Mike Milken Founder and Chairman, Prostate Cancer Foundation
When your life is on the line, changing your diet can be easy. I know. When I was diagnosed with advanced prostate cancer in 1993 at the age of 46, I went from tuna melts and peanut butter to rice cakes and steamed broccoli overnight.
I didn't particularly enjoy my bland new diet. But I was determined to do everything in my power to beat cancer. That meant learning about the best of Western and Eastern medicine, making dramatic changes in my lifestyle and beginning to think of what I ate as an integral part of my recovery. I didn't care for dry baked potatoes or limp piles of steamed vegetables. However, the pleasure of eating was a small sacrifice for the pleasure of living. If a doctor could have given me a pill containing all the nutrients I needed to fight the disease, I would have gladly given up food forever.
But the cravings didn't stop.
While eating a bowl of lettuce with red-wine vinegar, my mind would invariably wander. I started craving chef's salads topped with Thousand Island dressing. I had incredibly vivid recollections of Caesar salads that my wife, Lori, and I had eaten during our courtship as college students. I missed the joy of eating. In 1995, after consulting a number of scientists studying the role of diet and cancer, I went on a worldwide search for a chef who could incorporate nutritional research into food that I could actually enjoy.
The search led to Beth Ginsberg, an accomplished chef who specializes in healthy cuisine. Her cooking wasn't anything like what I had grudgingly come to accept as part of my recovery. Guided by the latest findings of scientists studying the link between diet and cancer, Beth created meals that tasted a lot like dishes I have always loved. Chili. Reuben sandwiches. Strawberry shortcake. It hardly seemed possible: I could eat well while undergoing nutrition therapy. I could have it both ways.
And so can you. The recipes in this book are designed to help you enjoy the pleasure of food while helping your body fight cancer. It is important to note that research on the role of diet in the progression of cancer is not yet conclusive. Researchers believe that wide global variations in the incidence of cancer are in part explained by differences in diet. But scientists are just beginning to understand how molecules in food and vitamins affect our bodies' cells and energize our bodies to fight cancer.
After five years of interacting with many of the world's leading scientists studying nutrition, I am increasingly convinced that it's not just what we eat in the typical American diet that puts us at a higher risk for cancer. It's also what we don't eat that contributes to the high incidence of cancer in the United States: one in two American men and one in three American women are diagnosed with cancer in their lifetime.
Like many of the estimated 11 million Americans living with cancer, I decided not to wait for rock-solid scientific evidence before changing my diet. Often we see relationships - the link between smoking and lung cancer, for instance - before scientists can document the exact molecular mechanisms that occur. Most important, I recognized that there is no harm, and probably a great deal of good, in beginning to eat low-fat foods rich in nutrients absent from the typical American diet.
I was born on July 4, 1946, during a period of unbridled optimism. Like many members of the Baby Boom generation, I was raised to believe that one person could make a difference and that any problem, no matter how difficult, could be solved if you put your mind to it. My parents provided a nurturing - but often quite rigorous - education.
At the dinner table, typically over such high-fat delicacies as fried chicken or brisket of beef, my brother and I had to be prepared to discuss any subject - the speed of light, the countries of the United Nations, social inequalities, balance sheets from my father's accounting clients, or the batting averages of major-league baseball players, past and present. Having dinner every night made for strong family bonding. But it wasn't exactly relaxing.
My choice for college was the University of California at Berkeley, for reasons both academic and personal. It was one of the top-rated universities in the country and had an internationally recognized faculty. More important, though, Berkeley represented a chance to see the world. Students came from all over to study, discuss and debate a dazzling variety of ideas. After years of discussing the world at the dinner table, it seemed I could see it all just by walking across campus.
The university's academic excellence did not extend, however, to the local cuisine. While the intellectual climate could be quite avant-garde, the food was absolutely mainstream. When a gourmet hot dog stand called Top Dog opened near campus in my junior year, it became the High Temple where we went to worship. Almost every night, my friends and I walked over to savor hot dogs or bratwurst on those fantastic buns. On a good night, I could eat a dozen at one sitting.
My diet wasn't just hot dogs. I became a star at breakfast eating contests in our fraternity kitchen. The contests were administered by a "chef" who thought of lard as one of the essential food groups. I would routinely put away 10 pancakes, 3 eggs over easy, 12 pieces of bacon, and cereal. I retired undefeated after reading about a college student who dropped dead after winning an eating contest. Weight was never a problem: I have an incredibly high metabolism. Even though I stopped for a giant hamburger and a large milk-shake every day on the way home from classes, it wasn't until the third semester at Berkeley that I permanently broke the 150-pound barrier.
After Berkeley, my wife Lori and I moved to Philadelphia to attend graduate school. I soon developed a taste for some of the finer regional dishes, particularly Philly cheese steaks, and my own concoction of soft pretzels topped with peanut butter.
After graduating from the Wharton School, I began commuting to Wall Street, and a whole new set of eating habits began. On a typical morning, I hurried to catch the 5:30 a.m. bus for my two-hour trip to New York. As I rushed through the kitchen, I grabbed one or two of my grandmother's buttery rolls, filled with nuts and raisins and topped with frosting.
By 1971, my life had changed substantially. I was 24, and running the research department at an investment firm. The work was invigorating. It provided opportunities to apply the theories I began developing on trips to visit my father's clients and later honed at Berkeley and Wharton. Once I reached the office I never left my desk. I ate breakfast and lunch - egg-and-bacon sandwiches, corned beef sandwiches, Chinese food, pizza - standing at the desk, often with two phones pressed to my ears.
By this time, technology was dramatically changing the way we worked. While the dramatic growth of CNN, MCI, Time Warner and the cable, cellular and health-care industries was still a few years off, innovations in technology were already beginning to have a profound impact not only on the economy, but on every other part of our lives. Intel had just introduced the first microchip, and Texas Instruments had just produced the first desktop electronic calculators.
I also remember reading that the President of the United States had declared war on cancer. In a speech to the American people, he promised a cure within a decade. At the time, I had never known anyone with cancer and had given the disease little thought. My only memory was being a block captain for the American Cancer Society in elementary school.
By 1976, technology had advanced even further. NASA's Viking I spacecraft beamed back images of Mars. A team at MIT synthesized a functioning gene. And as our firm became a world leader in research and trading for industrial companies, we established links to offices around the world using computers and telecommunications. That same year the war on cancer reached the promised halfway point. Then, in early June, I learned that my father had been diagnosed with malignant melanoma.
I began traveling with him to cancer centers, looking for treatments that might help. I read about cancer. I talked to scientists. I learned all I could. For the first time I was confronting a problem that could not be solved - not by me, nor by any doctor or any scientist I called on. I moved back to California so my children, 5 and 2 at the time, would have the chance to know their grandfather.
The relocation of my entire department to California had an unanticipated impact: I discovered a new world of food. I remember the first morning we arrived at 4:30 a.m. to prepare for the opening of the East Coast markets. By 7:30 a.m., the team of researchers, sales personnel and traders was starving but happy in the anticipation of our typical New York snack of greasy fast food and doughnuts. When the caterer wheeled in a trolley of brown wicker baskets brimming with vegetarian sandwiches on whole wheat bread, little cups of yogurt and bags of chopped veggies, he was almost devoured. He was lucky to get out alive.
By 1993, personal computers were in 31 million American homes. Fifty-eight million households were wired for cable. And 15 million Americans had become regular users of the Internet. As I attended an update on the Milken Family Foundation's cancer program, it struck me that the country had never made the moral or financial commitment necessary to bring the full promise of technology to bear on cancer. It had been 22 years since the President's declaration of war and another nine million Americans had died of cancer. I had lost my father, mother-in-law, stepfather, five other relatives and way too many friends.
That January, I had my first complete physical in two years. It was just a few weeks after one of my closest friends, Steve Ross, the chairman of Time Warner, had died of prostate cancer. Thinking of Steve, I asked my doctor to run a simple PSA test, one of the ways prostate cancer can be detected. He said I was too young to be tested.
"Humor me," I said.
And so I learned, in February 1993, that I had advanced prostate cancer. After consulting with researchers at a scientific conference in Houston and undergoing several weeks of additional tests, I discovered that my life expectancy was 12 to 18 months.
Because of my family history of cancer and our foundation's involvement in cancer research over the previous 17 years, I thought I understood cancer. I was astonished to learn that one in every five men will get prostate cancer. Prostate cancer appeared to be a "stealth" disease. It was not a major topic at scientific meetings, nor a priority on the national research agenda. I faced a crisis of uncertainty. No treatment option worked all the time. No medical expert could determine what would work best.
So many of my family and friends had lost their battles against cancer. What could I do that my relatives and friends had not? What could I do that would be different? My father and Steve Ross had not taken time off to wage war on their disease. My dad worried about his clients and their problems and was slow to seek a diagnosis. He had not wanted to take time away from his work. He might still be alive today if he had sought medical help earlier. Steve was focused on his overriding vision, to build Time Warner into the most important entertainment company in the world. He didn't want his health to distract him.
I decided to shift my energy and concentration into changing my lifestyle and diet and taking charge of my own illness. A month after my diagnosis, I established CaP CURE, the Association for the Cure of Cancer of the Prostate. With the support of thousands of people, it has become the largest private funder of prostate cancer research.
Since childhood, I had viewed life as a constant quest for knowledge. I set out to learn about Eastern medicine and ways to energize the world's greatest creation: the human body. It seemed clear that my health had suffered from all those years of eating fatty foods, all the meals eaten in haste and on the go, and more recently the stress from my legal problems.
My search for answers led to a meditation center in western Massachusetts that was based on the Ayurveda tradition of India. There Lori and I learned more about Eastern medicine, herbal cures and relaxation. We invited a doctor trained in both Western and Ayurveda medicine to move into our house for a few months. Early in the morning and late at night, we worked on breathing techniques, herbal therapy, meditation and yoga.
I learned how massage can activate the body's t-cells, which fight cancer, and how aromatherapy can energize the immune system. I rented a house at the beach and went for long walks. The smell of the seashore, and the water, brought back childhood memories of walks with my father at Lake Arrowhead in California.
Another benefit of the beach, I learned, was sunlight. Studies supported by CaP CURE show that sunlight and vitamin D help reduce the growth of prostate cancer. The studies also found a higher incidence of hormone-related cancers in northern Europe and the northern U.S. than in the southern parts of those continents. I thought back on all those long days in my windowless Wall Street office, and all those winter days I set off for work in darkness and returned in darkness. I had seen no more daylight than a hibernating bear.
After years of fielding a thousand calls a day, I turned off the phones in part of my house. And I changed how I ate. One Ayurveda teaching was "Better to eat a stone sitting down than a meal standing up." Similarly, rabbinical law cautions against eating while standing. For someone who had eaten 2,000 to 3,000 meals standing at his desk, this was another chilling thought.
I decided to drastically reduce the fat in my diet, to nine grams a day. I stopped eating meat, desserts and most dairy products. But that wasn't good enough. I found that even a single serving of "light" peanut butter exceeded my daily fat allowance. While I felt virtuous eating a mixed salad, I discovered that even a small amount of my favorite dressings put me way over the top. Even margarine that is 100 percent fat could legally be labeled "nonfat," so long as it contained less than one-half of 1 gram of fat per serving (Understanding Marketing Terms, page 42).
But cutting down on fat was not enough. Research supported by CaP CURE showed that soy protein could be a critical missing ingredient. I learned that Americans have a five times higher incidence of prostate cancer than people living in Asia and eating a traditional Asian diet. These diets are typically rich in soy protein, which contains a nutrient called genistein. This chemical has been found in laboratories to interfere with the growth of prostate cancer cells and to inhibit angiogenesis, the new blood vessel growth required for tumor cells to spread throughout the body (page 44). Genistein appears to help fight all hormonal cancers, including breast cancer. Soy had never been a staple of my diet, but now I substituted tofu or tempeh for meat, and I began mixing soy protein isolate powder with water or fruit juice.
But until I found Beth Ginsberg, eating was more of a burden than a pleasure. Beth made it her mission to incorporate the latest scientific knowledge in her adaptations of old, favorite recipes. Soon I was enjoying foods and flavors I had written off as long-lost memories. She turned my medicinal soy protein drinks into fruit smoothies that reminded me of the delicious Swiss orange-chip ice cream I would get at Swensen's Ice Cream in Berkeley (page 84). I could hardly guess that the drink was full of soy protein and other potential cancer-fighters like lemon and orange zest (the oils found in the of soy protein and other potential cancer-fighters skin contain limonene and geraniol, which have been shown to curtail tumor growth).
Even the hot dogs I had devoured as a college student made a comeback. Instead of red meat and who knows what else, these hot dogs are made of tofu. Beth even created a casserole using these hot dogs along with my beloved Philadelphia soft pretzels (page 42). Beth reviewed scientific studies while formulating her recipes. When research supported by CaP CURE found that beans and lentils help lower levels of hormones that indicate prostate cancer risk, Beth found delicious ways to introduce these foods into my diet. When scientists reported that a chemical called lycopene found in cooked tomatoes seems to produce a reduced risk of prostate cancer, Beth added tomato paste to many recipes (page 17). After research on garlic and other allium vegetables indicated that they inhibit growth in a number of tumor cell lines, Beth increased the use of garlic as a seasoning. And finally, when scientists discovered that curcumin, which is found in cumin and is the yellow pigment found in turmeric, inhibits the development of certain cancers, Beth increased its use in chili (page 41) and employed it for coloring in a sauce in her version of Eggs Benedict (page 85).
One day I decided to really put my new diet and Beth to the test. I invited some colleagues to lunch. They were as far removed from the vegetarian crowd as you could get, and I wanted to see how they would react to one of my typical meals. Beth served Reuben sandwiches (page 68), and afterwards I asked my guests what they thought they'd eaten. No one guessed that the cheese and Russian dressing were soy-based and the meat was actually tempeh. They all thought the sandwiches were delicious. I knew that if die-hard carnivores like these were convinced, we were on to something good.
I was highly motivated to change my diet because I believed it could mean the difference between life and death. But I wondered: How do we teach our children to make changes now?
One answer might lie with science. Both skeptics and young people, I feel certain, will increasingly become convinced of the value of nutrition as science unlocks the secrets of the human body. I am confident that biology and chemistry will drive the scientific breakthroughs of the 21st century, just as the 20th century was shaped by physics and remarkable advances in engineering, mechanization, data storage and telecommunications.
As previous generations envisioned the future through the science fiction of Jules Verne, and my generation glimpsed it through "Star Trek," the children of today are just beginning to imagine no less remarkable innovations in biology. I am sure the day will come when our grandchildren will be as flabbergasted at how naive we are about the relationship between food and the human body as we are by our own grandparents' unease with such modern contraptions as the laptop computer and the cell phone.
While there is no magic formula or secret cure, I know that good health requires healthy eating. Thanks to scientists all over the world and to Beth Ginsberg, I have learned to make practical use of the latest nutritional research without giving up the joy of eating.