Eating well in challenging times

Change, stress and the disruption that comes with social distancing may be derailing your healthy habits. But it is possible for you to stay on track.

Like many people, you probably started the new year working hard toward your nutrition and health goals. Just as you got into a great routine, suddenly life changed. A new work situation, kids at home, gyms closed, and many other stressors make it challenging to stay on track.

Luckily, healthy eating doesn’t have to be complicated or stressful. Consider these simple ideas to keep you moving in the right direction. Whether you implement one of these strategies or all of them, they can help you eat well while spending weeks at home.

Moderation and variety are key.  Aim to have the majority of the foods you eat be healthy options (80-90%). The other 10-20% can be more indulgent choices. Include a variety of foods, colors and cooking methods to maximize your nutrient intake.

Go plant-based. Studies show that if three-fourths of what you consume comes from plants, you can decrease your risk for many chronic diseases. It can also help with achieving weight loss goals. Load up on vegetables, fruits, whole grains, beans, nuts and seeds.

Watch portions. It’s easy to over-consume, especially when emotions, stress and boredom are high. Reduce your portions or use a smaller plate to keep your calories in check.

Make the healthy choice the easy choice. Keep temptations out of the house. Instead, surround yourself with nutritious options so choosing something healthy is easy to do.

Simplify. Life is already complicated. Give yourself a break and keep food simple. Choose uncomplicated recipes and meals with only a few whole food ingredients. This is better for your body and your mind.

Be mindful. Avoid grazing all day or eating your emotions by tuning into your body. Recognize your own hunger cues and identify your emotions. Aim to eat only when you experience true hunger.

Aim for progress, not perfection. Small changes can add up to a big impact. When we focus on perfection, we set ourselves up for failure and quitting. Take small steps and celebrate all steps in the right direction. Just keep going.

This is already a challenging time, but prioritizing nutrition in these simple ways can help beyond the dinner table. Good nutrition during stressful times can boost mood, prevent unwanted weight gain and reduce your risk for cancer and other chronic conditions. Use this time at home to take care of yourself and strengthen healthy habits that can benefit you now and throughout your lifetime.

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Sulforaphane benefits: How broccoli and Brussels sprouts may help reduce your cancer risk

Sulforaphane is a powerful phytochemical found mostly in green vegetables. Find out why you should increase your intake of sulforaphane as part of a healthy diet.

You may not have heard of sulforaphane, but you’ll definitely want its benefits.

This tiny sulfur-based nutrient is one of the reasons why dark green vegetables like broccoli, Brussels sprouts and even cauliflower are so good for you.

Sulforaphane is a powerful phytochemical and research is starting to show it may help protect your body against cancer.

It is found in all cruciferous vegetables including kale, bok choy, cabbage and more.                                                                               

Benefits of sulforaphane

It neutralizes toxins. Phytochemicals like sulforaphane are antioxidants that cancel out free radicals. Free radical are tiny particles that weaken and damage healthy cells. They form in your body because of pollution, UV rays, food additives and preservatives, and even through natural processes like digestion.

It reduces inflammation. Because sulforaphane neutralizes toxins, it also calms inflammation in your body. Inflammation has been linked to several kinds of cancer.

It may protect your DNA. Some studies have shown that sulforaphane blocks mutations in DNA that lead to cancer.

It may slow tumor growth. Sulforaphane has been shown to reduce the ability of cancerous cells to multiply. That means it may slow tumor growth or reduce its ability to spread to other parts of your body.

It is readily available. You don’t have to do anything complicated to access the sulforaphane in cruciferous vegetables. All you have to do is steam the veggies or eat them raw. Roasting them also retains most of the nutrients.

Eat sulforaphane in plant form

The best way to access this nutrient is to eat it in its plant form, along with a variety of other vegetables, fruits and whole grains.

That’s because there are many other nutrients in plant foods and it’s likely they all work together to provide the most benefit.

“We aren’t sure if it’s one phytochemical that’s working against cancer or if it’s a combination of all of them,” says MD Anderson Research Dietitian Erma Levy. “Many different phytochemicals have been shown to have anti-cancer properties and no one fruit or vegetable will provide everything your body needs.”

This means supplements are out because they isolate nutrients and remove many of the benefits of plants.

Also out are broccoli-only diets. To ensure you get all the benefits, always focus on eating a variety of different colored plant foods.

More about phytochemicals

Sulforaphane is associated with leafy vegetables that are usually green but can be purple. But plants of other colors have different phytochemicals and antioxidants.

And the way you cook them can increase the amount of healthy nutrients available to you. For example, cooked tomatoes have more lycopene. Lycopene also helps reduce your cancer risk.

Here are more vital nutrients and tips on how to eat them.

Whatever you do, use healthy cooking techniques and avoid methods that destroy the benefits of plants. That includes deep frying, adding a lot of sugar and coating vegetables in cream or cheese sauces.

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How to help your teen quit vaping

Vaping among high school students has more than doubled in the last two years. And the numbers for middle school students have tripled. Our expert has advice if you’re worried your teen might be vaping.

When e-cigarettes were first sold, many claimed users would be smokers who wanted to stop smoking regular cigarettes.

But youth oriented marketing, sweet flavors that appeal to kids and the availability of products that are easy to hide has led to an epidemic of use among children who have never tried regular cigarettes.

Up to 25% of high school students say they have vaped within the last 30 days and 10% of middle school students also admit they vape. That is a total of over 5.3 million children.

That’s a problem because most e-cigarettes contain nicotine, which damages young, developing brains.

And the aerosol produced by e-cigarettes has the same harmful toxins found in glue and paint, even if the liquid is labeled as nicotine-free. Researchers are still trying to find out if the toxic chemicals in e-cigarettes have long-term health effects. There have been no long-term studies on the health effects of these chemicals when they are inhaled.

If you suspect your child is vaping, it’s essential you talk to them about quitting.

Is my child using e-cigarettes?

It can be hard to tell if your child is vaping. The e-cigarette aerosol may have a mild sweet smell, but they won’t cause the tell-tale smoke smell on clothes, hair or in the air like regular cigarettes. Also, e-cigarettes like JUUL are often small and easy to conceal.

Maher Karam-Hage, M.D., Medical Director of MD Anderson’s Tobacco Treatment Program, says the first thing to do is find out what your child knows about e-cigarettes.

“You don’t want to come in and blast them with information because they may know more than you,” he says. “Ask them if they see people vaping at school or what their friends are saying about e-cigarettes. Explore and see where the conversation goes.”

You also can look at your child’s behavior.

“Kids who vape talk about feeling irritable,” he says. “They may start to have a short fuse and lose their temper easily.”

Irritability can be a sign that your teen is using nicotine because it’s a stimulant like caffeine.

“Nicotine puts them on hyper drive,” says Karam-Hage.

Withdrawal from nicotine also can cause irritability.

How can I help my child quit vaping?

If your child tells you they are using e-cigarettes or it becomes clear to you they are, approach the issue gently.

“Try to find out where they are with it,” says Karam-Hage. “Are they playing with it because they like the flavors or do they use regularly? Do they know e-cigarettes contain nicotine and flavors, which are both harmful?”

You can explain that it may become difficult for them to quit vaping because nicotine is addictive. It also causes damage to the parts of their brain that regulate mood and attention, and that could have lasting effects.

If they use e-cigarettes, they also may start to feel more anxious or depressed, or have problems concentrating.

Finally, ask your teen if they have tried to quit. If they find they cannot stop, there are support services available that connect with teens through text messaging.

Here are some organizations that specialize in helping children quit vaping:

• Truth Initiative
• Smokefree Teen

Aren’t e-cigarettes illegal for teens?

There are a number of laws that may help protect young people from e-cigarettes.

Tobacco 21. It is now illegal to sell tobacco products to people under 21 in the United States. That includes regular cigarettes, cigars and e-cigarettes.

That means that retailers should check buyers’ ID and refuse to sell vaping products to anyone who is under age 21. It also applies to online sales.

Partial flavor ban. All pod based e-cigarettes with flavors are banned. Only tobacco flavor and menthol flavor are exempt. But disposable e-cigarettes are not included and these one-time use products are becoming more popular. They are also cheap, so they appeal to young users.

FDA pre-approval. Finally, by May 2020 all manufacturers of any tobacco product that want to remain on the market must submit an application to be pre-approved by the Food and Drug Administration. Manufacturers now must prove that their product will not be used by children.

Even with these laws in place, underage users will be able to find a way to access e-cigarettes and other vaping products, so it’s important to stay connected to your teen.

“Try to talk with your children before they try vaping, or before they become addicted,” says Karam-Hage. “The longer they use nicotine, the more difficult it will be for them to quit.”

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What smokers and vapers need to know about COVID-19

If you smoke or vape, you are more like to get respiratory illnesses. So what about the 2019 novel coronavirus disease, COVID-19? Our expert explains what you need to know.

People with certain underlying health problems are more likely to become seriously ill with the 2019 novel coronavirus disease, COVID-19. That includes diabetes and asthma.

But what about people who smoke or vape? 

If your smoking or vaping has not led to a chronic disease yet, there’s not enough data to make a confident assertion about your risk for COVID-19. But you should still be extremely careful, and do all you can to quit now.

“We know that smokers are at higher risk for respiratory infections,” says George Eapen, M.D., Professor in MD Anderson’s department of Pulmonary Medicine. “Vaping could be even worse.”

That’s because smoking damages your lungs’ defense system and impairs your immune system. And vaping can lead to immediate inflammation and lung injury.

Why do smokers get more respiratory infections?

Your lungs rely on a complex mucous transportation system to stay clean and clear of debris.

Tiny structures called cilia continuously transport mucous up and out of the lungs. It is then swallowed or expelled by coughing. This process is key to keeping your lungs healthy.

“When you smoke a cigarette, it temporarily stuns these structures and they cannot clear your lungs as well,” says Eapen. “We think this is one reason why smokers get sick more often.”

Another reason is that hot smoke from cigarettes or cigars disrupts the cells of your sinuses, nasal passage and throat. This disruption of the cell barrier may make you vulnerable to infections, including respiratory viruses. 

Each infection you get causes a little more damage to your lungs.

“It’s like Russian roulette. We don’t know exactly which infection will lead to serious problems,” says Eapen. “But the one thing you can do is stop adding additional burden to your lungs.”

Those with smoking-related illnesses like COPD or heart disease may face more complications if they contract a COVID-19 infection.

What about vaping?

During a vape session, you take an aerosol of chemicals and nicotine into your lungs. The long term risks are unknown but many short term problems have been identified.

E-cigarettes can make asthma worse, and cause coughing and wheezing. The most serious risk is for vaping associated lung injury or EVALI.

Experts think this is caused by a bad reaction to untested ingredients. An outbreak in 2019 was linked to vitamin E and tetrahydrocannabinol or TCH. 

“The lung scans of people who have vaping associated lung injury look identical to people with COVID-19,” says Eapen. “So if people are vaping, I would say absolutely stop it now.”

Until vaping products are properly regulated, we don’t know for sure what they contain or what harm they cause. The important thing to remember is that any existing lung damage is likely to increase your risk for COVID-19 complications.

The less damage you do to your lungs through either smoking or vaping, the better your chances of surviving a COVID-19 infection.

You can quit vaping and smoking

The best way to quit smoking is to use a combination of medications and counseling.

You can get free phone and text support through the Quitline in your state by calling 800-784-8669 or text QUIT to 47848. Visit www.SmokeFree.gov for more information.

Programs designed for young people and teenagers also are available:

• Truth Initiative
• Smokefree Teen

“There’s not much we can do about COVID-19 right now except practice hand hygiene, social distancing and reduce our known risk factors,” says Eapen. “Smoking and vaping are risk factors you can change.”

Learn more about COVID-19 and precautions MD Anderson is taking.

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What men need to know about HPV-related throat cancer

HPV-related throat cancer is on the rise, and the typical patient is a male in his 50s or 60s. Our expert offers advice on how to spot this cancer early, when it's easiest to treat.

BY Danielle Underferth

Smoking rates have declined over the past two decades, and so have the rates of smoking-related throat cancer. But cancer of the middle throat – or oropharynx – is rising sharply. The reason: human papillomavirus (HPV).

HPV-related throat cancer patients are usually non-smoking, white, heterosexual males in their 50s or 60s, says Neil Gross, M.D., professor and director of clinical research in the Department of Head and Neck Surgery at MD Anderson.

"We used to see mostly smokers. Now we see mostly nonsmokers, and their throat cancers are almost uniformly HPV-related."

Experts are not sure why HPV-related throat cancer mostly strikes white males who don't smoke. Women can also get the disease, but it's less common.

How does HPV cause throat cancer?

The HPV virus spreads to the oropharynx through oral sex or intimate kissing.

The oropharynx, which includes the area in the back of the tongue and the tonsils, has an uneven surface with deep crevices that make it a good environment for the virus to lodge.

Gross compares the surface to a "cauliflower." He says it has similarities to the surface of the cervix, a common site for HPV infection in women.

The virus can lay dormant in cells for years if the body doesn't clear it. In some cases, it causes cancer. Once that happens, the cancer can be relatively slow-growing. It can take months to become noticeable -- most people don’t notice it until it becomes a lump in the neck.

"That means the cancer has spread to a lymph node," says Gross.

In addition to throat cancer, HPV can cause genital warts as well as a number of cancers in both men and women, including anal, cervical, penile, vaginal and vulvar.

What are the symptoms of HPV-related throat cancer?

A lump in the neck is the most common and most obvious symptom of HPV-related throat cancer.

In some patients, the cancer can cause ear pain as it presses on nerves that lead to the ear. But, it typically does not cause any pain or difficulty swallowing, even when it becomes large and visible.

"Because the cancer often develops in a crevice, people don't usually feel it. It can be painless," says Gross.

He says sometimes the swelling and discomfort are misdiagnosed as an infection. He's had many patients who have been treated with several rounds of antibiotics, or even had teeth removed, due to a mistaken diagnosis.

"They do well once they get the proper treatment, but it is always frustrating that there has been a delay," he says.

If you have a lump in your neck that has you concerned, Gross suggests seeing an ear, nose and throat specialist.

Reduce your risk for HPV-related throat cancer

Nearly every male and female will be infected with HPV in their lifetime. Most people clear the virus within a couple of years and never know they had it. You can protect yourself and prevent infecting someone else by:

• Getting the HPV vaccine. All males and females ages 9–26 should get the HPV vaccine. It is most effective when given at ages 11–12, before puberty. Unvaccinated men and women ages 27–45 can also get the HPV vaccine and should talk to their doctor about the benefits of the vaccine. "There's still time for a lot of people to get vaccinated after age 27. The vaccine can be preventive in patients who are older," says Gross.
• Paying attention to symptoms. Don't ignore a lump in the neck bigger than a grape. "A lump in the neck is not normal," says Gross. And don't ignore ear pain beyond what you would expect from a minor infection, or pain that does not respond to treatment within two weeks. The earlier cancer is detected, the better the chance that it can be treated successfully.

There currently is no screening test to detect HPV in the throat. But getting vaccinated against the virus and being aware of changes in your body can protect you against HPV-related throat cancer.

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Hair dye, hair relaxers and breast cancer: What’s the risk?

Recent studies have linked hair dye and hair straightening chemicals to breast cancer, showing a 60% increase in risk for some women who use them. Here are the facts from our expert.

Experts and consumers have expressed concerns about a link between hair products and breast cancer for years.

Some hair dye and hair straightening treatments like relaxers contain chemicals called endocrine disrupters that can interfere with your hormones.

This hormone disruption is a concern, especially when it comes to hormone driven cancers like breast, prostate and ovarian cancers.

We talked to Abenaa Brewster, M.D., M.H.S., professor in MD Anderson’s department of Clinical Cancer Prevention, for advice if you’re thinking about dying or straightening your hair.

What does research say about hair products and cancer?

For many years research has been inconclusive when it comes to hair products, with some studies confirming a cancer link and others not.

Now one large study has shown women who used permanent hair dye were 9% more likely to develop breast cancer.

For women who used hair straightening or relaxing chemicals regularly, breast cancer risk increased 31%.

 “This is just one study, but it is a good study,” says Brewster. “It means that there is an association, but it may not be very strong. What we need now is more research to support this.”

The study focused on women who had a sister who had breast cancer. The results might not be the same for women with no family history of the disease.

Hair products, breast cancer and race

The differences in risk were more striking when the results were split by race. African American women who used hair dye every 6-8 weeks were 60% more likely to develop breast cancer.

The increased risk may not be due to genetics. Brewster says the issue is likely the kind of dye used. The trend showed the higher increase in risk was for women dying their hair darker, not those dying their hair lighter.

“African American women are more likely to dye their hair darker,” says Brewster. “Whatever is in those products may be more of a problem than what is in the products that make your hair lighter.”

Should you use permanent hair dye?

More research needs to be done before we can say for sure that chemicals in hair products cause cancer.

“Cutting back on hair dye and straightening is potentially one of many things that you could do to reduce your risk for breast cancer,” says Brewster. “But there are other changes you can make that would be more significant.”

If you want to reduce your risk for breast cancer and other cancers, the best thing to do is to follow a healthy lifestyle.

“Many studies show that maintaining a healthy weight, exercising, reducing your alcohol intake and eating a healthy diet significantly reduce your risk for breast cancer,” says Brewster.

Here are all nine ways that have been proven to reduce your risk for cancer.

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5 tips for healthy living success from MD Anderson’s president

Find out how our leader fits cancer prevention into his daily life as one of the top 50 CEOs in the country.

BY Heather Alexander

Our President Peter WT Pisters, M.D., takes part in the President’s Fitness Challenge.

Time is often the biggest barrier to lifestyle change, so how do the busiest among us make health a priority?

MD Anderson’s President Peter WT Pisters, M.D., leads a team of 22,000 employees and is ranked as one of the top 50 CEOs in America. But he doesn’t let his responsibilities get in the way of his health.

“Healthy living is extremely important to me,” says Pisters. “With the demanding job that I have, I know that I have to make cancer prevention a priority.”

You can reduce your cancer risk significantly through healthy lifestyle choices like exercise, eating a plant-based diet, getting screened, getting vaccinated and protecting your skin.

Here is how Pisters ensures that he successfully follows all the ways to reduce the risk for cancer.

Integrate change into your life

When you ask a successful person what keeps them flying high, they will almost always say routine. Pisters is no different.

“I would hazard a guess that when you look at our employees, every one of them brushes their teeth before they go to bed,” Pisters says. “You need the same disciplined approach to diet, exercise and all your other priorities.”

Pisters has gone to the gym at 5 a.m. for most of his working life. It’s an integral part of his day and he’s created a community around it.

“It’s the same people there at that time of the day, so you get a different friend group on the machines,” he says. “That discipline helped me enormously.”

Pick your perfect time to exercise or prepare healthy meals and stick to it.

Our President Peter WT Pisters, M.D., talks with employees during the President’s Fitness Challenge.

Focus on the 168

Pisters is one of only a few people who know what the magic number, 168, means.

“It is the number of hours in a week,” says Pisters. “Everyone has the same, and how you allocate what you do against that 168 is very, very important.”

The principle is that everything we want to do will take up a part of that 168 hours. So if we want to exercise or plan healthy meals or de-stress, we must set aside some hours to do it.

Working with a large number like 168 relieves the pressure of trying to fit everything into one 24 hour day.

Grab a piece of paper, list your priorities and then note down how much time you dedicate to those goals each week.

Self-reflection

No commitment to change works unless you regularly check your progress. Pisters reviews his day each evening to check that his priorities really are getting the time that they deserve.

“If I say that exercise is a priority, I need to ask myself, how much of the 168 did I allocate to exercise?” he says.

This period of self-reflection allows you to consider what might be getting in the way of your goals and address any priorities that are falling by the wayside.

“The 168 plan and self-reflection allow me to bring the right energy to my job,” Pisters says. “And I can make certain that I don’t lose sight of the fact that I’m a husband and a father, and that I don’t let go of important things like friends.”

Our President Peter WT Pisters, M.D., uses daily self-reflection to help him meet his health goals.

Portion control

Even healthy foods will make you gain weight if you eat too much of them. Pisters says portion control is key to his healthy eating plan. Especially when he wants to treat himself to a guilty pleasure.

“My biggest health challenge is avoiding ice cream,” says Pisters. “I love mini ice cream bars. We keep them stocked at home, and I have got to limit myself on those.”

While it can be difficult, Pisters ensures he stays thoughtful about his portions.

It pays to take the time to learn the correct serving sizes for the foods you like to eat. It can save you thousands of calories a week.

 

How portion control can help you stay healthy

Form a partnership with your doctor

To maintain your health, a partnership with a doctor can help you keep track of cancer screening exams and other health checks that are essential.

“Ideally, that individual should be the architect of a health plan that is linked to your life plan,” says Pisters. “But there is a personal accountability part of it as well. I have got to be thinking about all I need to do.”

For both men and women, that includes colorectal cancer screening exams like a colonoscopy, and, in some cases, lung cancer and skin cancer screening. Men should discuss prostate cancer screening with their doctor. Women should get cervical and breast cancer screening exams.

“Katherine, my wife, just had an experience with melanoma and was treated here at MD Anderson,” Pisters says. “That sharpened our family focus on UV exposure.”

Cancer screening exams ensure that the disease is caught early, when it’s easiest to treat. Make sure you know the exams that are recommended for you.

“We know that many cancers can be prevented if we just deployed what we know works today,” says Pisters. “And so prevention has been deeply integrated into our mission for decades and is very, very important.”

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