Foods and Cancer

Neal D. Barnard, MD
Adjunct Associate Professor of Medicine
George Washington University School of Medic...
Milk and Prostate Cancer

Ganmaa D, Li X, Wang J, Qin L, Wang P, Sato A. Int J Cancer 2002:98,262-267.
Physicians’ Health Study (Harvard)

20,885
physicians

≥ 2.5
servings/day of
dairy products

Relative risk: 1.34 (1.04-1.7...
Health Professionals
Follow-up Study (Harvard)

47,781 health
professionals

> 2 servings/day
of milk

83% of milk consume...
Dairy and Prostate Cancer
• > 20 research reports link milk drinking to PC.
• Association with advanced and fatal PC risk
...
Milk Affects Hormones
↑ IGF-I

Milk
↓ Vitamin D
Insulin-Like Growth Factor I
“Insulin-like” = moves sugar into cells
“Growth factor” = encourages cell proliferation
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 le...
Physicians’ Health Study, Harvard
After 10-year follow-up:
cancer patients
(n = 152)
IGF-I

269 ng/ml

healthy controls
(n...
Vegetarians have lower IGF-I
• Plant-based diet is associated with lower
circulating levels of total IGF- I
• EPIC study: ...
Vitamin D

skin
Vitamin D

skin

liver
Vitamin D

skin

kidney
liver
Vitamin D

Calcium

skin

intestine

kidney
liver
Vitamin D

Calcium

skin

intestine

kidney
liver

prostate
Vitamin D

Calcium

skin

X
X
liver

kidney

intestine

X
prostate
Heterocyclic Amines
PhIP Structure*

* 2-amino-1-methyl-6-phenylimidazo[4,5-b]pyridine)
Processed meats:
Bacon
Sausage
Ham
Hot dogs
Deli meats
Lycopene vs Prostate Cancer
Health Professionals Follow-Up Study
47,365 participants
≥ 2 tomato sauce servings per week
Pr...
Vegan Diet and Prostate Cancer
Preventive Medicine Research Institute
84 men with untreated prostate cancer, 1-year study
...
Breast Cancer
(per 100,000 women, 45-69 yrs)

Breast Cancer Incidence

Association of Dietary Fat & Breast Cancer
250
r=0.76

USA
Canada...
Western Diets and Breast Cancer in China
The Shanghai Breast Cancer Study
The “meat-sweet” pattern:
meat dessert
fish
brea...
Excess body fat

Increased
estrogen
activity
Cancer promotion
Excess body fat

High-fat / low-fiber diet

Increased
estrogen
activity
Cancer promotion
Excess body fat

High-fat / low-fiber diet

Increased
estrogen
activity
Increased risk
of breast cancer
Excess body fat

Reduced
SHBG

High-fat / low-fiber diet

Increased
estrogen
activity
Increased risk
of breast cancer
Women’s Health Initiative
48,835 participants, aged 50-79
Diet: 20% fat, ↑ vegetables, fruits, and grains
Fat intake fell ...
Women’s Health Initiative
After 8.1 years:
Overall breast cancer risk ↓9% (not significant).
Progesterone-receptor-negativ...
Fat Content
(Percentage of Calories from Fat)

Leanest beef

29%

Skinless chicken breast

23%

Sea trout

32%

White tuna...
Diet and Breast Cancer Survival
Women’s Intervention Nutrition Study
(WINS)
2,437 women with breast cancer
Ages: 48-79, all postmenopausal
Reduced fat (15...
WINS
Diet and Cancer Recurrence

All cancers

↓ 24%

Estrogen receptor -

↓ 42%

Estrogen receptor +

↓ 15%
Women’s Healthy Eating and Living Study

3,109 pre- and postmenopausal women
previously treated for breast cancer
7 clinic...
Women’s Healthy Eating and Living Study

Comparison diet (“5-a-day”):
5 servings of vegetables and fruits
(<30% fat, 20 g ...
WHEL Study
Vegetables-Fruits and Regular Walking
1490 women in comparison group
Followed for 5-11 years
Mortality
↑ veg/fr...
What about Soy Products?

Source: Wood CE. Biology of Reproduction. 2006;75:477-86.
Soy and Prostate Cancer
Meta-analysis of 15 studies:
Risk for high versus low soy intake:
↓26% overall
↓48% in Asian popul...
Soy and Breast Cancer
Meta-analysis of 8 studies in Asians and Asian
Americans:
High soy intake: 29% ↓ risk of breast canc...
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
...
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 isofl...
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
...
Kaiser Permanente
Life After Cancer Epidemiology Study
Soy Intake and Breast Cancer Recurrence
Daidzein

Genistein

1

Gly...
After Breast Cancer Pooling Project
1. Women’s Healthy Eating &
Living Study

0.5

≥1

-9
.9
9
4.
0

9,514 breast cancer s...
Nutrition & Breast Cancer Survival
Summary
Reduced body fat → ↑ survival
Reduced dietary fat → ↑ survival
Vegetables & fru...
Nutrition and Cancer: Mechanisms
• Low-fat diets reduce body weight
• Fiber increases hormone elimination
• Low-fat, high-...
PCRM 2009

USDA 2011
Complete Nutrition
Protein
Calcium
Vitamin B12
Acceptability
•
•
•
•

No artificial calorie limits.
No portion sizes.
No carbohydrate-counting.
Benefits encourage adhere...
Acceptability
Acceptability is similar to that of other therapeutic diets.
•
•
•
•

Men and women with heart disease (1992...
Body Weight

P-value < 0.0001

Am J Health Promotion, In pre
Waist Circumference

P-value < 0.001

Am J Health Promotion, In pre
Beginning a Healthful Diet
Step 1. Check out the possibilities
Foods to Try
Breakfast
Lunch
Dinner
Snack
Beginning a Healthful Diet
Step 1. Check out the possibilities
Step 2. Do a 3-week test drive
Optional: Use transition foo...
PCRM.org
Resources
www.pcrm.org
Prostate cancer and diet
Prostate cancer and diet
Prostate cancer and diet
Prostate cancer and diet
Prostate cancer and diet
Prostate cancer and diet
Prostate cancer and diet
Prostate cancer and diet
Prostate cancer and diet
Prostate cancer and diet
Prostate cancer and diet
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Prostate cancer and diet

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The science behind how a plant-based diet provides cancer-fighting compounds and immune-boosting nutrients that cells need to be healthy

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  • {"60":"As you would expect, waist circumference also decreased in the vegan group – about two inches smaller (or X cm).\n","5":"Recent meta-analyses of 12 prospective and 11 case-controlled studies = positive association with both dairy and Ca+ intake on PC risk.\nResearches concluded that non-dairy calcium and protein sources had no significant associations with increased IGF-I levels, suggesting a rise in IGF-I was more likely to occur from the protein in dairy products. BUT some of the main studies observing increased risk stems from Harvard Reseach…..\n","59":"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. \n16 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 &gt;50% of meetings (n = 8), mean weight loss was 13 lbs. \n"}
  • Prostate cancer and diet

    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. Milk and Prostate Cancer Ganmaa D, Li X, Wang J, Qin L, Wang P, Sato A. Int J Cancer 2002:98,262-267.
    3. 3. 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
    4. 4. 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
    5. 5. Dairy and Prostate Cancer • > 20 research reports link milk drinking to PC. • Association with advanced and fatal PC risk Qin LQ. Nutr Cancer. 2004;48(1):22-27. Gao X. J Natl Cancer Inst. 2005 Dec 7;97(23):1768-1777. Crowe FL. Cancer Epidemiol Biomarkers Prev. 2009;18(5):1333-40 Gonzalez CA.. Eur J Cancer. 2010;46(14):2555-62. Butler LM.. Cancer Res. 2010;70(12):4941-8.
    6. 6. Milk Affects Hormones ↑ IGF-I Milk ↓ Vitamin D
    7. 7. Insulin-Like Growth Factor I “Insulin-like” = moves sugar into cells “Growth factor” = encourages cell proliferation
    8. 8. 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.
    9. 9. Physicians’ Health Study, Harvard After 10-year follow-up: cancer patients (n = 152) IGF-I 269 ng/ml healthy controls (n = 152) 249 ng/ml P=0.03 RR = 2.1 (95% CI = 1.3-3.2) per 100 ng/ml IGF-I increment Chan JM. Science 1998;279:563-6.
    10. 10. Vegetarians have lower IGF-I • Plant-based diet is associated with lower circulating levels of total IGF- I • EPIC study: 2019 participants – Animal protein, milk, and cheese ↑ IGF-I – Vegetables, β-carotene ↓ IGF-I Allen NE. Cancer Epidemiol Biomarkers Prev. 2002;11(11):1441-1448. Norat T. Eur J Clin Nutr. 2007;61(1):91-98.
    11. 11. Vitamin D skin
    12. 12. Vitamin D skin liver
    13. 13. Vitamin D skin kidney liver
    14. 14. Vitamin D Calcium skin intestine kidney liver
    15. 15. Vitamin D Calcium skin intestine kidney liver prostate
    16. 16. Vitamin D Calcium skin X X liver kidney intestine X prostate
    17. 17. Heterocyclic Amines
    18. 18. PhIP Structure* * 2-amino-1-methyl-6-phenylimidazo[4,5-b]pyridine)
    19. 19. Processed meats: Bacon Sausage Ham Hot dogs Deli meats
    20. 20. Lycopene vs Prostate Cancer Health Professionals Follow-Up Study 47,365 participants ≥ 2 tomato sauce servings per week Prostate cancer risk ↓ 23% Giovannucci E. A prospective study of tomato products, lycopene, and prostate cancer risk. J Natl Cancer Inst 2002;94:391-8.
    21. 21. 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.
    22. 22. Breast Cancer
    23. 23. (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
    24. 24. 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.
    25. 25. Excess body fat Increased estrogen activity Cancer promotion
    26. 26. Excess body fat High-fat / low-fiber diet Increased estrogen activity Cancer promotion
    27. 27. Excess body fat High-fat / low-fiber diet Increased estrogen activity Increased risk of breast cancer
    28. 28. Excess body fat Reduced SHBG High-fat / low-fiber diet Increased estrogen activity Increased risk of breast cancer
    29. 29. 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.
    30. 30. 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.
    31. 31. 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%
    32. 32. Diet and Breast Cancer Survival
    33. 33. 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
    34. 34. WINS Diet and Cancer Recurrence All cancers ↓ 24% Estrogen receptor - ↓ 42% Estrogen receptor + ↓ 15%
    35. 35. Women’s Healthy Eating and Living Study 3,109 pre- and postmenopausal women previously treated for breast cancer 7 clinical sites, enrollment 1995-2000
    36. 36. 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)
    37. 37. 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.
    38. 38. What about Soy Products? Source: Wood CE. Biology of Reproduction. 2006;75:477-86.
    39. 39. Soy and Prostate Cancer Meta-analysis of 15 studies: Risk for high versus low soy intake: ↓26% overall ↓48% in Asian populations Yan L, Spitznagel EL. Soy consumption and prostate cancer risk in men: a revisit of a meta-analysis. Am J Clin Nutr. 2009;89:1155-1163.
    40. 40. Soy and Breast Cancer Meta-analysis of 8 studies in Asians and Asian Americans: High soy intake: 29% ↓ risk of breast cancer. Wu AH. Br J Cancer. 2004;98:9-14.
    41. 41. 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.
    42. 42. 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.
    43. 43. 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
    44. 44. 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.
    45. 45. 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.
    46. 46. Nutrition & Breast Cancer Survival Summary Reduced body fat → ↑ survival Reduced dietary fat → ↑ survival Vegetables & fruits + exercise → ↑ survival Soy (~2 servings/day) → ↑ survival
    47. 47. Nutrition and Cancer: Mechanisms • Low-fat diets reduce body weight • Fiber increases hormone elimination • Low-fat, high-fiber diets boost hormone binding to SHBG • Isoflavones may reduce risk. • Avoiding meat reduces carcinogen exposure
    48. 48. PCRM 2009 USDA 2011
    49. 49. Complete Nutrition Protein Calcium Vitamin B12
    50. 50. Acceptability • • • • No artificial calorie limits. No portion sizes. No carbohydrate-counting. Benefits encourage adherence.
    51. 51. 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.
    52. 52. Body Weight P-value < 0.0001 Am J Health Promotion, In pre
    53. 53. Waist Circumference P-value < 0.001 Am J Health Promotion, In pre
    54. 54. Beginning a Healthful Diet Step 1. Check out the possibilities
    55. 55. Foods to Try Breakfast Lunch Dinner Snack
    56. 56. Beginning a Healthful Diet Step 1. Check out the possibilities Step 2. Do a 3-week test drive Optional: Use transition foods
    57. 57. PCRM.org
    58. 58. Resources www.pcrm.org
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