A diagnosis of cancer can feel overwhelming. Understanding terms like stage, grade, and surgical margins requires you to learn a new language overnight. But it is time well spent. To make the most informed decisions about treatment it is important to understand your diagnosis. In order to help interpret your biopsy report, scans and cancer type, I am pleased to post this informative article by naturopathic oncologist Dr. Katherine Neubauer of Survive and Thrive Cancer Care, a national integrative oncology consulting practice.

Breast Cancer Overview

A new breast cancer diagnosis brings a lot of information. The good news is that the prognosis is good when breast cancer is caught early. For advanced breast cancers, there are still many good treatment options.

When making treatment decisions, it is important to know your breast cancer type. Some breast cancers respond to hormone therapy, while others don’t. Chemotherapy is beneficial for some tumors and not others.

It’s also helpful to develop an overall approach before beginning treatment. For example, some types of surgery need subsequent radiation, while others don’t. And, the timing of breast reconstruction is affected by whether you need radiation.

How do I know my breast cancer type?

There are a few key pieces of information to review in your biopsy, scans, and blood tests:

Kind of breast cancer Invasive ductal carcinoma is the most common type. Others include lobular carcinoma and inflammatory carcinoma. Ductal carcinoma in situ (DCIS) is a precancerous condition.

Tumor’s response to hormones For example, a tumor can be “ER positive” if it uses estrogen to grow, or “ER negative if it is not sensitive to estrogen. ER-positive tumors can respond to hormonal therapies like Tamoxifen, while ER-negative tumors do not.

Genetic studies These tell us how aggressive the tumor is likely to be. Her-2 positive tumors are more aggressive than Her-2 negative tumors. However, Her-2 positive tumors can respond to the drug Herceptin. Ki-67 indicates how quickly the tumor cells are growing. BRCA mutation indicates aggressiveness. BRCA mutations increase the risk for other kinds of cancer and the gene is inherited, so this may also guide health care for you and your family.

Tumor grade tells us how similar the tumor is to normal breast cells. It is a good thing if the tumor is “high grade” or “well differentiated”. This means that the tumor is more similar to normal cells, and is less likely to grow or spread. Tumors that are “poorly differentiated” or “anaplastic” may need more thorough care.

Tumor stage explains where the tumor is in the body, as well as how large it is. Stage is expressed as a number between 1 and 4. 1 is a small tumor that is only in the breast. 2 and 3 are tumors that are larger or have spread to nearby tissues. 4 is a tumor that has spread to other organs. Stage is often written as a Roman numeral, from I to IV.

Surgical margins If you’ve had a mastectomy or lumpectomy, the pathology report will specify the size of the surgical margins. To reduce the risk of leaving tumor cells behind, the surgeon tries to cut out a border of healthy tissue from around the tumor. This healthy tissue is the surgical margin. While the surgeon makes every effort to get a good margin, the pathologist may later find microscopic tumor cells that were invisible to the surgeon. This is an “involved margin”. If you have a poor or involved margin, it may be wise to get radiation and additional surgery.

Oncotype Dx Score some tumors clearly benefit from chemotherapy. For others, the decision is less clear. This test can be done on a sample of your tumor tissue from a lumpectomy or mastectomy. The results can tell you how beneficial chemotherapy would be.

Millet Meatloaf

This simple loaf is a meal in itself.  The grain and vegetables disappear and even picky children love it.  The recipe is very versatile. For a traditional meatloaf try ground beef with carrots, celery, onion and rosemary.  With ground turkey try sage and thyme.  Many of the cruciferous vegetables like broccoli or cabbage work well in this recipe.

-       2 lb of ground grass fed beef or lamb or beef, or organic ground turkey

-       2 cups of minced vegetables (equal parts onion, carrot and celery work well)

-       ½ cup of millet (or use corn meal)

-       1 ½ teaspoons of salt.

-       2 teaspoon of fresh herbs such as rosemary, thyme, sage or basil, or use 1 teaspoon of dried herbs

Grind the millet in to coarse flour in a coffee grinder or food processor. Place all of the vegetables and the herbs in a food processor and chop them to a fine mince, or mince them by hand.  In a large bowl combine the minced vegetables, millet flour, salt, herbs and meat and mix them well.  Form the mixture into a loaf and place it on a cookie sheet. You may top it with catsup or bacon slices (before baking)if desired.  Bake the loaf at 400 degrees F. for ~ 45 minutes or until the internal temperature reaches 180 degrees F.  Cool the meatloaf for 10 minutes before slicing it.  Serve it with roasted brussel sprouts and a green salad. This loaf freezes well after slicing so try making a double batch.

Easy Roasted Brussel Sprouts or Broccoli

This is a delicious preparation of brussel sprouts when they are in season.  Roasting them yields crispy outer leaves with a soft, sweet center.  It is also a great way to prepare broccoli year round.

-       2 cups of brussel sprouts or broccoli florets

-       2 tablespoons of olive or coconut oil.

-       ½ teaspoon of salt

-       (optional) ½ teaspoon of dried thyme

 Preheat the oven to 400 degrees F. Prepare the brussel sprouts by cutting off the rough base and removing any tough outer leaves.  Toss them in a bowl with the oil and salt.  Spread them on a cookie sheet that has been lined with parchment paper and bake them for ~30 minutes, stirring occasionally.  The vegetables are ready when they are easily speared with a fork.  Serve them hot or at room temperature.

To understand how the foods we eat affect blood sugar it is important to understand the difference between simple sugars and complex carbohydrates. Most of the sugar in our blood is a specific type of sugar called glucose*. In its simple form (a single molecule) glucose is found in fruits and vegetables and in concentrated sweeteners like sugar or honey. Complex carbohydrates (aka starches) are long chains of glucose molecules. They are found in a variety of foods including rice, pasta, and potatoes. When complex carbohydrates are digested the chains are broken and glucose is released.

Simple sugars are absorbed quickly; it takes very little time for them to enter the blood stream and raise blood sugar. Because complex carbohydrates need to be broken down before they can be absorbed, they enter the blood stream more slowly. Certain foods slow the digestion of complex carbohydrates when they are eaten at the same time. These are foods rich in fats, proteins and fiber. There are many benefits to delaying carbohydrate digestion. The energy released from the food is slow and steady. Because food stays in the stomach longer hunger is abated and there are no sharp rises in insulin leading to increased fat production .

Here are some examples.

-         A soda (or fruit juice) has lots of concentrated simple sugars. These will be absorbed quickly and cause the blood sugar to rise quickly.

-        A bowl of brown rice will be digested fairly quickly and will cause blood sugar to rise ~ 1-2 hours after eating.

-        A bowl of brown rice that is eaten with a piece of chicken or fish and some olive oil will be digested slowly over ~ 3-4 hours. The sugar from the rice will be absorbed over a long period of time and there will not be a sharp rise in blood sugar.

Eating in a balanced way can lead to sustained energy and facilitate weight loss. Most importantly, keeping blood sugar level and low can help to prevent numerous health problems. Don’t miss the recipes in next weeks post!

*There are two other types of simple sugars – fructose and galactose. These are metabolized somewhat differently than glucose. In order to keep things simple and clear we will not be discussing them in today’s post.

I want to thank everyone for their patience during my relocation to Larkspur, California. On June 5th, 2012 I began practicing at Marin Natural Medicine Clinic http://www.marinnaturalmedicine.com/. I am excited to be a part of such dynamic group of skilled practitioners.

Regular weekly blog posts will resume on 6-25-12 with a continued discussion of blood sugar balance and how it is affected by the foods we eat.  As always I will post delicious recipes that are hypoallergenic and gluten-free. If there are topics that you would like to see covered in the future, please send me a comment and I will do my best to include them.

Be Well,

Dara Thompson N.D.

Pork and Pumpkin Stew

This simple stew is satisfying and delicious.  It is best with an heirloom variety of pork like Berkshire.  Pork has a reputation for being unhealthy. Indeed factory farmed pork is full of unsavory chemicals.  Organic, vegetable-fed pork from small family farms is a much better choice. Pigs serve and important function on small farms, eating the scraps that people don’t want.  Because pigs are not ruminant (grazing) animals they don’t produce very high levels of greenhouse gasses.  Raised in this way, pork is lower in saturated fats and many toxins than either beef or lamb.  Of course, it is always a good idea to trim the fat off of meat before cooking.

-          ~ 3 lb. of stewing pork, such as loin chops or Boston butte

-          2 teaspoons of sea salt

-          1 medium onion, chopped

-          2 cloves of garlic minced

-          1 tablespoon of fresh rosemary, minced

-          1 tablespoon of olive oil

-          1 large bunch of kale or collard greens, chopped

-          ½ of a sweet kabocha pumpkin (or use another type of winter squash) peeled, seeded and chopped onto 1 inch cubes

-          (Optional) 1 cup of additional chopped vegetables such as celery, carrots, turnips or green beans .

-          3 cups of water

Dice the pork into bite sized cubes and toss the pieces with the salt, coating them evenly.  Set them aside.  Heat the olive oil in a deep, heavy bottomed pot.  Add the onions and sauté them over medium heat until they are golden brown.  Add the garlic and rosemary and continue to cook the mixture until the garlic just begins to brown.  Add the meat cubes and stir them into the onion-garlic mixture.  Continue to cook the meat uncovered for ~ 5 minutes stirring frequently.  Add the water and kale.  Bring the mixture to a boil, stir it well and then reduce it to a simmer.  Cover the pot and allow the stew to cook over low heat for ~ 1 hour, stirring occasionally.  Taste the stew and add more salt if desired.  Then add the pumpkin and additional vegetables.  Bring the mixture back to a boil and then reduce the heat to a simmer again.  Cover the pot and cook the stew for an additional 30 minutes.  Test the meat and make sure it is tender; if not simmer it for an additional 30 minutes.  Salt to taste and serve. This stew may be served alone or over a whole grain like brown rice, buckwheat, millet, or quinoa.

Variation #1 – Instead of pork, try grass-fed beef or organic turkey thighs

Variation # 2 – Replace the rosemary with 1 teaspoon each of ground cumin and coriander and ½ teaspoon cinnamon.

Pickled Beets

This tangy side dish is an excellent liver and gall bladder tonic.  The brine is lite.  If you want a stronger pickle just increase the ratio of vinegar to water and add a bit more salt.

-          6 medium beets washed and trimmed, but not peeled

-          1 cup of apple cider vinegar

-          1 cup of filtered water

-          1 teaspoon of salt

Place the beets in a pot with water to cover them.  Bring the water to a boil and then simmer them for ~ 30 minutes, until they are tender when pierced with a fork.  Drain the water and allow the beets to cool to room temperature.  Peel the beets and dice them (note: Beets should slip out of their skins easily after they are cooked.) Place them in glass container with a tight fitting lid.  Mix the apple cider vinegar, water and salt together.  Pour the brine over the beets and stir it well.  Refrigerate the mixture for 2 or more days shaking it occasionally. Remove the beets from the brine before serving.

The trouble with too much sugar in the blood is that is tends to get stuck to other things.  This process is called glycation and its products are called AGEs (advanced glycation end products).  AGEs have been implicated in a variety of diseases.  They promote inflammation and oxidation.  It is easy to measure the level of glycation that is happening in the body by testing a specific AGE, glycosylated hemoglobin or HA1C.

Another problem with elevated blood glucose is that it causes an elevation of insulin.  Insulin is the one hormone in the body that lowers blood sugar.  It does this by increasing the uptake of glucose into cells.  For example if insulin binds to a muscle cell it will cause that cell to absorb more glucose from the blood.  This is insulin’s primary role.  However insulin has secondary roles of increasing fat stores in the body and increasing the production of cholesterol by the liver.  This can lead to obesity and elevated cholesterol.

In order to prevent many chronic diseases it is important to control blood sugar and try to keep it the ideal range.  In this range there is plenty of sugar available to run all of the body’s processes.  But it is not high enough to cause excess glycation or elevated insulin.

Strategies for balancing blood sugar through diet, exercise, supplements will be discussed in upcoming blog posts.  As always, there will be lots of delicious recipes included!

Blueberry pancakes

These protein rich pancakes use sprouted quinoa as the batter base. They have a wonderful spongy texture and a rich nutty flavor.

• 1 cup of quinoa soaked for 8 hours or overnight
• ½ cup of water
• ½ teaspoon of salt
• 1 tablespoon of oil (melted coconut oil or butter is best)
• 1 teaspoon of apple cider vinegar or lemon juice
• 1 tablespoon of honey or maple syrup (optional)
• 2 tablespoons of arrowroot starch, carob powder, or rice flour sifted together with ½ teaspoon of baking soda
• ½ cup of blueberries (thaw and drain if using frozen berries) or try blackberries

Rinse the quinoa in a mesh strainer and allow it to drain for ~5 minutes. Place the quinoa, water, salt, oil and vinegar in a blender. Start on a low setting and increase the speed to high, processing it until the mixture is smooth. Pour the batter into a bowl and add the flour and baking soda. Quickly mix the wet and dry ingredients until there are no lumps. Over medium heat melt some butter or coconut oil in heavy bottom skillet (well seasoned cast iron is best). Pour the batter onto the hot skillet using a ladle or measuring cup. Generously decorate the tops of the pancakes with blueberries. As soon as bubbles form on the edges of the pancakes flip them over and cook them on the opposite side for 3-4 minutes. Remove them from the pan and serve immediately.

Raspberry Ice Cream or Popsicles

This simple recipe is low in carbohydrates and high in nutrition.

• 1 can of organic coconut milk
• 2 cups of organic frozen raspberries, or other fruit
• 2 tablespoons of honey or 10 drops of white stevia liquid
• pinch of salt

Combine all of the ingredients in a blender and process them until the raspberries are pureed. Freeze the mixture in an ice cream maker or Popsicle molds. Enjoy!

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1)      Exercise – Exercise improves circulation, reduces stress, helps to control weight and strengthens the heart muscle.  It is important to find the appropriate exercise for your current state of health.  Pushing yourself to hard, may lead to injury.

2)      Strengthen your Blood Vessels – Proper nutrition is the key to strong, elastic blood vessels.  To form the muscles and connective tissue that makes up the vessel walls you need the proper building blocks. A diet rich in high quality protein, bioflavinoids, vitamin C, and other nutrients is essential for heart health.

3)      Reduce Inflammation – Most damage to the heart muscle and the blood vessels is a result of inflammation and oxidative damage.  Environmental factors, poor diet and genetics all play a role in promoting inflammation.  By making appropriate changes and using natural  anti-inflammatories, damage can be prevented before it occurs.

4)      Balance your Blood Sugar – Diabetes is one of the highest risk factors for heart disease.  This is because elevated blood sugar (even in the pre-diabetic range) leads to abnormal “Glycosylated” proteins or “AGEs”.  These molecules cause much of the vascular damage associated with diabetes.  In addition, the elevated insulin levels associated with high sugar consumption signal the liver to produce more fat and cholesterol.  For more information, watch for upcoming blog posts on blood sugar balance.

5)      Nourish your Lungs – The heart pumps all of our blood through the lungs to pick up the oxygen needed by the rest of the body.  If there is any illness in the lungs, the heart has to work harder.  Chronic lung disease can easily lead to heart disease. It is important to get appropriate treatment for lung disease to prevent these complications.

Tofu Scramble

This tofu and veggie saute is savory and satisfying for breakfast or brunch. It is a tasty substitute for eggs, but is delicious in its own right. Be sure your ingredients are organic, especially the tofu. Non-organic soy is genetically modified!

• 1 tablespoon of virgin olive or coconut oil
• 1 lb of firm tofu
• ½ large red or yellow onion, minced
• 1 clove of minced or crushed garlic
• ¼ teaspoon of turmeric powder
• 2 teaspoons of wheat-free tamari or Bragg’s liquid aminos
• 2 cups of loose leaf spinach or 1 cup of diced broccoli
• 2 tablespoons of water

Crumble your tofu in a bowl and mix it with the tamari and turmeric (be careful, turmeric stains). Heat the oil in a large heavy bottom skillet; cast iron works well. Add the onion to the oil and sautee it over medium heat until it is soft and starting to brown. Add the garlic and stir it until it is just starting to brown (be careful not to burn the garlic!) Add the tofu, vegetables and water. Mix all of the ingredients and cover the pan with a tight fitting lid. Continue to cook the mixture for 5-10 minutes, stirring occasionally, until the vegetables are tender and the tofu is heated through. Serves 2 as a meal and 4 as a side dish with toast or rice.

Simple crock pot stew

Stew for breakfast? It may sound strange but a hearty stew fits all of the criteria for a perfect breakfast. It is warm, nourishing and high in protein. Long slow cooking makes all of the ingredients eat to digest and blends the flavors perfectly. You can make this stew overnight in a crock pot or in a low heat oven. For oven cooking you will need an enameled cast-iron pot such as a Le Creuset casserole dish. If you are using turkey or chicken do not use skinless breasts; the flavor is too bland. Instead use thighs or mixed pieces.

• 2 lb of grass fed beef, lamb, or organic turkey or chicken
• 1 teaspoon of salt
• 4 cups of filtered water
• 1 large bunch of kale *
• 1 large onion
• 2 cups of diced carrots
• 1-2 cups of diced vegetables of choice such as zucchini, celery or peas
• ½ cup of brown rice or quinoa (optional)
• 1 teaspoon of fresh herbs such as rosemary, thyme, or oregano

If you are using beef or lamb dice the meat into 1 inch cubes. For poultry it is fine to use whole pieces such as legs, thighs or breasts. Place all of the ingredients into a crock pot or enameled cast iron pan and mix them well. If using a crock pot turn it into high until it comes to a boil. Then reduce it to low and let it cook 8 more hours or overnight. If using and enameled pot make sure the lid is on a tight and then cook it in a 250 degree F oven for 8-12 hours. Check it periodically to make sure it hasn’t run out of water. Stir the stew, add salt if desired and serve.

* All of your vegetables should be organic if possible, especially the kale. Commercial kale has very high levels of pesticide residues.

Fortunately, there are plenty of breakfast options that are tasty, filling and energizing. For people on the go, a shake or smoothie is a great option. These drinks combine nutrient dense fruits with protein powder and super foods (see the “immune smoothie” recipe in the 10-30-11 blog post) . They are easily prepared, portable and can be sipped through the morning.

Egg or tofu “scrambles” are good choices if there are no allergies to eggs or soy. Any number of vegetables can be added for a nutritional boost. Scrambles are easy to make in large batches and can feed a a group of people at breakfast or brunch.

Leftovers from lunch or dinner are fine breakfast foods. Often these food are more balanced in protein and carbohydrates than the standard morning fare. Soups and stew are especially good because they are warm, nourishing and easy to digest.

If you are still wondering what to make, don’t despair.   Read next weeks blog for some healthy breakfast recipes.