Foods and Cancer

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Food choices can help prevent cancer and, when cancer has been diagnosed, nutrition can improve survival. These links between diet and cancer are nothing short of dramatic. And now you can learn how certain dietary patterns help people diagnosed with cancer live longer, healthier lives.

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  • We saw no change in body weight in control group participants, but an average of 11 pound weight loss in participants in the vegan group.
    16 control-group participants began the optional program initiated at their site. These participants attended an average of 46% of meetings and lost a mean of 9 lb. Attendance was significantly correlated with weight loss (r = -0.61, P = 0.01). Of participants who attended >50% of meetings (n = 8), mean weight loss was 13 lbs.
  • As you would expect, waist circumference also decreased in the vegan group – about two inches smaller (or X cm).
  • Foods and Cancer

    1. 1. Foods and Cancer Neal D. Barnard, MD Adjunct Associate Professor of Medicine George Washington University School of Medicine President, Physicians Committee for Responsible Medicine Washington, DC
    2. 2. (per 100,000 women, 45-69 yrs) Breast Cancer Incidence Association of Dietary Fat & Breast Cancer 250 r=0.76 USA Canada 200 UK Italy Israel 150 Australia Romania 50 0 600 France Germany Denmark New Zealand Sweden Norway Finland Yugoslavia 100 Switzerland Spain Hong Kong Poland Hungary Japan 900 1200 Per Capita Fat Availability (kcal) from Prentice, et al. 1500 JNCI 1988
    3. 3. Western Diets and Breast Cancer in China The Shanghai Breast Cancer Study The “meat-sweet” pattern: meat dessert fish bread candy milk 30% percent increased breast cancer risk Cui X. Dietary Patterns and Breast Cancer Risk in the Shanghai Breast Cancer Study. Cancer Epidemiol Biomarkers Prev. 2007;16(7):1443-1448.
    4. 4. Excess body fat Increased estrogen activity Cancer promotion
    5. 5. Excess body fat High-fat / low-fiber diet Increased estrogen activity Cancer promotion
    6. 6. Women’s Health Initiative 48,835 participants, aged 50-79 Diet: 20% fat, ↑ vegetables, fruits, and grains Fat intake fell from 38% at baseline… to 24% at 1 year, and to 29% at 6 years. Prentice RI. JAMA. 2006;295:629-642.
    7. 7. Women’s Health Initiative After 8.1 years: Overall breast cancer risk ↓9% (not significant). Progesterone-receptor-negative tumor risk ↓24%. Prentice RI. JAMA. 2006;295:629-642.
    8. 8. Fat Content (Percentage of Calories from Fat) Leanest beef 29% Skinless chicken breast 23% Sea trout 32% White tuna 16% Broccoli 8% Beans 4% Rice 1–5%
    9. 9. Diet and Breast Cancer Survival
    10. 10. Women in Japan Less likely to develop breast cancer, compared with women in U.S. More likely to survive cancer, if it develops. Wynder EL, et al. A comparison of survival rates between American and Japanese patients with breast cancer. Surg Gynecol Obstet 1963;117:196-200.
    11. 11. Body Weight and Breast Cancer Survival Risk of recurrence or decreased survival: 26 studies: higher weight increases risk 8 studies: no increased risk Overall, a high BMI increased 5-year mortality by 91%. Included studies published 1990 – 2001. Chlebowski RT. J Clin Oncol 2002;20:1128-43.
    12. 12. Body Weight and Breast Cancer Survival Shanghai, China, 2006 1,455 women with breast cancer, aged 25-64 BMI < 23.00 23.00-24.99 ≥ 25.00 5-year survival 86.5% 83.8% 80.1% (P = 0.02) Tao MH. Association of overweight with breast cancer survival. Am J Epidemiol 2006;163:101-107.
    13. 13. Women’s Intervention Nutrition Study (WINS) 2,437 women with breast cancer Ages: 48-79, all postmenopausal Reduced fat (15% of energy) diet vs control
    14. 14. WINS Diet and Cancer Recurrence All cancers ↓ 24% Estrogen receptor - ↓ 42% Estrogen receptor + ↓ 15%
    15. 15. WINS Study 35 Body Mass Index and Relapse (%) 30 25 Intervention Control 20 % relapse 16.2% 15 10 12.8% 9.8% 10.2% 11.1% 8.9% 5 0 <25 25-30 >30 Body Mass Index Women previously treated for breast cancer, N = 957 intervention, 1424 control Chlebowski RT, et al. JNCI 2006;98:1767-76.
    16. 16. Women’s Healthy Eating and Living Study 3,109 pre- and postmenopausal women previously treated for breast cancer 7 clinical sites, enrollment 1995-2000
    17. 17. Women’s Healthy Eating and Living Study Comparison diet (“5-a-day”): 5 servings of vegetables and fruits (<30% fat, 20 g fiber) Intervention diet (“8-a-day”): 5 vegetable servings, 3 fruit servings 16 oz. vegetable juice (15-20% fat, 30 g fiber)
    18. 18. Vegetables and Fruits: “8-a-day” vs “5-a-day” Mean follow-up: 7.3 years Mortality Intervention group (“8-a-day+”) 10.1% Comparison group (5-a-day) 10.3% Pierce JP. JAMA 2007;858:289-98.
    19. 19. “A diet high in vegetables and fruits apparently does nothing to prevent breast cancer from returning, according to a seven-year U.S. government study of more than 3,000 women.” USAToday.com, accessed July 19, 2007
    20. 20. WHEL Study Vegetables-Fruits and Regular Walking 1490 women in comparison group Followed for 5-11 years Mortality ↑ veg/fruit (7.6 servings) + ↑ activity 4.8% ↓ veg/fruit (3.4 servings) + ↑ activity 10.4% ↑ veg/fruit (7.2 servings) + ↓ activity 10.7% ↓ veg/fruit (3.1 servings) + ↓ activity 11.5% Pierce JP. J Clin Oncol 2007;25:2345-51.
    21. 21. What about Soy Products? Source: Wood CE. Biology of Reproduction. 2006;75:477-86.
    22. 22. Soy and Breast Cancer Meta-analysis of 8 studies in Asians and Asian Americans: High soy intake: 29% ↓ risk of breast cancer. High: 20 mg isoflavones Low: 5 mg isoflavones Wu AH. Br J Cancer. 2004;98:9-14.
    23. 23. Soy and Cancer Recurrence or Mortality in WHEL 1 Hazard Ratio P for trend = 0.02 .3 3 >1 6 1. 01 -1 6. 33 1 0. 07 -1 .0 <0 .0 7 0 Isoflavone Intake (mg/d) Caan BJ. Cancer Epidemiology, Biomarkers, & Prevention. 2011;20:854-8.
    24. 24. Soy and Survival Soy and Cancer Recurrence or Mortality >1 6. 33 1. 01 -1 6. 33 0. 07 -1 .0 1 0 <0 .0 7 16.3 mg isoflavones = ½ cup soymilk or 2 oz. tofu P for trend = 0.02 Hazard Ratio High soy intake: 54% ↓ risk. 1 Isoflavone Intake (mg/d) Caan BJ. Cancer Epidemiology, Biomarkers, & Prevention. 2011;20:854-8.
    25. 25. Shanghai Breast Cancer Survival Study Soy and Cancer Mortality Hazard Ratio 1 >6 2. 68 36 .5 162 .6 8 20 .0 136 .5 0 <2 0. 01 0 Isoflavone Intake (mg/d) Shu XO. JAMA. 2009;302:2437-43 16.3 mg isoflavones = ½ cup soymilk or 2 oz. tofu
    26. 26. After Breast Cancer Pooling Project 1. Women’s Healthy Eating & Living Study 0.5 ≥1 -9 .9 9 4. 0 9,514 breast cancer survivors 0. 0 0.0 <4 .0 3. Life After Cancer Epidemiology Study 1.0 Hazard Ratio 2. Shanghai Breast Cancer Survival Study Soy and Breast Cancer Recurrence Isoflavone Intake (mg/d) Nechuta SJ. Am J Clin Nutr. 2012;96:123-32.
    27. 27. Kaiser Permanente Life After Cancer Epidemiology Study Soy Intake and Breast Cancer Recurrence Daidzein Genistein 1 Glycetein 1 Hazard Ratio Hazard Ratio Hazard Ratio 1 Genistein Intake (mcg/d) 3. 62 -8 .1 6 8. 17 -1 4. 99 15 .0 078 .5 78 3 .5 479 5. 39 >7 96 .3 9 0 03. 61 .7 7. 7 78 -1 14 49 9. .5 60 9 -1 1, ,4 45 53 3. .0 10 0 -9 ,5 96 .5 4 >9 ,5 96 .5 4 0 0. 10 -7 Daidzein Intake (mcg/d) 0 0. 10 -6 .9 7. 9 00 -2 20 22 .6 0. 1 62 2, -2 19 ,1 9. 84 82 .8 -1 3, 02 5. 87 >1 3, 02 5. 87 0 0 Glycetin Intake (mcg/d) Guha N. Breast Cancer Research & Treatment. 2009;118:395-405.
    28. 28. Nutrition & Breast Cancer Survival Summary Reduced body fat → ↑ survival Reduced dietary fat → ↑ survival Vegetables & fruits + exercise → ↑ survival Soy (~2 servings/day) → ↑ survival
    29. 29. Prostate Cancer
    30. 30. Milk and Prostate Cancer Ganmaa D, Li X, Wang J, Qin L, Wang P, Sato A. Int J Cancer 2002:98,262-267.
    31. 31. Physicians’ Health Study (Harvard) 20,885 physicians ≥ 2.5 servings/day of dairy products Relative risk: 1.34 (1.04-1.71) Chan JM. Am J Clin Nutr 2001;74:549-54. 34% increased risk of prostate cancer
    32. 32. Health Professionals Follow-up Study (Harvard) 47,781 health professionals > 2 servings/day of milk 83% of milk consumed was skim or lowfat Relative risk for advanced cancer: 1.6 (95% CI, 1.2-2.1) Giovannucci E. Cancer Res 1998;58:442-7. 60% increased risk of prostate cancer
    33. 33. Milk Affects Hormones ↑ IGF-I Milk ↓ Vitamin D
    34. 34. Insulin-Like Growth Factor I “Insulin-like” = moves sugar into cells “Growth factor” = encourages cell proliferation
    35. 35. Milk Drinking Raises Human IGF-I Men and women aged 55 to 85 years Three 8-oz servings of milk for 12 weeks Serum IGF-I levels: ↑ 10% P<.001 Heaney RP. J Am Dietetic Asso 1999;99:1228-33.
    36. 36. Vitamin D skin
    37. 37. Vitamin D skin liver
    38. 38. Vitamin D skin kidney liver
    39. 39. Vitamin D Calcium skin intestine kidney liver
    40. 40. Vitamin D Calcium skin intestine kidney liver prostate
    41. 41. Vitamin D Calcium skin X X liver kidney intestine X prostate
    42. 42. Vegan Diet and Prostate Cancer Preventive Medicine Research Institute 84 men with untreated prostate cancer, 1-year study Control group: PSA ↑ 6% 6 of the 43 participants required cancer treatment Vegan group: PSA ↓4% No one required treatment Ornish D, Weidner G, Fair WR, et al. Intensive lifestyle changes may affect the progression of prostate cancer. J Urol. 2005;174:1065-1069.
    43. 43. Heterocyclic Amines
    44. 44. PhIP Structure* * 2-amino-1-methyl-6-phenylimidazo[4,5-b]pyridine)
    45. 45. Processed meats: Bacon Sausage Ham Hot dogs Deli meats
    46. 46. Nutrition and Cancer: Mechanisms • Low-fat diets reduce body weight • Fiber increases hormone elimination • Low-fat, high-fiber diets reduce hormone effects • Isoflavones may reduce risk. • Avoiding meat reduces carcinogen exposure
    47. 47. Complete Nutrition Protein Calcium Vitamin B12
    48. 48. Acceptability • • • • No artificial calorie limits. No portion sizes. No carbohydrate-counting. Benefits encourage adherence.
    49. 49. Acceptability Acceptability is similar to that of other therapeutic diets. • • • • Men and women with heart disease (1992) Young women with dysmenorrhea (2000) Postmenopausal overweight women (2004) Men and women with diabetes (2008) Barnard ND, Scherwitz L, Ornish D. J Cardiopulmonary Rehab 1992;12:423-31. Barnard ND, Scialli AR, Bertron P, et al. J Nutr Educ 2000;32:314-9. Barnard ND, Scialli AR, Turner-McGrievy GM, et al. J Cardiopulm Rehab 2004;24:229-35. Barnard ND, et al. J Am Diet Assoc 2009;109:263-72.
    50. 50. Body Weight P-value < 0.0001 Am J Health Promotion, In pre
    51. 51. Waist Circumference P-value < 0.001 Am J Health Promotion, In pre

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