It Starts in the Roots

This past weekend we celebrated Ukrainian Christmas, which is something I grew up with on my Dad’s side of the family.  The meal includes 12 meatless dishes that have significance in the history of the Ukrainian people.  The meal has multiple courses and imparts a rich, comforting feeling for me and my family.  It starts with Kuktya, a cold wheat berry soup, then a hot beet soup known as borscht.  The main course is filled with fish and wheat dishes.  Ukrainians identify strongly with an abundance of wheat.  It is a spiritual symbol as well as one of sustenance.  So in this meal there are a LOT of refined carbohydrates in the form of white wheat flour.  I watch my intake of white flour  because of my family history of type 2 diabetes.  I choose whole grains as often as I can, make sourdough bread and limit my portion of white flour based foods.  

Family history can play a major role in our risk for diseases such as diabetes, heart disease and cancer.  Understanding your family history can be a strong motivator for habits and behaviors that can reduce your risk.  My Dad saw his father lose his leg to diabetes and be confined to a wheel chair for the last three years of his life.  The fear of this fate inspired him to make resistance exercise a part of his day while watching his intake of simple carbohydrates and sugar to maintain a healthy weight through adulthood.  And so far it's worked!  He still loves his crackers but he was able to mobilize one of his greatest fears into an action plan that has kept him active and healthy well into his 70s.  

Understanding our roots is a powerful way to connect our own experience with the knowledge of our ancestors to inspire us to be a better version of ourselves.  I see nutrigenomics testing as a connector as well.  By learning about the genes that influence how our body uses different energy sources, metabolizes nutrients and weaknesses in our metabolism we can target specific interventions and lower the risk of negative outcomes.  

Genes are inherited from our parents.  We get one copy of the “allele” from our mother and one from our father.  So just because one parent has a condition, does not mean you will inherit it.  The combination of alleles you inherit will inform your risk.  For example, The TCF7L2 can predict the odds of developing type 2 diabetes.  In studies it has been shown to demonstrate an increased risk of 30%–50% for each allele inherited.  I have two G alleles for the TCF7L2 gene.  Fortunately, this is not the risk variant “T”.  I got one G from my mother and one from my father.  It is not that simple though (shocker!).  There are up to 70 genes that have been shown to influence type 2 diabetes risk.  Each gene codes for one of the many components of a well tuned insulin response.  In the nutrigenomics report, I look for not only the TCF7L2 gene but also the CLOCK gene, GLUT2, FTO, ADIPOQ, IRS1, ADCY5, TRPM6 and SLC30A3.  All of these have key nutrition interventions that can be targeted to optimize blood sugar control.  Such as increasing magnesium rich foods in the diet to compensate for an elevated risk of low levels in people with the T allele of the TRPM6 gene.  A low magnesium level has been associated with metabolic syndrome and type 2 diabetes development.  Increasing magnesium intake has been shown to reduce diabetes risk and complications in susceptible people.  So if you have the T allele like I do, you can benefit from eating more magnesium rich foods like nuts, beans and whole grains.  

Genetics is a complicated field, and although the science of nutrigenomics starts back over 30 years, we are just beginning to be able to use it reliably to improve outcomes in personalized medicine.  If it all looks like alphabet soup to you, that’s ok.  The benefits of genetic counseling are cutting through the complexities and serving digestible insights along with actionable strategies.  

It can be hard to decide where to put your effort when it comes to reducing disease risk.  Nutrigenomic testing can help identify where you’ll get the most benefit.  When I read your report, I’m bringing together your personal food story and the key optimizations you can make so your persistence can have the biggest impact.  

Even though I don’t have the risk variant for the TCF7L2 gene, I do have it for the TPM6 and SLC30A3.  I prioritize magnesium and zinc rich foods.  Want to know more about what your genetic history would tell you to eat?  Schedule a free Discovery Call to get started.  You can listen to my introduction to Nutrigenomics and Personalized Nutrition here.

Enjoy this beautiful, flavonoid rich soup.  Add white kidney beans for a magnesium and protein boost!

Borscht

Adapted from More Cooking Favorites by St. Andrew’s Ukrainian Orthodox Ladies’ Auxiliary

I make quick work out of the root vegetable chopping by putting it all through the shredder in my food processor.  This was the way my Baba made it (although using a box grater) but you can dice the beets, carrots and potatoes with a knife too.

Ingredients

1 cup of fresh brown mushrooms

1 large onion, chopped

1 clove garlic, crushed

3 tbsp olive oil

2 cups of beets, shredded

1 cup carrots, shredded

1 small red or yellow potato, shredded

1 cup celery, diced

¼ cup parsley, chopped

3 cups purple cabbage, shredded

 2 tbsp tomato paste

Lemon juice or vinegar

Salt and pepper

8-10 cups water

1 cup canned white beans, rinsed and drained (optional)

Directions

1. Over low medium heat in a stockpot, saute onion and celery in oil until transparent.  

2. Add mushrooms and sweat until they lose half of their volume, then stir in tomato paste for 1-2 minutes.  Remove the mixture from the pot and set aside.

3. To pot add beets, carrots, potato and parsley, then cover with water and cook until barely tender.

4. Add cabbage and cook for an additional 5 minutes.  Add back onion mixture and beans, if using.

5. Add salt, pepper and lemon juice/vinegar to taste.  Bring to boil and serve.

References

Berna, G. Nutrients. Nutrigenetics and Nutrigenomics Insights into Diabetes Etiopathogenesis.  2014 Nov 21;6(11):5338–5369

Lyssenko V. Mechanisms by which common variants in the TCF7L2 gene increase the risk of type 2 diabetes. J. Clin. Investig. 2007;117:2155–2163.

To Supplement Or Not To Supplement

For Cancer? That is the question!

Supplements are a frequent topic  in my cancer care community.  As a registered dietitian nutritionist, I often get asked whether vitamin supplements can help prevent cancer recurrence. It’s an understandable question, especially when supplements like vitamin E, C, D, omega-3 fatty acids, beta-carotene, and folate are frequently promoted for their potential health benefits. But the relationship between supplements and cancer care is complex and, at times, controversial.

The Evidence on Supplements for Cancer Prevention

Let's start with the research. Several studies have explored whether vitamin supplements can reduce cancer risk, but the findings are often mixed or inconclusive. For example:

Vitamin E has been studied for its antioxidant properties, which theoretically could help reduce cancer risk by protecting cells from damage. However, large trials, such as the Selenium and Vitamin E Cancer Prevention Trial (SELECT), found that high doses of vitamin E did not prevent prostate cancer and may actually increase the risk of it in some men.

Vitamin C has long been touted for its immune-boosting effects, and while it plays a role in overall health, research has not demonstrated a strong connection between vitamin C supplementation and reduced cancer risk.

Vitamin D shows more promise. Some studies suggest that adequate vitamin D levels may help protect against certain cancers, particularly colorectal cancer. However, taking high doses of vitamin D in supplement form doesn’t automatically translate into cancer prevention, and more research is needed to confirm these findings.

Omega-3 fatty acids from fish oil have been examined for their potential to reduce the risk of cancer, especially breast and colon cancer. While some observational studies suggest a link between higher omega-3 intake and reduced cancer risk, intervention trials haven't consistently supported these findings.

Beta-carotene, a precursor to vitamin A, has been studied extensively, particularly in smokers. Surprisingly, studies found that beta-carotene supplements can actually increase the risk of lung cancer in smokers, emphasizing the potential dangers of high-dose supplementation in certain populations.

Folate is another nutrient with mixed findings. While it’s essential for DNA synthesis and repair, and low folate levels have been linked to increased cancer risk, supplementation—particularly at high doses—has not consistently been shown to reduce cancer risk and may even promote tumor growth in some cases.

Where Does That Leave Us?

Given the inconsistent findings, the general recommendation is to focus on obtaining these nutrients through a well-balanced diet rich in fruits, vegetables, whole grains, and healthy fats rather than relying on supplements for cancer prevention. That being said, there’s no one-size-fits-all approach, and that’s where the emerging field of nutrigenomics comes into play.

The Role of Nutrigenomics Testing

Nutrigenomics is the study of how our genes interact with the foods we eat, including how we metabolize certain nutrients. Genetic variations can influence how efficiently your body absorbs, processes, and utilizes vitamins and other compounds. For example, some people may have a genetic variation that impairs their ability to convert beta-carotene into active vitamin A, meaning they might benefit from a different form of supplementation.

Similarly, your genetic makeup can affect how well your body synthesizes vitamin D or metabolizes folate, which could influence whether you need to supplement these nutrients or adjust your dietary intake.

By undergoing nutrigenomics testing, individuals can receive more personalized recommendations regarding supplement use, potentially reducing the risk of both deficiency and excessive intake. Rather than guessing whether or not to take supplements like vitamin E, C, or omega-3, nutrigenomics provides data that can help guide these decisions based on your unique genetic profile.

In Conclusion

While vitamin supplements hold some promise in cancer prevention, the science is far from settled. Until we have more conclusive evidence, the best approach remains to focus on a nutrient-rich, whole-foods diet. For those interested in a more personalized approach, nutrigenomics testing can offer valuable insights into whether supplementing with specific vitamins might benefit your overall health and cancer risk reduction. Talk to me to find out more about what your individualized needs may require.

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Hydration Refresher

What if I told you that you may need to take in more salt this week? It’s going to be another hot one so today I’m talking about ways to optimize your hydration level so you can feel your best.  Optimal hydration can improve your treatment side effects, mood, physical performance and weight balance.  Your fluid and electrolyte needs are unique.  Learn about electrolytes and water goals in cancer care below.

There’s more to hydration than drinking 8 cups of water a day.  Understanding how much you need to drink and whether it can be helpful to supplement with electrolytes is a key topic in cancer care. 

Many of my clients have significantly decreased their processed food intake as well as eating out less often through working together.  That means a major drop in salt and sodium intake which is usually a really good thing, but on these hot days you may not be getting enough sodium for optimal hydration.

Why is sodium important?  Your body has the ability to absorb fluid in two main ways: passively and actively.  To actively absorb water, sodium and glucose (sugar) are needed.  When this is activated you can hydrate more completely which is important if you are struggling with dehydration or active outside in this hot weather.  

How do you know if you are dehydrated?  Cancer treatment is a risk factor for dehydration.  That’s why you get IV fluid during chemo.  A buildup of medications and chemo increases therapy side effects, so you want to be hydrated enough to flush them out effectively.  Mucositis, nausea, vomiting and diarrhea impact fluid intake and output but replacing these fluids can be challenging.   Also, inflammation from radiation treatment increases fluid requirements because extra fluid is used to protect and soothe the treated tissue.  If you are significantly dehydrated, on exam, your blood pressure may be low.  It can also show up as high sodium (Na) or high creatinine in your blood work.

Beyond treatment, dehydration can worsen lingering side effects like peripheral neuropathy, lymphedema, brain fog, fatigue, and decreased mental wellbeing.  Other risk factors for dehydration include being a “salty sweater”, not having strong thirst signals, advanced age and following a low carbohydrate diet.

If you are mildly dehydrated, just 2% below your optimal level, you may notice having more difficulty paying attention and feeling calm.  I’ve also seen dehydration contributing to the 3pm sticky spot of cravings and tiredness.

The best way to monitor your hydration level throughout the day is by paying attention to your urine colour.  You’ll notice in the morning urine is a dark yellow because you haven’t been drinking much through the night typically, and your body is repairing, recovering and creating waste.  You should notice your urine getting paler through the morning as you rehydrate.  The kidneys are most active for the first half of your awake hours.   Support their job of getting rid of that waste by starting your day with non-caffeinated fluid and continue to take in fluids every 1-2 hours.  A light straw colour is an indication of good hydration.  If your urine is clear it can mean you’re not absorbing the fluid you’re drinking efficiently.  This is a time where electrolytes can give you a boost.

Urine Colour Hydration Scale

Electrolytes can increase your body’s ability to absorb fluid from your diet as well as get that fluid into the cells so they can perform optimally.  The key ones are sodium and potassium but you may also see magnesium and calcium in some electrolyte and rehydration products.  These are all nutrients we can get in adequate amounts from a personalized diet.  But there are situations where supplementing with electrolytes can make a big difference.  During treatment, if you are having a hard time drinking water or you are struggling with GI (gastrointestinal/digestive) side effects including vomiting, diarrhea, high ostomy output, constipation or dry mouth/mucositis, fluid replacement is vital. Oral rehydration solutions used in severe dehydration contain about 600 mg of sodium per 250mL.   For day to day dehydration caused by long activities outdoors or mild/intermittent GI side effects, look for a product or recipe that has at least 300 mg of sodium per cup.  You will probably only need 1-3 cups to optimize your water absorption.  Potassium, magnesium and calcium supplementation need to be discussed with your health care provider.  Cancer can have a big effect your intake of food sources of these electrolytes as well as blood levels and requirements.  Supplementing too much with any of these can make side effects worse and possibly result in hospitalization.

What about sugar?  Zero calorie electrolyte products are everywhere.  To be a true rehydration drink sugar or glucose is needed.  Think of these more as a way to boost your fluid intake by giving your water taste.  A little bit of sodium can increase thirst and therefore increase your overall fluid intake through the day but it won’t be enough to replace high losses.  Speak to your health care team to understand what your requirements are based on your unique situation.

Is 8 cups of water a day really the goal? I’ve seen 8 cups of water a day recommended all over the place.  That’s a very general recommendation but often a reasonable target for most people.  However, for optimal results it's best to calculate your fluid needs based on your age, weight, body composition, daily environment and activity patterns. I usually find people's needs are higher than 8 cups.  

Here are some ways to take action and improve your hydration level this week:

• Start the day fresh with a clear glass of water

• Find a water bottle you love and carry it with you

• Put a visual reminder to have a drink in the place you spend most of your day

• Measurements on a water bottle can help you track your progress and get you closer to your goal

• Water isn’t the only fluid: herbal tea, 1-2 cups of coffee, sparkling water, milk, nutritional supplements, soup and yogurt count!

• Add flavour to keep things interesting: try a slice of lemon or lime, True Lemon crystals, dilute juice 1:5, low calorie electrolyte powders such as Nuun if appropriate for your individualized needs.

• Keep a pitcher of water with a known volume in the fridge, infuse it with chopped fruit or herbal tea if desired.

Rose Sun Tea

Rose petals contain polyphenols that have anti-inflammatory activity.  It may aid in reducing mucositis pain as well as chemo-induced nausea and vomiting.

Enjoy this slightly sweetened tea chilled on a sunny day.

Ingredients 

¼ cup of dried organic rose petals

2-4 tsp of honey, to taste

1.5 L of water

Instructions

In a glass or BPA free pitcher, add dried rose petals, honey, then water.

Cover and place the pitcher in a sunny spot for 4-6 hours. Stir halfway.

Refrigerate or pour over ice through a tea strainer to enjoy!

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Homemade-Aid

Make your own sports drink to take with you on an activity lasting more than 2 hours outside such as hiking, golfing, gardening, Dragon Boating or biking

Ingredients

½ cup juice such a grape, cherry, cranberry (if struggling with constipation try apple or pear, if struggling with mouth sensitivity try peach or pear nectar)

3½ cups water

½ tsp salt

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DIY Oral Rehydration Solution

To replace high losses, an oral rehydration solution may be recommended.  To make your own, use this recipe.

Ingredients

3/8 tsp salt (sodium chloride)

¼ tsp Windsor Salt Free® (potassium chloride)

½ tsp baking soda (sodium bicarbonate)

2 tbsp + 2 tsp sugar

Add tap water to make 1 liter