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Optimal Nutrition for Cancer
Survivors
Jessica Iannotta MS, RD, CSO, CDN
What is on your mind?
• Many patients and survivors struggle with
weight gain as a result of their treatment
• Often patients are very confused with the
wealth of health information
– What about soy or dietary supplements?
– What is the best diet?
– How do I lose weight?
Some important questions to ask…
• Is there a magic bullet or miracle food?
• What can we do to help promote a healthy
weight and possibly reduce the risk of
cancer recurrence?
American Institute for Cancer
Research Guidelines
• Be as lean as possible without becoming underweight.
• Be physically active for at least 30 minutes every day.
• Avoid sugary drinks. Limit consumption of energy-dense
foods.
• Eat more of a variety of vegetables, fruits, whole grains and
legumes such as beans.
• Limit consumption of red meats (such as beef, pork and
lamb) and avoid processed meats.
• If consumed at all, limit alcoholic drinks to 2 for men and 1
for women a day.
• Limit consumption of salty foods and foods processed
with salt (sodium).
• Don't use supplements to protect against cancer.
Limit Alcoholic Beverages
• Current research – women who drink
one alcoholic beverage per day, may
have small increase in risk
– Those who drink more may increase their
risk even greater
– If estrogen sensitive cancer, use caution
with alcohol
Chen WY, et al. Use of postmenopausal hormones, alcohol, and risk for invasive breast cancer. Ann Intern Med 2002;
Limiting Alcohol Consumption
What is a serving?
-12oz beer
-6oz wine
-1.5 oz hard liquor
• Include folate rich foods in the diet to
reduce risk:
– Bananas, oranges, tomatoes
– Dark leafy greens
– Legumes, lentils
– Fortified cereals, whole grain
breads
– Supplement 400 micrograms of
folic acid under physician guidance
Include Foods Rich in Folate
Achieve and Maintain a Healthy
Weight
• Definition of “Healthy Weight”
– Ideal Body Weight +/- 10%
– BMI = weight in lbs x 700
height in inches2
BMI = 19-25 “Healthy Weight”
BMI = 26-30 Overweight
BMI > 30 Obese
Apple verses Pear Shape
Apple Shape
• A larger distribution of body fat around
the abdomen
Pear Shape
• A larger distribution of body fat around
the thighs and hips
Apple shapes may be at higher risk
What does this mean?
• Don’t get too caught up in numbers and
shapes
– These formulas do not take into account
amounts of lean muscle and physical
activity
– BMI and body shape should not be used
as sole predictors of someone’s health
status
Body Weight and Fat Distribution and
Risk of Breast Cancer
The theory is:
Hormones are stored in body fat tissue.
With a greater percentage of body fat, the
higher the level of estrogen storage.
These higher estrogen levels may increase
the risk of breast cancer.
How to Achieve a Healthy Weight
Higher Fiber
• Aim for 25-35 g/day
– Choose mostly whole
grains or complex
carbohydrates
• Avoid Simple
Carbohydrates
– Empty calories
Lower Fat
• Choose lean proteins
• Avoid unnecessary added
fats
• Choose low fat dairy
products
• Be mindful of hidden
sources of fat
Sources of Complex Carbohydrates
Grains
•Bulgur, Brown Rice, Whole Wheat Pasta, Kasha,
Millet
Cereals (aim for >=5g fiber per serving)
•Bran Flakes, Kashi, Muesli, Whole oats
Breads (aim for >= 3g fiber per slice)
•Whole Wheat, Multi Grain, Rye, Pumpernickel
Legumes and Nuts (1-2oz portion or palmful)
• Include all types of beans, lentils, variety of
unsalted nuts
Lower Fat Intake
• Choose Lean Proteins
– Dairy Products
• Choose nonfat/skim milk only
• Consume low fat or non fat cheese
• Consume low fat or non fat yogurt
– Meats
• Choose white meat chicken and turkey,
lean pork
• Consume fish 2-3 times per week
• Limit red meat intake to less than twice per
week
How to Choose the Right Fats
1. Eat more omega-3 fat
• Fish, nuts, seeds, canola oil, flax, fish oil
supplementation.
2. Eat some monounsaturated fat
• Olive oil, avocados, canola oil, nuts,
seeds
3. Eat less omega-6 fat
• Processed foods like crackers, cookies,
chips
4. Eat less saturated fat
• Fast foods, full fat dairy, poultry skin,
tropical oils
The Importance of Physical Activity
• Strengthens immune system
• Improves digestion
• Helps control weight or increase weight
loss
• Can help decrease hormone levels
• Resistance exercise is also important to
increase metabolism
Physical Activity
The American Cancer Society
recommends:
150 minutes of moderate physical
activity
or
75 minutes of vigorous physical
activity
spread throughout the week
Benefits of Fruit and Vegetables
Phytochemicals
Naturally found in fruits and vegetables
Help destroy carcinogens in the body before
they can damage healthy cells
Benefits of Fruits and Vegetables
Antioxidants
Naturally found in fruits and vegetables
Help protect the body from free radicals
- the dangerous byproducts of some
natural metabolic processes in the body,
smoking, and exhaust from cars
- Free radicals have shown to play a role
as a cancer causing agent
Which are the best to choose?
• All fruits and vegetables contain potential
cancer fighting phytonutrients
• Eat a variety with varying colors to
ensure you are including the spectrum of
phytochemicals and antioxidants your
body may need
• Aim for 8 to 10 servings per day
• 2-4 fruit servings
• 4-7 vegetable servings
Milner JA. J Nutr2004; 134:2492S.
Making Educated Decisions
when Choosing Food
Supplements and Evaluating
Food Trends
Soy and Cancer
• Soy contains phytoestrogens that may
compete with estrogen to prevent cancer
• Earlier concerns were that soy could increase
cancer recurrence in hormonal breast cancer
• Research to date has demonstrated that in
moderate amounts (1-2 servings per day) soy
intake from whole soy foods is safe
Phytoestrogens – Noteworthy
Observations
• Rates of colon, breast, and prostate cancers
are much lower in Asia, where soy is a
staple of diet
• Asian women have about one fifth the rate of
breast cancer as American women
• Asian women moving to the US develop an
increasing incidence of “Western” cancers
within 1-2 generations
Could the phytoestrogens in soy
products be responsible for these
findings?
• Mean daily soy intake 10-50 gm in Asia
and 1-3 gm in US
• Estrogen levels are 40% lower in Asian
populations
• It may be important at what stage of life
the body is exposed to phytoestrogens
– During the period of breast
development and adolescence or
before the first mutational step in
carcinogenesis has occurred.
Breast Cancer Res 2004; 6:119-127
Making the Decision about Soy
Foods and other Phytoestrogens
• Discuss with physician or registered
dietitian assessing:
– Stage of cancer with estrogen
status
– Family history
– Diet history and prior soy intake
– General diet and exercise habits
– Weight history
– Menopausal status
What is a serving of soy? Choose
WHOLE foods
• Soybeans ½ cup
• Roasted soybeans ¼ cup
• Soy milk 1 cup
• Soy yogurt 1 cup
• Soy cheese 1 oz
• Soy flour ¼ cup
• Tempeh ½ cup
• Avoid soy supplements, powders
• Limit high sodium processed soy foods
like burgers, nuggets, etc.
GUIDELINES FOR OPTIMAL
NUTRITION
Guidelines for Optimal Nutrition
• A cancer fighting and healthy weight loss diet
comes down to more than just one food.
• A person’s whole eating pattern is vital for
cancer prevention and promotion of healthy
weight.
• Don’t make the mistake of focusing on one
food to get the job done.
– You will be missing out on the great
benefits of all of the others!
A Healthy CANCER-FIGHTING Diet
• Limit alcohol consumption to one or less drink
per day
• Maintain a healthy weight by limiting intake of
fatty foods especially of animal origin
• Choose whole grains, beans, and legumes to
increase fiber intake
• Increase intake of nuts, seeds, and fish to 2-3
times per week.
• Include regular physical activity
• Aim for 8-10 servings of vegetables and fruit per
day of varying colors
• Make educated decisions when choosing
supplements and evaluating food trends
Thank You!

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SHARE Webinar: Optimal Nutrition for Cancer Survivors

  • 1. Optimal Nutrition for Cancer Survivors Jessica Iannotta MS, RD, CSO, CDN
  • 2. What is on your mind? • Many patients and survivors struggle with weight gain as a result of their treatment • Often patients are very confused with the wealth of health information – What about soy or dietary supplements? – What is the best diet? – How do I lose weight?
  • 3. Some important questions to ask… • Is there a magic bullet or miracle food? • What can we do to help promote a healthy weight and possibly reduce the risk of cancer recurrence?
  • 4. American Institute for Cancer Research Guidelines • Be as lean as possible without becoming underweight. • Be physically active for at least 30 minutes every day. • Avoid sugary drinks. Limit consumption of energy-dense foods. • Eat more of a variety of vegetables, fruits, whole grains and legumes such as beans. • Limit consumption of red meats (such as beef, pork and lamb) and avoid processed meats. • If consumed at all, limit alcoholic drinks to 2 for men and 1 for women a day. • Limit consumption of salty foods and foods processed with salt (sodium). • Don't use supplements to protect against cancer.
  • 5. Limit Alcoholic Beverages • Current research – women who drink one alcoholic beverage per day, may have small increase in risk – Those who drink more may increase their risk even greater – If estrogen sensitive cancer, use caution with alcohol Chen WY, et al. Use of postmenopausal hormones, alcohol, and risk for invasive breast cancer. Ann Intern Med 2002;
  • 6. Limiting Alcohol Consumption What is a serving? -12oz beer -6oz wine -1.5 oz hard liquor
  • 7. • Include folate rich foods in the diet to reduce risk: – Bananas, oranges, tomatoes – Dark leafy greens – Legumes, lentils – Fortified cereals, whole grain breads – Supplement 400 micrograms of folic acid under physician guidance Include Foods Rich in Folate
  • 8. Achieve and Maintain a Healthy Weight • Definition of “Healthy Weight” – Ideal Body Weight +/- 10% – BMI = weight in lbs x 700 height in inches2 BMI = 19-25 “Healthy Weight” BMI = 26-30 Overweight BMI > 30 Obese
  • 9. Apple verses Pear Shape Apple Shape • A larger distribution of body fat around the abdomen Pear Shape • A larger distribution of body fat around the thighs and hips Apple shapes may be at higher risk
  • 10. What does this mean? • Don’t get too caught up in numbers and shapes – These formulas do not take into account amounts of lean muscle and physical activity – BMI and body shape should not be used as sole predictors of someone’s health status
  • 11. Body Weight and Fat Distribution and Risk of Breast Cancer The theory is: Hormones are stored in body fat tissue. With a greater percentage of body fat, the higher the level of estrogen storage. These higher estrogen levels may increase the risk of breast cancer.
  • 12. How to Achieve a Healthy Weight Higher Fiber • Aim for 25-35 g/day – Choose mostly whole grains or complex carbohydrates • Avoid Simple Carbohydrates – Empty calories Lower Fat • Choose lean proteins • Avoid unnecessary added fats • Choose low fat dairy products • Be mindful of hidden sources of fat
  • 13. Sources of Complex Carbohydrates Grains •Bulgur, Brown Rice, Whole Wheat Pasta, Kasha, Millet Cereals (aim for >=5g fiber per serving) •Bran Flakes, Kashi, Muesli, Whole oats Breads (aim for >= 3g fiber per slice) •Whole Wheat, Multi Grain, Rye, Pumpernickel Legumes and Nuts (1-2oz portion or palmful) • Include all types of beans, lentils, variety of unsalted nuts
  • 14. Lower Fat Intake • Choose Lean Proteins – Dairy Products • Choose nonfat/skim milk only • Consume low fat or non fat cheese • Consume low fat or non fat yogurt – Meats • Choose white meat chicken and turkey, lean pork • Consume fish 2-3 times per week • Limit red meat intake to less than twice per week
  • 15. How to Choose the Right Fats 1. Eat more omega-3 fat • Fish, nuts, seeds, canola oil, flax, fish oil supplementation. 2. Eat some monounsaturated fat • Olive oil, avocados, canola oil, nuts, seeds 3. Eat less omega-6 fat • Processed foods like crackers, cookies, chips 4. Eat less saturated fat • Fast foods, full fat dairy, poultry skin, tropical oils
  • 16. The Importance of Physical Activity • Strengthens immune system • Improves digestion • Helps control weight or increase weight loss • Can help decrease hormone levels • Resistance exercise is also important to increase metabolism
  • 17. Physical Activity The American Cancer Society recommends: 150 minutes of moderate physical activity or 75 minutes of vigorous physical activity spread throughout the week
  • 18. Benefits of Fruit and Vegetables Phytochemicals Naturally found in fruits and vegetables Help destroy carcinogens in the body before they can damage healthy cells
  • 19. Benefits of Fruits and Vegetables Antioxidants Naturally found in fruits and vegetables Help protect the body from free radicals - the dangerous byproducts of some natural metabolic processes in the body, smoking, and exhaust from cars - Free radicals have shown to play a role as a cancer causing agent
  • 20. Which are the best to choose? • All fruits and vegetables contain potential cancer fighting phytonutrients • Eat a variety with varying colors to ensure you are including the spectrum of phytochemicals and antioxidants your body may need • Aim for 8 to 10 servings per day • 2-4 fruit servings • 4-7 vegetable servings
  • 21. Milner JA. J Nutr2004; 134:2492S.
  • 22. Making Educated Decisions when Choosing Food Supplements and Evaluating Food Trends
  • 23. Soy and Cancer • Soy contains phytoestrogens that may compete with estrogen to prevent cancer • Earlier concerns were that soy could increase cancer recurrence in hormonal breast cancer • Research to date has demonstrated that in moderate amounts (1-2 servings per day) soy intake from whole soy foods is safe
  • 24. Phytoestrogens – Noteworthy Observations • Rates of colon, breast, and prostate cancers are much lower in Asia, where soy is a staple of diet • Asian women have about one fifth the rate of breast cancer as American women • Asian women moving to the US develop an increasing incidence of “Western” cancers within 1-2 generations
  • 25. Could the phytoestrogens in soy products be responsible for these findings? • Mean daily soy intake 10-50 gm in Asia and 1-3 gm in US • Estrogen levels are 40% lower in Asian populations • It may be important at what stage of life the body is exposed to phytoestrogens – During the period of breast development and adolescence or before the first mutational step in carcinogenesis has occurred. Breast Cancer Res 2004; 6:119-127
  • 26. Making the Decision about Soy Foods and other Phytoestrogens • Discuss with physician or registered dietitian assessing: – Stage of cancer with estrogen status – Family history – Diet history and prior soy intake – General diet and exercise habits – Weight history – Menopausal status
  • 27. What is a serving of soy? Choose WHOLE foods • Soybeans ½ cup • Roasted soybeans ¼ cup • Soy milk 1 cup • Soy yogurt 1 cup • Soy cheese 1 oz • Soy flour ¼ cup • Tempeh ½ cup • Avoid soy supplements, powders • Limit high sodium processed soy foods like burgers, nuggets, etc.
  • 29. Guidelines for Optimal Nutrition • A cancer fighting and healthy weight loss diet comes down to more than just one food. • A person’s whole eating pattern is vital for cancer prevention and promotion of healthy weight. • Don’t make the mistake of focusing on one food to get the job done. – You will be missing out on the great benefits of all of the others!
  • 30. A Healthy CANCER-FIGHTING Diet • Limit alcohol consumption to one or less drink per day • Maintain a healthy weight by limiting intake of fatty foods especially of animal origin • Choose whole grains, beans, and legumes to increase fiber intake • Increase intake of nuts, seeds, and fish to 2-3 times per week. • Include regular physical activity • Aim for 8-10 servings of vegetables and fruit per day of varying colors • Make educated decisions when choosing supplements and evaluating food trends

Editor's Notes

  1. Took for median of 6.1 years, recruited 1985 through 1988