By Dena McDowell, MS, RD

Many people have heard the adage "You are what you eat." When it comes to surviving a cancer diagnosis, this phrase could not be more true. After receiving medical treatment to help manage or hopefully rid the body of the disease, many people wonder what else they can do to prevent a recurrence. Eating a healthy diet is one thing people can do to help themselves in their fight to survive. In The Cancer Project's free online book "The Survivor Handbook: Eating Right for Cancer Survival" Dr. Neal Barnard and Jennifer Reilly, RD discuss some dietary principles of cancer survival.

The principles of the Book

Section 1: Low-fat foods

This section explains why eating low-fat foods are important in preventing cancer recurrence. Homework for analyzing your dietary fat intake and looking for low-fat options are given at the end of this chapter. Low-fat recipes are also provided to give the reader ideas of how low-fat foods can be appetizing and incorporated into a healthy diet.

Section 2: Fiber Basics

Fiber is important to maintain a healthy gut. This section explains why you need fiber in the diet and the different types of dietary fiber. There is an excellent quiz at the end of this section which helps the reader analyze how much fiber they are currently taking in each day. However it should be noted that the recommended amount of dietary fiber of 40 grams a day is higher than what the United States Department of Agriculture recommends in its dietary guidelines (20-35 grams/day). Recipes are also given at the end of this chapter.

Section 3: Reducing dairy consumption

In this section Dr. Barnard and Ms. Reilly recommend reducing dairy consumption as some studies show an increased risk of prostate cancer that they believe is linked to dairy consumption. Although the authors list alternative sources of calcium-rich food sources, they lack enough research to make the claim that cancer cells are fueled by cow's milk. Furthermore, the authors recommend soy milk as a good alternative to cow's milk; however, they fail to cite research relating to soy and the potential for an increase of cancer cell growth in women who have had estrogen receptor positive breast cancer. More research is needed to understand how the components of cow's milk affect cancer cell growth. At this time the American Cancer Society still recommends consuming low-fat dairy products to help meet calcium needs. There is also a well-known link to calcium and a reduced risk of developing colon cancer, which is not discussed in this book (American Cancer Society www.cancer.org and American Institute for Cancer Research www.aicr.org ). Osteoporosis, as it is related to calcium consumption, is also reviewed. According to the authors, "(Osteoporosis) is a condition of overly rapid calcium loss." Yet the authors say that calcium is not as important to bone mass development and retention as avoiding salt, sulfur containing amino acids, and smoking. According to the National Osteoporosis Foundation, getting enough calcium throughout life through dairy sources or supplements is a key to preventing the development of this crippling disease (www.nof.org ).

Section 4: Alternatives to meat

Dr. Barnard and Ms. Reilly recommend that cancer survivors avoid all meats and fish. In this section the discussion of vegan eating is discussed (avoiding all meat, fish, eggs, and dairy). Alternatives to meat are given as well as meatless recipes. It is true that a diet high in meat can increase risk of cancer as well as other health conditions due to carcinogen content (cancer causing compounds) of cooked meat and fat content. However to avoid all meat and fish is an over generalization. Lean meats and fish can be part of a healthy varied diet according to the American Cancer Society. Fish, although potentially high in mercury can be eaten safely in small amounts and provides healthy fats that are cancer protective. The authors' recommendation of plant protein sources including soy, legumes (beans), and nuts are warranted; however, a healthy anticancer diet can also incorporate lean meats and fish.

Section 5: Phytochemicals and antioxidants

This section explains what phytochemicals and antioxidants are and how they relate to disease prevention. The authors recommend food first which is important since research shows that eating foods rich in antioxidants and phytochemicals is more beneficial then taking supplements. Charts of common foods rich in these disease-fighting compounds are given; however, this book does not give the reader recommended daily intakes of each antioxidant.

Section 6: Immune-enhancing foods

Vitamins and minerals, including beta carotene, vitamin C, vitamin E, and zinc and the relatedness to providing protection to the body are discussed in this section. The authors also briefly discuss how fat and cholesterol decreases ones' immune system, yet they fail to discuss the role of sugar and decreased immunity. Refined sugar consumption and immunity need to be addressed to make this a complete chapter.

Section 7: Weight loss

Losing weight if overweight is an important part of cancer survival. This section provides a good overview of how to take the pounds off sensibly. Avoiding fad diets and losing the weight slowly are the keys to success. There are good meal planning tips in this section and good basic dietary information to help the reader start a weight loss plan.

Section 8: Appendix and recipes

In this section the authors address basic nutrition questions. These concise answers are helpful for novice readers to decipher nutrition information given in the book. Recipes are also given at the end of the book which are seemingly easy and helpful in allowing the reader to apply the principles of vegan eating.

Bottom line: There is more to cancer prevention than what is in this book

Although some the principles that Dr. Barnard and Ms. Reilly discuss are warranted in the fight against cancer recurrence, other important information is left out. First of all in the note to the reader, the authors reference the "four food groups" as the basis for an American diet. The "four food group" concept is completely outdated and has since been revised twice with the latest being the Food Guide Pyramid which came out in 2005 from the United States Department of Agriculture (log onto www.mypyramid.gov for more information). Although this handbook was first published in 2003, no revision or new edition has been made to update this information. Secondly, the authors fail to include the American Cancer Society's guidelines in their recommendations. These guidelines have been created by scientists who review all current nutrition and cancer research. The principles outlined by Dr. Barnard and Ms. Reilly are a little too extreme when it comes to the validity of the current research that is available. As a clinical dietitian who works directly with cancer patients, I would not recommend this book as it lacks enough scientific evidence in its recommendations. I would refer a patient to read it with caution, keeping the American Cancer Society's principles at the forefront of their minds. However that being said, the recipes listed at the end of this book are worth reviewing and may be incorporated into a healthy anticancer diet.