This document discusses how diet and lifestyle factors can affect cancer risk and survivorship. It analyzes over 7,000 studies from the American Institute for Cancer Research to provide 10 evidence-based recommendations. These include maintaining a healthy weight, being physically active, eating a predominantly plant-based diet with emphasis on variety and color, and limiting red meat and alcohol intake. While supplements like vitamin D and omega-3s may help survivors, a whole food diet is most important for obtaining nutrients and phytonutrients that can exert protective effects against cancer.

1. Fighting Cancer with Your Fork:
Separating Fact From Fiction
Hillary M. Wright, MEd, RD, LDN
Dana-Farber Cancer Institute
Leonard P. Zakim Center for Integrated Therapies

2. How Do We Figure Out What May
Affect Cancer Risk/Survivorship?
The American Institute for Cancer Research
“Food, Nutrition, Physical Activity and the Prevention of
Cancer: a Global Perspective”
• The result of an analysis of over 7000 research studies on
the link between diet, lifestyle and cancer, and for the first
time cancer survivors
• www.aicr.org   “comprehensive global report”  10
Recommendations, last one specific to survivors.

3. America’s Challenging Food Environment

4. Question: Is it also our lifestyle?

5. Watch Your Weight!
• 65% of Americans are overweight or obese.
• Only 6% of Americans identify being overweight or obese as a risk
factor for cancer despite a clearly established scientific link.
• Research shows that fat cells can act as "hormone pumps,"
secreting hormones and other growth factors into the
bloodstream.
• If the body's cells are exposed to very high levels of these
substances over an extended period, they tend to reproduce
more quickly  ? Increase cancer cell growth.
• Researchers stress that this potentially dangerous condition is
reversible!

6. Question: But after cancer treatment, I
actually lost weight?

7. Weight Loss during Cancer Treatment
• Possible causes:
– Changes in metabolism, anorexia, side effects of treatment
(nausea, vomiting, fatigue, taste changes, dry mouth, throat
soreness if esophagus affected by radiation), over-aggressive
efforts to eat a “cancer-fighting” diet.
• Weight loss is associated with increased difficulty tolerating
treatment and poorer quality of life.
• Nutritionist can help:
– Five or six small meals/snacks
– Suggestions for smoothies or liquid nutrition supplements
– Strategies to concentrate calories in food and increase overall
intake

8. Movement is critical to the health of the
human body!!
Absolutely necessary if you want to
maintain a healthy weight!
• New Guidelines from the Dept of Health & Human
Services
Minimum 150 min moderate, or 75 min
vigorous to reduce risk of chronic disease
– Ideally aim for more – and necessary if weight loss
and maintenance of loss is the goal – 300 min of
moderate or 150 minutes of vigorous.
• Physical activity linked to lower risk of breast, prostate
and colorectal cancer; necessary for weight control.

9. Different ways to be active…
If you like it – you’ll do it!

10. Fruits and vegetables may exert a protective effect:

11. Phytonutrients
• Beyond vitamins, minerals and fiber,
natural compounds found in plants may
exert profound disease preventive effects
• The “immune system” of a plant – many
also represent the pigment that gives the
plant it’s color.

13. Phytonutrients:
Prevention in a Plant
• How do they work?
– Stimulate enzymes that help the body detoxify
– Reduce the genetic damage from cancer
causing agents
– May interfere with growth and multiplication
of cancer cells
– Decrease inflammation

14. If It Stains Your Shirt…
• If a fruit or vegetable
has a strong smell or
taste, it’s probably
biomedically active
• If it stains your shirt,
it’s definitely
biomedically active!

15. Antioxidants
• Vitamin A, C, E, Selenium & Phytonutrients
• Help prevent damage to cells from the attack of
free radicals
• “But I take antioxidant supplements in pill
form, so I’m getting all the antioxidant
benefits that way, right?”

16. Food First
• Phytonutrients work together to provide
a synergistic benefit

17. Choose a Predominately Plant Based Diet
• Eat 5-10 servings fruits & veggies each day
– 1 serving = 1/2 cup cut, cooked or sliced; 1
piece medium fruit; 1 cup leafy greens
• Emphasis on variety
• Look for richly colored plant foods

18. Question: What about juicing
vegetables?

19. How to Get It All In:
Fruits & Veggies
lTry to eat at least 2 colorful plant foods
before noon
lMake a breakfast smoothie with low-fat
milk, yogurt and fresh or frozen fruits
lAdd frozen veggies to soup, casseroles
lKeep veggies & fruit cut-up and readily
available for quick snacks anywhere

20. Great Gains from Whole Grains
• Keep weight off (portions still matter!)
• Isoprenoids in whole grains suppress tumor
growth
• Tepernoids and Tocotrienols encourage tumor
dormancy and decrease tumor cell division
• Stimulate GST (detoxifying enzyme)

22. Sugar and Cancer – It’s not that simple…..
• Sugar does not FEED
cancer
• Chronic, excess intake
of simple sugar leads to
excess production of
hormones like insulin,
IGF that encourage
cellular growth

23. Insulin and Cancer
• Excess insulin can promote tumor cell growth
• Behaviors that increase insulin levels
– Consumption of refined sugar and flour
– Overeating
– Weight gain
– Sedentary lifestyle
• Behavior that reduces insulin levels
– Physical activity, weight loss, unrefined carbs

24. Question: Some programs I’ve seen
suggest links between sugar and brain
function?

25. Question: What’s the difference
between sugar and carbohydrates that
turn into sugar?

26. Question: So should we follow the
adage: eat breakfast like a king, lunch
like a prince and dinner like a pauper?

27. Insulin and Cancer
• Excess insulin can promote tumor cell growth
• Behaviors that increase insulin levels
– Consumption of refined sugar and flour
– Overeating
– Weight gain
– Sedentary lifestyle
• Behavior that reduces insulin levels
– Physical activity, weight loss, unrefined carbs

28. Donut vs. Orange
• 200 calories • 62 calories
• 10 grams sugar • 12 grams sugar
• 0 grams fiber • 3 grams fiber
• 0 phytonutrients • 170 phytonutrients

29. Get Into the Bean Routine….

30. Question: I take Arimidex so is it not a
good idea to experiment with
soybeans?

31. Get Into the Bean Routine….

32. Question: What about multivitamins?

33. Question: Can you talk about the acid
vs. alkaline diet?

34. Get Into the Bean Routine….

35. Question: Can someone get enough
protein from eating beans?

36. Find Healthful Fats
 Reduce consumption  Choose
of saturated and trans- Monounsaturated and
fats Omega-3 Fats
 Saturated  Monounsaturated
• Found in animal fat, • Found in olive oil, canola
butter, full-fat dairy, oil, olives, avocado, nuts
coconut and palm oils and nut butters
 Trans  Omega-3
• Found in margarine, • Found in salmon,
processed foods herring, sardines,
containing hydrogenated mackerel, bluefish and
or partially tuna
hydrogenated oils • Strive to include 4 oz of
oily fish 2-3 times a week

37. The Typical American Plate
50% Meat
25%
vegetable
> 25% starch

38. AICR: Limit Red Meat Intake
• Limit red meat to 18 ounces per week (includes beef, pork and lamb)
• Avoid processed meats
• “Processed meat” refers to meats preserved by smoking, curing or salting,
or by the addition of preservatives (ham, bacon, pastrami, salami, hot
dogs and sausages.
• When meat is preserved by smoking, curing or salting, or by the addition
of preservatives, cancer-causing substances (carcinogens) can be formed.
These substances can damage cells in the body, leading to the
development of cancer.
• Studies show people who eat more meat often eat less plant-based food.

39. Healthy Eating Plate
• Aim for ½ plate of
plants (preferably
vegetables) at lunch and
dinner
• ¼ of plate as lean
protein
• ¼ of plate of complex
carbohydrate

40. Question: I heard that you should eat
your fruits and vegetables separately.
Is that true?

41. Organic vs. Conventional
• No scientific evidence to date that organic offers
anti-cancer advantage at this point
• More than ½ of dietary pesticide exposure comes
from 12 foods – EWG “Dirty Dozen”
• Bottom line: wash things thoroughly

42. Question: What about eating the skin
on apples?

44. Question: What about veggies
washes?

46. Food First
• 75% of Americans don’t eat “5 a day”
• Americans eat 1.5 servings of vegetables & less than 1
serving of fruit daily, despite consistent evidence that these
foods decrease the risk of many chronic diseases.
• We throw away more than 11 billion pounds of fruits and
vegetables every year in the US!!
• Americans spend $18.7 billion per year on dietary
supplements despite limited and inconclusive scientific
evidence of effectiveness in disease prevention and
treatment

47. Dietary Supplements That May
Help Cancer Survivors
• Vitamin D
• Omega-3
• Probiotics and
calcium if needed
24,000 Dietary Supplements
marketed to Cancer Survivors!

48. Vitamin D and Cancer
• Inverse relationship
between Vitamin D and
several types of cancer
– Possible anti-angiogenesis
and helps keep cell
replication normal
• Ask your doctor to check
your serum 25(OH) vitamin
D level.
• Supplementation is likely
necessary.
– 1000 IU/day is safe for most
people.

49. Omega 3 Fats
– Anti-inflammatory
– Reduce muscle wasting during treatment
– Great for your cardiovascular system
• Salmon, herring, sardines, mackerel
• Aim for 4 oz of oily fish 2-3 times a week
• Daily goal: 1000 mg of EPA/DHA
• Look for 500 EPA/DHA per capsule

50. Question: Should I be worried about
mercury in Omega 3 supplements?

51. Question: Can you give yourself too
much Omega 3?

52. Alcohol
– Alcohol intake should be limited – one per day
for women, 2 per day for men.
– Serving is:
12 ounce beer
5 ounces wine
1.5 ounces spirits

54. Question: I have oatmeal and
blueberries for breakfast every day,
but I use the instant oatmeal. Is that
okay?

55. Question: Is there any research on
pesticides on certain vegetables that
says that contributes to cancer?

56. Thank You!
• For more information about fighting cancer
with your fork, please visit the nutrition
section of our web site:
www.dana-farber.org/Adult-Care/Treatment-and-Su