Wednesday, March 26, 2014

Why I'm Not Giving up Dessert

Chocolate Cassis Scone. Not so much chocolate you can’t taste the dark berry, but enough melty richness to feel plenty decadent. The outside has a perfect golden crispness, the inside airy, flaky, rich with the texture that only plenty of butter can bestow. I am savoring every morsel with my pot of Earl Grey tea in my favorite patisserie in San Francisco.

By common wisdom, I am doing everything wrong. I am eating everything I shouldn’t be: white flour, animal fat, and—capital sin—sugar. How many times have I heard the reductionist mantra “sugar feeds cancer” in the past two years? Can it really be that simple? And what about pleasure? Not simply gratification, but the intensely savored pleasure of something as wonderful as a perfectly baked good? While we’re throwing clichés around, don’t the partisans of the “Life’s Short—Eat Dessert First” school have something there?

There are perhaps no more treacherous waters to wade into in terms of cancer survivorship than the debates about what one should and shouldn’t eat. The shrill or evangelistic tone these discussions about diet take remind me of the same tenor and fervor that any question of not breastfeeding would take in parenting forums back when I had children of an age to nurse—or wean.

I myself have been—admittedly—on every side of this debate, from my post-diagnosis juicing regimen (beets, carrots, fresh turmeric root!) to my full-throated refusal to give up yet another aspect of my life that matters to me. Sick of quinoa and green tea, I’ve thrown up my hands and said “I can’t live the rest of my life like I’m on a cleanse.”

I’ve yet to meet a single person diagnosed with cancer or another serious disease that hasn’t attempted to radically change their food regimen. Anodyne recommendations about a “plant-based” diet become, through the lens of existential panic, an embrace of vegan aceticism; “moderation” a palliative for our missteps when we can’t adhere to the austere doctrine we’ve convinced ourselves will ward off another recurrence.

But what’s behind all this emphasis on food, I believe, is an illusion of control. The causes of cancer are obscure and complex, encompassing inherited genetics and myriad potential environmental factors; the biology of metastasis remains very poorly understood even today. We have little control over the course of our disease, and so we overemphasize—radically—the part that what we eat has to play.

I’m the last person that would argue that nutrition isn’t important; it clearly is. Obesity is responsible for worse outcomes; and eating processed food with little nutritional value is obviously a poor choice for anyone. Eating lots of fresh vegetables is a baseline measure of what constitutes a “good” diet, and doing so helps us combat fatigue, maintain our energy, and withstand all the abuses of conventional treatment. But we are fooling ourselves if we think that kale is doing hand-to-hand combat with malignant cells, or beets are “healing” our liver. If chemotherapy isn’t killing off those wily little buggers, cauliflower is simply not going to cut it.

The other problem with overestimating our putative control over our disease through nutrition is its correlative: guilt. We blame ourselves for disease progression—we must have not being doing enough—or for getting cancer in the first place (“Was it all that cheese I ate? Or my penchant for Red Vines?”). Here is a personal example of where this kind of thinking can lead: last summer, I switched to a new and promising hormone therapy. Just after that, our family spent the summer on the Central Coast, eating amazing produce from local farms, picking fresh berries at a U-Pick nearby, even trying our hand at pickling. We were outdoors hiking and going to the beach every day, getting plenty of exercise, enjoying life with friends and family. I also indulged in perhaps more local wine than might be advised. Even so, I was convinced I was doing everything to promote health and well-being. At the end of the summer, however, my scans came back with bad news: the treatment wasn’t working at all. I spent a lot of time fretting about the wine—could that have been why the cancer was gaining the upper hand?

Well, recently I got results of genetic sequencing that put all this in a radically different perspective. Among other revelations, the test showed my tumor has a mutation that makes me resistant to hormone therapy. All that guilt was wasted energy. The progression was due to the particular genetics of my disease, not because my virtue had faltered. This lesson is a powerful one.

We cannot get into the mindset that what we eat alone causes or cures our maladies. The elephant in the room as far as causality goes are the tens of thousands of environmental toxins and industrial chemicals we are bombarded with every day. When the water supply in Charleston, West Virginia, was contaminated recently to the point that no one could safely drink it or even wash their hands with it, the most shocking element of this story to my mindwas the fact that no agency, federal, private or otherwise had the most minimalsafety data on the chemical whatsoever. The local government was soon making statements that the water was now safe to drink—but they admitted that they did not know what the safe level of this chemical was in the first place. The 80,000 industrial chemicals in use that are not tested or regulated are far more likely to have a role in disease etiology than whether or not we enjoy bagels with cream cheese.

Putting an emphasis on individual “lifestyle choices” rather than the political choices we make as a society is a screen that exculpates industry and the utter failures of government regulation. The discourse of “individual responsibility” obscures the collective responsibility we have to act on these other spheres that bear far more responsibility for rising costs to public health.

The burden of guilt and the level of self-flagellation that goes on in survivors’ groups is not an incidental issue—it casts a long, dark shadow on our lives. A few months ago, I met a woman at a café whom I had been introduced to through a mutual friend because she had recently been diagnosed with Stage III breast cancer. Single, in her thirties, still devastated by a recent romantic breakup, she felt terrified and alone. When she walked in, however, her first comments to me were, “Oh my god, you’re eating eggs? And is that butter on your toast?” She had convinced herself that she had to change to a strictly vegan diet, and yet, her mouth was almost visibly watering. It made me sad to think that in the midst of all that she was already contending with, she was sticking to this regime of deprivation, as though that were the life raft that would save her.

The same angst flared recently on our BAYS listserve: a new study condemned a high-protein diet as bad for cancer recurrence and our members bemoaned, “What can we eat? Meat is out, soy is bad, carbs are evil, no sugar, no alcohol…” Another said “I wish they’d decide whether it’s estrogen or animal protein that’s responsible for our cancers, so they could give one of them back to us.” It pained me to imagine all these women, who’ve been through the cutting, slashing, and burning of surgeries, chemo, and radiation and all the attendant scars, infections, nausea, fatigue. The early menopause and the career breakdowns. The debt and the divorces. And I thought, how did we get here, to this place where after all this we are afraid to simply eat?

So, wanting to offer an alternative vision, I posted the following:

“When I was in my twenties, I lived in Europe for a while, and once, when my parents visited, we went together to Positano. This dramatic centerpoint of the Amalfi Coast is one of those dream-like towns with ice-cream colored houses impossibly stacked on each other on steep cliffs down to the Mediterranean. One day, on the suggestion of a local, we hiked up away from the town even higher on the cliffs—up and up and up. We steadily climbed 1,742 stairs up to the peak, past tiny vegetable gardens wedged in between houses, olive groves and lemon trees on precipitous terraces, until we reached a tiny restaurant with a patio looking down over all we had climbed, the sea sparkling unbelievably far below. To call it a restaurant is actually a misnomer: don’t think menus or waiters or even a cash register. It was really two or three rickety tables on the back patio of an Italian grandma who was basically letting a few knowing strangers come over for lunch. You ate whatever she brought you, and you blessed every single morsel for the unbelievable tastes it emitted.

Can you picture this? I want to take you all there. If we were there, there would be no “kosher,” no “vegan,” no “gluten-free.” She would not countenance putting anything “on the side.” There would be squash blossoms picked that day, and pillows of pasta she rolled out on her counter that morning, and tomatoes that would make you think you’d never before had a tomato in your life. There would be fish, grilled with spices and herbs so insane you’d be sucking the bones for every last possible nibble because you did not want it to end. There would most certainly be wine, but washed down with a lot of water, and possibly some grappa at the end. When you finished this meal, pushing the chair back from the table with the sun on your face, every cell in your body would be singing with contentment. Then you would have to figure out how to get back down those 1,742 stairs.

Can you feel it? Can we remember that food is not medicine and food is not poison? It is nourishment we need both body and soul. It is communal and it is pleasurable and it does not have the final word on our future.

When we make our food choices, could we have this Italian “nonna” on our shoulder? Paraphrasing Michael Pollan, if she wouldn’t recognize it as food, we shouldn’t eat it. No edible “food-like” substances. Eat stuff that comes from the ground. Eat eggplant, eat white beans, eat chicken soup; when you have meat, have it simmered a long time in a stew of many other things. Would she approve of shakes for every meal or protein bars on the go? On the other hand, would she want us forcing down some friggin’ kale and quinoa just because we think we should? I’m sure the microwave would merit some warding-off-the-evil-eye-like spitting on the ground and crossing herself.

I’m not suggesting we spend all day in the kitchen. Far from it. Let’s just love food more and torment ourselves less. Let’s give thanks for the choices we have and try our best not to torture ourselves over them. Let’s please remember that if we climb 1,742 steps, we deserve an incredible meal.”

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