My Favourite Feast – Non-Ketogenic

The festival of Tabernacles has long been my favourite. It goes back to my childhood. Both my brother and sister now fondly remember “how we helped schlep the (wall) panels of the succa (booth) from the garage to the patio, bolt the pieces together and close the roof! Also sitting in overcoats at night with the heater on – magical!”  My late father was probably the first, certainly in our suburb of London, to have hand-made his own succa, replete with floor and opening roof. For years it served as the centre piece of my parents’ socializing; an annual gathering after the Festival services.

We’ve come a long way in the fifty (almost sixty) years since then. I’ve managed to reinvent my own succa-building tradition in Israel – in a slightly more “hands-on” manner – using the help of Pam’s every increasing next generation of little cousins. And our succa also allows us the opportunity to welcome friends.

This year, however, I felt a change of mindset. For some reason I wanted to read more about the festival of Tabernacles and its concept of rejoicing. I looked up the biblical text of Deuteronomy 16: 13-15: “And you shall rejoice in your feast, you and your son, and your daughter, and your manservant, and your maidservant, and the Levite, and the stranger, and the fatherless and the widow… and you shall be altogether joyful.”

Rabbi Shlomo Riskin wrote about the festival in The Jerusalem Post this week. He pointed out that the Bible “is teaching us the sequence of joy. A person must be able to rejoice, first of all, with himself, with his own development, growth and accomplishments. Then with his family, the people who are closest to him, and finally his community. One has to appreciate what one has and share it with others.”

On the one hand, how apt and timely I find Riskin’s words. He seemed to summarize my feeling exactly. I sit in my succa thinking through my situation and realizing how much happiness I’ve found in the past year. How my family has helped me and how friends have rallied round. The humility of the succa’s flimsy surrounds seemed to envelop me.

But on the other hand, I found myself thinking that in some ways I’m a bit of a fraud. How nice it’s been that I’ve chirped away on my blog and have received accolades from people I’ve “helped”. They’ve being telling me how much pain they’re suffering and how tiredness and lethargy completely overwhelms them. Only in the last few weeks have I realized that the “words of wisdom” I was waffling about came from a place of less pain, less discomfort and far more energy. Recently I’ve been far closer to the conditions they were suffering – and couldn’t do much to help myself. The feast of Tabernacles comes along and puts things in perspective for me.

I realize that this illness is not going away and has depths that I can’t imagine. My succa made me realize that everything has proportions.  But thankfully I’ve been feeling better over the last few days – and this respite from pain allows me to post this blog.

Ketogenic in Cape Town

Is there a ketogenic challenge in Cape Town? My research started this week thanks to more hospitality from that indefatigable supply of Pam’s cousins. My writing skills took a back seat in the Western Cape while we were whisked through the rolling wine fields of Franschhoek and Stellenbosch. The backdrop was the rocky mountain peaks topped by a clear blue African sky. A feast for the eyes – but what about the stomach?

How fortunate that one of the only difficulties of being driven through this glorious countryside is the choice of restaurant or vineyard to visit. If ever one needed an incentive to keep up the pancreatic cancer fight – or for anyone, for that matter, wanting motivation in a mundane life – this is the place. However much time one has, it would seem inadequate even to scratch the surface of what this country has to offer.

What I’m wishing is that everyone would have the chance to witness this beauty – but I’ll try to be more practical and relate some of my experiences. Let’s start at the beginning – breakfast at the hotel. First problem – tempering the temptation. Long gone for me are the days of “Continental” or “Full English” breakfast. Someone has to come up with a new term. “New Improved Israeli” is probably not politically correct – but many might know what I mean. The Cape Town variety includes my allowable raspberries and strawberries with Cape gooseberries thrown in (they’re the size of a Malteezer but not as tasty). These can be covered, or smothered, or in my case totally immersed in clotted cream thicker than a London”pea-souper” (fog, for the uninitiated). The thickest cream carbs have ever evaded. This was the easier bit – especially as it’s self-service.

Lunch and dinner shouldn’t have been a problem either – as the choice of fresh fish and meat is mind-boggling. And service in this part of the world tries to be so friendly and helpful. But here’s the caveat – and it happened more than once. I explain carefully that my ketogenic diet means no carbs, suger, or fruit etc. Surprisingly enough, the word carbs was met with a blank until I give a few examples; no bread, potatoes, chips, – yes that includes boiled potatoes, etc.

Surprising enough my plain grilled fish comes majestically covered in bread crumbs. Maybe something was lost in the “translation” from my version of the Queen’s English to the local vernacular – but whatever, beware that your food requests have been properly understood; particularly for those for whom the ketogenic diet is as important as it is to me.

It’s a minute price to pay to for the miracle of being here. The pay-off comes from seeing Pam back in her element. Perhaps I’ll let her share her point of view with another of her perspectives. Perhaps when she’s “home” in Port Elizabeth tomorrow night.

Ketogenic Breakfast Special – Shakshouka

I thought it’s time to share with you one of my favourite ketogenic recipes – something really special: Shakshouka

Shakshouka is a staple of Tunisian, Libyan, Algerian and Moroccan cuisines traditionally served up in a cast iron pan with bread to mop up the sauce. It is also popular in Israel, where it was introduced by Tunisian Jews. Like in Libya, Shakshouka is a traditional breakfast meal in Israel. In Hebrew Shakshouka (actually a word derived from a North African dialect) means “all mixed up”.

The dish has been said to challenge hummus and felafel as a national favourite, especially in the winter. According to some food historians, the dish was invented in the Ottoman Empire, spreading throughout the Middle East and Spain, where it is often served with spicy sausage. Another belief is that it hails from Yemen, where it is served with zhug, a hot green paste.

Shakshouka is normally made from tomatoes. My version is a spinach variety (with thanks to my eldest daughter). Here goes – for 4 servings:

1 medium sized onion, diced

4 gloves of garlic, peeled and sliced

4 eggs

500 gms fresh spinach

50 gms butter

1/4 cup full fat cream

1/4 cup goats milk

50 gms grated cheese (chedder or whatever)

handful of wallnuts –broken into smallish pieces (“the secret ingredient”)

Heat butter in medium-sized frying pan – or wok – and sauté onions over a medium heat, stirring occasionally until onions are golden brown. Add the garlic and spinach and steam for about 3 minutes (to steam I simply cover the mixture with a lid).

Add the cream and goat’s milk and keep stirring for about another 5 minutes.

Drop in the eggs – I try not to break the yolks – and cover with the grated cheese and walnuts. Let the whole dish cook for another 2 minutes on a low light. Take care not to overcook.

Enjoy – needless to say without bread – unless it’s ketogenic (see my recipe from 5^th March 2012)

Keith’s Perspective

Other than Pam’s two perspectives, the only other contribution so far, not written in my own hand, was from my brother-in-law Pip “Can Cancer be Fun”. Now, it’s my brother-in-law Keith’s turn to give his professional perspective. I have no words to thank these two incredible human beings:

 

Shortly after Martin’s diagnosis of pancreatic cancer, Sheila and I flew to Israel, painfully aware of the dire situation and the grim prognosis. The initial ultrasound assessment had showed a possibly benign cyst in the pancreas, but the MRI scan was far more sinister – highly suggestive of an invasive pancreatic cancer.  A diagnostic laparoscopy confirmed the worst–adenocarcinoma of the pancreas with multiple metastatic deposits in the peritoneum.  Aggressive treatment with radiotherapy and gemcitabine chemotherapy was started the day following his laparotomy. Within days Martin was gravely ill, primarily as a result of side effects of his treatment regime.  We arrived to this awful scene, finding Martin severely weakened and exhausted.

I needed to spend time with Martin and Pam at the hospital during his treatments. Sheila took to spending hours researching conventional and alternative treatments for pancreatic cancer.  Just prior to flying out, we had become interested in the growing movement showing various health benefits to a low carbohydrate/ gluten free diet. Surprisingly, some of the research Sheila was investigating showed this approach might influence tumor progression and growth.  Unfortunately no well- researched studies have ever been done in this area, so we had to be guided by the basic science and our instincts. There certainly was evidence that individuals with metabolic syndrome, elevated blood glucose and diabetes were more likely to develop pancreatic cancer.  Martin’s blood testing had revealed glucose intolerance.  The basic science also made sense – pancreatic cancer cells lose the ability to switch to metabolize ketones instead of glucose – an ability normal, healthy cells retain. The theory was simple and compelling – decreasing the amount of glucose available to tumor cells would choke their growth and lead to cancer cell death. This is the metabolic approach to tumor genesis, known as the Warburg hypothesis (proposed by Nobel Laureate Otto Warburg).

Could a simple dietary intervention be effective in treating such an aggressive cancer? What other safe interventions looked promising?  The research showed Curcumin (an extract of tumeric) effective as a synergistic agent with standard chemotherapy, resveratrol as a powerful antioxidant with activity against tumor cells, and metformin (a glucose lowering drug used for diabetes) to be the prime candidates. How though to convince Martin to embark on this restrictive diet and multiple supplement regime, with a dearth of scientific evidence to back it up? Well-intentioned oncologists and nutritionists were treating him with intravenous glucose infusions and encouraging him to eat ice cream and sugar in order to “gain weight”!

Somehow Martin found the strength to live up to the challenge, and became the most compliant and faithful “patient” I have ever seen! Since hearing the theory and explanation, he made his decision to embrace the diet and supplements and has stuck 100% to a ketogenic lifestyle subsequently.  His blog attests to the remarkable progress he has made. At the time of writing, his disease remains in a stable remission, he has done numerous overseas trips (including a fantastic visit to us in Canada!), plays golf regularly and for the most part has good energy and no pain.  There have been various changes in his chemotherapy regime, which can be read in his blog.

There is no way of telling what factors have led to such a remarkable outcome. Perhaps it is a combination of medical therapy, diet and genome.  It is highly unlikely that a good double-blinded study will be done soon on the ketogenic diet effect on cancer. Rather than wait for that day, Martin has made a lifestyle switch, which seems to have had a very positive effect on his condition. He has by chance or fate become part of the “paleo” movement, which sees the modern Western diet as the source of many chronic diseases and he has shown that eating a more “ancestral” diet can be a healthy and possibly therapeutic choice.

We pray that our “experiment” will go on for many, many years!

Why the Ketogenic Diet?

Following the positive interest shown in my recipe for cauliflower kugel last week-end – including from “The Ranting Chef”  http://rantingchef.com who described the recipe as “awesome” – I thought I ‘d share with you why the ketogenic diet and food supplements are so important. Let me introduce you to the thoughts of Chris Kresser. For this introduction I must thank my friend, Laurie Bean.

Incidentally, Laurie’s dad is an example we could all follow. How happy I was to see him back at the golf club yesterday. A nonagenarian, just recovering from a shoulder injury. He regularly goes round the course in a score lower than his age – and has recorded seven holes-in-one (so far!).

Chris Kresser, according to his own web site,  is a licensed acupuncturist and practitioner of integrative medicine. He did his undergraduate work at UC Berkeley, where he was introduced to Eastern spirituality and a wide range of health modalities and practices, from nutrition to meditation to tai chi, yoga and massage. While traveling inIndonesia, he contracted a mysterious tropical illness which became a chronic condition. He saw more than twenty doctors around the world in an effort to diagnose and treat the condition and realized he would have to treat himself. Today, he gathers and analyzes medical research to stay abreast of the latest developments.

Here’s a link to a transcript of one of his latest medical interviews. I’ts long and not exactly in “Queen’s English”. If you’ve got the time and patience – go for it. If not, read my summary underneath.

http://chriskresser.com/rhr-chronic-stress-cortisol-resistance-and-modern-disease?utm_sou

He reminds us that there is no one-size-fits-all approach, and something that works for people who are sick may actually cause harm in people who are well. The interview deals with burning fat, boosting energy, and preventing and reversing disease without drugs – probiotics, stress-relief and antioxidants.  He looks at pancreatic cancer treatment at the Integrative Medical Center in New Mexico.

I’m NOT suggesting you follow him blindly – if at all. But he is apparently extremely knowledgeable and well researched. Here’s an extract:

“The Integrative Medical Center in New Mexico is using a protocol that involves two components: intravenous administration of alpha lipoic acid at 300 mg to 600 mg two days a week and 4.5 mg of low-dose naltrexone, which is the standard low dose of naltrexone.  They also were giving 600 mg per day, of oral alpha lipoic acid; 400 mcg per day of selenium and 1,200 mg per day of milk thistle extract, which is another potent antioxidant. 

Chemotherapy can help people to survive cancer, but you would never give chemotherapy to somebody who doesn’t have cancer, right?  And I think that’s a more extreme example than this, but if someone’s just under extreme amounts of oxidative stress, as you find with cancer, something like high doses of all of these antioxidants might be beneficial, but in someone who’s otherwise healthy, it may have undesirable effects.  In the same way, you know, we get questions about diet.  If somebody has no gallbladder and a lot of difficulty digesting fat, they may have trouble with a really high-fat diet, but that doesn’t mean someone who has an intact gallbladder and good digestion is gonna have trouble with a high-fat diet.  So, we always have to consider who we’re talking about, what the goal is, and even what the length of time is that we’re talking about, you know, short-term versus long-term supplementation, or supplementation for therapeutic uses versus supplementation for longer-term, just kind of indiscriminate, indefinite use”.

Beware, the ketogenic diet may be the answer for me and you – but it’s certainly not easy.

 

 

A Ketogenic Kugel (Pie)

My tenacity at sticking to the ketogenic diet is invariably met with marvel rather than “I’ll kick the carb habit too”. So to help those that might find the prospect of diet daunting, here’s a recipe to try – Cauliflower Kugel (Pie).

It’s good as a side dish to meat or fish or can become a meal in itself. The chosen cauliflower could just as easily be changed for courgettes, broccoli, mushrooms or whatever takes your fancy. This is for 4 to 6 servings:

1 large cauliflower (900 gms)

2 large eggs

1 tbl ground almond

2 tbl extra-virgin olive oil

1 large onion, chopped

half tsp tumeric

half tsp cumin

salt and freshly ground pepper to taste

cayenne pepper or paprika to taste (for topping)

Divide cauliflower into medium florets. Slice leaf stems and/or stalks.

Boil/steam for 8 to 10 minutes until tender. Take care not to overcook.

Drain well and when cool mash (or blend) but not too finely. Transfer to bowl.

Heat olive oil in medium-sized pan and sauté onions over a medium heat, stirring occasionally until onions are golden brown. Add tumeric and cumin for a final quick stir.

Add the onions to cauliflower and fold in the eggs and ground almonds.

Oil a shallow 20-cms square baking dish and add in the mixture. Sprinkle another tbl olive oil over the top and your preferred spice to taste.

Bake in upper third of oven pre-heated to 190C until lightly browned on top – about 40 minutes.

Enjoy

 

 

Surviving Pancreatic Cancer

As the holiday season advances, I realise I have two other reasons to celebrate. Firstly, it’s now almost a year and a half since diagnosis and secondly my blog seems to be growing in momentum – more readers from more exotic places.

It’s exciting to see someone has clicked in from Chile– or from places as improbable as Papua New Guinea or thePhilippines. And that people have shown interest from Indonesia to Italy. So be it. I have no idea who they are, but assuming they are interested in treatment for pancreatic cancer I thought it might just be time to give some sort of interim report.

Chemotherapy:

I’m now on my new chemotherapy regime of Gemcitobene and Abraxane. Tomorrow will be the third treatment, then I get a week’s break. This will hopefully be the pattern for the foreseeable future, especially as the side effects have fortunately been minimal thus far. The threat of hair loss and worsening neuropathy still hang heavily over my head.

This latest regime replaced my short tangle with Tarceva. I survived six weeks of Gemcitobene with a daily dose of one Tarceva pill. Although the treatment seemed to be working, I simply couldn’t stand the side effects.

The change to Tarceva followed almost a year on “5FU” – a cocktail of Folfirinox, Oxalyplatine and Irinotecan. How user-friendly it now seems to have been on a regime that my treatment was every other week – interspersed with a week’s break here and there.

Diet:

I’m still clinging religiously to my ketogenic diet. To remind you, it’s a diet of no carbohydrates (pasta, potato, rice, etc for the uninitiated), no fruit, nothing containing sugar – nor cakes or biscuits! If you’re having trouble not eating bread this week, bread is something that hasn’t passed my lips since January last year!  (For the reader who enquired about courgettes – yes! They’re allowed.) 

Daily Medication & Food Supplements:

Everything listed I take daily with meals – with the exception of Ompradex, which I take an hour before breakfast and dinner:

Omepradex Caplets (Omeprazole 1 x 20mg before breakfast & dinner) 

–  Manufacturer: Dexcel Pharma Ltd, OrAkiva,Israel

–  Purpose: Inhibiting acid secretion in the gastrointestinal tract.

Metformin Hydrochloride (Glucomin 2 x 850mg; 1 morning/1 evening)

 – Manufacturer: Dexcel Pharma Ltd, OrAkiva,Israel

 – Purpose: Antidiabetic to reduce sugar levels

Pankreoflat (Pancreatin [Amylase, Lipase, Proteases & Simethicone] 3 x daily

– Manufacturer: Solvay-Faes Farma SA,Spain

 – Purpose: Relief of abdominal distension due to cumulative gas & foam.

Curcumin (3 x 500mg with every meal)

– Manufacturer: VRP Brand, LLC,Carson City,NV89706,USA

Omega 3 (1 x 300mg with every meal)

– Manufacturer: Ocean Nutrition,Bedford,Nova Scotia,Canada

Pro-biotic (1 x 450mg with every meal)

– Manufacturer: Supherb, UpperNazereth,Israel

Calcium & Magnesium – ratio 2:1(1 x 300mg at breakfast and dinner)

– Manufacturer: Solgar,Leonia,NJ07605,USA

Multi-vitamin (1 x 150mg at breakfast and dinner)

– Manufacturer:Contrex Pharmaceutical,New York,USA

 

Hopefully I’m still helpful to fellow sufferers out there…

 

 

 

 

 

 

Lots to Celebrate

I have lots to celebrate. First of all, the holiday season is upon us again. Passover coincides with Easter – and whatever your persuasion – enjoy.

I must say that I had doubts that I would participate in last year’s Seder. This year I just feel blessed. And a great part of my good feeling – psychologically, if not always physically – is realizing how kind people are to me. The kindness manifests itself in so many ways. There are those who phone or e-mail. Those who take the trouble to bring me succulents that go directly to my stomach – and instantly help my well-being. I’ve been brought cheeses – even been charmed by home-made camembert. And biltong and berries. And meats and meals all made with ketogenic care. Food for thought indeed.

Kindness takes the cake. There have been so many examples – yesterday there was another one. A friend actually went to the trouble of contacting one of my life-time likes – West Ham United Football Club – and he was rewarded with an autographed photo of the players and an accompanying letter. These, he brought round in a surprise visit which caught me in a complete quandary. Abraxane had laid me low. Two days after my second treatment I’d “hit the wall” and I didn’t think myself capable of getting out of bed. Pam would have been perfectly capable of explaining my incapacity – and my visitor is too much of a gentleman to be intrusive.

Kindness is a therapy in a class of its own. I popped a Percocet[1] to relieve myself of some pain – and then was uplifted by the double act of kindness. Visits are so nice – but when so many of you are so thoughtful and so caring, I feel it is you who are carrying me through this ordeal.

I’ve been lucky enough to experience the same kindnesses before. Only this time the blog allows to me to cyberspace my thanks.

I’m still not on Facebook  – because there’s no substitute for “face to face”.

Happy Holidays to you all.     

 

 

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[1] Percocet is a prescription drug. It’s a Paracetamol with Oxycodone, an opiate analgesic. It’s a local drug manufactured by Taro Pharmaceutical Industries,Haifa.

If it was only as easy as ABC – Abraxane, Ben, Children…

The abdominal pains I’ve been suffering told me to go to hospital sooner rather than later. On Monday I was scheduled to start my new treatment – but Pam prevailed upon me to go on Sunday. This is how it panned out.

Tel Hashomer has an oncology doctor on call – saving sufferers the added discomfort of unnecessary queuing and quibbling. Call me “Ben” says the young man. You know you’re getting old not when the body lets you down but when the doctors don’t seem old enough to have finished school. I briefly tell him my case history – and smile to myself as he raises his eyebrows when I date my diagnosis as October 2010. He seems extremely competent and caring – but couldn’t confirm whether my pain was a direct cause of the illness or side effects of Tarceva. “At least you’ve done with Tarceva”, he says encouragingly, but can’t allay my concern. His best effort is to prescribe better pain killers – and give me the all-clear to start Abraxane.

Good that new beginnings fill me with optimism. But on what is it based? Do I have any idea of the side effects in the offing? When and where they’ll kick in? And I have to get the naïveté that everything will be better into some prospective. Not easy. Is it such a wonder drug or is it only so much wishful  thinking? What I am learning is that the my oncology department doesn’t seem to have too much first hand experience with pancreatic cancer patients on Abraxane – it’s certainly not in our Ministry of Health’s basket of medicines – so I might be on the cutting edge again. But we manage the administrative hurdles and I had the first treatment on Sunday. So far so good…

But now comes the crunch – the children. It seems that whatever age your children – the accuracy of their perception can surprise you. No hiding my pain and no hiding yet another change of treatment. Their concern moves me to tears and emphasizes yet again what a strain this illness is on the whole family. But this gives us all strength as well … so maybe things will be easier.

As usual, the family have rallied round. Sheila came up with the idea that the recent addition to my diet of “bread” may have been too much too soon. So I’ve cut back for the moment – and happily, the first couple of days have me almost back to my old self.

The Ketogenic Diet – and “Thank Yous”

Firstly, let me say thank you to Libby, from Austria, who pointed out that the web page for the link I’ve been giving to the ketogenic diet is no longer available. I referred to the link a couple of times in a footnote. I like my footnotes. Ever since I saw Josef Kedar’s superb movie of the same name, “Footnotes”, something has changed. If previously I had a tendency to pass them over – especially in technical or academic articles – today I’m more aware. I’m rambling – but that could be the result of the change in treatment over the last few weeks.

As I’ve mentioned I’ve done with 5-F-U (or vice versa). For the last few weeks I’ve been on a weekly infusion of Gemcitobene and one pill of Tarceva a day. The side effects have been debilitating. Which brings me to my second thank you. I literally “cried off” my Sunday game of golf. Karl was again my saviour. Doubled over in pain, and trying hard to hide my tears, he helped as only a true friend can. There are no words of thanks for good deeds.  This illness has certainly given me the perspective of being able to look around and see the best out of so many situations.

So why is the world in such a mess – especially in our corner of it? It’s easy to say that “it’s complicated” or “there’re always two sides to a story”. But somehow I seem to see things in much sharper focus. Should I share these thoughts with you – or keep my blog as I intended it – to help other cancer sufferers, pancreatic cancer patients in particular? An open question – perhaps you’ll oblige me with some open answers.

In the meantime, I’ll stick to the ketogenic diet. Here’s Libby’s link: 

http://lchf.de/wp-content/uploads/2011/06/ketogene_ernaehrung_bei_krebs.pdf . It’s great if you speak German – a tad difficult if you don’t. Skip down to page 19 to find lots of links to interesting recipes – but again in German.

More helpful for my English-only readers is a link forwarded to me by my indefatigable sister-in-law-researcher, Sheila, who has come up with a site that gives a clear (if not new) insight to the diet:

http://www.drbriffa.com/2011/11/29/low-carbohydrate-diets-look-good-for-the-prevention-and-treatment-of-cancer . Sheila, thanks for your continuing support and research.

Why the ketogenic diet? It might just be that my bad side-effects to Tarceva were limited by my diet. I’ll never know. I was warned that Tarceva would be a waste of time. That’s another thing I won’t know. A two-week treatment break and a chance to break new ground with Abraxane is next on the agenda. Suddenly I’ve got the urge to keep the fight going.