiovascular system over time.  It damages the insides of the artery walls and when they heal they scar, which causes plaque.

Arachidonic acid is a precursor for a lot of pro-inflammatory signaling molecules in the body.  EPA is a precursor for ANTI-inflammatory molecules.  So you want MORE EPA and LESS AA.

Where does EPA come from?  The richest dietary source of EPA is fatty fish, although it is also found in low levels in seaweed.  When I’m talking to patients I tell them there are 6 fish that are “fatty” fish: salmon, mackerel, anchovies, sardines, herring and tuna.  (The mnemonic is SMASH-T.)  All other fish (like cod, whitefish, tilapia, catfish, etc) are meat and should be eaten sparingly, if at all.  The human body can make small amounts of EPA from alpha-linolenic acid (ALA) which is found in walnuts, seeds like flaxseed and chia seed, and canola oil.

What about arachidonic acid?  AA can be made from another essential fatty acid, linoleic acid, which in humans must come from the diet.  The only dietary sources of AA are animal foods like meat, dairy and eggs.

Here comes the question I keep expecting: Dr. Jen, you keep telling us that the healthiest diet is completely plant-based.  If we need EPA and the best source is fish (which are undoubtedly animals), why is a completely plant-based diet so heart-healthy?

That’s a great question.  First of all, scientists are still working on the “why” but there is no doubt that a completely plant-based, whole-foods diet is the best choice if your goal is overall health and avoiding heart attacks and strokes.  My patients who choose to try a plant-based diet find their blood pressure goes down, they feel better and they usually lose some weight.

My personal interpretation of current research is that if you give the body ALA and LA from plant sources, it will manufacture the EPA and AA that it needs for its purposes.  The ratio of AA to EPA will be low because the body won’t make extra AA.  However, if you eat a lot of meat you get a lot of AA from the diet and the body isn’t so much in control of how much is floating around.

The best choice for those who want to reduce their risk of heart disease is to eat NO animal foods at all.  Adding a small amount of fish oil as a supplement is good insurance to further reduce inflammation in the body.

If you have high cholesterol, ask your doctor to order an Essential Fatty Acid profile or a Boston Heart Diagnostics panel.  If it is coded with a high-cholesterol or high-triglyceride diagnosis code, it will almost certainly be covered by your insurance.The results should look something like what is shown at this link.  Calculate the ratio of arachidonic acid to EPA.  The goal is <3, an elevated level is >10 and a high level is >15.  I’ve seen it over 30.

Then look at the ratio of omega-3 to polyunsaturated fatty acids (w3:PUFA).  The healthiest people in the world have a ratio of about 50%, but we eat so many omega-6 oils in the USA that I’m usually content with a ratio of 15-20%.

The last thing to look at is the total saturated fat level.  If it is high you REALLY need to think about how much meat you’re eating.  The main sources of saturated fat in the body are animal foods (meat, dairy and eggs).  Palm kernel oil is found in many processed foods and is also a big dietary source of saturated fat.  Read your ingredient lists.  There is currently a big craze to eat coconut oil, which is also a rich source of saturated fat.  No research suggests adding more coconut oil to your diet improves health at all.

You are what you eat.  Your body is 100% created from the food and drink you put in your mouth.  Your health is 90% determined by lifestyle factors, mostly diet.  Now is the time to look at what you’re choosing to feed your body and make good choices.  It’s up to you!

QUESTION: Will you change your diet based on this information?

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Less Saturated And Trans Fat Intake Recommended

What should we eat to be healthy?  This is the ultimate question that EVERYONE is trying to answer and nobody really has a good handle on it.

Our diets are getting worse and worse.  We are eating more processed foods, more convenience foods, more sugar and fat and salt.  Our risks of diabetes, heart disease and cancer are climbing.  Our kids are the first generation that has a shorter life expectancy than their parents.

The World Health Organization is intensely interested in these worrisome trends.  They are trying to analyze the confusing array of nutritional research coming out to make recommendations to help people all over the world live longer, healthier lives.

Recently the WHO came out with a report recommending less saturated and trans fat intake in the diet.  The goal is to reduce saturated fat intake to less than 10% of daily total calorie intake, and trans fats to less than 1% of calories.

Saturated fat and trans fats are both largely found in animal foods.  Animal flesh from all species, eggs and dairy are rich sources of both saturated and trans fats.  While many people know to avoid partially hydrogenated vegetable oils which are added to processed foods to make them taste better, surveys suggest that trans fat intake from animal foods is greater than that from industrial sources.

If you’ve been following my blog for any length of time, you know I recommend that the whole-foods plant-based diet is the healthiest diet for humans.  This type of diet has the best research showing reduced heart risk and reduced cancer risk.  It has been shown to decrease diabetes risk (a major risk factor for cardiovascular disease and cancer).  In fact, switching as little as 5% calorie intake from animal protein to plant protein reduced diabetes risk by 20-25%.  This translates to 25 grams of protein from plant sources rather than animal for someone who eats 2000 calories per day.

I get that not too many of my readers are going to switch tomorrow from a Standard American Diet to a whole-foods plant-based diet and never look back.  I’m about progress, not perfection.  Hey, my husband calls me “vegan-ish!”  I avoid animal foods as much as I possibly can but every once in a while I have ice cream or macarons for a treat.

So gradually substituting plant-based meals for ones with meat and dairy will reduce your heart and cancer risk.  Reducing animal foods to have less saturated and trans fat intake in the diet is a good step to take for improving your health.  You’ll feel better, and your body will thank you!

QUESTION: Do you try to reduce animal foods in your diet?

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