CCSN Webinar 2023 2023 11 Diet for PEP.pdf
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About this Webinar: We know that methods of eating and diet are a large part of cancer care, but how can you make your diet work for you in your cancer journey? Dr. Rob Rutelege is back to present the latest science around healthy eating and cancer care. In addition, Dr. Rutledge will share the benefits of time-restricted eating, and how you can incorporate it into your daily routine.
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CCSN Webinar 2023 2023 11 Diet for PEP.pdf
- 1. E A T I N G A F T E R A C A N C E R D I A G N O S I S : T H E S C I E N C E A N D P R A C T I C E O F N O U R I S H I N G Y O U R S E L F W I T H D R . R O B R U T L E D G E O N C O L O G I S T , A S S O C I A T E P R O F E S S O R , D A L H O U S I E U N I V E R S I T Y
- 2. CancerPEP.com Healthy Eating after a Cancer Diagnosis: The science and practice of nourishing yourself Rob Rutledge, MD, Oncologist Cancer Patient Empowerment Program
- 3. CancerPEP.com Take Home Points •Improving your diet can be a powerful way to improve your physical and mental health •Tap into information and advice from experts •Plant-based, anti-inflammatory diet is best •When you eat is often as important as what you eat •Time-restricted eating is recommended •Transform your diet over months – and enjoy!!
- 4. CancerPEP.com Healthy Eating Lecture Content ●How diet promotes healing ●Components of healthy eating ●Ultra-processed food-like substances ●Healthy fluids, fats and sources of protein ●Vitamins and supplements ●Your microbiome ●Types of diet ●Time-restricted eating ●Myths about diet ●How to organize and shop
- 5. CancerPEP.com Complete Cancer Care (Integrative Oncology) • Understanding what’s happening to you • Getting the best from the medical system • Empowering yourself with healthy lifestyle - Exercise, diet, weight, sleep, relaxation techniques • Healing at level of the mind • Nurturing your spirit
- 6. CancerPEP.com When to get expert dietary advice • Recommended for everyone! • Ask your physician, and see a Registered Dietitian • But especially for people who suffer • Weight loss or weight gain • Diarrhea / constipation • Difficulty eating • Issues with relationship with food
- 7. CancerPEP.com Epigenetics: Change the Soup! • The fluid around the cells contain chemicals which can drive cell growth • Inflammation in the body releases chemicals into the blood which can cause damage to the cells and increase cell turnover • Choose an anti-inflammatory lifestyle • Diet, exercise, meditation, stress reduction
- 8. CancerPEP.com How diet helps to heal cancer •Prevents slow growing cells from becoming fast growing •Anti-oxidants mop up damaging and stimulating chemicals •Turns off the signals for the cells to grow •High sugar levels prime insulin / growth •Change in the soup, change the conditions for cell growth •Improves immune function •Unleashes body’s innate healing potential
- 9. CancerPEP.com The Microbiome • 100 trillion bacteria in your gut • Essential to digestion, immunity, hormone production • A diet of processed and refined foods will • Change the types and amount of bacteria in your gut • Irritate the lining of the gut (leaky gut syndrome) • Feed your bacteria • Fiber – from whole foods! • Prebiotics add ‘good’ bacteria to your gut
- 10. CancerPEP.com Principles of a healthy diet • Eat food, mostly plants, not too much • 50%+ of your plate should be veggies (+ fruits) • Healthy complex carbos (neither low nor high carb diet) • Proteins and fats from non-meat sources • Less meat or no meat, no red meat • Healthy fluids and fiber • Multiple types of whole nutrient-dense foods at each meal • Combines vitamins, minerals • Supplement with Vitamin D (and B12 if vegan) • Talk to your physician if other supplements are needed • Adopt an eating pattern you will enjoy for the long term
- 11. CancerPEP.com The Big Four Five Food Groups •Veggies •Fruits •Whole (intact) grains •Legumes, beans, seeds and nuts •Mushrooms •There are no ‘super foods’
- 13. CancerPEP.com The Food Industry is Driven by Profit • Minimize costs • Industrial production – cheaper ingredients • Extraction of food components (processing often strips foods of micronutrients) • Distribution often requires preservatives • Produce cheaper (ultra- processed) food-like substances
- 14. CancerPEP.com The Food Industry is Driven by Profit • Maximize profits • Food is designed to taste addictive: sugar, salt, fat (soft and energy dense) • Increases consumption (overeating is the goal) • Marketing is designed to make you feel good and buy more product • Iterative cycles of food design, testing, focus groups, marketing, market share, increasing profits
- 18. CancerPEP.com Defining Ultra-Processes Foods •Generally speaking they contain many ingredients •Extracts from other foods •Chemicals you don’t recognize •Emulsifiers, preservatives, .. •Substances you wouldn’t have in your kitchen •You can’t make this food yourself •Examples – supermarket bread, breakfast cereals, most yogurt, energy bars, ‘food’ wrapped in plastic
- 19. CancerPEP.com
- 20. CancerPEP.com
- 21. CancerPEP.com Canada Food Guide Update 2022 of highly processed foods • sugary drinks • syrups and jams • chocolate and candies • potato chips and pretzels • sauces, dressings and gravies • ice cream and frozen desserts • bakery products like muffins and cakes • fast foods like French fries and burgers • frozen entrées like pasta dishes and pizzas • processed meats like sausages and deli meats
- 22. CancerPEP.com
- 23. CancerPEP.com Ultra-Processed Food-like Substances as a percentage of our caloric intake •In the USA, UPF accounts for 50- 60% of our caloric intake •Similar in Canada and the UK •In children: 75% caloric intake •Associated with anxiety and depression, ADHD, obesity and diabetes
- 24. CancerPEP.com Eating Ultra-Processed Food-like substances is associated with • Poor mental health • Cancer • Obesity and diabetes • Alzheimers and other neurodegenerative disease • Many other medical conditions
- 25. CancerPEP.com
- 26. CancerPEP.com UK Study • 197,000 people • 2009-2013 • 24-hour diet assess • Average 22.9% UPF • Followed for 10y • UPF associated with cancer
- 27. CancerPEP.com • 20 overweight adults for 28 days held inside / measured++ • Randomly assigned to Healthy Diet vs UPF diet for two weeks – then cross over for 2 weeks • Unhealthy diet is 80% of calories made of UPF • Healthy diet 80% of calories with whole foods • Diets matched for calorie density, macronutrients, fibre, etc
- 28. CancerPEP.com Landmark UPF Study • Both groups had same feeling of satiety, enjoyment of food • UPF group ate 500 Kcal more per day!! • (2900 vs 2400 Kcal daily) • UPF group gained 2 lbs • Healthy group lost 2 lbs • Reason for weight gain? • Calorie density – don’t feel full until after overeating • Chemicals interfere with appetite
- 29. CancerPEP.com AVOID Junk •Sugar drinks and refined sugars •Fried foods •Processed foods •Red meat
- 30. CancerPEP.com Sugar feeds cancer? •Refined sugars and high glycemic foods on their own can “spike” blood sugars •↑ insulin = inflammation = cancer risk •We need protein, fibre, healthier fats •Best to consume slow burning fuel
- 31. CancerPEP.com Little or No red meat! • Red meat irritates your gut, kills off healthy bacteria and leads to inflammation • Fish in small amounts is OK • Eg. one serving per week gives you the omega 3s • Beware of high metal levels (eg. tuna) • Canned wild salmon, sardines, cod, herring, mackerel • Skinless chicken or turkey breast in small amounts
- 32. CancerPEP.com Myth: we won’t get enough protein if we don’t eat meat • Wrong! • Vegetables contain the same amino acids (ie protein) as the muscle of animals • Eat several foods at each meal • Get a full complement of essential amino acids • Nuts, seeds, beans and legumes all have very high protein content • A balanced vegan diet contains more protein than our bodies can use.
- 33. CancerPEP.com Healthy Sources of Protein •GRAINS – NUTS - BEANS •Nuts – almonds, peanut butter, pasticcios, pumpkin seeds, flax, sunflower, brazil •Kidney beans, black beans, lentils, garbanzo, chick peas, edamame, amaranth •Sprouted grain bread
- 34. CancerPEP.com
- 35. CancerPEP.com Healthy (intact) Whole Grains •Quinoa •Brown rice / wild rice •Flax seeds •Whole oats •Whole barley •Buckwheat •Cous cous
- 36. CancerPEP.com No sweet, no wheat, no dairy and no refined foods •Greatly increase vegetable and fruit intake •Eat organic foods •Drink filtered water
- 37. CancerPEP.com Supplements • Vitamin D – 1000-2000 IU • Probably a multi-vitamin good if older • Vitamin B12 is 2.4 mcg if vegan • Get your blood levels checked • Eat a varied and balanced diet and you won’t need to take supplements • unless directed by a physician • General supplement probably good for older folks • Omega 3 from algae if vegetarian
- 38. CancerPEP.com Healthy fluids •Reminder to stay hydrated – bottle close by •Tea: green, chaga mushrooms, saffron •Warm water with lemon in am •Reduce alcohol (eg. one drink per week) •Almond milk or oat milk (less water to produce)
- 39. CancerPEP.com Myth: Coffee is bad for you •Caffeine is a stimulant (hard to relax) •Drink your coffee earlier in the day •Enjoy your life fully!
- 40. CancerPEP.com Myth: Fat is bad for you •Trans and saturated fats are not good •We need healthy fats for our brain, nerves and many other cells •Good unsaturated fats (mono and poly) include veggie oils (olive, canola, sunflower, soy), nuts, seeds, and fish
- 41. CancerPEP.com Healthy Oils •Olive – cold pressed, and less than a year old •Grape seed for salads •Avocado – good for cooking •Better to get from the plant •Get your healthy oils from multiple sources each day
- 42. CancerPEP.com Essential fatty acids - Omega 3 • Omega 3 reduces inflammation • Omega 6: pro inflammatory (sometimes necessary) Accepted ratio: 4 parts omega 6: 1 part omega 3 • Current western diets have too much omega 6 (20:1) • Omega 3 parent molecule: alpha linolenic acid is found in flax, walnuts, chia seeds and small amounts in green vegetables (very stable and can convert in body to longer chains EPA and DHA) • Derivative molecules: EPA, DHA (fish oil) very unstable and can go rancid quickly (why fish smell fishy!)
- 43. CancerPEP.com Diet that Elevates Mood • Low glycemic • Brazil nuts • Dark chocolate • Mangos • Oranges • Nettle leaf • Kiwis • Figs
- 44. CancerPEP.com Personalizing Your Diet •Use mindfulness to assess how you feel •Blood sugar monitors •Fecal sampling of diversity of microbiome
- 45. CancerPEP.com Brain food • Omega 3s / fish • Pumpkin seeds • Dark chocolate • Blueberries • Turmeric • Broccoli • Nuts • Apples
- 46. CancerPEP.com Anti-inflammatory spices • Turmeric -tea, curries, sautée vegetables, rice, soups, smoothies • Ginger - stir fry, tea, salad dressings, smoothie, stir fry, soup • Garlic - fresh salsa, roasted on top of pizza, salad, sandwich, homemade hummus
- 47. CancerPEP.com Healthy swaps • Water for soda pop • Piece of fruit for a cookie • Bean salad for a meat dish • Loaded oatmeal for cereal • Spaghetti squash for pasta • Roasted vegetables and whole grain (farro, quinoa, bulgur) vs white rice or pasta • Popcorn for chips • Apple and nut butter for granola bar
- 48. CancerPEP.com Dairy – Good or Bad? • Limit high fat dairy • Need to replace calcium • Fortified plant milks • Chia Seeds • Almonds • Tofu • Leafy greens • Soybeans
- 49. CancerPEP.com Shopping! •Plan ahead •Don’t shop when you’re hungry or tired •Read the labels •Don’t buy unhealthy food
- 50. CancerPEP.com Watch for sugar and chemicals
- 51. CancerPEP.com Efficient Preparation •Spend a couple of hours doing meal prep one day a week - pot of whole grain, roasted vegetables, etc. •Pre-chopped veggies
- 52. CancerPEP.com Frozen foods lose nutrients? •Message – good option for getting veggies and fruits
- 53. CancerPEP.com Frozen foods • Berries – blueberries, strawberries • Veggies • Broccoli and cauliflower, brussel sprouts • Green beans and peas • Spinach • Cauliflower crust pizza • Veggie burgers ?? • Frozen soups – corn and potato chowder, split pea, black bean
- 54. CancerPEP.com Examples of Healthy Breakfast •Oatmeal with plant milk, frozen blueberries, chia seeds, hemp hearts and ground flax •Egg frittata loaded with vegetables •Sprouted grain bread, avocado, hemp hearts •Sprouted grain bread, nut butter, chia seed jam
- 55. CancerPEP.com Oatmeal with Seeds and Fruit
- 56. CancerPEP.com Examples of healthy lunch •Soups - lentil, mung beans, beans, load up with vegetables, creamy with cashews •Salad - include nuts, seeds, avocado, protein, healthy fat •Veggies, hummus, whole grain crackers, fruit
- 57. CancerPEP.com Cauliflower / chick pea curry
- 58. CancerPEP.com Examples of Healthy Supper •Bean or lentil curry •Protein, whole grain, vegetables •“Buddha bowls” - whole grain, veggies, protein, hummus, herbs, dressing •Lentil Walnut tacos with salad
- 59. CancerPEP.com Examples of Healthy Supper
- 60. CancerPEP.com Very Smoothie • Berries • 1/2 banana • Plant milk • Yogurt • Chia seeds, ground flax, hemp hearts, nuts, seeds • Cocoa/ginger/spices
- 61. CancerPEP.com Ketogenic Diet Starves Cancer? •Ketogenic diet is high-fat, adequate-protein, low- carb diet •Forces the body to burn fats rather than carbs •Keto diet is therapeutic for epilepsy •Very strict, missing many antioxidants •Can compromise fibre and bowel health
- 62. CancerPEP.com Time-Restricted Eating - Intermittent Fasting • Fasting / time-restricted eating – focuses on timing and not the content of diet • When we eat a meal • Glucose from carbs goes to the cells, and becomes glycogen in the liver • Fatty acids go to cells, and stored in fat cells • When not eating: Once liver is drained of glycogen, it processes fatty acids to produce ketones (energy source for cells) • Ketones improve cell functions, make them more resistant to stress, enhance recovery and autophagy • Decrease inflammation • Allows your gut to repair itself
- 63. CancerPEP.com Sync Eating and Circadian Rhythm • All cells are linked to the daily cycle • Eat during the day, don’t eat at night • results in lower post-meal blood sugar and insulin levels, lower fat production, and better blood pressure control • Ideally don’t eat for the first hour after waking • Don’t eat within 2-3 hours of going to sleep • Coffee and tea (no sugar or milk) and water are allowed during the non-eating times
- 64. CancerPEP.com Types of Fasting • Time-restricted eating • E.g. Eat only during the day (10 hours), don’t eat at night (14 hours) • Periodic fasting • E.g. reducing caloric intake on the weekend to 0-40% of normal • Requires calorie counting • Fasting 24 hours prior to, plus 24 hours after chemo may make the cancer cells more vulnerable to the Rx
- 65. CancerPEP.com How to Time-Restrict Your Diet • Train your body over a 4-month period • Increase capacity to produce and metabolize ketones • Example • Month 1: Fast for 10 hours per day Monday to Friday • Month 2: Eat for 8 hours (eg. 10am-6pm) +/- eat normally on weekends • Month 3: Alternate days between eating for 6 hours and 8 hours • Month 4: Eat during 6 hours – but modify timing • Goal: ketosis for at least a few hours every day, which usually means not eating for at least 12-14 hours
- 66. CancerPEP.com Usually lasts 2-4 weeks
- 67. CancerPEP.com
- 68. CancerPEP.com Vegan Diet •Vegan diet – no animal or dairy products •Can be a very nutrient-dense if focus is whole foods •Whole grains, vegetables, fruit, nuts, seeds •May need a supplement - ask a dietitian •Get support to ensure good intake
- 69. CancerPEP.com Chocolate – good or bad? •Higher cocoa percentage = less sugar •Flavanols - but not enough •With meal or snack •Craving chocolate or sugar
- 70. CancerPEP.com Soy – good or bad? • Plant sources of estrogen help regulate estrogen levels in the body • Estrogen receptor +ve breast cancer •Please discuss with your physician • Traditional forms: tofu, miso, tempeh, natto, edamame, soy milk • Organic
- 71. CancerPEP.com Organic - necessary? •Less pesticides •May mean better farming practices, better for environment •EWG - shoppers guide - clean 15 dirty dozen •Local is best
- 72. CancerPEP.com Can you alkalize your body? •The idea is to change the pH (acid/base balance) of the blood so cancer cells can’t grow •It’s not possible to change the pH as the body has kidney and lung mechanisms to keep it normal
- 73. CancerPEP.com Alcohol? •As little as possible •Men less than 6 drinks per week, women < 3 drinks
- 74. CancerPEP.com Low-Carb vs Low-Fat vs Fad X •Eat what makes you feel good! •Use the healthy swaps •Don’t buy the unhealthy / ultra-processed junk •Eat your veggies and whole foods first •Will allow your hunger center to feel satiated •Look for a healthy eating pattern with variety! •Slow transition into foods you enjoy
- 75. CancerPEP.com Tips to making this work •Eat at least one veggie at every meal (and work up to 50%+ of your plate) •Don’t buy the unhealthy foods •Look for healthy swaps
- 76. CancerPEP.com Overview of CancerPEP • Cancer Patient Empowerment Program • Six-month daily science-based program of daily emails and daily PEP videos delivered by an Oncologist and Psychology Professor Scientist • Comprehensive – overview videos and daily teaching and encouragement via emails and 3-5min videos • Exercise, strength training / yoga, dietary advice, time- restricted eating, relaxation training with biofeedback, sleep science, habit formation, stress reduction, relationship teaching and activities • Buddy system and monthly zoom conferences with us • Sign up by visiting CancerPEP.com
- 77. CancerPEP.com
- 79. CancerPEP.com gildasclubtoronto.org/nutritionshowcase/ Chef Amy Symington – Gilda’s Club Toronto
- 80. CancerPEP.com Ellicser Kitchen •Another great resource coming from Princess Margaret Hospital in Toronto
- 81. CancerPEP.com For the love of this planet •Please eat non-animal foods as much as possible
- 82. Questions? Rob Rutledge, MD, FRCPC Rob.Rutledge@nshealth.ca
- 83. CancerPEP.com How cancer starts • A cancer cell is a normal cell with dozens of mistakes • The cells grow fast and in an uncontrolled way • The transformation from normal to cancer typically takes many years
- 84. CancerPEP.com Don’t turn slow growing cancer cells into fast growing cells •Damage to the normal cells causes them to turn into cancer cells •Further damage to slow growing cancer cells cause them to become fast growing cells •What’s good for reducing risk of your type of cancer is good after a diagnosis •What’s known to increase risk of your type of cancer should be avoided