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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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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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