Being interviewed by Sheila Dillon for BBC Radio this week was a great pleasure for me. Sheila is a food expert with an interest in the relationship between food and cancer.
A key question was the relevance of a U.K. book, "Food to Fight Cancer," by Richard Beliveau and Denis Bingras. This beautifully illustrated book summarizes the health benefits of everything from cabbage to chocolate! But the question is: can one really fight cancer with food alone? My answer quite simply was no! I stressed that one cannot eat one's way out of cancer.
In 2013, for myeloma in particular, there are many novel therapy approaches to treatment, which work extremely well: VELCADE, Thalomid, REVLIMID, plus new agents, POMALYST and KYPROLIS. These are the mainstays of treatment.
So what aspects of food are important? Eating "real food" is the most important step to healthy living. Avoid processed and fast foods as well as sodas, as I have discussed in previous blogs. Do not go overboard. There are only limited data to support the added value of particular healthy vegetables, fruits, herbal drinks, and juices.
In "The Blue Zones," a book by Dan Buettner about places in the world where people live to be over 100 years old, the diets are rather simple plant-based diets that include omega-3 fatty acids and usually some red wine with polyphenols. What is missing are the fast foods and sodas.
"That's all very well for people living in beautiful 'Blue Zones' with wonderful air and water, but what about us living in London or Los Angeles?" Sheila asked.
My answer is that we have to do the best we can to create our own "blue zones." Eating as healthfully as we can undoubtedly boosts our immune systems, as does reducing stress, getting exercise and sleep. As they say on Ikaria--the Blue Zone island close to Turkey--naps are OK!
But where does one get this kind of advice and specific help?
Unfortunately, doctors are really not trained in detailed nutrition and health as they should be! The focus is on disease. So
it is important to seek the best advice possible from experts such as Sheila Dillon, as well as authors, such as Nina Planck (author of "Real Food") and Michael Pollan (whose new book is "Cooked"). If you want to really know what NOT TO EAT, the new bible on this is, in my view, "Salt Sugar Fat" by Michael Moss, who provides a comprehensive, sobering look at the processed food industry.
So, there you have it! Focus on the new treatments we have, but also pay close attention to what you eat. These are exciting times in myeloma research. The IMF's Black Swan Research Initiative⢠is for the first time redefining and searching for a cure! Exciting times indeed!
Check back at the IMF website for the air date of Dr. Durie's interview on BBC Radio 4.
The IMF team has just returned from the International Myeloma Workshop (IMW) meeting in Kyoto, Japan, held from April 3rd through April 7th, 2013. The IMW was like a "mini-ASH" devoted to myeloma.
The meeting had a jam-packed program running from 7 a.m. until 9 p.m. with investigators squeezing in extra meetings before, after and in between. The broad scope of myeloma was covered in education sessions as well as debates and Q & A sessions. Corporate-sponsored sessions were interspersed with traditional scientific sessions. There was also a large area for poster presentations.
The meeting began with a fireworks display, which kicked off the first night's special opening ceremony at the lake area adjacent to the venue in Kyoto. This was greatly appreciated by the attendees who, from that point forward, were busy from morning until late at night.
Although many sessions were overview summaries, a number of new aspects are worthy of note. For example, on Friday April 5th there was a spirited debate between Dr. Sagar Lonial and Dr. Robert Orlowski on the value of Minimal Residual Disease assessment. It seemed that Dr. Orlowski "won," affirming the need for new and better testing for M.R.D., which is part of the IMF's Black Swan Research Initiative™ (BSRI™).
In the Plenary Session on Saturday morning, several treatment-related abstracts were presented, many with updates from ASH presentations in December 2012. An important new presentation was from Dr. Ola Landgren, who showed for the first time results with Kyprolis/Revlimid/Dexamethasone in high-risk smoldering myeloma (early active myeloma).
Although the results are early, the depth of responses is very impressive and results are promisingly excellent.
A key added benefit at the workshop for most myeloma investigators was the opportunity to network and discuss active and potential new projects. It was clear that, for the future, this is an important aspect and needs to be enhanced by allowing more time during the meeting and locating it at a venue nearer to hotels and lodgings.
By arriving a day early, the IMF was able to facilitate several meetings, including the International Myeloma Working Group (IMWG) breakfast meeting, the Asian Myeloma Network meeting, a Pomalidomide Roundtable, and an interactive discussion/debate of current myeloma therapies in Asia versus those in the U.S. and Europe. In addition, IMF team members Lisa Paik and Dan Navid accompanied a group of Chinese myeloma specialists for a full-day hospital visit, which was very well received.
The following day, at the official start of the IMW, IMF President and Co-Founder Susie Novis was given the opportunity to present on the research activities of the IMF. The audience was treated to a short video presentation that highlighted the work of the International Myeloma Working Group, Asian Myeloma Network, and some of the other research programs supported by the IMF.
In addition, the IMF Japan held a patient seminar on Saturday, April 6th. Susie presented a program about the "power of information" for patient care and was very well received by the group meeting, led by Ms. Kyoko Joko and supported by Mrs. Midori Horinouchi.
This IMW was exhausting, but rewarding. Many new connections were made. Many plans for the future were organized. There are now great hopes and expectations for the next IMW, to be held in Rome in September 2015, hosted by Doctors Antonio Palumbo, Mario Boccadoro, and Michele Cavo. In the meantime, we all have very pleasant memories of the cherry blossoms, which were in full bloom for the Kyoto meeting and greatly appreciated by all.
Congratulations to Prof. Kazuyuki Shimizu and his local organizing committee for organizing a great workshop.
EDIT 3/27/2013: Over the past few weeks I have received many comments my two most recent blogs. I apologize for not responding to your comments and questions. Please know that they are very important to me. I am travelling to the International Myeloma Workshop in Kyoto, Japan, and will respond on my return. In the meantime, if you have a medical question, please contact the IMF Hotline at 1-800-452-CURE (2873).
Two recent journal reports--one in NATURE
the other in CLINICAL
ONCOLOGY--draw attention to concerns about the occurrence of
second primary malignancies (SPMs) in patients with myeloma.
The first article reports the long-term follow-up of patients who received plerixafor (Mozobil®) to mobilize stem cells prior to auto-stem cell transplant (ASCT) between 2006 and 2009. Of 43 patients who were able to proceed to ASCT, 4 developed MDS (myelodysplastic syndrome) and 1 developed AML (acute myelogenous leukemia). Actually, only one of these patients had myeloma: the others had a prior diagnosis of lymphoma. In addition, the single myeloma patient had received a prior ASCT before the second harvesting using plerixafor. Thus, the subsequent onset of MDS/AML in this sole myeloma patient is definitely multifactorial in origin.
Let me explain.
First, it is known that there is an increased risk of MDS/AML in patients even before therapy when they have an MGUS/smoldering myeloma precursor state. Second, therapy-related MDS/AML is a well-recognized late complication with the use of high-dose melphalan (200 mg/m2) which this patient received. Third, patients who are difficult to harvest--in which plerixafor is used preferentially--are known to have reduced stem function
and may have pre-existing latent MDS type cellular injury.
So to what extent did the use of plerixafor as a growth factor increase the likelihood of overt MDS/AML in this one myeloma patient?
Although the authors clearly raise this concern, they also write that further studies are required. The key point in my mind is that this difficult-to-harvest subgroup of patients is intrinsically at higher risk of developing MDS/AML. Thus, it is especially important to carefully assess for underlying MDS in such patients before proceeding to harvest. Until more information is available, it is probably reasonable to consider excluding such patients with documented underlying MDS (based upon cytogenetic/FISH) from further harvesting attempts. In this single
reported myeloma case, the MDS/AML is more linked to the myeloma itself and prior myeloma therapy than the brief use of plerixafor for mobilization.
The second study provides an update with longer term follow-up of the previously reported VISTA trial, which compares melphalan/prednisone (MP) with Velcade® plus melphalan/prednisone (VMP). In this study, use of Velcade for up to approximately one year in the VMP arm did not lead to an increased occurrence of SPMs versus the MP arm of the study. The SPM rates of 4-6% are similar to previous studies evaluating the impact of melphalan. Thus, in this case, there is an increased SPM risk linked to use of oral melphalan, but this is not enhanced with Velcade use. The open question is the use of melphalan versus Cytoxan® (cyclophosphamide) as an alkylating agent. The recent excellent results with CyBorD (Cyotxan/bortezomib [Velcade]/dexamethasone [weekly]) provide an option to be considered
With all the novel approaches, as in life in general, "the devil is the details." So stay tuned as more information becomes available to assess the risks and options related to the development of SPMs. But for now, no drastic change in recommendations.
EDIT 3/27/2013: Over the past few weeks I have received many comments my two most recent blogs. I apologize for not responding to your comments and questions. Please know that they are very important to me. I am travelling to the International Myeloma Workshop in Kyoto, Japan, and will respond on my return. In the meantime, if you have a medical question, please contact the IMF Hotline at 1-800-452-CURE (2873).
On Tuesday, March 12, we were excited to announce the launch of the IMF's BLACK SWAN RESEARCH INITIATIVE⢠(BSRIâ¢) to develop the first definitive cure for myeloma. The BSRI now joins the groundbreaking and innovative myeloma research the IMF has actively supported for more than twenty years.
Gratifyingly, the launch announcement is generating lots of enthusiasm ("Bring it on!" reads a post on our Facebook Page). It has also prompted questions from some patients who want to know how the BSRI will affect them depending on whether they are newly diagnosed or were diagnosed many years ago.
Let me explain by reviewing the key components of the Black Swan Research Initiative.
A combination of new myeloma treatment options available now and the availability of ultra-sensitive means of measuring the disease has set the stage for this unique approach to research.
Within the new paradigm of the BSRI, the definitive key to the cure is something we call MRD-Zeroâ¢. MRD stands for Minimal Residual Disease, and by measuring minimal residual disease we can determine how close a patient is to being cured of myeloma. With no detectable MRD, we are there.
Sophisticated, ultra-sensitive testing tools that can measure MRD on cellular and molecular levels will allow researchers to study individual myeloma patients at all stages to determine which treatments given at which times yield the best results. The best results, of course, will be the eradication of all residual disease.
Armed with that knowledge, acquired through clinical trials, we can begin to develop a cure for all myeloma patients.
The BSRI announcement focused on one avenue of curing myeloma for a subset of patients, but it is only the first step of many to come. Initial work began on the Black Swan Research Initiative in the summer of 2012, and while some early results are promising, a number of important ramifications will be revealed moving forward.
The important point in our announcement this week was to set out the framework for the Black Swan Research Initiative's unique approach to a cure. Now that we have, we hope you are as excited as we are to see what materializes as we unlock the mysteries of myeloma. Our goal is to have testing in place and clinical trials ready to start by year's end.
The personal stories of toxic exposures potentially linked to myeloma just keep on coming! I am grateful to all who shared them with me. And once again, the 9/11 compensation fund was in the news on January 30th. The first 15 compensation awards were given out--but none to cancer patients. Sheila Birnbaum, the special master of the $2.8-billion fund, said she had not awarded money for cancer yet because she had not received completed applications. Of the 16,000 people who have registered, only 2,500 have submitted eligibility forms, and, of those, only 190 have submitted compensation forms and many lack documentation!
So, the dreadful task of completing all the paperwork seems to be the key to potential compensation, and staff advice is apparently available. Myeloma patients need to work through these details in as timely a manner as possible to take advantage of available compensation, as the fund expires in 2016! Current estimates are that over of $8.5 billion will be required to compensate the thousands of people potentially eligible--$6 billion more than the amount approved by Congress in 2010. Being at the front of the queue could prove to be quite important!
Many people have responded to my previous blogs on this topic, including Hardy Jones. Hardy documented the toxic pollution in his system by having his tissue levels tested and had extremely high mercury levels reduced with chelation therapy. His unwavering work to assess and document environmental pollution (he was featured in an NPR story in 2009) is applauded by all and can hopefully lead to meaningful protections and regulatory changes.
Comments posted by many people here support the correlation between toxic exposures and the subsequent diagnosis of myeloma. Unfortunately, these have to be evaluated on a case by case basis. There are two key points to keep in mind. First, anyone concerned about toxic exposure should limit potentially harmful exposure. Second, fortunately, the outcomes for myeloma patients have been improving dramatically with use of novel therapies available in the last 5-10 years, with new drugs being approved in rapid succession. Early diagnosis and getting started on therapy are very important. I urge people who were exposed to toxic chemicals during 9/11 be screened for MGUS or smoldering myeloma, which are precursors to active myeloma. I strongly recommended this course of action since early diagnosis will undoubtedly lead to the best results.
My recent blog, "New Study Provides Clues to What Causes Myeloma," clearly struck a chord with many myeloma patients. The heartfelt comments and questions are noted and really appreciated. A first point is that New York residents or people working in New York who believe they were exposed to toxins by the 9/11 event ARE indeed eligible for screening and
treatment under the Zadroga Act and World Trade Center Health Program. But the powerful vision of toxic exposures in New York reminded many of you of possible or probable toxic exposures in your own cases. From 1-3 butadiene exposure at Rexam Graphics to pesticide exposures, tours of duty in Vietnam (and/or neighboring countries) with Agent Orange and dioxin exposures, fumes from asphalt and/or construction sites, or general industrial pollution, very valid correlations and concerns are raised.
For New Yorkers, it is very important to seek screening and follow-up or treatment. The designated centers of
excellence are noted in the link above. Early assessment, diagnosis, and treatment are keys to achieve the best
outcomes.
For others with broader concerns and questions about toxic exposures, much more needs to be done. In a new
editorial in the New York Times (Sunday, January 20, 2013), Nicholas D. Kristof discusses what he calls "warnings from a flabby mouse." You may be aware that obesity has been linked to an increased likelihood of myeloma. The key question has been: "Does obesity in some way trigger myeloma or does some chemical or toxic exposure trigger obesity, diabetes, myeloma, and possibly other cancers?" Nicholas highlights the work of renowned researcher, Bruce Blumberg, at the University of California, who coined the term, "obesogen," for chemicals that cause increased fat storage. These obesogens are the exact same types of chemicals that can cause myeloma: endocrine disrupter chemicals including dioxins, chemicals from plastics and rubber, agricultural chemicals, as well as
chemicals in foam cushions and jet fuel (http://endo.endojournals.org/content/147/6/s50.full.pdf+html).
So it seems that the epidemic of obesity and diabetes may be linked to increases in the incidence of myeloma in recent years. Thus, as they say, "the plot thickens." The scenario of widespread environmental chemical pollution, how to assess it, and what to do about it is such a large and important topic that I will return to it in future blogs.
For now, be aware and seek advice as needed. The overriding motto of the IMF is "knowledge
is power."
Six
months ago, cancer was added to the list of illnesses covered by the $3.4
billion World Trade Center fund. Now, as reported on December 19th in the New York Times, the New York
City Health Department has completed a study that compares cancer rates among
9/11 responders with overall cancer rates for New York State. Myeloma is at the
top of the list of cancers occurring at a statistically higher rate in 9/11
responders. Myeloma is occurring at a 3-fold increased rate: the rate being +185%
versus the average for New York State. Thyroid cancer was at +102% and prostate
cancer at +43%. All others were not statistically increased in this study.
The
findings are controversial in part because it is very early to be assessing the
ultimate risks--and therefore much too soon to be drawing conclusions for most
cancers, the occurrence of which will increase over time. However, the early
increase in myeloma cases is quite remarkable and suggests a particular
susceptibility to the exposures at 9/11 sites.
The
specific chemical identified by the Zadroga Act reviewers (6 months ago) was
1-3 butadiene, a chemical linked to rubbers and other fumes present at the 9/11 sites. The chemical 1-3 butadiene is metabolized in
the body via an epoxy mechanism. A study which I published in 2009 (Leukemia article
on DNA SNP)
showed that myeloma patients are more likely to have a defect in this epoxy
metabolism, and, therefore, are potentially more susceptible to the toxic
effects.
So
it seems that a story is coming together linking exposure, susceptibility, and
early onset of myeloma in the 9/11 setting. More studies and follow-ups are
needed, but these findings are plausible and satisfy elements of what are
called the "Bradford Hill Criteria," used to link toxic exposures and the
development of cancer such as myeloma. There is already "proof of principle"
that several toxic chemicals can cause myeloma, including pesticides, solvents,
and chemicals such as 1-3 butadiene.
With
this knowledge, there is now an opportunity for early screening to diagnose any
case as soon as possible and look toward even curative intervention.Every cloud has a silver lining--in this case,
the ability to understand the process and intervene early.
As I paged through the second edition of Dan Buettner's "The Blue Zones," pondering the benefits of goat's milk, beans, garden vegetables and the like, I suddenly noticed a sentence with the word "cookies" in it! His personal interviews with the centenarians from the Sardinian mountain regions were most revealing and interesting. Before heading off to visit the family mountaintop pasture, Dan "downed a dozen cookies with a few glasses of wine" with Tonino, the 75-year-old son of a centenarian. It turns out that "papassini," Sardinian cookies made with raisins, almonds, and jam from cooked red wine (saba), are very popular, especially at festivals and during holiday seasons. So right before Thanksgiving and the Christmas/New Year season, I learn that cookies may be okay after all! The recipe for papassini includes almonds (or walnuts), golden raisins, flour, eggs, vanilla powder, vegetable shortening, plus whole milk.
So do Sardinians live a long life despite eating cookies or are cookies actually part of the magic formula for life beyond 100 years? Maybe, if they didn't eat cookies they could live to be 150 years? At this point, I am thinking that 100 years seem fine. But, as I focused in on the individual stories of centenarians from "The Blue Zones" in Sardinia, Okinawa, California, Costa Rica, and the island of Ikaria in Greece, I appreciated the great diversity in factors contributing to long life. With regard to food, there are both similarities and differences. The major common feature is reliance upon a lean, plant-based diet. Herbal and medicinal teas are common. Red wine (Cannonau or Grenache) high in flavonoids is popular in Sardinia and Ikaria. Fresh goat's milk and grass-fed sheep cheeses are also popular in both these blue zones. The high omega-3 fatty acids in these products may be especially important since fish is eaten, but is not a consistent staple across the blue zones. There is liberal use of olive oil as well as frequent use of pork lard in cooking. Of note, eggs often accompany beans, rice, and tortillas. Breads are whole grain. Both sweet and traditional potatoes are used. Meat-eating is definitely low, and is restricted mainly to pork, with less frequent beef reserved for holidays and festivals.
But it turns out that many key features of blue zones are not food related. It is important to realize that "The Blue Zones" are not idyllic paradises with individuals focused on their "best diet." These centenarians, by and large, have endured many hardships in their lives and eaten what is available: often not enough. Even when they have enough food in Okinawa, the centenarians stop eating when they are 80% full. These are tough, decisive people doing their best to survive. There is an underlying faith that "God will provide" despite precarious circumstances. There is freedom from the financial and social pressures of modern society. Elders are revered within the family and community. These are not "me" societies: it is all about the extended family. Time and deadlines are not important. Naps are okay and part of the pattern of life.
Dan Buettner and his diverse collection of experts have tried very hard to sort out the dietary, genetic, and social factors that can lead to long life. In Costa Rica, the centenarians are closely linked to the Chorotega Indians, but there may still be genetic diversity and strength from what locals call "mixed blood" in this blue zone. Ultimately, the causes of longevity are clearly multifactorial.
And so, I came back to my starting question: what about the cookies? As I turned to page 238, I spotted another sentence with cookies in it: this time anisette cookies. It turns out that, in Ikaria, they also love cookies, in this case, anisette cookies, which are remarkably similar to "papassini," using almond extract instead of crushed almonds.
So my final take-away is to rely on what Dan Buettner's team calls "Vitamin S" as a magic ingredient. In this case, S is for Smile! Centenarians and the rest of us, if we want to be like them, need to be happy, sociable, welcoming people always ready with a smile. If that smile, from time to time, combines with cookies and red wine, this can be a good thing!
In the October 28, 2012 issue of the New York Times Sunday Magazine, Dan Buettner discusses "The Blue Zones": places in the world where an unexpectedly high percentage of people live to be over 100 years old (or
close). Dan has a newly
updated book out on this topic, but the focus of the New York Times article is the story of a Greek-born war veteran who moved to the U.S. and, in his 60s, developed lung cancer (presumed terminal). Expecting to die very soon, he returned to his native island, Ikaria, a Greek island 30 miles off the west coast of Turkey. Now, 35 years later and approximately 100 years old, he is cancer free and living an active life on Ikaria.
The question is why?
To come up with an answer, Dan Buettner has zeroed in on a "Blue Zone," which is a cluster of villages high in the mountains of Nuoro province in Sardinia, which contains the highest concentration of men over age 100
anywhere in the world.
He has recruited a team of experts, including Dr. Gianni Pes (University of Sassari in Italy) and Dr. Michel Poulain, a Belgian demographer, to help assess and validate if "Blue Zone" residents are really living longer than expected and why. So it is possible to compare and contrast the diet and lifestyle of residents of Ikaria, including Stamatis Moraitis, the long-lived cancer survivor, with centenarians from Sardinia and the other "Blue Zone" regions.
A key common feature is the local variations on the "Mediterranean type diet." The residents of Ikaria drink a popular "mountain tea" made from dried herbs such as marjoram, sage, mint (fliskouni), rosemary and dandelion. Local honey is widely used, and old people start their day with a spoonful of honey.
The menu in Ikaria include goat's milk, two-to-four glasses of local red wine daily, lentils, garbanzos, potatoes, fennel and seasonal vegetables from the garden. Residents also enjoy fish three times each week and small portions of larded pork from the family pig. There is generous use of olive oil with meals, plus local sourdough bread made with stone-ground wheat.
So there you have it, "Mediterranean Real Food": but there is also what they do not eat! Very little refined sugar and white flour; no sodas. All of this is remarkably like the "Real Food" approach we have been discussing in recent weeks.
Asked why she lived past 90 years, an old lady on Ikaria said it was the clean air and wine. A 101-year-old woman just shrugged and said, "We just forget to die."
There may be a lot of truth in this. The island residents do not track time (no clocks), work in their gardens, socialize, drink wine, have naps and are happy to wake up each day. So, although food is definitely important, the impact of the whole lifestyle cannot be ignored.
I have the impression that rushing to the gym eating an energy bar is not going to replicate the long life on Ikaria no matter how much "Real Food" we add in. We need true lifestyle changes, plus every effort to eat as best we can!
After the teleconference on "10 Steps To Better Nutrition," numerous comments, questions, and helpful suggestions came into the International Myeloma Foundation (IMF). It is clear that many details about food and drinks are of great interest. So I will start with some of the recurring themes.
Are some cookies okay?
The answer is yes! It is important to understand about acrylamide and some other aspects of cookies. Let me again refer you to the Mayo Clinic nutrition article plus the National Cancer Institute's "Fact Sheet: Acrylamide in Food and Cancer Risk." Acrylamide is a toxic chemical which is produced by high temperature cooking (above 248°F [120°C]) when asparagine, an amino acid (in proteins), binds with sugars in whatever is being cooked. So keep temperatures low and avoid excessive browning or burning: these are key to keep acrylamide low. Preparative pre-cooking can also be important, such as the use of coating with olive oil before cooking meat. Likewise blanching potatoes before frying can be helpful in reducing acrylamide. So what about cookies? It is definitely possible to have cookies with low acrylamide. For example, lightly baked, fully organic oatmeal cookies or shortbread cookies can be options. Obviously, one needs to separately consider the sugar content and calories: nothing is simple these days!
Talking about sugars, let me switch to the number one area of questions and comments:
What about sodas? Are there some safe options there?
On the teleconference call on Thursday, October 11th, I cautioned that quite a number of processed and packaged foods and drinks can contain toxic chemicals, hormones, antibiotics, and some can even contain dangerous fungus or bacteria.
So what can one do to stay healthy? My strong recommendation is to eat "Real Food" and carefully selected drinks. I also recommended that you stay above the fray of the often confusing and controversial discussions about which chemical or hormone is toxic or not. Just do your best to avoid chemicals or processes which are in dispute and potentially dangerous. Read labels and make a commitment to maximize the amount of "Real Food" in your diet. If you can't go to a Farmer's Market or don't have one close by, check at your local store- many are now stocking organic food (Time Magazine, October 2012). Another option is to see if fresh, local, organic produce can be delivered (Fresh Direct) or perhaps friends or neighbors can help.
What is best with regard to sodas?
The main point is to do your best to avoid:
Artificial sweeteners: Sucralose (Splenda®) and Aspartame (Nutrasweet® and Equal®
Also, bisphenol A from plastics and phosphate preservatives
A recent editorial in the New England Journal of Medicine (this and another article are linked as references from the teleconference page) highlights the need to restrict soda intake, because of the high-fructose corn syrup, to reduce the risk of developing obesity, diabetes, and/or a range of other ailments.
A useful website source is "Rodale" (Where Health Meets Life), which highlights 8 healthy sodas. Go to the site to get full details. The sodas and healthy drinks are:
Fizzy Lizzy, a carbonated fruit juice drink
Reed's Light extra ginger brew
Virgil's Root Beer
Bionade, which comes in a range of fruit flavors
Oogave, a certified organic soda with multiple flavors
Kombucha fermented tea
Hot Lips cranberry or pear soda
Steaz sparkling green tea
These are options if you feel like having a soda or a healthy drink! Another option, in response to a question posed, is simply to add some natural pomegranate juice into sparkling water, which can produce quite a delicious drink. Pomegranate is an ancient and healthy fruit, which contains many active ingredients, such as antioxidants and polyphenols. Claims have been made that it is helpful for a variety of medical conditions and have been taken seriously enough to lead to several ongoing trials. Pomegranate is a good fruit- just how good, we don't know yet!
So this is perhaps enough information for now. I will be back again soon to discuss additional topics of particular interest or concern. In the meantime, don't forget to read the labels!
