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Do Nutrition and Exercise Play a Role in Cancer Prevention? · PDF fileGreen / black tea...
Transcript of Do Nutrition and Exercise Play a Role in Cancer Prevention? · PDF fileGreen / black tea...
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Do Nutrition and Exercise Play a Role in Cancer Prevention?
Nancy Rogers, MS, RD, CWWSRegistered Dietitian
Certified Worksite Wellness Specialist
University of Arizona
CancerDr. David Alberts, Director AZ Cancer Center, 2005
Cancer is not just one disease; there are >100 kinds and each has its own Cause Natural history Preventative strategies treatments
American Cancer Society 2012For most Americans, cancer deaths: 1/3 of deaths – tobacco products 1/3 diet, physical activity and body
weight 1/3 genetic and other causes
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Stages of Cancer FormationNormal cell
Mild (initiated) Moderate dysplagia
Severe dysplagia
Cancer
Post cancer
Dr. Alberts: Ideal Preventive Agent
IdealAgent
Known mechanism
No/low toxicity
High efficacy
Human acceptance
Low cost Oral consumability
Dr. Alberts: Ideal Preventive Agent
Known mechanism
No/low toxicity
High efficacy
Human acceptance
Low cost Oral consumability
FOOD
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Cancer Prevention
Food
Physical Activity Weight
“The most effective cancer prevention therapy can’t be found in a miracle pill or through an expensive series of medical procedures. The best treatment can be found in the produce section of your local supermarket.
Many of the compounds and bioactive chemicals that occur naturally in vegetables and fruit act to protect us against cancer. Many of the medicines we use to treat people are derived from these foods.”
Cynthia Thomson, PhD, RD, CSO AZ Cancer Center, Food as Medicine, 2012
Nutrition and Cancer PreventionDr. John Milner, Nat’l Cancer Institute, 2005
25,000 bio-active ingredients in foods have been identified with a preventative role: Animals Plants Fungus Bacteria
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Superfoods Blueberries Sweet Potatoes Nuts Fish Dried beans Pomegranates Dark, leafy greens Garlic Green / black tea Coffee Tart cherries Cruciferous vegetables
Whole Grains Reduce Cancer RiskAmaranth Barley Buckwheat Polenta
Corn millet Oats QuinoaBrown rice Rye Teff Triticale
Wheat Kamut Spelt Farro Emmer
High intake of dietary fiber from whole grains reduced risk for colorectal cancer and other cancers.
Limit refined carbs and high sugar foods and drinks.
Tufts Health and Nutrition Letter 2/2012American Cancer Society 2012
Food: Cancer Prevention Guidelines
Eat at least 2 ½ cups of vegetables and fruit a day
Choose whole grains instead of refined carbs
Primarily a plant-based diet Limit processed meats and red meats Choose foods that help you maintain a
healthy weightAmerican Cancer Society 2012
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Cancer and Coffeepolyphenols – chlorogenic acid
Lower rates of cancer of the oral cavity and pharynx, and basal cell cancers
Cancer Research 2012, Annuals of Oncology 2011, Tufts Health & Nutrition Letter 8/2011Cancer Epi. Biomarkers Prev. 2010
Green TeaPolyphenols
a broad class of anti-oxidantsCatechins
associated with anti-carcinogenic, anti-viral, anti-inflammatory properties
Catechins – Green TeaVary with processing before dryingSoil and climateFertilizersBrew timeTemperatureType of tea (instant,
ready to drink, etc)Amount is 4-5 cups a day
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Help from Spices: TurmericJournal of Cancer Research, January 2006
Turmeric is found in curry powder Active ingredient is curcumin Worldwide, lowest incidence of prostate cancer
is in India and China
Cruciferous VegetablesPhytochemicals – cancer prevention Brassica genus: Broccoli, Brussel sprouts,
cabbage, cauliflower, collard greens, kale, kohlrabi, mustard, rutabaga, turnips, bokchoy, Chinese cabbage
Raphnus genus: radish, daikon radish Nasturtium genus: watercress Eruca genus: arugula Armoracia genus: horseradish Wasabia genus: wasabi
Fermented Foods Ancient beginnings: 6000
years ago in the Fertile Crescent.
China, Korea, Rome, Viet Nam, Japan, Laos, Bulgaria
Most common lacto-fermentation using lactobacilli (lactic acid and
H2O2) Bifidobacteria (acetic acid)
Wild Fermentation2003. Chelsea Green Publishing
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Nutrition Summary Whole grains Fruits, vegetables, and beans Limit red meats, processed meat Avoid charred meats Enjoy coffee and teas Limit alcohol Eat Food not supplements
Nutrition and Cancer PreventionDr. John Milner, Nat’l Cancer Institute, 2005
Individuals vary in how they respond to the bio-active ingredients in foods
Responders and non-responders Genetic testing
Cancer Research Donato F. Romagnolo, Ph.D., MSc.
Professor, Nutritional and Cancer Biology
Department of Nutritional Sciences University of Arizona Cancer Center
University of Arizona, 2013
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Epigenetics Definition Genetics: the study of heritable changes in gene
function that occur with a change in the DNA sequence
Epigenetics: the study of heritable changes in gene function that occur without a change in DNA sequence. Study of the regulation of gene activity that is not
dependent on gene sequence Can be reversible
Donato F. Romagnolo
Diet and Epigenetics Inappropriate diets can contribute to
chronic diseases and cancer formation Important to uncover the molecular
mechanisms to develop interventions Of bioactive factors in foods Of environmental factors
Nutrition and Health: Bioactive Compounds and Cancer. 2010DOI 10.1007/978-1-60761-627-6_5
Epigenetics - CuesIn the DNA coding process
Transcriptural Cell silencing Transcriptural Cell activationActivating something that should be silent, or silencing something that should be active.
May overcome a predisposition to tumor development
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Nutrients from our food are turned into methyl groups along a pathway: the pathway is made up of many players that manipulate molecules into methyl groups and ultimately put them on our DNA.
http://learn.genetics.utah.edu/content/epigenetics/nutrition/
Current epigenetic animal research Effect of maternal nutrition BRCA-1 on fetus –
possibly prevent cancer in offspring
Mediterranean type diet, high in folate Mediterranean Diet and Disease Prevention, 2014
Dr. Donato Ramagnolo Resveratrol – grapes, blueberries, red wine, peanuts
Nutritional Supplements
Should they be routinely prescribed???
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Supplements may be Harmful –including Fortification of Foods
Food not supplements Some concern of supplemental folic acid over
1400 mcg / day in increased risk of colorectal cancer
High levels of supplemental Vitamin A in smokers increased lung cancer
Supp. Vitamin E is not recommended Supp. Selenium is not recommended
American Cancer Society 2012
Cancer Prevention
Food
Physical Activity Weight
Body weight and Cancer Risk In the U.S. excess body weight may contribute
to 1 out of 5 of all cancer-related deaths.
Increased risk of cancers: Breast (among women who have gone through
menopause) Colon and rectum Endometrium (lining of the uterus) Esophagus Kidney Pancreas
American Cancer Society 2012
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Being overweight or obese likely raises the risk of other cancers:
Gallbladder Liver Non-Hodgkin lymphoma Multiple myeloma Cervix Ovary Aggressive forms of prostate cancer High belly fat is linked with an increased risk of
colorectal cancer; probably higher risk of cancers of the pancreas, endometrium and breast cancer in women past menopause.
American Cancer Society 2012
American Cancer Society Summary
Be as lean as possible throughout life without being underweight
Avoid excessive weight gain at any age Even a small amount of weight loss is
helpful Engage in regular physical activity Limit consumption of high calorie foods
and beverages
Cancer Prevention
Food
Physical Activity Weight
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Physical Activity Limit sedentary behavior Moderate to vigorous physical activity
>5 days/week 150 minutes moderate level 75 minutes vigorous
Do exercise beyond usual activities.
American Cancer Society 2012
Medscape 3/15/2013 John Marshall MD 150,000 people in survey 860 got colon cancer 2300 people met physical activity
guidelines – 150 minutes/week Risk reduction by .5% - better outcome
than chemotherapy BMI, physical activity, and cancer –
may have a epigenetic component
Specific Site Recommendations
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Cancer Survivors and Nutrition 1° plant based diet High in fruits / vegetables Low in fat / saturated fat
J. Am Dietetic Assoc. Dec 2011
Esophageal Cancer and Obesity Increased gastro-esophageal reflux Acid breaks down squamous cell lining in
esophagus - Increased risk for cancer
Preventative measures: Decrease obesity to a healthy weight Control reflux
Society of Thoracic Surgeons, 43rd annual meeting: Abstract 77. Presented 1/30/07
Stomach Cancer Prevention
2 ½ cups of fruits / vegetables daily Reduce salt-preserved
foods and salt Reduce processed meats Be physically active Maintain a healthy body
weight
American Cancer Society 2012
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Prostate Cancer Prevention Most common cancer in men 2 1/2cups vegetables/fruits a day Healthy weight and physical activity ~ avoid Vitamin E, selenium and calcium
supplements
Localized prostate cancer Research ~4,000 men Conclusion: No need to avoid dairy products Avoid whole milk Choose nonfat or 1% milk
Cancer Epidemiology, Biomarkers & Prevention, doi 2012
Black tea and Prostate Cancer
Netherlands Cohort study Amer. J. of Epidemiology 2012
~58,000 men Higher intake of black tea had a
decreased risk of advanced stage prostate cancer
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Colon Cancer Prevention Consume a diet rich in fiber: vegetables,
fruits, whole grains and beans
Get sufficient calcium
Limit red meats to 18 oz a week
Avoid high cooking temperatures (charring) / use marinades
Limit processed meats
American Institute for Cancer Research, 12/2011
Colorectal Cancer Prevention
Analysis of 41 studies Most fish eaten had 12% reduction of
cancerThe American J. of Medicine June 2012
Choose fish low on the food chain
Colorectal cancer Modify microbiome in the gut
Use of probiotics Various bifido and lactobacillus species
Use of prebiotics Dietary fiber, various sources
Synergistic effect of using prebiotics and probiotics to reduce cancer risk
January 2013 webinar: Frontiers in Nutrition and cancer Prevention, NIH, DHHS, NCI
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Prebiotics Non-digestible food ingredients that
stimulate the growth and/or activity of bacteria in the digestive system in ways claimed to be beneficial to health.
A prebiotic should increase the number and/or activity of bifido and lactic acid bacteria
Food sources: onion, garlic, Jerusalem artichoke, jicama, chicory root, whole wheat
Probiotics Yogurt Kefir Fermented foods
Physical Activity and Breast Cancer Helps control weight May reduce circulating levels of
hormones associated with cell and tumor growth
Include daily exercise
American Cancer Society 2012
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Breast Cancer Estrogen receptor negative cancers only
Pooled analysis of 18 prospective cohort studies, over 1 million women; 13% lower risk for Er neg. breast cancer tumors
**Include foods high in a-carotene, b-carotene, lutein/zeaxanthin –dark green and orange fruits and vegetables
Am. J. of Clinical Nutrition doi 2012
Breast Cancer
T AICR/WCRF Report: Breastfeeding lowers the risk for both pre- and
post-menopausal breast cancer. Protection against all-age breast cancer risk:
avoid alcohol. Regular physical activity protects against
post-menopausal breast cancer, A healthy weight is also associated with lower
risk for post-menopausal breast cancer.American Institute for Cancer Research, 2012
Breast Cancer Prevention BMJ. Published online June 27, 2013 The meta-analysis involved 26 publications, 20,905
cases of breast cancer, and 883,585 participants from 21 independent prospective cohort studies.
This study provides solid and robust evidence that marine n-3 PUFA are inversely associated with risk of breast cancer. The protective effect of fish or individual n-3 PUFA warrants further investigation of prospective studies.
Tuna, salmon, sardines, herring, mackerel
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Endometrial Cancer Prevention Top 2:
Maintain a healthy body weight Regular physical activity
American Cancer Society 2012
UA Life & Work Connections, Human Resource Department
What’s in the Future? Genetic testing for individual’s risks New research on plants and their active
ingredients to help prevent cancers New medications to treat or cure cancers Ongoing research and collaborations
What Can You Change?Lifestyle / epigenetic Factors:
Appropriate screenings
Foods you eat
Physical activity
Healthy weight
Tobacco use
Alcohol use
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Cancer Prevention
Food
Physical Activity Weight
Resources•American Cancer Society: www.cancer.org
• http://cacancerjournal.com
•Centers for Disease Control and Prevention: www.cdc.gov
•American Institute for Cancer Research: www.aicr.org
•National Cancer Institute: www.cancer.gov