Transcript Nutrition and Healthy Lifestyle: Fighting Cancer with Your Fork

Fighting Cancer with Your Fork:
Separating Fact From Fiction
Hillary M. Wright, MEd, RD, LDN
Dana Farber Cancer Institute
Leonard P. Zakim Center for Integrated Therapies
How Do We Figure Out What May
Affect Cancer Risk/Survivorship?
The American Institute for Cancer Research
“Food, Nutrition, Physical Activity and the Prevention of
Cancer: a Global Perspective”
 The result of an analysis of over 7000 research studies on
the link between diet, lifestyle and cancer, and for the
first time cancer survivors
 www.aicr.org   “comprehensive global report”  10
Recommendations, last one specific to survivors.
AICR Global Report Recommendations:
1. Be as lean as possible without becoming underweight.
2. Be physically active for at least 30 minutes every day.
3. Avoid sugary drinks. Limit consumption of energy-dense
foods.  due to correlation with obesity
4. Eat more of a variety of vegetables, fruits, whole grains
and legumes such as beans.
5. Limit consumption of red meats (such as beef, pork and
lamb) and avoid processed meats.  11 – 18 oz per week
max
AICR Global Report Recommendations
(continued):
6. If consumed at all, limit alcoholic drinks to 2 for men and 1 for
women a day.  12 oz beer, 5 oz wine, 1.5 oz spirits
7. Limit consumption of salty foods and foods processed with salt
(sodium). stomach cancer (also moldy foods due to liver cancer in
developing countries)
8. Don’t use supplements to protect against cancer.
9. * It is best for mothers to breastfeed exclusively for up to 6 months
and then add other liquids and foods.  reduce breast cancer in mom
and obesity in child
10. * After treatment, cancer survivors should follow the
recommendations for cancer prevention.
*Special Population Recommendations
America’s Challenging Food
Environment
Watch Your Weight!
 65% of Americans are overweight or obese.
 Only 6% of Americans identify being overweight or obese as a
risk factor for cancer despite a clearly established scientific link.
 Research shows that fat cells can act as "hormone pumps,"
secreting hormones and other growth factors into the
bloodstream.
 If the body's cells are exposed to very high levels of these
substances over an extended period, they tend to reproduce
more quickly  ? Increase cancer cell growth.
 Researchers stress that this potentially dangerous condition is
reversible!
Physical activity and Cancer: Critical for weight control,
growth hormone regulation, stress management,
counteract fatigue, support immune system , etc:
 New Guidelines from the Dept of Health & Human
Services
Minimum 150 min moderate, or 75 min vigorous to
reduce risk of chronic disease
 Ideally aim for more – and necessary if weight loss and
maintenance of loss is the goal – 300 min of moderate or
150 minutes of vigorous.
 Physical activity linked to lower risk of breast,
prostate and colorectal cancer
Beyond weight control, fruits and
vegetables may exert a protective effect:
Phytonutrients
 Beyond vitamins, minerals and fiber,
natural compounds found in plants may
exert profound disease preventive effects
 The “immune system” of a plant – many
also represent the pigment that gives the
plant it’s color.
Phytonutrients:
Prevention in a Plant
 How do they work?
 Stimulate enzymes that help the body detoxify
 Reduce the genetic damage from cancer causing agents
 May interfere with growth and multiplication of
cancer cells
 Decrease inflammation
If It Stains Your Shirt…
 If a fruit or vegetable has
a strong smell or taste, it’s
probably biomedically
active
 If it stains your shirt, it’s
definitely biomedically
active!
Antioxidants
 Vitamin A, C, E, Selenium, phytonutrients from plants
 Help prevent damage to cells from the attack of free
radicals

“But I take antioxidant supplements in pill form, so
I’m getting all the antioxidant benefits that way,
right?”
Food First!
 Phytonutrients work together to provide a
synergistic benefit
Some studies show high dose nutrient
supplementation can be detrimental:
Beta carotene supplementation in smokers
 N Engl J Med. 1994 Apr 14;330(15):1029-35. (ATBC)
The effect of vitamin E and beta carotene on the
incidence of lung cancer and other cancers in male
smokers. The Alpha-Tocopherol, Beta Carotene
Cancer Prevention Study Group.
 N Engl J Med. 1996 May 2;334(18):1150-5. (CARET)
Effects of a combination of beta
carotene and vitamin A on lung
cancer and cardiovascular disease.
Choose a Predominately Plant Based
Diet
 Eat 5-10 servings fruits & veggies each day
 1 serving = 1/2 cup cut, cooked or sliced; 1
piece medium fruit; 1 cup leafy greens
 Emphasis on variety
 Richly colored plant foods are most phytonutrient-dense
Organic vs. Conventional
 No scientific evidence to date that organic offers anti-cancer
advantage at this point
= one study suggested organic blueberries significantly higher
sugars (fructose and glucose), malic acid, total phenolics, total
anthocyanins, and antioxidant activity (ORAC) *
 Thousands of studies support the health benefits of diets high in
fruits & vegetables and none done exclusively on organics
 More than ½ of dietary pesticide exposure comes from 12 foods –
EWG “Dirty Dozen”
 Bottom line: wash things thoroughly and don’t
let this decrease # of fruits/vegetables you eat!
*J Agric Food Chem. 2008 Jul 23;56(14):5788-94. Epub 2008 Jul 1
Food First
 75% of Americans don’t eat “5 a day”
 Americans eat 1.5 servings of vegetables & less than 1
serving of fruit daily, despite consistent evidence that
these foods decrease the risk of many chronic diseases.
 We throw away more than 11 billion pounds of fruits and
vegetables every year in the US!!
 Americans spent $26.7 billion per year on dietary
supplements in 2009 despite limited and inconclusive
scientific evidence of effectiveness in disease prevention
and treatment
Phytonutrients in Whole Grains
 Isoprenoids in whole grains suppress tumor
growth
 Tepernoids and Tocotrienols encourage tumor
dormancy and decrease tumor cell division
 Stimulate GST (detoxifying enzyme)
**Also, dietary fiber has a “probable”
connection to decrease risk of colorectal CA
Does Sugar Feed Cancer?
 Popular myth
 Unknown root of myth
 PET Scan
Inject radioactive glucose into veins
Areas of higher metabolic activity “glow”
Yes, BUT…
 All cells in the body use sugar for energy
This includes cancer cells
 Cancer cells are more metabolically active than other
cells
Use more energy (sugar)
 Body will make sugar from other sources if you
do not get enough through diet
Break down muscle and fat tissue
Tumor can make its own glucose
Sugar and Cancer – It’s not that
simple…..
 Sugar does not FEED
cancer
 Chronic, excess intake
of simple sugar leads to
excess production of
hormones like insulin,
IGF that encourage
cellular growth
Insulin and Cancer
 Excess insulin can promote tumor cell growth
 Behaviors that increase insulin levels
 Consumption of refined sugar and flour
 Overeating
 Weight gain
 Sedentary lifestyle
 Behavior that reduces insulin levels
 Physical activity, weight loss, unrefined carbs
Lower fasting insulin level at time of breast cancer
diagnosis is associated with improved survival.
Mulligan et al. Breast Ca Res Treat. 2007 Jan 13
Donut vs.Orange: It is not necessary to
avoid fruit!
 200 calories
 62 calories
 10 grams sugar
 12 grams sugar
 0 grams fiber
 3 grams fiber
 0 phytonutrients
 170 phytonutrients
Another reason to mute post-prandial
glucose/insulin response!
 Include fat, protein and fiber with carbohydrates
 Process sugar more slowly
 Less insulin released
 Glycemic Index: number representing insulin response by body
to a particular food
Summary
 Sugar does “feed” cancer cells – but no differently than it “feeds” the
rest of the body’s cells
 Choose healthier carbohydrate foods
 Unprocessed/minimally processed
 Fruits, Vegetables, whole grains
 Combine foods at meals and
snacks
 Fat and/or protein with
carbohydrates
Aim to get some protein from plants
as well - legumes, nuts, seeds, quinoa
What About Soy?
 Whole soy foods may help
prevent:
 Breast cancer
 Colon cancer
 Prostate cancer
 Bladder caner
 Heart disease
 Osteoporosis
 Issue is phytoestrogens up to
1000 x weaker than estradiol
 Soy sauce, soy lecithin and soy
oil contain no phytoestrogens
 Caution for people with ER+
breast cancer  avoid soy
isosflavones in supplements,
pills, bars, and powders.
Whole soy foods are fine in
moderation
What about women who have had
breast cancer?
 Two recent studies of Asian women showed reduced risk of
recurrence with higher dietary intake of soy
foods/isoflavones:
Effect of soy isoflavones on breast cancer recurrence and death
for patients receiving adjuvant endocrine therapy, Kang X et
al, CMAJ. 2010 Oct 18
= 534 women with medium follow up of 5.1 years
Soy food intake and breast cancer survival, Shu XO et al,
JAMA. 2009 Dec 9: 302(22):2483-4
= 5042 women with median follow up 3.9 years
Acid/Alkaline Balance Diet for Cancer Prevention:
Proponents Claim  Cancer grows in an acidic environment
 Chemotherapy is more effective the more alkaline the
environment
 pH of 8.5 “kills” cancer cells
Tumor Cell
cell wall
pH gradient
Inner area
Outer area
Less acidic
MORE ACIDIC
Definition of Acidity and Alkalinity
pH 1.0
7.35
14.0
_____________________________________________
Acidic
Normal
Alkaline
pH of human body is naturally slightly alkaline ~ 7.35-7.45.
To eat or not to eat….
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ACID FOODS
beef, chicken, duck, eggs,
farmed fish, lobster, organ meat,
pork, seafood, turkey, veal,
venison
Cheese, cottage cheese, whey
protein
mushrooms, potatoes
apple, apricot, banana, berries,
dried fruit, papaya, peach,
pineapple, tangerine
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ALKALINE FOODS
lima beans, soy beans, white
beans, pumpkin seeds
wheat grass, barley grass, alfalfa
spouts, broccoli sprouts, kale,
parsley, sea vegetable
buckwheat, quinoa, spelt
coconut, grapefruit, lemon, lime
What patients/families hear from us….
 The body’s pH levels may change slightly as a result of eating
some foods, but will remain in the tightly held range of 7.357.45.
 Eating certain foods may change urinary pH levels, however,
this does not necessarily mean that your blood pH will
change.
Bottom Line on Alkaline Diets for
Cancer Survivors
 Studies on the effects of acid/alkaline diets on
tumor growth and proliferation are limited only
to animal and test tube trials.
 Scientific research has not proven a beneficial
effect of an alkalinizing diet for prevention or
treatment of cancer.
Dietary Fat and Cancer
 Issue has been raised in colorectal, breast, pancreatic, prostate
cancer, and possibly others
 AICR Global found no “probable or convincing” connection
between cancer and total fat intake (only “limited/suggestive” with
post-menopausal breast cancer and lung cancer  weak)
 Concern in primarily with saturated fat, but it’s hard to tease out
what’s a dietary fat effect, calorie effect, affect on weight
influence, tied to the source of fat (i.e. high intakes of red and
processed meats).
Bottom Line: Encourage Mono’s and Omega 3’s; limit
Saturatedand trans fats; portion control
Typical American Plate
AICR: Limit Red Meat Intake
 Limit red meat to 18 ounces per week (includes beef pork and
lamb), with a long-term goal of no more than 11 oz/week.
 Avoid processed meats
 “Processed meat” refers to meats preserved by smoking, curing or
salting, or by the addition of preservatives (ham, bacon, pastrami,
salami, hot dogs and sausages.
 When meat is preserved by smoking, curing or salting, or by the
addition of preservatives, cancer-causing substances (carcinogens)
can be formed. These substances can damage cells in the body,
leading to the development of cancer.
 Studies show people who eat more meat often eat less plant-based food.
Healthy Eating Plate
 Aim for ½ plate of plants
(preferably vegetables) at
lunch and dinner
 ¼ of plate as lean protein
 ¼ of plate of complex
carbohydrate
Dietary Supplements That May
Help Cancer Survivors
 Vitamin D
 Omega-3’s
 Probiotics and calcium
(based on individual
circumstances)
24,000 Dietary Supplements
marketed to Cancer Survivors!
Vitamin D and Cancer
 Inverse relationship between
Vitamin D and several types of
cancer
 Possible anti-angiogenesis and helps
keep cell replication normal
 Goal of serum 25(OH) vitamin
D level is > 40 ng/ml.
 Supplementation is likely
necessary.
 1000 IU/day is safe for most
people; many need more.
Intake/Exposure
 Sun Exposure (arms/legs 10



15 min)
Fortified Multi-vitamin
Fortified Milk
3.5oz salmon (fresh, wild)
3.5oz salmon (fresh, farmed)
Amount of Vitamin D
 3000 – 20,000 IU
 400 IU
 100 IU
 600-1000 IU
 100-250 IU
Vitamin D and Cancer
 Link first hypothesized in 1980s
 Rate of colon cancer 3x higher in New York than New Mexico
 Lower exposure to natural light in large cities and areas at higher
latitude
 Research has been mostly observational, few clinical trials
 “…Vitamin D levels in the blood vary by race, with the season, and
possibly with the activity of genes whose products are involved in
vitamin D transport and metabolism. These variations complicate
the interpretation of studies that measure the concentration of
vitamin D in serum at a single point in time.” - OCCAM
Observational Studies
Lower serum vitamin D levels were found more often in oncology
patients compared to primary care clinic patients of same region
 Researchers did adjust results based on age, BMI, and season of
blood draw
 Relationship maintained significance
Churilla, T.M., BMJ Open. 2011 Dec 19;1(2).
2. Serum vitamin D levels between 50 and 75nmol were associated
with lower risk of colorectal cancer
 Levels less than 50nmol were associated with increased risk
Jenab, M. BMJ. 2010 Jan 21.
1.
Clinical Trials
1. Women’s Health Initiative: Calcium+D supplement
significantly decreased the risk of total, breast, and invasive
breast cancers by 14-20% and nonsignificantly reduced the
risk of colorectal cancer by 17%
Did not decrease risk in women already taking calcium or
vitamin D supplement
Bolland, M.J. Am J Clin Nutr. 2011 Oct;94(4):1144-9
2. Prostate Cancer Prevention Trial: Dietary or supplemental
vitamin D use was not associated with decreased risk of
prostate cancer
Kristal, A.R. Am J Epidemiol. 2010 Sep 1;172(5):566-77
Summary on Vitamin D
 Inconclusive results between observational studies and
clinical trials
 Many studies only test serum vitamin D levels at one point
in time, not the effect of a supplement
 Recommendation: Don’t be Deficient!
Take a daily MVI or calcium+D supplement
If you are concerned, talk to your doctor. Have him/her
measure a baseline level before taking a large
supplemental amount
Omega 3 Fats
 Anti-inflammatory
 Reduce muscle wasting during treatment
(cancer cachexia)
 Great for your cardiovascular system
 Salmon, herring, sardines, mackerel
 Aim for 4 oz of oily fish 2-3 times a week
 Daily goal: 1000 mg of combined EPA/DHA
Fish oil supplements during
treatment:
Alcohol

Limit alcohol intake
 < 1 drink/day for women
 < 2 drinks/day for men
 Women who consume 1 drink or more/day have an
increased risk of breast cancer (10-40% increased
risk)
 Adequate folate intake (400mcg/d) may reduce the
increased risk of breast cancer associated with alcohol
use
Questions?
www.DanaFarber.org/nutrition