Connection - Amazon Web Servicesdpg-storage.s3.amazonaws.com/ondpg/documents/efe6e...Also, be sure to ‘like’ us on Facebook and follow us on twitter.com@ondpg. I look forward to

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A public ation of the ON DPG ON DPG Websitew w w.oncolo gynutrit ion.org

2014 Volume 22 No. 3 ISSN 1545-9896

Oncology Nutrition

ConnectionTable of Contents

• Chairs’ Message page 1

• 2015 John Milner Nutrition and Cancer Prevention Research Practicum Now Accepting Applications page 2

• Update on Nutrition and Cancer Survivorship: Plant-based Diets page 3

• CPE Article: Plant Foods and Cancer Prevention: A Review of the Literature page 5

• Alternatives to Grilled Meat page 8

• Vegetarian and Vegan Diets After Cancer Diagnosis: Individualization is Key page 10

• A Dietitian’s Story page 12

• Meet Our Members: Kelay Trentham page 14

• Basics About Vegan and Blenderized Tube Feeding Options page 15

Speaking of projects, I would like to share with you some exciting events that ON DPG has accomplished, or that are in the works.

Earlier this year, we held our second Oncology Nutrition Symposium: Make Your Practice Shine in Orlando, FL. It was an innovative conference featuring engaging speakers, networking opportunities, and provided 15 hours of continuing education. There were over 300 in attendance including dietitians traveling from outside of the US. New this year, all presentations including synced videos, mp3 audio, and handout PDFs, are free of

charge to all registered attendees. Due to requests from those who could not attend this year’s symposium, they are also available for purchase on the DPG’s website. The symposium committee has already started planting the planning seeds for the next event, tentatively scheduled for Spring 2016.

The ON DPG Benchmarking project, which aims to show that there is a need for better nutrition staffing in cancer centers, and that having an RD involved will yield better patient outcomes, is making great strides in the direction of holding a workshop, in

Chair’s MessageWelcome ON DPG members! It is such an honor to serve as Chair of this amazing group of devoted dietitians. Six years ago, when I first joined the Executive Committee (EC) as the Development Coordinator, then as Treasurer, and finally as Chair-Elect, I would have had a hard time believing that one day, I would have the privilege of being the Chair of ON DPG. But the positive energy of this group empowered me to stay active within ON DPG and help drive the oncology nutrition field forward. During this year, I am eager to collaborate and work together on the various, wonderful projects that ON DPG has going on.

2 ❙ Oncology Nutrition Connection ❙ Summer 2014

Oncology Nutrition ConnectionA publication of Oncology Nutrition (ON), a dietetic practice group of the Academy of Nutrition and Dietetics. ISSN 1545-9896.

Visit the ON DPG website at www.oncologynutrition.org

Editor: Suzanne Dixon, MPH, MS, RDN [email protected]

Associate Editors: Robin Brannon, MS, RD, CSO [email protected]

Jodie Greear, MS, RD, LDN [email protected]

Maureen Leser, MS, RD, CSO, LD [email protected]

Jocelyne O’Brien, MPH, RDN, CSO, LDN [email protected]

Oncology Nutrition Connection (ONC) ISSN 1545-9896, is the official newsletter of the Oncology Nutrition Dietetic Practice Group (ON DPG), a practice group of the Academy of Nutrition and Dietetics, and is published quarterly. All issues of ONC are distributed to members in electronic format only.

Articles published in ONC highlight specific diseases or areas of practice in oncology nutrition. Viewpoints and statements in each newsletter do not necessarily reflect the policies and/or positions of the Academy of Nutrition and Dietetics or ON DPG.

Oncology Nutrition Connection is indexed in the Cumulative Index to Nursing and Allied Health Literature. For inquiries regarding copyright, single-issue sales and past issues, contact the editor. Individuals interested in submitting a manuscript to ONC should contact the editor or check the ON website for author guidelines. Individuals who are ineligible for membership in the Academy of Nutrition and Dietetics can order yearly subscriptions to ONC for $35.00 (domestic fee) and $40.00 (International fee), payable to the Academy of Nutrition and Dietetics/ON DPG. Institutions can subscribe to ONC for $50.00 (domestic yearly fee) and $65.00 (International yearly fee). ON DPG members have access to archived back issues in pdf format. Non-members can order printed copies of back issues (contact editor for availability) at a cost of $10.00 each if mailed domestically and $20.00 each if mailed internationally. Send requests for subscriptions or back issues to the editor. All ON DPG member mailing address changes and email address changes should be sent to the Academy using the address change card in the Journal of the Academy of Nutrition and Dietetics or at eatright.org in the members-only section.

©2014. Oncology Nutrition Dietetic Practice Group. All rights reserved.

collaboration with the Institute of Medicine (IOM). The ON DPG EC is busy fund raising to support this effort, and the workshop is tentatively scheduled for Spring 2015.

The Oncology Nutrition for Clinical Practice book, published last Fall, has proven to be a great success and is now in its second printing, while our webinars on various topics from Parenteral Nutrition to Fad Diets continue to attract hundreds of registrants.

Our newly updated website www.oncologynutrition.org has added a public side with practical information, while the member sections offers professional resources, DPG activities, and benefits.

We had a productive time at FNCE in Atlanta, where the EC held several events, including a scientific session entitled Fasting and the Ketogenic Diet: The Next Therapies for

Cancer Treatment and Prevention? presented by Valter Longo, PhD, and Leonora Renda, RDN. The speakers at our ON breakfast reception, Elaine Trujillo, MS, RDN and Ann Yaktine, PhD, RD, addressed the very exciting ON DPG – IOM Benchmarking project. Both events were very well-attended and received excellent feedback from attendees.

Also, be sure to ‘like’ us on Facebook and follow us on twitter.com@ondpg.

I look forward to a productive year and I want to thank you for your continued support. I welcome your comments and ideas on how to further strive for the best in the field of oncology nutrition. I can be reached at [email protected].

Sincerely, Andreea Nguyen

The 2015 John Milner Nutrition and Cancer Prevention Research Practicum will take place March 2 to 6, and is now accepting applications – application deadline is December 19, 2014. The Practicum will be held at the National Cancer Institute in Rockville, Maryland, the NIH Clinical Center and the USDA Beltsville Human Nutrition Center. This week-long educational offering provides specialized instruction about the role of diet and bioactive food components as modifiers of cancer incidence and tumor behavior. The intent of the Practicum is to introduce participants to research currently being conducted in the field, expose them to available research opportunities, and lay the foundation for future researchers in diet and cancer prevention.

For details about the practicum, eligibility and applying to the practicum, please go to: http://prevention.cancer.gov/news-events/events/20150302-06.The application deadline is December 19, 2014.

There is no cost to attend the Practicum. However, room, board and travel expenses are the responsibility of the participant.

CPEUs will be available to RDNs.

For additional information, please contact Elaine Trujillo at [email protected].

Oncology Nutrition Connection ❙ Volume 22 No. 3 ❙ 3

Research on cancer survivorship and diet continues to generate interest, because the growing population of cancer survivors is at increased risk for recurrence, as well as for new primary and secondary tumors, and chronic diseases such as diabetes and cardiovascular disease (1–2). Diet is a modifiable factor that studies indicate may be helpful in preventing cancer recurrence, though research suggests that cancer survivors experience difficulty following recommended diets (1–3). Cancer survivorship and nutrition is an area in which registered dietitians (RDs) can make a significant contribution in educating and supporting healthy lifestyle changes in this at-risk population.

Factors such as physical activity, tobacco use, and weight and body mass index (BMI) can affect cancer incidence and survivorship. Dietary factors, particularly vegetarianism, also can have an effect on both incidence and survival (3–5). Though much remains to be examined in the survivorship field, studies historically have shown a strong correlation between vegetarian diets and overall incidence of cancer, and experts have concluded that a plant-based diet offers a degree of protection against the development of cancer (6). In a recent meta-analysis of seven studies including a total of 124,706 subjects, vegetarians experienced an 18% lower cancer incidence compared with non-vegetarians (95% CI, 0.67-0.97) (4). Vegetarian diets continue to be identified as healthy alternatives to meat-containing diets. For example, a 2013 cohort study found mean BMI was lowest among pescatarians and vegetarians. Compared with people following other dietary patterns, the vegetarians and pescatarians consumed the most fruit, vegetables, dried beans, grains, nuts and seeds, soy products, and dairy

products, and had higher intakes of fiber, and micronutrients including vitamin A, B2, C, E, beta-carotene, calcium, folate and phosphorus (7). A plant-based diet appears to reduce cancer incidence; studies show it also plays a role in healthy survivorship and reducing risk of recurrence post-diagnosis (2).

Guidelines for cancer survivors include consuming a diet rich in fruit, vegetables, and whole grains while limiting red meat, processed meat and alcohol (5). Cancer survivors struggle, like many patients, with adhering to dietary recommendations. The National Health and Nutrition Examination Survey, 2003-2006 revealed that the diet of breast cancer survivors was not significantly different than the diet of women with no cancer history (8). More than 90% of both study groups did not meet the recommendations for fruit, vegetable and whole grain intake (8). Another recent study produced similar findings, demonstrating survivors are no more likely than those without a history of cancer to engage in preventive lifestyle behaviors, including following a healthy diet (1). Further, just half of cancer survivors, 65 years and older, consumed at least five servings of fruits and vegetables per day (1). While 50% may be a higher proportion compared with the general population, it still falls far short of the goal of having all cancer survivors follow this basic healthy-eating principle. Making positive changes in health behaviors, particularly dietary patterns, may be effective for prolonging life after a diagnosis of cancer, and efforts should be targeted towards promoting a healthy diet in this population (1–3,9).

Breast CancerThere is increasing evidence that diets high in plant foods and unsaturated fats may be

Update on Nutrition and Cancer Survivorship: Plant-based DietsGinger Hultin, MS, RD, LDN

This article was developed and reviewed collaboratively by the Oncology Nutrition (ON) and Vegetarian Nutrition (VN) Dietetic Practice Groups


beneficial for breast cancer survivorship. One large study of women diagnosed with invasive breast cancer in the Women’s Health Initiative’s Dietary Modification Trial showed that women consuming a better quality diet post-diagnosis had 26% lower risk of all-cause mortality (P trend = 0.043)(9). In this study, diet quality was evaluated using 2005 Healthy Eating Index scores (10). Another large study of similar design analyzed the association between dietary patterns and breast cancer survival in Germany and found comparable results, indicating that a “healthy” diet with high intakes of vegetables, fruits, vegetable oil, sauces/condiments and soups/bouillon may reduce the risk of overall mortality (P trend=0.02) and recurrence (P trend=0.02), compared to an “unhealthy” diet with high intakes of red and processed meats and fried foods (11).

The relationship between dietary fat and breast cancer post-diagnosis is important to consider. A recent meta-analysis attempting to summarize current evidence on post-diagnosis dietary fat intake found a low-fat diet reduced breast cancer recurrence risk by 23% (P=0.009), and all-cause mortality by 17% (P=0.05); the study authors concluded a lower fat intake may improve breast cancer survivorship (12). Follow-up research of women participating in the Life After Cancer Epidemiology Study indicated that women consuming the most high-fat dairy had higher breast cancer mortality (P trend = 0.05), all-cause mortality (P trend < 0.001) and non-breast cancer mortality (P trend = 0.007) compared with women consuming low-fat dairy and with women consuming a mix of dairy types (13). RDs should advise breast cancer survivors to select a diet low in fat, red and processed meats, and fried foods, and high in fresh produce and minimally-processed plant foods.

Colorectal CancerStudies of meat consumption vs. a vegetarian diet, and the impact of these dietary patterns on colorectal cancer incidence and survivorship continue to be studied. Recent research confirms that red and processed meats are convincingly


associated with colorectal cancer, particularly pre-diagnosis, possibly because these foods are pro-inflammatory and pro-carcinogenic (14–17). As a follow-up to American cohort studies showing these trends, the European Prospective Investigation into Cancer and Nutrition (EPIC) also found that the association for all-cause mortality remained a significant factor for both red (HR=1.14, 95% CI, 1.01-1.28) and processed (HR=1.44, 95% CI, 1.24-1.66) meat (17). A recent review of the literature suggests red and processed meats influence colorectal cancer recurrence and mortality in survivors (16). Fiber appears to be inversely related to colorectal cancer risk, and vegetarian diets are typically higher in fiber than nonvegetarian diets (6,15). Therefore, decreased meat consumption and increased dietary fiber may help improve colorectal cancer survivorship.

Prostate CancerDiet has been identified as a modifiable risk factor for prostate cancer as well, with early research indicating increased risk associated with saturated fat from animal sources including dairy, and red and processed meats; reduced risk is associated with consumption of fruit (2). Whole grain foods, fatty fish, and vegetables including lycopene-containing foods, and phytoestrogens, have been shown to be protective (18). Alarmingly, studies show that prostate cancer survivors struggle with a low adherence to the American Cancer Society’s recommendations of five servings of fruits and vegetables per day; an estimated 28% of prostate cancer survivors meet this goal (18–19). Approximately 35% of men treated for prostate cancer are expected to experience recurrence within 10 years of treatment related to their initial diagnosis (20). Given that research on diet and prostate cancer incidence supports the adoption of a plant-based diet, nutrition interventions delivered by an RD who is a certified specialist in oncology nutrition (CSO) is important for improving survivorship.

As with breast cancer, dietary fat has been a topic of much interest for prostate cancer. In a large, prospective study, the intake of saturated fat (P=0.02) and trans-fat (P=0.01) after diagnosis were associated with higher all-cause mortality in prostate cancer patients (21). Another randomized trial analyzing diet, physical activity, and stress reduction in prostate cancer survivors with recurrent disease found that increased fruit consumption and a reduced saturated fat intake were associated with maintaining stable prostate-specific antigen (PSA) concentrations in patients (20).

SummaryDespite a growing body of evidence indicating the importance of lifestyle factors for reducing cancer-related and all-cause mortality, studies show that cancer survivors, like the general population, need support to make and maintain positive lifestyle changes. As research continues to demonstrate the positive influence of a diet low in animal fats, and high in fruits, vegetables, fiber and antioxidants, as well as the benefit of physical activity and a healthy body weight, RDs will be an increasingly important part of the cancer-care team. They are ideally positioned to support positive lifestyle changes and educate patients on potential benefits of a plant-based diet after a cancer diagnosis.

Ginger Hultin is a Chicago-based RD and freelance writer who believes in an unprocessed, plant-based diet. She recently completed two years as the Illinois State Vegetarian Nutrition DPG State Coordinator. She currently serves as President for the Chicago Academy of Nutrition and Dietetics and works at the Block Center for Integrative Cancer Treatment. You can find her @GingerhultinRD and on her blog becomingginger.blogspot.com.

References 1. Miller PE, Morey MC, Hartman TJ, et al.

Dietary patterns differ between urban and rural older, long-term survivors of breast, prostate, and colorectal cancer and are associated with body mass index. J Acad Nutr Diet. 2012;112(6):824–831.

2. Rock CL, Doyle C, Demark-Wahnefried W, et al. Nutrition and Physical Activity for Cancer Survivors. CA Cancer J Clin. 2013;63(3):215.

3. Inoue-Choi M, Robien K, Lazovich D. Adherence to the WCFR/AICR guidelines for cancer prevention is associated with lower mortality among older female cancer survivors. Cancer Epidemiol Biomarkers Prev. 2013;22(5):792–802.

4. Huang T, Yang B, Zheng J, Li G, Wahlgyist ML, Li D. Cardiovascular disease mortality and cancer incidence in vegetarians: a meta-analysis and systematic review. Ann Nutr Metab. 2012;60(4):233–40.

5. National Cancer Institute. Nutrition and Survivorship. http://www.cancer.gov/cancertopics/pdq/supportivecare/nutrition/HealthProfessional/page5. Published February 2014. Accessed April 9, 2014.

6. Tantamango-Bartley Y, Jaceldo-Siegl K, Fan J, Fraser G. Vegetarian diets and the incidence of cancer in a low-risk population. Cancer Epidemiol Biomarkers Prev. 2013;22(2): 286–94.

7. Gilsing AMJ, Weijenberg MP, Goldbohm RA, Dagnelie PC, Van Den Brandt PA, Schouten LJ. The Netherlands Cohort Study – Meat Investigation Cohort; a population-based cohort over-represented with vegetarians, pescatarians, and low meat consumers. Nutr J. 2013;12:156. http://www.nutritionj.com/content/12/1/156. Published November 29, 2013. Accessed April 9, 2014.

8. Milliron BJ, Vitolins MZ, Tooze JA. Usual dietary intake among female breast cancer survivors is not significantly different from women with no cancer history: results from the National Health and Nutrition Examination Survey, 2003-2006. J Acad Nutr Diet. 2014; 114(6):932–937.

9. George SM, Ballard-Barbash RD, Shikany JM, et al. Better postdiagnosis diet quality is associated with reduced risk of death among postmenopausal women with invasive breast cancer in the Women’s Health Initiative. Cancer Epidemiol Biomarkers Prev. 2014; 23(4):575–583.

10. USDA. Center for Nutrition Policy and Promotion. Healthy Eating Index. http://www.cnpp.usda.gov/publications/hei/healthyeatingindex2005factsheet.pdf. Published December 2006. Revised June 2008. Accessed April 2014.



Cancer is the second leading cause of death in the United States, with over half a million lives lost each year to the disease (1). Significant efforts have been made to fight cancer over the past several decades, yet we are far from curing it. Cancer in each organ and each individual behaves very differently, and the success in treating various types of cancer has been uneven. Improvements in screening, anti-smoking campaigns, and increased knowledge about appropriate use of hormone replacement therapy have reduced the incidence of cancers of the colon, lung, and breast, but the incidence continues to increase for cancers of the esophagus, liver, pancreas, kidney, and other tumor types (2). Further, it is troubling that the incidence of many types of cancer could be much lower than they currently are in the U.S. Not only is the incidence of some cancers increasing despite clinical advancements, many countries with significantly less healthcare-related spending have significantly lower cancer incidence. For example, the incidence of prostate cancer is 23 times higher in the United States than it is in India, while colorectal and kidney cancers are about 10 times higher in the U.S. (3–4). Breast cancer incidence is about 4 times higher in the U.S. and Western Europe than it is in eastern Africa and parts of Asia (4–5). Why is there such a big difference? Does the Western medical model overlook important, modifiable factors, or are these comparisons unfair because of other confounders?

Although there are concerns about potentially lower cancer diagnosis rates in developing countries, evidence from well-controlled studies sheds light on the links between diet and cancer. Some case-

control studies have reported an association between “Western” style diets high in processed foods and fat and cancers of the colon and breast (6–7); other studies have shown no association with cancers of the stomach and breast (8–9). These results raise questions about the effect of Western diets on cancer incidence, but it is important to consider other dietary differences between developed and less-developed countries. Rates of meat consumption are increasing in many developing countries, in some cases approaching Western levels of intake, and the incidence of colorectal cancer in these areas is increasing as well (10). Indeed, the World Cancer Research Fund and the American Institute for Cancer Research (WCRF/AICR) analyzed dozens of scientific studies on diet and cancer, and concluded that red meat and processed meat “convincingly” increase the risk of colorectal cancer, and are “suggestive” for increasing risk of six other cancer types (11). The thorough report also concluded that non-starchy vegetables, allium and other vegetables, and fruit are “probable” factors that decrease cancer risk (12). They found no evidence that natural plant foods increase the risk of cancer, except possibly for chilies (12). These conclusions are supported by international cancer data. Countries with the highest proportions of vegetarians, such as India, have among the lowest rates of cancer (4).

If a plant-based diet is good for reducing cancer risk, what specific plant foods might be the best? The biological mechanisms underlying different types of cancer vary, so there is no one food that can be a cure-all. However, recent evidence provides insight

CPE Article: Plant Foods and Cancer Prevention: A Review of the Literature. Benjamin White, PhD


11. Vrieling A, Buck K, Seibold P, et al. Dietary patterns and survival in German postmenopausal breast cancer survivors. Brit J Cancer. 2013;108(1):188–192.

12. Xing MY, Xu SZ, Shen P. Effect of low-fat diet on breast cancer survival: a meta-analysis. Asian Pac J Cancer Prev. 2014;15(3):1141–1144.

13. Kroenke CH, Kwan ML, Sweeney C, Castillo A, Caan BJ. High- and low-fat dairy intake, recurrence, and mortality after breast cancer diagnosis. J Natl Cancer Inst. 2013;105(9): 616–623.

14. McCullough ML, Gapstur SM, Shah R, Jacobs EJ, Campbell PT. Association between red and processed meat intake and mortality among colorectal cancer survivors. J Clin Oncol. 2013; 31(22):2773–2782.

15. Zhu Y, Wu H, Wang PP, et al. Dietary patterns and colorectal cancer recurrence and survival: a cohort study. BMJ Open. 2013;3:e002270.

16. Bazzan AJ, Newberg AB, Cho WC, Monti DA. Diet and nutrition in cancer survivorship and palliative care. Evid Based Complement Alternat Med. 2013;2013:917647. doi: 10.1155/2013/917647. Epub 2013 Oct 30.

17. Rohmann S, Overvad K, Bueno-de-Mesquita HB, et al. Meat consumption and mortality—results from the European Prospective Investigation into Cancer and Nutrition. BMC Med. 2013;11:63. http://www.biomedcentral.com/1741-7015/11/63. Published March 7, 2013. Accessed April 9, 2014.

18. Carmody JF, Olendzki BC, Merriam PA, Liu Q, Qiao Y, Ma Y. A novel measure of dietary change in a prostate cancer dietary program incorporating mindfulness training. J Acad Nutr Diet. 2012;112(11):1822–1827.

19. American Cancer Society. It’s easy to add fruits and vegetables to your diet. http://www.cancer.org/healthy/eathealthy getactive/eathealthy/add-fruits-and-veggies-to-your-diet. Published October 16, 2013. Accessed April 9, 2014.

20. Hebert JR, Hurley TG, Harmon BE, Heiney S, Hebert CJ, Steck SE. A diet, physical activity, and stress reduction intervention in men with rising prostate-specific antigen after treatment for prostate cancer. Cancer Epidemiol. 2012;36(2):e128–136.

21. Richman EL, Kenfield SA, Chavarro JE, et al. Fat intake after diagnosis and risk of lethal prostate cancer and all-cause mortality. JAMA Intern Med. 2013;173(14):1318–1326.


into which foods may most effectively reduce the risk of specific cancers.

Esophageal CancerThe 5-year survival rate for esophageal cancer is low, ranging from approximately 4 to 40% (13), and it is often treated with aggressive surgery that impairs quality of life (14–15). Radiation and chemotherapy also can have serious side effects. But, how about strawberries? A randomized trial demonstrated that 60 grams (~2 oz.) of freeze-dried strawberries, given orally daily for six months to patients not currently receiving any additional cancer treatment, was sufficient to reverse precancerous esophageal lesions in 80% of the subjects (16). Physiological markers of pre-malignancy also declined significantly. Dietary therapy holds especially great promise because esophageal cancer incidence is increasing (2).

CurcuminSome foods have been used as medicine for thousands of years, but science is still discovering new benefits. Curcumin, as a major component of turmeric, historically has been used to treat biliary disorders, anorexia, and other ailments, but recent evidence is uncovering its potential role in preventing cancer as well (17). Curcumin appears to inhibit multiple stages of cancer growth and development, and could be a factor in low cancer rates in countries with high turmeric consumption (18). Studies investigating curcumin’s action on human cell lines have shown that it suppresses the transformation of normal cells into tumor cells by blocking activation of pro-inflammatory transcription factors (18–19). It stops proliferation of tumor cells by inhibiting expression of oncogenes and growth factors, and it helps prevent metastases by blocking over-expression of cytokines and adhesion molecules (17, 19). Curcumin also is an antioxidant, and may help prevent mutagens from damaging DNA. Currently, it cannot be used as an effective clinical treatment because of its low bioavailability, though researchers are working on improving absorption and efficacy (19).

Prostate CancerProstate cancer has the highest incidence of any cancer in the U.S., and its incidence is expected to increase worldwide (20). Cranberry extracts have been shown to significantly impair the growth of human breast, brain, oral, and ovarian cancers in cell lines in vitro (21). Recent research suggests that cranberries may be effective for preventing the growth of prostate tumors. Although not tested in humans specifically for this purpose, cranberry extract was shown to arrest the growth of human prostate cancer cells in vitro by altering the expression of regulatory proteins (22). Importantly, the anthocyanins thought to be responsible for much of the antiproliferative effect remain in small quantities in the blood and urine after drinking cranberry juice (23). Whole, unprocessed cranberries may have much more anti-cancer potential than isolated anthocyanins though (24), and are a better source than juice or canned sauce, both of which are high in sugar (25).

Pancreatic, Colorectal, Kidney, and Bladder CancersStudies that expand our knowledge of how natural plant foods combat cancer continue to be published. Recent science indicates that nut consumption is linked to a decreased risk of pancreatic cancer. Researchers followed over 75,000 women, and found that lowered risk remained even after adjusting for several lifestyle, dietary, and anthropometric factors (26). In other research, phytic acid, present in many foods, including bran and beans, has been shown to induce apoptosis (programmed cell death) in human colorectal cancer cells in vitro (27). A study of nearly half a million Americans found that high dietary fiber intake (found only in plant foods), was associated with a reduced risk of kidney cancer (28). Individuals with the highest intake of refined grains, on the other hand, had an increased risk of kidney cancer (28). Finally, a study of more than 469,000 Europeans who were followed for more than 11 years found increased consumption

of animal foods was associated with an increased risk of urinary bladder cancer; increased plant food consumption was associated with a lower risk after adjusting for other potential confounders (29).

Whole Food ApproachWhile many of the mechanisms underlying plants’ anti-cancer properties are still under investigation, considerable progress is being made in understanding how plants may improve health. While it is tempting to conclude that researchers will isolate the compounds responsible for fighting cancer and deliver them to us in pill form, there is evidence that whole foods confer significant benefits, with lower risk of harm. For example, antioxidants are known to help protect and repair our DNA from the damaging effects of reactive molecules (30), and companies are eager to sell antioxidant supplements that claim to deliver the benefits of a healthy diet without the effort. However, plant foods rich in antioxidants have been shown to reduce cancer risk (30–31), while antioxidant supplements have often proved ineffective, and may actually increase mortality for some cancers (32).

SummaryWhatever the precise mechanisms, it appears that whole plant foods, along with physical activity and a healthy lifestyle, are important components for reducing the risk of most types of cancer, as well as other chronic diseases. Perhaps the medical community and our society as a whole should reconsider our priorities in our war on cancer. While health care costs in the U.S. are high and rising, fruits and vegetables are a comparatively inexpensive way to improve health and reduce disease risk. Technological advances in medical treatment may help us treat more cancers with pharmaceuticals, radiation, and invasive surgery. Indeed, these forms of treatment remain critical in cancer care. Yet, a diet rich in fruits and vegetables continues to be the safest, most enjoyable way to ward off cancer, and will continue to be an essential part of cancer prevention well into the future.


Ben White has a PhD in neuroscience from Brandeis University, and is currently pursuing an MPH-RD degree at the University of North Carolina at Chapel Hill. He is working part-time on research that uses 24-hour food recalls and a food frequency questionnaire to assess dietary patterns in cancer survivors. In his free time, he enjoys running, traveling, and cooking different foods from around the world. In addition to cancer prevention through a vegetarian diet, he is interested in the contribution of the food environment to obesity and science education.

References 1. Centers for Disease Control and Prevention/

National Center for Health Statistics. Leading Causes of Death. FastStats Web site. http://www.cdc.gov/nchs/fastats/lcod.htm. Updated December 20, 2013. Accessed April 4, 2014.

2. American Cancer Society. Cancers with Increasing Incidence trends in the US: 1999-2008: Cancer Facts & Figures 2012 Special Section. http://www.cancer.org/research/cancerfactsstatistics/cancer-facts-figures-2012-special-section. Published 2014. Accessed April 4, 2014.

3. Hutchins-Wolfbrandt A, Mistry AM. Dietary turmeric potentially reduces the risk of cancer. Asian Pac J Cancer Prev. 2011; 12(12):3169–3173.

4. Bengmark S, Mesa MD, Gill A. Plant-derived health: the effects of turmeric and curcuminoids. Nutr. Hosp. 2009;24(3): 273–281.

5. World Health Organization. Breast cancer: prevention and control. http://www.who.int/cancer/detection/breastcancer/en/index1.html. Published 2014. Accessed April 4, 2014.

6. Ronco AL, De Stefani E, Boffetta P, et al. Food patterns and risk of breast cancer: a factor analysis study in Uruguay. Int J Cancer. 2006; 119(7):1672–1678.

7. Slattery ML, Boucher KM, Caan BJ, et al. Eating patterns and risk of colon cancer. Am J Epidemiol. 1998;148(1):4–16.

8. Kim MK, Sasaki S, Sasazuki S, et al. Prospective study of three major dietary patterns and risk of gastric cancer in Japan. Int J Cancer. 2004;110(3):435–442.

9. Terry P, Hu FB, Hansen H, et al. Prospective study of major dietary patterns and colorectal cancer risk in women. Am J Epidemiol. 2001;154:1143–1149.

10. Kim E, Coelho D, Blachier F. Review of the association between meat consumption and risk of colorectal cancer. Nutr Res. 2013; 33(12):983–994.

11. World Cancer Research Fund/American Institute for Cancer Research. Food, Nutrition, Physical Activity, and the Prevention of Cancer: a Global Perspective. Washington DC: AICR, 2007;116–128.

12. World Cancer Research Fund/American Institute for Cancer Research. Food, Nutrition, Physical Activity, and the Prevention of Cancer: a Global Perspective. Washington DC: AICR, 2007;75–115.

13. The American Cancer Society. Esophagus Cancer. Survival Rates for Cancer of the Esophagus by Stage. http://www.cancer.org/cancer/esophaguscancer/detailedguide/esophagus-cancer-survival-rates Published 2014. Accessed April 4, 2014.

14. Polednak AP. Trends in survival for both histologic types of esophageal cancer in US surveillance, epidemiology and end results areas. Int J Cancer. 2003;105(1):98–100.

15. Headrick JR, Nichols FC, Miller DL, et al. High-grade esophageal dysplasia: long-term survival and quality of life after esophagectomy. Ann Thorac Surg. 2002;73(6):1697–1703.

16. Chen T, Yan F, Qian J, et al. Randomized phase II trial of lyophilized strawberries in patients with dysplastic precancerous lesions of the esophagus. Cancer Prev Res (Phila). 2012; 5(1):41–50.

17. Shishodia S. Molecular mechanisms of curcumin action: gene expression. Biofactors. 2013;39(1):37–55.

18. Kim JH, Gupta SC, Park B, Yadav VR, Aggarwal BB. Turmeric (Curcuma longa) inhibits inflammatory nuclear factor (NF)-kB and (NF)-kB-regulated gene products and induces death receptors leading to suppressed proliferation, induced chemosensitization, and suppressed osteoclastogenesis. Mol Nutr Food Res. 2012;56(3):454–465.

19. Park W, Amin ARMR, Chen ZG, Shin DM. New perspectives of curcumin in cancer prevention. Cancer Prev Res(Phila). 2013;6(5):387–400.

20. U.S. Cancer Statistics Working Group. United States Cancer Statistics: 1999–2010. Incidence and Mortality Web-based Report. Atlanta: U.S. Department of Health and Human Services, Centers for Disease Control and Prevention and National Cancer Institute. http://apps.nccd.cdc.gov/uscs/toptencancers.aspx. Published 2013. Accessed April 4, 2014.

21. Neto CC. Cranberries: ripe for more cancer research? J Sci Food Agric. 2011;91(13): 2303–2307.

22. Déziel B, MacPhee J, Patel K, et al. American cranberry (Vaccinium macrocarpon) extract affects human prostate cancer cell growth via cell cycle arrest by modulating expression of cell cycle regulators. Food Funct. 2012;3(5): 556–564.

23. Milbury PE, Vita JA, Blumberg JB. Anthocyanins are bioavailable in humans following an acute dose of cranberry juice. J Nutr. 2010;140(6):1099–1104.

24. Seeram NP, Adams LS, Hardy ML, Heber D. Total cranberry extract versus its phytochemical constituents: antiproliferative and synergistic effects against human tumor cell lines. J Agric Food Chem. 2004;52(9): 2512–2517.

25. Grace H, Massey AR, Mbeunkui F, Yousef GG, Lila MA. Comparison of health-relevant flavonoids in commonly consumed cranberry products. J Food Sci. 2012; 77(8):H176–183.

26. Bao Y, Hu FB, Giovannucci EL, et al. Nut consumption and risk of pancreatic cancer in women. Br J Cancer. 2013;109(11):2911–2916.

27. Shafie NH, Esa NM, Ithnin H, Saad N, Pandurangan AK. Pro-apoptotic effect of rice bran inositol hexaphosphate (IP6) on HT-29 colorectal cancer cells. Int J Mol Sci. 2013; 14(12):23545–23558.

28. Daniel CR, Park Y, Chow WH, Graubard BI, Hollenbeck AR, Sinha R. Intake of fiber and fiber-rich plant foods is associated with a lower risk of renal cell carcinoma in a large US cohort. Am J Clin Nutr. 2013;97(5): 1036–1043.

29. Allen NE, Appleby PN, Key TJ, et al. Macronutrient intake and risk of urothelial cell carcinoma in the European Prospective Investigation into Cancer and Nutrition. Int J Cancer. 2013;132(3):635–644.

30. Percival SS, Vanden Heuvel JP, Nieves CJ, Montero C, Migliaccio AJ, Meadors JJ. Bioavailability of herbs and spices in humans as determined by ex vivo inflammatory suppression and DNA strand breaks. J Am Coll Nutr. 2012;31(4):288–294.

31. Serafini M, Jakszyn P, Luján-Barroso L, et al. Dietary total antioxidant capacity and gastric cancer risk in the European Prospective Investigation into Cancer and Nutrition Study. Int J Cancer. 2012;131(4):E544–554.

32. Bjelakovic G, Nikolova D, Simonetti RG, Gluud C. Antioxidant supplements for prevention of gastrointestinal cancers: a systematic review and meta-analysis. Lancet. 2004;364(9441): 1219–1228.


As the sun shines, grilling outdoors becomes a popular past time. However, consumption of grilled meat should be decreased to reduce overall cancer risk. We can power up with plant-based meals and try a variety of vegetables as an alternative to grilling meat. Plant protein sources such as tofu, tempeh and plant-based burgers can replace traditional meats as well.

Red meat including beef, pork, and lamb contain heme iron, which has been related to cellular damage and can stimulate the production of N-nitroso compounds, which may in turn increase cancer risk (1). These foods also tend to be calorie-dense (2). If consumed, aim to keep your portions small—three ounces per meal or less, eaten no more than six times per week, or no more than 18 ounces total per week (3).

Furthermore, the American Institute for Cancer Research (AICR) recommends avoiding processed meats such as ham, bacon, hot dogs, sausages and deli meats (1). Carcinogens can be formed in meat preserved by smoking, curing, salting or with added preservatives (1). Nitrates are added to many processed meats, and may damage the lining of the gut (2). Additionally, cooking animal foods at high temperatures can produce carcinogens, including heterocyclic amines (HCAs) and polycyclic aromatic hydrocarbons (PAHs), both of which may increase colon cancer risk (1–2).

Eating a well-balanced diet can provide adequate nutrients to prevent and fight cancer. Consuming a mostly plant-based diet plays a protective role, and may

Alternatives to Grilled MeatRenee Pieroth, RD, CSO, LDN


inactivate damaging compounds. Plant foods are low in calories, but nutrient dense and therefore can help with weight maintenance as well.

Also, consider beverage choices. The World Cancer Research Fund and American Institute for Cancer Research (WCRF/AICR) Second Expert Report, Food, Nutrition, Physical Activity, and the Prevention of Cancer: a Global Perspective recommends avoiding sugary drinks, and if alcohol is consumed, limiting it to no more than two drinks per day for men and one drink daily for women (1). A chilled soup such as cucumber-dill or gazpacho can be a refreshing addition to a meal. Fruit-infused water made by adding sliced lemons, limes, oranges, cucumber or berries, and using herbs and spices such as mint, basil, rosemary, sage, thyme, lavender or ginger, can enhance taste and provide healthful nutrients and electrolytes.

The Nutrition team at Cancer Treatment Centers of America® (CTCA) partners closely with the Culinary team to optimize patients’ nutritional status. Try these plant-based recipes on the grill.

Renee Pieroth, RD, CSO, LDN is a Clinical Oncology Dietitian at the Cancer Treatment Centers of America.

References 1. World Cancer Research Fund, American Institute for Cancer Research. Food, Nutrition, Physical Activity, and the Prevention of Cancer: a Global Perspective.

Washington DC: AICR, 2007. 2. American Institute for Cancer Research. Colorectal cancer: learn about colorectal cancer. http://www.aicr.org/learn-more-about-cancer/colorectal-cancer/

#prevention. Updated August 5, 2013. Accessed April 2, 2014. 3. American Institute for Cancer Research. Food, physical activity, weight and colon cancer: stopping cancer series. Washington, DC; 2003. Updated 2010.

Images used with permission by the Academy of Nutrition and Dietetics.


Eggplant Roulade Yields 4 Portions

Ingredients1 large eggplant2 tablespoons extra virgin olive oil2 teaspoons salt2 teaspoons black pepper1 garlic clove, minced1 red onion, small diced2 red bell peppers, small diced2 cups ricotta cheese (or 1 block of 14 ounces firm tofu, drained)1 bunch fresh Italian parsley, minced½ cup of homemade or store-bought basil pesto

Preparation 1. Slice off the top and bottom of the eggplant. Slice eggplant lengthwise into large strips,

roughly 1/8 inch thick. Discard end pieces. 2. Using 1 tablespoon olive oil, brush the eggplant slices on each side. Season with 1 teaspoon salt

and 1 teaspoon pepper. 3. Over a hot grill, cook each eggplant slice 2-3 minutes each side. Remove from grill and reserve. 4. In a medium skillet, heat 1 tablespoon oil over medium heat. Add garlic and cook, frequently

stirring, for 30 seconds. Add onions and peppers. Again cook, frequently stirring, for 4-5 minutes until onions are translucent.

5. The vegetable mixture will be slightly moist. Drain onto paper towels and reserve. 6. In a medium bowl, fold together the ricotta cheese (or tofu), vegetables, parsley

(reserve 1 tablespoon), and remaining salt and pepper. 7. Lay eggplant slices out on a clean work surface. Dividing equally among all slices,

spread ¼ cup of the pesto. 8. Add ¾ cup of the cheese (or tofu) mixture onto each slice of eggplant. 9. Roll each slice into a roulade, leaving the seam on the bottom, and place in a baking dish.

Be careful not to allow the cheese (or tofu) mixture to come out of the sides.10. In a 350 degree oven, bake the roulades for 12-15 minutes.11. Place each roulade on 1 of 4 plates. Drizzle remaining pesto around each plate, garnish with

reserved parsley and serve.

Grilled Vegetable Flatbread with Goat Cheese Yields 4 Portions

Ingredients¼ cup all-purpose flour9 ounces pizza dough, homemade or store-bought2 tablespoons extra virgin olive oil1 red onion, julienned1 garlic clove, minced1 bunch of asparagus, ends removed, cut into 1 inch pieces1 cup of cherry tomatoes, cut in half lengthwise1 teaspoon salt1 teaspoon black pepper4 ounces soft goat cheese (optional) 4 ounces fresh arugula1 tablespoon balsamic vinegar

Preparation 1. Spread flour over a clean work surface. Roll out dough into a rectangle ¼ inch thick. 2. Brush each side of dough with the olive oil, reserve 1 tablespoon. 3. Carefully place dough on a hot grill. Let cook for 2-3 minutes, carefully flip the dough and

cook for another 2 minutes. Remove dough to a sheet tray and allow to cool. 4. In a small bowl, toss onions, garlic, asparagus, and tomatoes with the remaining olive oil,

salt and pepper. 5. Spoon mixture over the flatbread from edge to edge. 6. (Optional) Divide goat cheese evenly around the flatbread. 7. On a baking sheet, bake the flatbread in a 375 degree oven for 7-9 minutes. 8. Remove from oven, garnish with fresh arugula and balsamic vinegar. 9. Cut into squares, roughly 4 inches and serve.

Stuffed Grilled Portobello Mushrooms Yields 4 portions

Ingredients4 Portobello mushrooms, stems and gills removed2 tablespoons extra virgin olive oil1 tablespoons balsamic vinegar1 teaspoon salt1 teaspoon black pepper2 Spanish onions, julienned8 ounces fresh baby spinach4 large eggs (optional)4 ounces feta cheese crumbled (or vegan cheese)2 tablespoons chives, minced

Preparation 1. Marinate clean Portobello mushrooms with 1 tablespoon olive oil, 1 tablespoon balsamic

vinegar, ½ teaspoon each of salt and pepper. Refrigerate for 2 hours. 2. On a hot grill, cook mushrooms for 4-5 minutes a side, until lightly caramelized and tender. 3. In a medium skillet, heat remaining tablespoon of olive oil over medium high heat. When oil is

hot, add onions and cook until caramelized stirring every 4 minutes. This will take 12-15 minutes. 4. Once onions are caramelized, add spinach and sauté until just wilted. Season mixture with

remaining salt and pepper and set aside. 5. (Optional) In a nonstick pan, cook eggs sunny-side up. 6. Place one mushroom on each of four plates, cap side down. Equally distribute onion mixture

inside each mushroom until all mixture is used. 7. Equally distribute feta (or vegan) cheese onto each mushroom. 8. (Optional) Place one egg onto each mushroom (Alternatives: place mushroom over a quinoa

salad or in a whole wheat bun). 9. Garnish with fresh chives.


A diagnosis of cancer is a “game changer” for many. People who have never before considered making lifestyle changes will, upon learning they have cancer, begin searching for ways to improve their health, increase the chance of being cured, and prevent cancer recurrence. Quite often, this takes the form of trying new dietary regimens. Books such as The China Study (1) and Crazy, Sexy Cancer, (2) and the movie Forks Over Knives (3) espouse the virtues of vegan diets in the prevention and management of cancer and other chronic diseases. Influenced by these claims, some cancer patients start treatment determined to become vegetarian or vegan overnight. Other patients may have been following a vegetarian or vegan diet for some time before diagnosis. In both cases, patients following a vegetarian, and in particular a vegan diet during cancer treatment will benefit from expert nutritional counseling and guidance.

At cancer diagnosis, patients and caregivers often begin searching for any and all approaches to effect a cure. Some patients are notably fearful of conventional treatments, instead seeking “natural” treatment options, while those who do elect to have surgery, and/or receive chemotherapy, and/or radiation therapy may simply wish to employ dietary measures to complement their treatment. Evidence of benefit of following a vegetarian or vegan diet during, or in lieu of, conventional treatments is limited. Ornish and colleagues studied the effect of lifestyle changes—one of which included following a vegan diet—in men with low-grade prostate cancer who elected to forgo conventional treatment (4). Researchers found significant decreases in prostate specific antigen and decreased growth of prostate cancer cells exposed to the serum of men from the intervention

group. Further follow-up of this population demonstrated that men who made comprehensive lifestyle changes, including following a vegan diet, had significantly improved relative length of telomeres compared with controls (5). While this is a biomarker finding, and does not prove a vegan diet improves survival in men with prostate cancer, it suggests the diet and other lifestyle changes had a positive effect on health: telomere shortness in human beings is a marker of aging, disease, and premature morbidity. However, the long-term impact of lifestyle changes on prostate cancer progression has yet to be determined, and unlike prostate cancer, most tumor types cannot be managed with a “watchful waiting” protocol. Only low-grade, apparently non-aggressive prostate tumors are appropriate for this type of approach.

Other proposed dietary regimens for the treatment of cancer include: Alkaline diet, Budwig diet, Gerson Therapy, the Gonzalez regimen, Livingston-Wheeler therapy, Macrobiotics and the Raw Foods (or Living Foods) diet, which may or may not be nutritionally adequate and appropriate for an individual in active cancer treatment. Of these, the Budwig Diet, Gerson Therapy, Livingston-Wheeler therapy and Raw Foods regimens typically advise a vegetarian or vegan diet. The Alkaline diet limits meat and dairy to no more than 20% of intake, and Macrobiotic diets may be vegan or include fish (6,7). The Gonzalez dietary regimen is individualized and ranges from vegan to significant consumption of red meat (6). Many of these regimens also include the use of vitamin and mineral supplements, pancreatic enzymes, hormones, coffee enemas and/or vaccines (6). No randomized, controlled clinical trials have been published in support of these

Vegetarian and Vegan Diets After Cancer Diagnosis: Individualization is KeyKelay Trentham, MS, RDN, CSO


regimens. One non-randomized clinical trial demonstrated longer survival time and better quality of life in individuals receiving conventional chemotherapy compared with patients undergoing the Gonzalez regimen, (6) suggesting the regimen was ineffective. Nutritional needs of cancer patients vary considerably by disease type, and depend on stage of disease, short- and long-term prognoses, and planned course of treatment. Patients with head and neck, gastrointestinal (including pancreatic), and lung cancer are at greatest risk of malnutrition and weight loss, which has been shown to impact tolerance to, and effectiveness of, cancer treatment (8). For these patients, the clinician’s role is to promote adequate nutritional intake and minimize weight loss while minimizing treatment toxicities, treatment breaks, and/or dose-reductions—all of which can decrease long-term survival (8).

Conversely, obesity at diagnosis, and/or weight gain during or after treatment are detrimental for individuals with other tumor types. Overweight and obese prostate cancer patients have higher mortality and recurrence rates compared with normal weight patients (9), and weight gain post-prostatectomy is associated with increased recurrence risk (10). Similarly, women with breast cancer who gain weight during treatment are at increased risk for recurrence and mortality compared with women who maintain their pre-diagnosis weight (11). Some studies suggest obesity may increase mortality and recurrence rates for men with colorectal cancer as well (12).

Counseling these patients regarding the benefit of achieving a healthy weight is appropriate, and with proper guidance and monitoring, some patients can safely pursue modest, intentional weight loss during treatment. It is important to differentiate between intentional and unintentional weight loss. Even in obese cancer patients, unintentional weight loss can contribute to increased mortality (13). In their Second Expert Report, the American Institute of Cancer Research and World Cancer Research Fund recommend a plant-based diet along with regular physical


activity and maintenance of a healthy weight for both cancer prevention and survivorship (14). Given that vegetarian and vegan diets are associated with a lower body mass index (15–16), they can be a viable approach to weight management for those patients motivated to try them, and who are not experiencing unintentional weight loss.

In the clinical setting, potential nutritional issues for the vegetarian or vegan oncology patient include: 1. Enteral feedings (e.g. for those with

head/neck, esophageal, gastric cancers): commercial options for vegan formula currently are very limited; patient may need guidance in creating home-made formulas to ensure nutritional adequacy; home-made enteral feeds also may increase risk of clogged tubes, and possibly, food-borne illness;

2. Pancreatic enzyme replacement: many pancreatic cancer patients, especially those who have Whipple surgery, will need pancreatic enzyme support; current prescription strength enzymes are porcine-based while over-the-counter, plant based enzymes may not be of adequate strength to prevent malabsorption; over-the-counter, plant-based enzymes also may vary from batch to batch, further complicating dosing;

3. Treatment-related diarrhea (pelvic radiation, some chemotherapies): diets high in insoluble fiber from fruits, vegetables, whole grains and legumes may not be tolerated during bouts of severe diarrhea; intolerance to legumes may create difficulty with meeting protein needs for vegans;

4. Bowel obstruction: high fiber intake may be poorly tolerated or contraindicated for those who have had, or are at risk for, bowel obstructions (gynecological, gastrointestinal cancers); meeting protein needs may be difficult as well;

5. Fatigue: for those electing to make their own enteral formula, or people who are new to following a vegetarian or vegan diet, fatigue may be an added challenge.

Understanding your patients’ motivations for following a vegetarian/vegan diet is crucial to successful collaboration. The “overnight” vegan may benefit from discussing the pros and cons of trying to adopt new eating habits while adjusting to the ups and downs of cancer treatment and its side effects. Rather than agonizing over adhering to an unfamiliar diet, the Registered Dietitian Nutritionist (RDN) might encourage him/her to be flexible, and consider a more gradual approach to diet change that will be less overwhelming and more sustainable in the long term. The long-term vegetarian/vegan patient may appreciate early education about how potential side effects could impact tolerance of his/her usual diet, and options available for vegetarian/vegan enteral and supplemental nutrition products.

Cancer patients have a unique set of nutritional needs that depend on their diagnosis, prognosis, elected treatment modality and co-morbidities. For some, a vegetarian or vegan diet may present nutritional challenges during or after treatment that add unnecessary stress to an already stressful situation. For others, moving towards a plant-based, vegetarian or vegan diet may aid in weight management and prevention of cancer recurrence. While it is exciting to have the opportunity to work with patients highly motivated to adopt a healthier, plant-based diet, it is important to help patients prioritize nutritional needs based on their diagnosis, treatment and current condition. This may mean advising some patients to delay significant diet changes or reconsider their diet of choice. The RDN can be an invaluable resource by helping patients who follow a vegetarian or vegan diet plan individualized, healthful diets that meet nutrient needs and promote optimal health both during and after treatment.

Kelay Trentham is a Board Certified Specialist in Oncology working at the MultiCare Regional Cancer Center in Tacoma, WA.

References 1. Campbell TC, Campbell TM. The China Study.

Dallas, TX: Benbella Books; 2004. 2. Carr K. Crazy Sexy Cancer. Guilford, CT:

Skirt!; 2007.

3. Fulkerson L. Forks Over Knives [DVD]. United States: Monica Beach Media; 2011.

4. Ornish D, Weidner G, Fair WR, et al. Intensive lifestyle changes may affect the progression of prostate cancer. J Urol. 2005; 174(3): 1065–1070.

5. Ornish D, Lin J, Chan JM, et al. Effect of comprehensive lifestyle changes on telomerase activity and telomere length in men with biopsy-proven low-risk prostate cancer: 5-year follow-up of a descriptive pilot study. Lancet Oncol. 2013;14(11):1112–1120.

6. O’Brien S, Leser M, Ledesma N. Diets, functional foods and dietary supplements for cancer prevention and survival. In: Leser MM, Ledesma N, Bergerson S, Trujillo E, eds. Oncology Nutrition for Clinical Practice. Oncology Nutrition Dietetic Practice Group; 2013:61–65.

7. Kushi LH, Cunningham JE, Hebert JR, Lerman RH, Bandera EV, Teas J. The macrobiotic diet in cancer. J Nutr. 2001; 131(11 Suppl):3056S–3064S.

8. Von Meyenfeldt M. Cancer-associated malnutrition: an introduction. Eur J Onc Nurs. 2005; 9(Suppl 2):S35–S38.

9. Cao Y, Ma J. Body-mass index, prostate cancer-specific mortality and biochemical recurrence: A systematic review and meta-analysis. Cancer Prev Res (Phila). 2011;4(4): 486–501.

10. Joshu CE, Mondul AM, Menke A, et al. Weight gain is associated with an increased risk of prostate cancer recurrence after prostatectomy in the PSA era. Cancer Prev Res (Phila). 2011;4(4):544–551.

11. Thivat E, Therondel S, Lapirot O, et al. Weight change during chemotherapy changes the prognosis in non-metastatic breast cancer. BMC Cancer 2010;10:648–657. http://www.biomedcentral.com/1471-2407/10/648. Published November 25, 2010. Accessed April 23, 2014.

12. Sinicrope FA, Foster NR, Yothers G, et al. Body mass index at diagnosis and survival among colon cancer patients enrolled in clinical trials of adjuvant chemotherapy. Cancer. 2013;119(8):1528–1536.

13. Martin L, Birdsell L, Macdonald N, et al. Cancer cachexia in the age of obesity: skeletal muscle depletion is a powerful prognostic factor, independent of body mass index. J Clin Oncol. 2013;31(12):1539–1547.

14. World Cancer Research Fund /American Institute for Cancer Research. Food, Nutrition, Physical Activity, and the Prevention of Cancer: a Global Perspective. Washington, DC: AICR; 2007.

15. Spencer EA, Appleby PN, Davey GK, Key TJ. Diet and body mass index in 38000 EPIC-Oxford meat-eaters, fish-eaters, vegetarians and vegans. Int J Obes. 2003;27(6):728–734.

16. Tonstad S, Butler T, Yan R, Fraser GE. Type of vegetarian diet, body weight and prevalence of type 2 diabetes. Diabetes Care. 2009;32(5):791–796.


It is fitting that I begin this article on the second anniversary of my stepson Josh’s death from lymphoma. He had been diagnosed eleven months prior and immediately began the R-CHOP protocol, which consisted of the medications Rituximab, Cyclophosphamide, Hydroxydaunomycin (Doxorubicin Hydrochloride), Oncovin (Vincristine Sulfate), and Prednisone. Our world changed as we learned to live the reality of conventional, medically-focused cancer treatment (Josh was treated at a premiere teaching Children’s Hospital in the East Coast tri-state area) from the receiving end.

My goal in sharing my story is not to write an exposé, but to relate my experience with the lack of awareness, knowledge and importance of the role of nutrition for aiding recovery from chemotherapy/radiation and supporting immune function. It is my hope that nutrition, specifically plant-based whole foods, will be given greater emphasis in oncology care, and become mainstream.

Two major barriers preventing this functional use of food were lack of availability and lack of staff knowledge. Other institutional barriers also may contribute to the problem. The hospital menu was nearly identical to the “children’s menu” category of fast food restaurants or diner fare. Typical meals were mac-and-cheese, grilled cheese, or cheeseburger with fries; a carton of milk was routinely placed on every tray. I found it ironic that the foods served to heal were those that ample research has implicated in the development of chronic disease, including cancer.

Three staff interactions are particularly illustrative of lack of staff knowledge, the second barrier.

Around Father’s Day, after two rounds of chemotherapy, we had a family meeting with Josh’s primary oncologist. The above observations led to my initiating this meeting. I chose my words carefully when I asked for his thoughts on the link between food and cancer. His uninformed response concluded with, “I know there’s a link between colon cancer and red meat, but I’m really looking forward to firing up the grill this weekend and enjoying some steaks!

The surreal part was that this meeting took place in Josh’s room, with Josh lying in his bed, eyes closed, in so much pain he could barely move his head.

The second interaction took place a few months later. I was discussing Josh’s care with one of the Oncology Residents. The conversation was mutually respectful until I brought up the link between casein and tumor-growth. She had no knowledge of the work of T. Colin Campbell or The Physician’s Committee for Responsible Medicine. When I used the words “milk” and “cancer” in the same sentence, a look flashed across her face, as a smug smile crossed her lips. She dismissed me as readily as doctors of old must have dismissed those who spoke out against blood-letting, or prescribing smoking for nerves.

A Dietitian’s StoryCarole Goldstein, MA, MFC, NCC, MS, RD, CDE


Too many Oncology RDs will relate to the third interaction. Throughout treatment Josh had been losing weight; his pre-cancer, 5’10”, 220 pound frame had rapidly declined to ~160 lbs. I had voiced my concerns to his team on several occasions, emphasizing each time that he was malnourished and unable to ingest sufficient calories. I had to physically describe each sign of malnutrition to another resident, and insist that more pertinent labs be drawn, to finally get a feeding tube placed.

These experiences have reinforced my commitment to advancing the knowledge and practice of medical nutrition therapy, with the inclusion of plant-based options being the standard of care. Additionally, I have become more passionate about the support I provide to my clients. Prior to Josh’s illness, I began taking counseling classes to enhance my nutrition therapy skills. I graduated this May with a second Master’s in Marriage and Family Therapy, and plan to help other families dealing with illnesses with nutrition relevance.

Carole Goldstein has been in private practice at Solid Ground Nutritional Counseling for the past 10 years. Her specialization in eating disorders and diabetes taught her the significant role of the environment and family system on making lasting behavior changes. To better serve her clients, she recently completed a Master’s program in Marriage and Family Therapy and is a Nationally Certified Counselor.

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Kelay Trentham, MS, RDN, CSO Vegetarian Nutrition (VN) and Oncology Nutrition (ON) DPG member

Kelay, how did you first become interested in plant-based nutrition? I became a vegetarian at age 13 when a family member got me a subscription to Vegetarian Times. I

devoured the articles about nutrition and health. Ultimately, it led to my becoming a registered dietitian!

Please explain your training background, and the nutrition-related jobs you’ve held including your current job. I have a Bachelor of Science in Biochemistry from North Carolina State University and a Master’s in Food and Nutrition from the University of Georgia. My internship was a combined Master’s degree and dietetic internship. I have worked in acute care, long-term acute care, long-term care, home health, hospice, congregate meal services, and now I work as an outpatient oncology dietitian. I worked at the Seattle Cancer Care Alliance before I came to MultiCare Regional Cancer Center in Tacoma, WA, where I have been for 7 years.

How do you incorporate plant-based nutrition into your work with cancer patients? I explain to patients that the typical Western diet is meat, starch, and vegetables, with limited seasoning added, while vegetarian cooking often combines vegetables, grains and legumes with a variety of herbs, spices and seasonings for much more interesting fare. I provide a list of cookbooks and websites that I encourage them to review to get inspired. I educate patients regarding the health benefits of various phytonutrients and where they are found. I often write out recipes for patients on the spot and encourage them to experiment with foods and cooking methods (such as pressure cooking). For patients who need to manage their weight,

I discuss the calorie “cost” per serving of different foods and show them that non-starchy vegetables are typically the lowest, and yet can be very filling. However, I’m not convinced that people need to become vegan after a cancer diagnosis. I discuss that depending on their diagnosis and mode of treatment, it may be difficult to maintain good nutritional status on a vegetarian or vegan diet. Sometimes it’s best to wait until treatment has concluded to make more significant diet changes. No one diet fits all situations, and context is everything.

Do you have any projects in the works you’d like readers to know about? I dream of writing a vegan comfort food cookbook and developing some tempeh-based products. My husband and I have been developing recipes for years. I’ve been rather busy the last two years as Secretary of the Oncology Nutrition DPG. I am volunteering for the planning committee for the next Oncology Nutrition Symposium (2016), and I expect to continue being active with the ON DPG.

In what ways do you feel that you approach nutrition as a profession rather than a job?It took me a while to really connect with being an RDN. Something started to click when I did some work with the hospice team during my time at Tahoe Forest Hospital District in Truckee, California. Now that I work in oncology, I have found my passion. I believe that having a passion for and commitment to your work is what defines it as a “profession.” I truly love working with oncology patients across the continuum of care—from initial diagnosis to the end of life. I especially enjoy connecting with patients who happen to be vegetarian or vegan—there is an almost instant bond.

What would a day in your life look like? I live on Vashon Island, WA and on a workday I take a ferry to get to Tacoma, WA, where I work. At work, I review our infusion room schedule and results of our nutrition screening, and add patients to my schedule accordingly. I see patients in the infusion room, a consult room or in the radiation department, coordinating care with home infusion companies, and collaborating with our social workers, nurses and physicians.

Meet Our MembersAmanda L. Sager, Maj, USAF, MS, RD

In between, I fit in various projects or meetings, such as those of our institution’s Cancer Committee and Medical Ethics Committee. After a ferry ride home comes exercise, time with my husband and the cats, volunteering for ON DPG, a vegan meal, and time for meditation.

How do you enjoy spending your free time? I’ve been slowly building a mobile meditation hut. I bought and repurposed a used snowmobile trailer to hold an 8’ x 10’ shed—four walls, roof, a door and three windows. The idea was to be able to move it around our property—closer to the house in the winter and rainy season, or out in our pasture when the weather is nice. It will be a place I can meditate, do yoga, spend time writing or knitting, or just generally have some quiet time. I call it the “Shanti Shanty” (shanti means peace in Sanskrit). I have really enjoyed designing it and working on it with my husband, to whom I owe great thanks for helping make the concept a reality. I also enjoy knitting, jogging, being outdoors and working around our “farm” (we have pet chickens and cats), traveling, camping, and, of course, cooking.

What is one of your favorite vegan/vegetarian meals? I love Thai and Indian food, and eclectic vegan cuisine. My go-to comfort and celebration meal is pasta puttanesca (hold the anchovies!) with a vegan Caesar salad (homemade croutons) and rosemary bread. Finish this with a good old-fashioned vegan chocolate cake and a glass of Prosecco and I am one happy vegan camper.

Do you aim to follow any particular type of diet (vegetarian, vegan, raw, etc.)? I elect to follow a vegan diet. I became vegan 8 years ago after reading The Pig Who Sang to the Moon.

What advice would you give to dietitians who would like to work in the area of vegetarian nutrition? Know your audience. Be flexible and open to helping people “lean in” to a vegetarian diet. Also, vegetarian cooking skills are a must! Take culinary classes to learn new techniques and ideas to share with your patients/clients.


Kelay Trentham, MS, RDN, CSO



Historically, knowledge of the digestive system and appropriate nutrition has developed over centuries, accompanied by the development of the technology to provide supplemental feedings to individuals unable to eat normally. Initially, gastrostomy tubes were used for only the most serious medical cases, and the majority of mid-twentieth century dietitians typically had limited experience with them. Most commonly, tube feeding would involve large catheter tubes through which infant formula would be fed to an infant. As the patient grew, baby food and pureed food might be added to the tube feeding regimen. These early practices formed the basis of knowledge about enteral tube feeding and “blenderized diets” (1).

As nutrition science evolved, commercial enteral formulae and delivery systems evolved to reflect new scientific knowledge. Newer formulas began taking into consideration patient specific macro- and micronutrient requirements, as well as tube size, and placement for various disease states, trauma and congenital challenges (2–5). Lloyd and Tuck offer an early summary of basic physiological principles, delivery routes, and potential difficulties and complications of enteral feeding (6). More recent guidelines from the American Society for Parenteral and Enteral Nutrition (A.S.P.E.N) and the Society of Critical Care Medicine (SCCM) are more comprehensive (7).

Today in America, enteral nutrition support has become as commonplace as the diagnosis of cancer. The A.S.P.E.N. Board of Directors states, “Enteral tube feeding (and parenteral nutrition support) may benefit some severely malnourished cancer patients or those in whom gastrointestinal or other toxicities are

anticipated to preclude adequate oral nutritional intake for more than one week. Patients who are candidates for nutrition intervention under these circumstances should receive nutrition support, if possible, in conjunction with the initiation of oncologic therapy.” Clinical guidelines from A.S.P.E.N 2014 best practice recommendations for patient care will be published in 2014 (8).

In addition to oncology, there are many other reasons for a person to be fed enterally, both short- and long-term. The social, cultural and emotional aspects of food, along with changes in food preference, intake, and eating behaviors have enormous impact on an individual’s sense of control and independence (9). Commercially manufactured formulae are well designed and generally considered superior to blenderized feedings in terms of safety, viscosity, osmolality (10–11), ease of storage and administration, and allowing the medical nutritional team to accurately track and modify what the patient is receiving (12–13). However, it is also recognized that nutrition support is more than its obvious components, and perhaps should be more than its usual ingredients (14).

Families/caregivers of individuals on long term enteral feeding may choose to create their own homemade, blenderized enteral ‘meals,’ because homemade formulae may be more easily tolerated and can be less expensive. Furthermore, homemade allows for a wider variety of foods from which the patient can choose, especially if the patient is vegetarian or vegan. It is unlikely that an individual can be fed the same nutrient profile, day in and day out, and remain well nourished, and very few commercial formulae meet vegan criteria.

Basics About Vegan and Blenderized Tube Feeding OptionsSarah Ellis, MS, RD


The Oncology DPG’s handbook Oncology Nutrition for Clinical Practice includes a chapter devoted to nutrition support that includes information on making tube feeds at home. Seattle Children’s Hospital publishes a simple, comprehensive, family-friendly guide to homemade blenderized tube feedings as well (15), however, the recipes do not include vegan examples. Klein and Morris address the vegetarian alternative in Homemade Blended Formula Handbook (1) and provide extensive support on their website (16). There are two commercially available vegan options, made from whole foods, called LIQUID HOPE, These options provide a nutritionally dense, vegan, gluten free whole foods meal replacement (17), and are

created by Robin Gentry McGee, founder of Functional Formularies and Real Food Blends. These products provide vegan options for individuals who rely on tube feeding, and may be more likely to be accepted because they are made from ‘just real food,’ and contain no corn syrup, soy, gluten, dairy, or genetically modified food ingredients, and no additives (18). One 12 ounce pouch of LIQUID HOPE provides 440 calories and 23 grams of protein, and can be used as sole source of nutrition.

Regardless of the choices a vegan, tube-fed patient elects to make, support and information from the RDN will be key to successful initiation of tube feeding, and the ability to meet nutrition needs in a culturally and ethically acceptable manner

Sarah Ellis is an Independent Health, Wellness and Fitness Professional. She enjoys working as a Community Dietitian where she focuses on preventive and behavioral health. Sarah works with individuals and groups to reduce their risks for chronic disease, using a holistic approach of plant based nutrition and stress management. During her personal time, Sarah delights in cultivating her meditation practice, cooking with friends, and being outdoors.

References 1. Klein MD, Morris SE. Homemade Blended

Formula Handbook. Tucson, AZ: Mealtime Notions, LLC; 2007.

2. Chernoff R. Nutrition support: formulas and delivery of enteral feeding. II. Delivery systems. J Am Diet Assoc. 1981;79(4):430–432.

3. Bowers S. Tubes: a nurse’s guide to enteral feeding devices. Medsurg Nurs. 1996;5(5):313–24.

4. Varella LD, Young RJ. New options for pumps and tubes: progress in enteral feeding techniques and devices. Curr Opin Clin Nutr Metab Care. 1999;2(4):271–275.

5. DiSario J. Endoscopic approaches to enteral nutrition support. Best Pract Res Clin Gastroenterol. 2006;20(3):605–630.

6. Lloyd DAJ, Powell-Tuck J. Artificial nutrition: principles and practice of enteral feeding. Clin Colon Rectal Surg. 2004;17(2):107–118.

7. McClave SA, Martindale RG, Vanek VW, et al. Guidelines for the provision and assessment of nutrition support therapy in the adult critically ill patient. JPEN. 2009;33(3):277–316.

8. Malone A. Clinical guidelines from the American Society for Parental and Enteral Nutrition: best practice recommendations for patient care. J Infus Nurs. 2014;37(3):179–184.

9. Winkler ME. The American Society of Parenteral and Enteral Nutrition Presidential Address: food for thought: it’s more than nutrition. JPEN. 2007;31(4)334–40.

10. Mokhalalati JK, Druyan ME, Shott SB, Comer GM. Microbial, nutritional and physical quality of commercial and hospital prepared tube feedings in Saudi Arabia. Saudi Med J. 2004;25(3):331–41.

11. Jalai M, Sabzghabaee AM, Badri SS et al. Bacterial contamination of hospital prepared enteral tube feeding formulas in Isfahan, Iran. J Res Med Sci. 2009;14(3):1149–1156.

12. Santos VE, Morais TB. Nutritional quality and osmolality of home-made enteral diets, and follow up of growth of severely disabled children receiving home enteral nutrition therapy. J Trop Pediatr. 2010;56(2):127–128.

13. Borghi R, Araujo TD, Vieira RIA et al. ILSI Task Force on Enteral Nutrition; estimated composition and costs of blenderized diets. Nutr Hosp. 2013;28(6):2033–2038.

14. Practice Paper of the Academy of Nutrition and Dietetics: Ethical and Legal Issues in Feeding and Hydration. J Acad Nutr Diet. 2013 Jul;113(7):981. doi: 10.1016/j.jand. 2013.05.006.

15. Seattle Children’s Hospital. Homemade Blenderized Tube Feeding. Seattle Children’s Hospital website. http://www.seattle childrens.org/pdf/pe442.pdf Published October, 2013. Accessed July 3, 2014.

16. Mealtime Notions. http://mealtimenotions.com Accessed June 21, 2014.

17. WholeFoods Meal Replacement: Liquid Hope. Robin Gentry McGee’s Functional Formularies website. http://functional formularies.com. Accessed July 3, 2014.

18. Real Food Blends: Meals for Tube-Fed People. http://realfoodblends.com/ Accessed July 3, 2014.

At 31 years old, Kris Carr was diagnosed with incurable, stage IV epithelioid hemangioendothelioma (EHE), a rare vascular cancer in the lining of the blood vessels in her liver and lungs. She chose to change her diet and lifestyle, which involved getting into the kitchen and embracing a plant-based diet. She has lived with the cancer for more than ten years, and explains that she feels better than before she was diagnosed. She produced a documentary about her story, “Crazy Sexy Cancer,” and has started what she refers to as the Crazy Sexy movement. In the introduction, she describes the following equations: Crazy = Forward Thinking; Sexy = Empowered; Kitchen = Pharmacy. For this book, she teamed up with Chef Chad Sarno, who is the lead culinary educator for Whole Foods Market’s “Health Starts Here” program.

The book is more than just a “cookbook;” it is divided into 4 “courses.” The first “course” addresses a variety of topics including the healing and disease prevention power of plant-based diets, inflammation, pH balance, the importance of raw foods, and an FAQ section written by Jennifer Reilly, RD, LD, former managing director of The Cancer Project. The second “course” explains staples of the plant-based diet with useful tips, information about kitchen tools, and simple advice for making good choices on a budget. The third “course” defines cooking terms in an easy-to-understand manner, provides guidance for cooking beans and grains, and ends with a great list of “Tips for Gastronomic Delight.”

The fourth “course” includes 150 recipes, and although no nutritional information is provided, each recipe has an assigned difficulty level, and includes one or more of the following labels: gluten-free, soy-free, raw and/or kid-friendly. The recipes include juices, smoothies, wraps, stews, sandwiches, appetizers, salads, main entrees, sides, dressings, marinades, condiments, snacks, and desserts. This course culminates with 21 different menus that creatively combine the recipes for a variety of occasions and themes. The recipes focus on utilizing fresh, ripe produce, whole grains, legumes and nuts, with very few processed ingredients. Fruit is used to sweeten many dessert recipes, and the fats primarily used include nuts, seeds, avocados, and olive oil.

Though a cancer diagnosis is often perceived as dark and scary, this book is quite the opposite: full of life, color and joy! The pages are filled with fun, upbeat and approachable language, and gorgeous pictures that will inspire people on a culinary journey toward a plant-based diet. Although some recipes are quite basic and would be a good place to start for someone without a lot of cooking experience, such as Bok Choy with Lemon Tahini Sauce or Tofu Country Scramble, many, like Indian Chickpea Blinis with Cashew Coconut Chutney will keep seasoned veterans entertained, as they are more elaborate and result in edible works of art!

Bookshelf Reviewed by Timaree Hagenburger, MPH, RD, ACSM Certified Health Fitness Specialist, www.thenutritionprofessor.com

Crazy Sexy Kitchen: 150 Plant-Empowered Recipes to Ignite a Mouthwatering Revolution, by Kris Carr and Chef Chad Sarno. Published by Hay House, 2012, 286 pages, $29.99 (cover price), ISBN: 978-1-4019-4104-8.


(* Voting member)

Chair*Andreea Nguyen, MS, RD, CSO, LD, CNSCPhone (C): 214-794-0683Email: [email protected]

Chair-elect*Tricia Cox, MS, RD, LD, CNSCPhone (W): 214-865-1642Email: [email protected]

Secretary*Katie Fowlkes, MS, RD, CSP, LDNPhone (W): 901-595-4180Email: [email protected]

Treasurer*Kristin Ringo, RD, CSO, LD, CNSCPhone (W): 214-820-7745Email: [email protected]

Past Chair*Elaine Trujillo, MS, RDNPhone (W): 240-276-7116Email: [email protected]

Nominating Committee Chair*Heidi Scarsella, RDN, CSO, LDNPhone (C): 330-519-7133Email: [email protected]

Western Area Representative(CA, TX, AZ, NM, WA, OR, NV, WY, ND, SD, HI, AK, ID, MT, UT, CO, Asia, NZ, AU)Shari Oakland Schulze, RD, CSOPhone (W):303-318-1304Email: [email protected]

Eastern Area Representative(VA, GA, PA, DE, NH, RI, NC, SC, NY, FL, NJ, MD, VT, ME, CT, MA, DC, PR, and Europe)Phone: 301-257-3299Email: [email protected]

Central Area Representative(MI, IN,AR, AL, IA, KS, OH, KY, MO, MS, MN, OK, WV, TN, LA, IL, WI, NE and Canada)Keri Layton, MS, RD, CSO, LDPhone (C): 913-428-6522Email: [email protected]

Development CoordinatorLouise Chen, RD, LD, CNSC, CSOPhone (W): 214-865-1645Email: [email protected]

Account ManagerJanet Mildrew, RDPhone (C): 757-647-3821Email: [email protected]

Alliance CoordinatorRhone M. Levin, MEd, RD, CSO, LDPhone (W): 208-706-4170Email: [email protected] or [email protected]

Electronic Mailing List (EML) AdministratorMaureen Gardner, MA, RD, CSO, LDNPhone (W): 813-745-2875Email: [email protected]

Membership ChairMichelle Bratton, RD, CSOPhone (W): 520-694-1826Email: [email protected]

Academy Representative to CoCKathryn Hamilton MA, RD, CSO, CDNPhone (W): 973-971-6288Email: [email protected]

Project Chair – Awards & Research AwardErin Gurd, RD, LDNPhone (W): (813) 745-1055Email: [email protected]

Oncology Nutrition Connection Newsletter EditorSuzanne Dixon, MPH, MS, RDPhone (C): 503-313-5202Email: [email protected]

Associate EditorsRobin Brannon, MS, RD, CSOPhone (W): 202-715-4498Email: [email protected]

Jodie Greear, MS, RD, CSO, LDNPhone (W): 901-226-5743Email: [email protected]

Maureen Leser, MS, RD, CSO, LDPhone (C): 240-994-0533Email: [email protected]

Jocelyne O’Brien, MPH, RD, CSO, LDNPhone (C): 617-549-8826Email: [email protected]

Continuing Education ChairPaula Charuhas-Macris, MS, RD, CSO, FAND, CDPhone (W): 206-288-1157Email: [email protected]

Policy & Advocacy LeaderColleen Spees, PhD, MEd, RD, LDPhone (W): 614-688-4651Email: [email protected]

House of Delegates ONDPG DelegateNicole Fox, RD, LMNT, CNSC, CSOPhone (W): 402-559-6808Email: [email protected]

Website AdministratorHeather Bell-Temin MS, RD, CSO, LDNPhone (W): 813-745-6189Email: [email protected] [email protected]

Public Content Manager – ONDPG WebsiteAlison Ryan, MS, RD, CSO, CNSCPhone (C): 415-627-8122Email: [email protected]

Social Media CoordinatorLindsay Kovacic Sappah, RD, CSO, LDNPhone (W): (910) 481-9110/x235; Fax: [email protected]

EBlast CoordinatorKristen Lange, MS, RD, CSO, LD/NPhone(W): 813-745-1314Email: [email protected]

Webinar Planning CommitteeChair: Amy Patton, RD, CSO, CNSDPhone (W): 702-947-0286Email: [email protected]

Bernadette Festa, MS, RD, CSOPhone (W): (510) 204-5916Email: [email protected]

Abby Traul, RD, CSO, LDPhone (W): (208) 239-1702Email: [email protected]

Cheryl Tuttle, MHS, RD, CSO, LDPhone: (828) 699-1088Email: [email protected]

Small Project Research Grant ChairHeidi Ganzer, MS, RD, CSO, LD

SPECIAL PROJECT CHAIRS

Project Chair – Oncology Nutrition in Clinical PracticeMaureen Leser, MS, RD, CSO, LDPhone (C): 240-994-0533Email: [email protected]

Project Coordinators – Oncology Nutrition Symposium (Spring 2016)Jeannine Mills, MS, RD, CSO, LDPhone (W): 603-650-9404Email: [email protected]

Andreea Nguyen, MS, RD, CSO, LD, CNSCPhone (C): 214-794-0683Email: [email protected]

Planning Committee – Oncology Nutrition Symposium (Spring 2016)JJ Barten, RD, CSOPhone (W): (720) 848-6368, (720) 848-8086Email: [email protected]

Katrina Claghorn, MS, RD, CSO, LDNPhone (W): 215-615-0538Email: [email protected]

Tricia Cox, MS, RD, LD, CNSCPhone (W): 214 820-1923Email: [email protected]

Elise Cushman, MS, RD, LDPhone: (W): (653) 650-2568Email: [email protected]

Suzanne Dixon, MPH, MS, RDPhone (C): 503-313-5202Email: [email protected]

Katie Harper, MS, RD, CSOPhone (C): 425-894-8065Email: [email protected]; ([email protected])

Kristen Lange, MS, RD, CSO, LD/NPhone(W): 813-745-1314Email: [email protected]

Alison Ryan, MS, RD, CSO, CNSCPhone (C): 415-627-8122Email: [email protected]

Denise C Snyder, MS, RD, CSO, LDNPhone (W): 919-660-7580 (preferred)Email: [email protected]

Heather Bell-Temin MS, RD, CSO, LDNPhone (W): 813-745-6189Email: [email protected]

Kelay Trentham, MS, RDN, CSO, CDPhone (W): 253-403-3298Email: [email protected]

Elaine Trujillo, MS, RDPhone (W): 301-594-0903Email: [email protected]

Project Chair – EAL Oncology Nutrition Guideline RevisionExpert Workgroup Chair & ON PublicationsLaura Elliott, MPH, RD, CSO, LDPhone (W): 515-239-2547Email: [email protected]

Project Chair – SOP/SOPPKim Robien, PhD, RD, CSO-FADAPhone (W): (202) 994-2574Email: [email protected]

Academy DPG Relations ManagerCarrie KileyPhone: 312-899-4778Email: [email protected]

2014-2015 Oncology Nutrition DPG Officers and Committee Chairs


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