Here is a book for all women to read, particularly those who have had breast cancer, and those who wish to reduce their risks for developing it. Suzannah Olivier is an expert in the field of nutrition and has researched her subject thoroughly. Throughout the book her infectious enthusiasm bubbles through, and practical advice and help are to be found throughout. It is not the whole answer, as she is the first to admit, but it makes sense. It offers a means of taking control of one's body, of adopting a positive approach and saying, 'this is what I can do to help myself.'

I met Suzannah Olivier when, typically, she was hosting a dinner in aid of a breast cancer charity. She herself had developed breast cancer at an early age. She took a positive approach to her illness and during her treatment decided that her diet and lifestyle were wrong of health and a testimony to her convictions. Many people would be content with just that but Suzannah felt that her experience needed to be passed on to others. As a nutritionist she started advising women with breast cancer, and now with this book she is able to reach an even wider audience. She is a pains to point out that attention to diet is and must be complementary to conventional medical treatment and I obviously endorse this.

Diet has been known to be a factor in the development of some cancers for a long time. There are many other factors, of course, but sufficient heed has not been taken of diet, and advice, when given, frequently falls on deaf ears. Eating is a habit after all which, like many other habits, may at first seem hard to change.

As a surgeon specializing in the treatment of breast diseases I have, all too frequently, to utter those fateful words, 'You have breast cancer.' For the patient a period of anxious waiting has ended and life will never be quite the same again. It is then my task, together with my dedicated team, to treat that patient. The emphasis here is the word 'patient' - not just the cancer, but the whole patient.

Over twenty-five years ago I spent my research year in America working on the immune response to breast cancer and I have always been aware of the need to preserve this immune response. The body has it own natural defence mechanism against cancer cells - the immune system. Antibodies to breast cancer cells are produced in the same way as they are to infections. These antibodies attach themselves to the cancer cells and inhibit their ability to divide. Treatment therefore needs to be directed towards eradicating the tumour by conventional means - surgery, radiotherapy, chemotherapy or hormonal manipulation - and restoring the balance in favour of the immune system. Surgery, radiotherapy and chemotherapy will themselves cause temporary imunosuppression, but the overall benefits in destroying the tumour are of greater value, and the adverse effect on the immune system is a temporary one.

One of the first things to do it to build a positive approach which involves being outgoing and looking forward. Saying, 'What can I do to help myself?' Improving one's general healthy and level of fitness will boost the body's immune system, and here diet, exercise and stress-reduction play in important part.

The past fifty years have seen a dramatic increase in the incidence of breast cancer. Is it just coincidence that our diet had changed along with this? We look with dismay at the food our teenagers are eating, ready-prepared foods abound on supermarket shelves, sugar and salt are added to canned foods, and so-called fresh fruit and vegetables have withstood the onslaught of chemicals and pesticides. The pace of life has increased and food to has become 'fast'. We expect and demand more and more, yet stress levels rise and we remain discontented. Nor should we ignore the other changes in our lifestyle. The majority of breast cancers are hormone dependent, that is to say they are stimulated by the body's oestrogen. Nowadays, we can test the cancer cells for oestrogen receptors as a means of predicting whether they will respond to hormone manipulation using, for example, the drug Tamoxifen. Suzannah discusses the changes in our lifestyle that have changed women's hormone balance - the move towards smaller families later in life, the contraceptive pill and HRT.

Suzannah is the ideal person to write this book and will, I'm sure, inspire her readers with her common sense and advice. Read on....
Introduction
Moving Towards Health
As I write this, I am ten years post-diagnosis for breast cancer and I am going to do everything in my power to give other women with my breast cancer the tools to make his, and more, a very real possibility for them. Eighty per cent of breast lumps and irregularities turn out not to be breast cancer, and there is much that can be done to prevent this disease. For the 20 per cent of women for whom the diagnosis does turn out to be cancer, there are many ways in which they can give themselves the best chance of recovery. Breast cancer is not a disease against which we are helpless. It is the result of a series of biological and environmental imbalances, and we are all able to take action to adjust these conditions.

My story
At the time I was thirty years old - a very young statistic - and found that the cancer had spread to half of my lymph glands. Whilst apportioning 'blame' for the development of cancer is probably ill-advised, I decided in later years, if there was a walking example of a woman most likely to get breast cancer I was probably her (genetics aside). I had not had any pregnancies; I had started my periods early in life; I had been put on the contraceptive pill as a young teenager to 'regulate' my periods and had stayed on it for many years; my diet was based on what was speedy and easy rather than nourishing and healthy; my food was certainly not organic; my stress levels were fantastically high; I had stopped doing any appreciable amounts of exercise, and so on.

After the shock of the discovery of the lump I set to work. The first item on my agenda was to find expert help. I asked around and found the most wonderful breast surgeon at a specialized National Health Service cancer centre. I had learnt that being operated on by a specialist, rather than a general surgeon, was likely to improve my chances of survival. He was sensitive to the fact that I was going through a divorce and felt extremely vulnerable, and was happy to do a lumpectomy and lymph gland clearance instead of a mastectomy. It was only as the 1980s were clicking over to the 1990s that this became an option, and I have since spoken to many women with much smaller cancers who endured fare more radical surgery only a few years previously.

Then I learned an interesting thing. The incidence of breast cancer had been rising steadily, and significantly, since the Second World War. It was startlingly obvious to me that there must be something we were doing, as a nation, for this to be so.

Providence then came into play. A friend, and nutritionist, Marjorie Green, started putting packets of vitamin C through my letter-box, along with books to read. She was reduced to using my letter-box as I was feeling so low, emotionally and physically, that I would frequently avoid answering the door-bell. I was very depressed at this stage and it is hard to motivate yourself when you are feeling low and are on your own. I was having a bad reaction to my chemotherapy and feeling very unwell. Then I finally did as I was advised and started taking the vitamin C (I had slowly started to address my diet earlier). The vitamin C helped me turn the corner and the remaining three months of chemotherapy had nothing like the same negative impact.

Making changes
Subsequent to this I started to address other areas of my life that needed changing, always with a view to improving my chances of survival. I did not become a 'martyr to the cause' but made changes at a steady pace as and when I was able. First on my hit list was improving my diet further. I became fascinated with the subject of nutrition and it is, of course, the one area where we have the most control. Along the way I cleared up a number of other health issues that had plagued me in previous years - they would make good reading for a hypochondriac: an underachieve thyroid, digestive problems, pre-menstrual swings, yeast infections and others. I believe that addressing all my health issues is what really made the difference, because these are not isolated processes that have no bearing on each other. By addressing the whole I am sure I was putting myself in the best possible position to avoid succumbing to breast cancer again, either with the original cancer spreading (if any microscopic amounts were left after hospital treatment) or new cancers having the opportunity to develop. I also addressed other key areas which I believe made a difference. I learned all about stress, its impact on the body and ways to make changes, some of which were quite radical. And I am still evolving. After fits and starts, I have been much better about taking regular exercise in the last two years and since remarrying and becoming pregnant with our son, he has been the catalyst I needed to get really serious about ensuring that most of our food comes from organic sources. In the first half of my forties, I feel physically much better than in the second half of my twenties.

Knowledge is power
As I researched this book, I hoped to include personal stories from long-term breast cancer survivors - and to my delight women came out of the woodwork in their droves, all of them wonderful, warm and keen to let other women know that life goes on. I often heard repeated from these women similar stories about how they coped at the time, how breast cancer as changed their view of life, and if they could have their time again how they would have wanted more information. As late as the mid-1980s breast cancer was not a widely discussed subject, but it has come out of the closet and women are prepared to share their experiences with others. Knowledge is power, and all these women feel that they have learnt from their experience and applied the information gained for the benefit of themselves and their families. Rarely did I encounter women who did not radically change their attitudes to life, living more for the moment and savouring precious times. The majority of them felt empowered by learning and changing their lifestyles and diets and were happy that they had become more aware of their health. And when I say the majority, these were not a carefully selected group of nutritionally paranoid women, but women that I met at breast cancer support groups who came from all walks of life. The one thing that is assured these days, if you are unfortunate enough to have just been diagnosed with breast cancer, is that you have a wealth of opportunities to meet other women who have been through a similar experience and who are willing to listen to provide information, as needed.

Loading the dice
I have a major question which I have been asking ever since my own encounter with cancer: If some survive and some don't, what can we learn from the survivors and what can we do to load the dice in our favour? The bald truth is that it is up to us to do what we can to help ourselves. Our families and friends can encourage and support us, but doing what it takes to give ourselves the best opportunity to thrive must come from within. Nobody gets it right all the time, but as long as we are making educated choices for ourselves we know that we are giving it our best shot.

Prevention is best
Today I practice as a nutritionist specializing in the care of women with breast cancer and I find myself becoming frustrated that insufficient attention is paid to prevention of this disease. It must be obvious to most people that it is a better strategy to avoid such a problem than to pick up the pieces afterwards. 'Reliable evidence shows that what we eat and drink is crucial in determining our risk of cancer,' stated professor Philip James when launching the World Cancer Research Fund report in 1998. 'The evidence linking diet to cancer is now as compelling as the evidence on diet and heart disease,' added Professor Walter Willett of Harvard University, one of the world's leading nutritional epidemiologists.

Why do more people not concern themselves wit prevention when the information is out there? Cancer is s difficult subject for most people. It is feared far more than cardiovascular disease even though, statistically, heart attacks and strokes outnumber cancer as killers. Breast cancer in particular is very threatening to women - it attacks their sense of attractiveness as well as forcing them to deal with the issue of mortality. The fear of death, the fear of losing a breast to surgery, of hair loss during chemotherapy, of tiredness and sickness during treatment are huge issues. And many of us are ostriches. If we don't think about it or address the problem, then maybe it will not happen. Even those who don't think about it know how far to take preventive measures - there is a mass of information, much of it conflicting, so it is often easier just to ignore it all And then there is a feeling of helplessness. If, as it seems, environmental factors are so important, and chemicals in our diet, and in the water we drink and the air we breathe contribute to breast cancer, what do we do - stop breathing? It can all seem quite complex. Others are simply unaware that diet, environment and lifestyle may have an impact - until they have no choice but to face the issues.

Ideally this is a book that will be used for prevention. This is, without a doubt, the area where the most significant changes to women's health can be made. In the last thirty years the incidence of breast cancer has increased by a massive 50 per cent. If these cases could have been prevented, we would have avoided untold heartache and saved millions of pounds.

Though prevention is the ideal, women who have already been diagnosed with breast cancer can benefit enormously from nutritional intervention. It is these women who are most likely to heed such advice - and these are the women who will bring the message to others. Every woman with breast cancer touches the lives of others and, whether she realizes it or not, is a bearer of information about this disease. It is my hope that this book will be read by the female relatives and friends of breast cancer patients for their own benefit. Their male relatives and friends may also take an interest - breast cancer affects the whole family. This book is about choices, opportunities and hope.

What can nutrition offer those with breast cancer?
Quite a lot, as it happens. You should be able to improve your quantity and quality of life an your chances for remission, without any conflict with your existing treatment and with no downsides - an insurance policy without significant cost.

A tumour is not a disease. A tumour is a consequence of a disease state. A disease state is, fundamentally, a metabolic disorder, and while surgery, chemotherapy and radiation will deal with the immediate crisis they do nothing to change the original factors, the metabolic imbalances or disorders, which allowed the condition to develop. By changing these imbalances you can create an environment where the cancer finds it difficult to survive.

There is a lot of information - several thousand research papers - to support the use of nutrition in the return to health of breast cancer patients, but doubters will always be looking for more research before recommending such measures. It must be stated plainly that the area of nutrition and cancer is controversial, and is regarded with scepticism by some members of the medical profession. Nevertheless hundreds of women have asked me for information about how to support themselves nutritionally after a diagnosis of breast cancer, and I have no doubt as to the need for, and the value of, this advice.

Costly research is a luxury that many people do not have the time for, and the wait could be fatal for some. Common sense dictates that, with the amount of data already available, those whose want to adopt nutritional and lifestyle changes have clear incentives to act now.

How far, how fast?
We are all different. There is no one approach that is right for everybody, with nutrition as with anything else. We know from studies that the right sort of fat in the diet, less overall fat, more vegetarian sources of protein, more fruit and veg, more oily fish, less alcohol, more soya, will decrease the risk of developing breast cancer. And yet, for some, the reforms required to lead a nutritionally exemplary life would be so tiresome, or even stressful, that they are not feasible - at the moment.

This book outlines the information needed to make personal choices for a way forward and sets out the most widely accepted nutritional and lifestyle factors in managing breast cancer. You may not want to follow all the advice, and even if you want to do as much as you can, you don't have to do it all in one go. Establishing new habits takes time, and these should be viewed as habits for life - not just for the weekend.

You may be reading this book while only half-way thought treatment and may not have time, as suggested, to 'prepare' for surgery or chemotherapy, or you may feel that the mental stamina needed to change your diet is more than you have strength for at this time. I set before you the information; its up to you to decide how fare you want to take it.

An active role in your return to health
For some women the mental tonic of taking charge and doing something positive is a tremendous boost. If you are lucky, you will have a partner, family or friends to support you - thought do not expect them to want to do as you do. Remember, there is nothing worse than a preaching convert!

Find your own place within this framework, and go at the speed you find acceptable. Don't let anyone dissuade you with 'It's not proven' or 'You are wasting your time'. If it feels right, do it. The power of the mind in the healing process is not the domain of this book, but never under-estimate its impact. Don't measure yourself against other people who may be doing more or less - it's not a race! This is a time, more than any other, when you are probably taking stock and becoming body-aware - maybe more than you want to. As with any other health regime, you will quickly become aware of what makes you feel good and what doesn't - listen to this inner wisdom. The seriousness of breast cancer does not detract from that, and probably gives an extra incentive which may have been lacking in the past. If I could patent the feel-good factor (FGF) of nutrition I would be rich! Take some of the FGF for yourself and make it your own.

Does Diet Really Influence Breast Cancer?
In the past, those who drew a link between breast cancer and diet endured a degree of ridicule from the establishment. However, it appears that the climate is now changing, with many important studies backing up the claims that diet and breast cancer do have strong links. Evidence shows that food choices can make a significant difference to the risk of developing the disease and this is now almost becoming received wisdom. The national Cancer Institute of Canada made the prediction that dietary modifications (in particular increasing fruits, vegetables, vitamin C and reducing saturated fats) could reduce breast cancer statistics by 24 per cent in post-menopausal women and by 14 per cent in pre-menopausal women.1 If dietary changes are likely to make this much difference, and you then incorporate other influencing factors such as hormone balance, exercise and reduced exposure to environmental chemicals, you begin to see how you can make a really dramatic impact on a disease which affects so many women.

The body cures cancer daily
Cancer doesn't just 'happen'. Breast cancer takes an average of ten years to develop from the point where damage is done to a cell, until it had replicated itself to the point where a cancerous mass can be found.

Cell damage occurs daily, but we have many ways of dealing with this development. We can stop the damage happening in the first place, or at least dramatically reduce the chances of it developing. We can repair damage to DNA or cell membranes. We can get rid of, or detoxify, carcinogens. We can recognize cells that have mutated, and even started to proliferate, and eliminate them. We can encourage cells to live out their pre-programmed healthy lifespan, instead of going on to become cancer cells which do not die. There are several stages along the way in the development of cancer, and the healthy body can interrupt the process at most stages.

It is only when we are overwhelmed by cancer-causing or cancer-promoting factors, or when our defence mechanisms are not sufficiently able to deal with the abuses and imbalances, that cancer - in this case, breast cancer - gets a hold. Prevention of breast cancer makes sense because, if you can enhance your natural mechanisms which deal with early cancer, you may be able to avoid the traumatic experience of medical intervention.

A significant number of women, if they apply the principles in this book, may avoid the initiation of breast cancer. Or if they are in the very early stages of breast cancer which are as yet undetectable they may help to reverse the process. Even more astounding is the potential for women who have a genetic predisposition to breast cancer possibly to avoid their fate by applying these measures. Diet and lifestyle appear to be more significant influences on the development of breast cancer then is a genetic susceptibility. Women are likely to be able, literally, to reprogramme their genes.

Beyond a basic eating plan, we all have individual health issues that predispose us to an increased risk of breast cancer. For some it may be question of hormone balance, for others their immune system may not be as effective as it ideal, and others still may not have the 'cast-iron' digestive systems that allow them to get away with dietary discrepancies. Taking a very personal approach, and working out which are the most important issues for you, can significantly raise your level of healthy and energy, enabling your defence mechanisms to work to maximum efficiency. Balance, or homeostasis, is what the body is always seeking to achieve, and if you allow this natural state to happen you are better disposed to deal with the threat of breast cancer.

Preventing recurrence
Whilst it is widely accepted that nutrition plays an important part in breast cancer prevention, the corollary that nutrition can be involved in reducing the recurrence of this disease is sometimes still viewed as novel. Research into this area is still at an early stage, and it looking promising,2 but it will probably not be confirmed until well into the twenty-first century that we can help to prevent recurrence with dietary measures. The closest we come to anything that resembles evidence are Japanese women, whose low incidence of breast cancer is linked to their diet, and who also have a much better chance of their breast cancer not returning. Why? Probably because they are carrying on doing what they have been doing all along, eating a diet which is protective against breast cancer.3 So this is where you have to apply some logic to the situation and decide for yourself if the link between nutrition and breast cancer prevention is likely or not. The truth is that when all the evidence is in, sorted and made sense of it, you will probably have died of old age anyway. Why wait? Given that dietary manipulation doesn't do any harm, and you believe that you may be loading the dice in your favour, why not go with your instincts? It really is a no-lose situation. A key principle of the Hippocratic Oath, to which all doctors we owe allegiance, is 'First Do No Harm'. Nutrition, when used wisely, at the very least does no harm and, at most, can make all the difference in the world. Supporting the body's defence mechanism and giving it the raw materials that it needs to function optimally can do a massive amount to help thousands of women to live many years beyond their initial diagnosis of breast cancer.

In all other fields the advice given for secondary treatment - in other words, prevention of recurrence - is the same as that which is given for initial prevention. This is the rule, not the exception. If you have a heart attack you will be told to reduce salt, reduce saturated fat, take exercise and avoid smoking - the same strategies that are suggested for avoiding heart disease in the first place. If you have osteoporosis you will be advised to take calcium and do exercise, as will a person who wants to prevent the disease. If you have kidney stones you will be asked to drink a lot of water, as this is known to prevent them in the first place.

And, it may not be just nutrition that works - the knock-on effect of doing something positive which may be helpful can bring into play the little-understood matter of the power of the mind in the healing process. A woman who is actively participating in her return to health will probably have the edge.

There is another exciting way in which nutrition can be used, to improve not only a woman's chance of surviving the cancer, but her recovery from the treatment she undergoes to deal with the disease. The treatment may have worked, but for some women may not have been 100 per cent successful in the long term. Nutrition can create the right environment for the immune system to operate optimally, mop up any residual cancer, recover from surgery and other treatments, and create an environment which is hostile to the development of new cancers.

What is good for prevention must be good for promoting recovery and preventing recurrence.

Nutrition and research
The 'gold standard' of research is the Randomized Double-Blind Cross-Over Placebo-Conrolled Trial. This means that a substance is tested on people (or animals) who do not know if they are receiving the substance in question. It is all controlled by sealed, numbered doses, and at some point in the trial the participants are 'crossed over' from the substance being tested to the placebo, or vice versa. This method is fine if you are testing a drug, but if you are examining the merits of a vitamin or a food it has severe limitations.

Nutrition does not lend itself well to studies and trials and in years to come trials may need to be redesigned in order to obtain meaningful data from this whole area. To quote one researcher, 'The tools being applied are generally blunt instruments that are simple or the scientist to administer and analyse.'4 Furthermore, most experiments are not funded for more than a few months (at best), while the effect of nutrition, though it can sometimes be speedy, takes longer in most cases and depends on long-term lifestyle changes.

Researchers at the International Agency for Research on Cancer put it succinctly when they said, 'Understanding the multi-dimensional nature of diet and of its relationship with different cancers is a major scientific challenge.'5 To put it another way: with nutrition, the whole is greater than the parts.

There is now a significant body of research building up, with thousands of papers available examining the influences of nutrition on cancer. Evidence is accumulating that points firmly towards a useful therapy with no side-effects.

Magic bullets?
The search has been on for many years now to find magic bullets which are effective as the 'cure' for breast cancer and other diseases. None has yet been found, despite billions of dollars spent on research looking for what are termed 'biological response modifiers'. Attempts to 'bottle' the substances we make in our bodies which play a part in fighting cancer, such as interferon, tumour-derived activator killer cells and interleukin, have all been disappointing, expensive and have had traumatic side-effects for patients.

But suppose that drugs being developed as biological response modifiers had shown successful results, without any side-effects at all. You can imagine the blaze of excitement which would have been generated by such 'miracle drugs' and the huge effort which the drug companies would devote to having them patented, licensed and publicized.

Well, guess what? Such substances have been found. Foods are now being described by scientists as 'chemopreventive' and it is acknowledged tat certain foods have a pharmacological effect - items such as broccoli, soya, oriental mushrooms, garlic and live yoghurt. These foods have been shown to:
support the immune system

balance hormones and block their effect on breast tissue

improve the liver's handling of carcinogens

block cancer-promoting growth hormones

stop damage to DNA and the excessive cell growth that leads to cancer
Powerful stuff indeed. The problem is that these foods and nutrients can't be patented and there is no money to be had in researching them, meaning that any research is motivated by academic interest rather than profit. Nevertheless, the fact that trails are taking place at all, with the considerable funding that is required, is a strong indication of how seriously the role of nutrition in the prevention and treatment of breast cancer is being taken. Money is not thrown around for such research, and reputations are at stake; results which are meaningful are sought.

Throughout this book we will look at ways in which foods in our diet can lower the risk of, and promote recovery from, breast cancer by maximizing these pharmacological effects.

The best strategy
Certain concepts of holistic health care are alien to the medical profession as a whole. One is 'cleansing' the body of toxins, another is the idea of a 'healing crisis' where symptoms get worse before they get better. Whilst both can have value in the right context it is vital to differentiate between healing phenomena and the symptoms of serious disease, such as cancer.

It is the experience of many clinicians (and I have read this in every single orthodox book on the subject of cancer) that occasionally patients will come to them saying they noticed an abnormality a while ago, but had been told that it was the result of toxins in the body, or had been given some other explanation. This is a dangerous situation as early diagnosis is a life-saver. I must stress that if any lump or other untoward symptom is encountered, medical advice must be sought to rule out cancer. Professor Baum said in 1995 that he saw one person a month who delayed treatment while they tried other therapies, and that the other 3,000 consultant surgeons around the country probably had similar experiences.

Cancer is an area where alternative programmes and remedies abound. Some alternative therapies advocate rigorous dietary regimes consisting of exclusively vegan, macrobiotic or fruit- and vegetable- based diets encompassing juices and enemas. Whilst these may have had merit for some individuals, there is insufficient evidence that they can stand alone as successful therapies for the majority of people. And by far the majority of people who can be helped with nutrition are not going to entertain such strict regimes, let alone disciplines which might advocate not using conventional treatments.

If cancer has been diagnosed, the optimum way forward for the majority of people, with our current state of knowledge, is to use the best that conventional medicine can offer and the best that nutritional therapy can offer, along with a smattering of 'what makes you feel good' therapies.

Nutrition - the adventure
Many people avoid the subject of diet and other lifestyle changes because they are worried about what why are going to be asked to give up. Food is a great pleasure for most of us and I prefer to think of changes in a more positive framework. It helps if you are a 'foodie' and enjoy different cuisines, the preparation of food and planning menus - and, of course, it you have the energy and time to devote to the issue. It is also helpful if you have the energy and time to devote to this issue. It is also helpful if you have a supportive family, especially if you are feeling unwell. But healthy eating can also be made simple and doesn't have to take up a lot of time. I would urge you to find ways to enjoy healthy food and good nutrition - this is meant to be a positive experience. For those who are not so hot in the kitchen, I have put in my own simple recipes. Rather than featuring lists of ingredients that need to be carefully weighed out, these are more the sort of recipe that reads 'a handful of this, and a pinch of that'. They are meant to be guides rather than 'the law'. The recipes are all short on preparation time and long on taste, enjoyment and healthy ingredients.

How to use this book
This book will take you through the facts about breast cancer, including its development, diagnosis and medical treatment. We will look at risk factors and how to use this information to help prevent the disease developing. The main thrust is to examine dietary, lifestyle and environmental impacts on breast cancer.

In Your Basic Nutrition and Supplement Plan (page 197), the measures covered are appropriate for all of us, whether we already have a diagnosis of breast cancer or are interested in preventing the disease. Your Basic Nutrition and Supplement Plan will offer ways of changing habits and providing the tools to optimize the fight against breast cancer.

But we are not all clones of each other and the influences of the body chemistry are different in every individual. To give you the best of all chances in avoiding or recovering from breast cancer The Five Pillars of Health (page 235) provide measures to individualize your plan to suit your personal body chemistry and optimize your prevention or recovery goals. The check-lists at the front of the book will guide you to the areas which are most important for your address.

Finally, for those who are undergoing, or about to undergo, medical treatment for breast cancer, Supporting Your Medical Treatment Choices with Nutrition(page 301) will provide measures to reduce side-effects that may be encountered.

Some people are browsers, some are readers, some are hoppers and skippers and some just want to get straight to the point. It would be great if you were to read this book from cover to cover, and then make a plan which is right for you. Those who do not wish to do that, or who do not have the time, could go straight to the Basic Nutrition Plan (page 202). Here guidelines are outlined for changes to get on with straight away, providing the basics of using nutrition to fight breast cancer for both prevention and recovery. You can then go on to the more 'advanced' information outlined in The Five Pillars of Health for measures which are specific to you, to rebalance your body chemistry. However, I would strongly urge you at some point to read the other chapters giving you the background to what you are doing and why. Educate yourself on the reasons behind the plan and you will be more effective at making informed choices at al stages.

Five Inspiring Stories
The following stories are from women who used nutrition as an intrinsic part of their healing process from the moment they were told of their diagnosis. Each has a touching and inspiring tale to tell:

Persephone Arbour's story

Extract from a letter sent by Persephone, a 'veteran' of breast cancer, to Mary, newly diagnosed with the disease.

'When I was diagnosed, my first reaction - in shock - was "I have no future." Suddenly I had no idea of future at all - no sense of direction - no plans. I sat in my doctor's surgery in tears and asked him, "If it was you what would you do?" He said "I would have surgery and would go to the Gawler Foundation [a complementary cancer support centre in Australia set up by Ian Gawler after he had been given two weeks to live eighteen years ago]..." I learned about diets and why, not just what., So I cam back to Perth very well informed, rested and clearer. I had already decided that surgery was absolutely OK, because my obviously misfunctioning immune system did not need to cope with recalcitrant cells in a lump! However, I also...did not see the point of nuking this body either...I was sixty-one...that makes a difference. I think I knew that quality of my life was more important than quantity...Here I am (now) hale and hearty with a clean record. I do have a tremendous respect for this disease. I understand what it can do, how it can lie dormant somewhere and - bingo - take off again. So I treat this body much better than I used to. I am much more conscious, though not fanatical, about what does into it!! I am more sensitive to what I need in terms of a stress-free environment. I make sure that I sleep enough. I take antioxidants and vitamin C. There were twenty-one women in (my)group - and without exception thy are all, including me, "Doers and Copers"....Learn to be selfish, find out what you need to stay relaxed, happy and fulfilled.'

Zoë Lingren's story
Listening to Zoë tell her story I became very aware of the excitement in her voice as she got to the turning point in her life. She was having a blood transfusion, needed because her red blood cell count had plummeted after chemotherapy, when 'The clouds parted and I realized that I must take charge, must make what I was going through a positive experience and learn something from it all.'

Zoë's story began when she was diagnosed with breast cancer when six months pregnant in 1988 at the age of thirty-one She already had a nine-month-old son, and eventually her daughter was induced about six weeks early. It had been suggested that she have a termination - which she refused - and she was given a partial mastectomy, with lymph node clearance, while pregnant. Radiotherapy was postponed until after the birth. Zoë's mother died of breast cancer in 1990 and it is difficult to understand the kind of mixed emotions and pressures that accompanied her own experience with the disease at such a vulnerable point in her life.

The next dramatic turn of events came when Zoë was told, in 1991, that she had metastases in her lungs, for which she needed chemotherapy.

From day one Zoë threw herself into the business of getting well, what she describes as a 'healing journey'. As the years progressed she learned more and more about what worked for her and used a number of disciplines alongside her hospital treatment - diet, supplements, acupuncture (which helped to normalize her red blood cell count), meditation, visualization, reflexology and progesterone cream. The day she was informed of her breast cancer she became a vegetarian - 'I think I had always been looking for an excuse to do so.' Zoë attended the Bristol Cancer Help Centre and discovered the power of healing foods including raw foods, soya, and spices such as ginger and garlic. She also started a regime of supplemented nutrients, including high doses of beta-carotene, vitamin C and other anti-oxidants. The hospital also put her on Tamoxifen, and Zoë has used progesterone cream which offset the resultant menopausal problems and restored her well-being. After her fourth chemotherapy for the lung metastases Zoë went on holiday to New York with her husband, and with no children and the opportunity to think about other things they really enjoyed themselves. On her return she began to work for the same architectural practice as her husband (they are both architects). She felt that they holiday helped to make a shift in her thinking and to normalize her life. Then came the payoff - she was told that no more cancer was showing in her lungs. 'I felt I had conquered the disease.'

Sue Pembrey's story*

'Looking back, my experience of cancer has acted as a great bridge between my old life, working with orthodox medicine of thirty -three years as a nurse in the NHS, and a new one which is embracing wider approaches to health and healing. I retired from full-time nursing at the age of fifty-two (in 1994), having nursed many patients with breast cancer. I discovered my own just two weeks later. Suddenly I was on the other side.

'The whole experience was, at one level, excellent. I felt safe and well cared for; the staff were competent, kind, happy to provide information and supportive when I did not take their advice, for example, not taking Tamoxifen. But inside the good advice, for example, not taking Tamoxifen. But inside the good experience and outcome is a more complicated personal story which is about my own responsibility for healing and maintaining good health. The diagnosis of cancer presented a challenge; how was I going to protect my body and dedicate healing mechanisms from the assaults of surgery, radiotherapy and possibly chemotherapy? Alternative therapies seemed too extreme; I trusted surgery but felt anxious that the assault on the enemy, which is how Western medicine deals with breast cancer, would over-ride my own healing resources. I did not see the cancer as an enemy but as a messenger.

'What happened next helped me trust more, that the answers would come if I remained open. The day after diagnosis I was struck down with flu. A dear friend who is an orthodox doctor and scientist, and also has some homeopathic training, came to see me. He immediately gave me homeopathic remedies which had amazingly good effects within hours. This integrated physician also gave me remedies that protected my body against harm: such as Arnica to prevent or reduce bruising at the time of surgery, and X-ray and Radium to protect against the ill-effects of radiotherapy. These remedies really worked for me.

Excellent nutrition has also played a vital part in this strengthening of my immune system. Giving up milk encouraged me to eat soya instead. Soya is probably the single most important food that women with breast cancer, or other hormone-dependent cancers, can take. I eat a wide range of natural foods, organic where possible, as pesticides, fungicides and herbicides are implicated in the big rise in breast cancer. I try to maintain a balance between raw and cooked foods and to take as many essential nutrients as possible as food, although some supplements such as vitamin C are necessary. For me, the theory of oestrogen dominance developed by Dr John Lee from twenty years of clinical observation makes the most sense. I take progesterone as there is a family history of heart disease and osteoporosis and I have a low bone mineral density. I feel very well on it - though it has not helped my hot flushes! - but my breasts are much smoother, a point noted by the surgeon.'

*Sue Pembrey now runs workshops for women interested in balancing hormones (see page 245). This extract was previously published as part of a longer article in Positive Health, special breast cancer feature, October 1998. For further details, please contact Positive Health Publications Ltd, 51 Queen Square, Bristol BS1 4LH, UK. Tel: 0117 983 8851, email sandra@positive.u-net.com
Jayne Calgary's story

Jayne thought she was going to die when she was diagnosed nearly twenty years ago, at the age of thirty, with breast cancer. Her reaction was to write tearful goodbye letters to her daughter, aged two, and her son, aged five. Instead, despite two mastectomies and recurrences in 1988 and 1996, she feels incredibly well, holds down a full-time job and has lived to see her children grow up (though sadly her son died two years ago).

By chance Jayne heard about a self-help group for those with breast cancer on the radio - it was newsworthy because it was such a novel idea at the time. This gave her the idea of seeking out a local group and one was just starting - Jayne became a founder member. She also contacted the Bristol Cancer Help Centre and 'felt I was in control for the first time. I had never thought about food as a tool for healing and realized I needed to change my diet radically. It was difficult because the children were already set in their ways, and sometimes I found myself preparing three meals. I was always in the kitchen and sometimes my jaw ached from eating so much raw food. But I have learned how to work with it now and I have no set rules. It is all more familiar. I take high doses of vitamin C alongside lots of the vitamins and supplements, I avoid red meat, eat fish, chicken and pulses, organic if possible.

'The Bristol Centre was a revelation. Relaxation and meditation have played an important part in my health - a time to be still. The thought of healing was initially strange as I had never come across the idea. The centre offers so much, something for everyone, and it felt so good. The whole experience has changed my life and I am actually glad I had a cancer because I've discovered so much and met so many wonderful people.'

The Revd Evelyn Davies's story
When she went into hospital to have a small, 'probably benign', lump removed in 1986, Evelyn Davies - then aged forty-six - had no idea how it would change the focus of her life. Evelyn, previously a teacher and now a trained counsellor, psychologist and vicar, runs the busy Melangell Centre for cancer patients in mid-Wales

So convinced was she that her hospital visit would entail a weekend in hospital, followed by a return to work on Monday, that she took some urgent work into the hospital. As she was coming round from the anaesthetic the sister gently explained to her that she had, in fact, had a mastectomy. In retrospect she believes this was the right decision as it meant that she did not have to be awakened from her anaesthetic for discussion of the procedure and she is happy about what happened, though at the time she was quite unsettled. Chemotherapy was suggested but she decided to reject this treatment.

When Evelyn went to the Bristol Cancer Centre she immediately saw that she could help herself. She addressed her diet, going on a very strict regime initially (after five years this relaxed somewhat but she still applies the principles) and received healing from Canon Pilkington. She began to get more involved with supporting new patients and would talk to them and give talks herself, and even accompany patients on their visits to the hospital.

She is fascinated by the mental realm of dealing with cancer and does not see the need to fight it as if it were a battle - as some people do. Her approach is an altogether gentler one. Evelyn expresses the need to 'get rid of baggage, heal memories, deal with low self-image, learning to say no, not allowing oneself to be a doormat and, above all, restoring balance in all areas of life and learning to build on strong foundations. Restoring balance leads to health.'

The Five Pillars of Health Check-list
The human body is a remarkable self-regulating mechanism. We are not simply made up of separate 'systems' - the digestive system, the nervous system, the immune system, and so on. It is nearer the mark to think of these as components of a complex web of interactions. Human biology is infinitely more complicated than it once seemed when we started categorizing the various parts - almost as if they were the parts of a car engine. We now know that the digestive system has important immune functions - is it part of the immune system? Various organs with other primary functions, including the heart, secrete hormones - does that make the heart a part of the endocrine system? Thyroid hormones affect fertility - does that make the thyroid part of the reproductive system? However, breaking the area of attention into separate categories can assist in creating a way forward for the individual. As the 'systems' are a part of the web-like structure we call the human being, improving the performance of any one area will impact positively on all other areas of health.

From the holistic perspective there are five areas, or pillars of health, to look at, to give you the best chance of avoiding, or recovering from, breast cancer:

Supporting your immune system

Balancing hormones

Including blood sugar balance, oestrogen and progesterone balance, thyroid hormone balance and adrenal, or stress, hormone balance

Digestive health

Optimizing your detoxification mechanisms

Reducing stress and managing its impact on the body
The following check-lists will give you an idea of the most important areas for you to examine for clues to improving your health. By taking this personalized approach to your health you can balance your body's chemistry which in turn optimizes your ability to stay disease-free.

Each of the check-lists corresponds to a chapter discussing the health issues that are at the forefront of each 'system'. Before dealing with any one, or more, of these health issues it will be helpful to read Your Basic Nutrition (page 202) which gives the basic 'springboard' which all the other health measures can be built upon.
Building powerful immunityOne of the vital jobs of the immune system is to identify cells that are 'non-self', that is, cells which have mutated into pre-cancerous cells and no longer match the surrounding tissue or cells, cells which have been damaged in some way and need repair, or have to be disposed of. The immune system is well equipped to do this under normal circumstances, but there are times when it does not work effectively, for a variety of reasons.

Do any of the following apply to you?

Do you take antibiotics more than twice a year?1 point

Have you done excessive exercise in the recent past? (More than one hour a day of cardiovascular exercise) (1 point)

Do you suffer from frequent colds or infections and find them hard to shake off? (2 points)

Do you suffer from an allergy-related problems such as hay fever, asthma, migraines, eczema, dermatitis, or reactions to any drugs or chemicals? (2 points)

Do you have any food allergies or sensitivities? (2 points)

Have you had a major personal loss in the last year or so? (Death, divorce, financial problems, etc.) (2 points)

Is there a history of cancer in your family? (2 points)

Do you suffer from poor wound healing?(3 points)

Have you recently undergone any medical treatment such as surgery, radiotherapy or chemotherapy (all of which have immuno-suppresive effect)? (5 points)

Do you have a diagnosis of breast cancer, either oestrogen receptor positive or non-oestrogen receptor positive? (5 points)
If you have a total score of 5 or more, read the chapter Building Powerful Immunity (page 239) after you have read Your Basic Nutrition Plan (page 202).
Harmonizing hormones

In the last fifteen years breast cancer treatment has concentrated on ways of blocking the effect of the hormone oestrogen on breast tissue, and this approach is beginning to pay dividends, with statistics showing a lowering in mortality.

Whilst this approach seems to be effective up to a point, it may be focused too narrowly. Dealing with breast cancer may require more than simply blocking oestrogen overload - it is the total balance of hormones which we need to seek.
Do any of the following apply to you?
Signs of blood-sugar imbalance which can include:

A need for frequent meals (1 point)

Headaches of migraines which are relieved by eating or drinking something (2 points)

Irritability, especially as a result of not having eaten regularly (2 points)

An inability to wake up feeling refreshed (2 points)

Excessive thirst or sweating (2 points)

A lack of energy (3 points

Excessive carbohydrate cravings for food such as bread, rice, pasta and biscuits (3 points)

Drowsiness during the day, especially mid-afternoon or after a substantial meal (3 points)

Feeling dizzy especially after a missed meal or after a sweet snack (3 points)

A need for stimulants at regular intervals, such as tea, coffee, sweet, sugar, cigarettes, alcohol (5 points

An addiction to sweet foods (5 points)
If you have a total score of 5 or more, read the section Blood-sugar balance (page 246) in the chapter Harmonizing Hormones after you have read Your Basic Nutrition Plan.
Signs of oestrogen and progesteron imbalance which can include: Blood sugar swings (1 point)

Monthly water retention (2 points)

Breast swelling and discomfort (3 points

Polycystic ovaries (3 points)

A history of pre-menstrual problems (3 points)

Unpleasant pre-menopausal symptoms (3 points)

Uterine fibroids (3 points

Fibrocysic breasts (4 points

Oestrogen receptor positive breast cancer, or endomitrial (uterine) or cervical cancers (5 points)
If you have a total score of 5 or more, read the section power of progesteronege 250) in the chapter Harmonizing Hormones after you have read Your Basic Nutrition Plan.
Signs of a sub-optimally functioning thyroid which can include:

Blood sugar fluctuations (1 point)

Mental confusion (1 point

Thickened skin (especially on face or feet) (1 point)

A tendency to being puffy or bloated (2 points

A tendency to put on weight easily (2 points

Feeling more tired than normal (2 points)

Always feeling cold when others feel warm (4 points
If you have a total score of 5 or more, read the section The thyroid (page 257) in the chapter Harmonizing Hormones after you have read Your Basic Nutrition Plan.
Healthy digestion
You are what you eat? No - you are what you digest, absorb and assimilate. This means that you may have an exemplary diet, but if you digestive system is not working at maximum efficiency you run the risk of being sub-optimally nourished. In order to say free of breast cancer you will want your body's defence and hormone systems to be able to protect you. Providing them with the right nutrients and energy requirements to function properly is critical, and is dependent on a healthy digestive tract. Bowel health, constipation and levels of fibre in the diet have been intimately linked to breast cancer.
Do any of the following apply to you?

Do you experience anal irritation? (2 points)

Do you take antacids or get a burning sensation in your stomach? (2 points)

Do you have any food allergies or sensitivities? (3 points

Do you suffer from excessive wind? (4 points

Do you suffer from bloating around the middle that arises during the day or after a meal that is not related to your menstrual cycle? (5 points

Are you constipated, do you get diarrhoea, or do you have irritable bowel syndrome? (5 points)

Have you recently had a course of chemotherapy? (5 points)
If you have a total score of 5 or more, read the chapter Healthy Digestion (page 267) after you have read Your Basic Nutrition Plan.
Detox your system
We have managed to create an alarming chemical soup in which we live. The air we breath carries agrichemicals and pollution, the water we drink is laced with chemicals and heavy metals, the food we eat has insecticides ad pesticides on it, as well as additives, colours and preservatives. We have to detoxify, and store or eliminate, all these compounds, and this can reduce our physical reserves when we are dealing wit other priorities such as fending off breast cancer.
Do any of the following apply to you?

Do you ever have water-retention problems? (2 points)

Do you have 'range-peel' skin? (2 points)

Do you generally eat non-organic produce? (2 points)

Do you drink unfiltered tap water? (2 points)

Do you live in a city, by a busy road or near a crop-spraying area? (2 points)

Do you spend a lot of time in traffic or exercise by busy road? (2 points)

Do you regularly drink coffee, tea or alcohol? (3 points)

Do you frequently suffer from mucus in your nose, throat, ears or even in your stools? (4 points)

Do you have any food allergies or sensitivities? (4 points)

Do you live or work in a smoky atmosphere? Do you smoke or have you smoked in the past? (4 points)

Are you having, or have you had, chemotherapy? (5 points)
Reducing your stress load
Stress is a word that is hard to define and there is definitely such a thing as positive stress, as well as negative stress. Inevitably, it is the negative connotations of the word that we are talking about in relation to breast cancer.

Stress does not just mean mental stress or, for that matter, taxing life events - such as being diagnosed with breast cancer. It can also man dietary stress and the stress that chemicals may place on your body.
Do any of the following apply to you?
Do you set unrealistic goals, are you generally dissatisfied, or do you always do several tasks at the same time? (2 points)

Do you find it difficult to communicate feelings and tend to 'internalize' problems? (2 points)

Do you dislike your work or home environment? (3 pints)

Do you tend to over-commit and do too much, or find it hard to say no? (3 points)

Are you inexplicably fatigued all the time? (4 points)

Have you recently been diagnosed with, or treated for, a major illness? (5 points)

Have you suffered a major personal loss in the last two years (death, divorce, financial problems, etc.)? (5 points

Are you generally depressed or anxious? (5 points)
If you have total score of 5 or more, read the chapter Reducing Your Stress Load (page 290) after you have read Your Basic Nutrition Plan.
These check-lists are signposts to guide you to areas of your health that may need attention. Later in the book each of these topics will be discusses in detail, with ideas for achieving changes in order to minimize your chance of developing breast cancer, or to speed recovery if you have already been diagnosed with the disease. Some sections will be more relevant to you than others. If you get colds frequently and have asthma, maybe your immune system needs more help than that of others. If you have pre-menstrual problems, with sore and tender breasts before your period, perhaps hormone balance is more relevant. In any event, maximizing your health to support these pillars is the key measure needed to load the dice in your favour.
1. Howe, G. R. et al. Dietary factors and risk of breast cancer: combined analysis of 12 case-control studies, J Natl Cancer Inst 1990; 82(7): 561-9.

2. Pierce, J. P. et al. Feasibility of a randomized trial of high-vegetable diet to prevent breast cancer recurrence, Nutrition and Cancer 1997; 28(3): 282-8.

3. Holm, L.E. et al. Treatment failure and dietary habits in women with breast cancer, J Natl Cancer Inst 1993; 85(1): 32-6.

4. Stoll, B. A. Diet and exercise regimens to improve breast carcinoma prognosis Cancer 1996; 78(12): 2465-70.

5. Normura, A. M. Y. et al. The effects of dietary fat in breast cancer survival among Caucasian and Japanese women in Hawaii, Breast Cancer Res Treat 1991; 18: S135-41.

6. Kohlmeier, L. Future of dietary exposure assessment, AmJ Clin Nutr 1995; 61 (suppl.); 702S-9S.

7. Riboli, E. et al. Identifiability of food components for cancer chemoprevention, IARC Sci Publ 1996; 139: 23-31. In The Breast Cancer Prevention and Recovery Diet there is an easy to follow 12 - step plan to help prevent breast cancer. Here are the twelve steps: