Hillary M. Wright, MEd, RD, LDN

1
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

2
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.

3
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
4

• 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. Dont 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

5
Americas Challenging Food Environment
6
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!

7
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

8
Beyond weight control, fruits and vegetables may
exert a protective effect
9
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 its
  color.

10
(No Transcript)
11
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

12
If It Stains Your Shirt

• If a fruit or vegetable has a strong smell or
  taste, its probably biomedically active
• If it stains your shirt, its definitely
  biomedically active!

13
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 Im getting all the antioxidant benefits that
  way, right?

14

Food First!

• Phytonutrients work together to provide a
  synergistic benefit

15
Some studies show high dose nutrient
supplementation can be detrimental

• Beta carotene supplementation in smokers
• N Engl J Med. 1994 Apr 14330(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 2334(18)1150-5. (CARET)
• Effects of a combination of beta
  carotene and vitamin A on lung cancer and cardiova
  scular disease.

16
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

17
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 dont let
  this decrease of fruits/vegetables you eat!
• J Agric Food Chem. 2008 Jul 2356(14)5788-94.
  Epub 2008 Jul 1

18
(No Transcript)
19
Food First

• 75 of Americans dont 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

20
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

21
(No Transcript)
22
Does Sugar Feed Cancer?

• Popular myth
• Unknown root of myth
• PET Scan
• Inject radioactive glucose into veins
• Areas of higher metabolic activity glow

23
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

24
Sugar and Cancer Its 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

25
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

26
Donut vs.Orange It is not necessary to avoid
fruit!

• 200 calories
• 10 grams sugar
• 0 grams fiber
• 0 phytonutrients

• 62 calories
• 12 grams sugar
• 3 grams fiber
• 170 phytonutrients

27
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

28
Summary

• Sugar does feed cancer cells but no
  differently than it feeds the rest of the
  bodys cells
• Choose healthier carbohydrate foods
• Unprocessed/minimally processed
• Fruits, Vegetables, whole grains
• Combine foods at meals and
• snacks
• Fat and/or protein with
• carbohydrates

29
Aim to get some protein from plants as well -
legumes, nuts, seeds, quinoa
30
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

31
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

32
Acid/Alkaline Balance Diet for Cancer
PreventionProponents Claim -

• Cancer grows in an acidic environment
• Chemotherapy is more effective the more alkaline
  the environment
• pH of 8.5 kills cancer cells

33
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.
34
To eat or not to eat.

• 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

• 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

35
What patients/families hear from us.

• The bodys pH levels may change slightly as a
  result of eating some foods, but will remain in
  the tightly held range of 7.35-7.45.
• Eating certain foods may change urinary pH
  levels, however, this does not necessarily mean
  that your blood pH will change.

36
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.

37
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 its
  hard to tease out whats 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 Monos and Omega 3s
  limit
• Saturatedand trans fats portion control

38
Typical American Plate
39
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.

40
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

41
(No Transcript)
42
Dietary Supplements That May Help Cancer Survivors

• Vitamin D
• Omega-3s
• Probiotics and calcium (based on individual
  circumstances)

24,000 Dietary Supplements marketed to Cancer
Survivors!
43
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 gt 40
  ng/ml.
• Supplementation is likely necessary.
• 1000 IU/day is safe for most people many need
  more.

44

• Intake/Exposure

• Amount of Vitamin D

• Sun Exposure (arms/legs 10-15 min)
• Fortified Multi-vitamin
• Fortified Milk
• 3.5oz salmon (fresh, wild)
• 3.5oz salmon (fresh, farmed)

• 3000 20,000 IU
• 400 IU
• 100 IU
• 600-1000 IU
• 100-250 IU

45
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

46
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 191(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.

47
Clinical Trials

• Womens Health Initiative CalciumD 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
  Oct94(4)1144-9
• 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
  1172(5)566-77

48
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 Dont be Deficient!
• Take a daily MVI or calciumD supplement
• If you are concerned, talk to your doctor. Have
  him/her measure a baseline level before taking a
  large supplemental amount

49
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

50
Fish oil supplements during treatment
51
Alcohol

• Limit alcohol intake
• lt 1 drink/day for women
• lt 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

52
Questions?
www.DanaFarber.org/nutrition
53
(No Transcript)