Role of Nutrition Before, During, and After Colorectal Cancer Crystal Tallman, MFCS, RD, CSO, LD Oncology Dietitian March 1, 2019
Dietary Risk Factors for Colorectal Cancer High red meat intake (>18oz/week) Processed meat intake Low fiber diet Alcohol consumption Overweight/obesity
Treatment Side Effects Radiation therapy diarrhea, bloating, gas, pelvic discomfort/pain, decreased appetite Chemotherapy diarrhea, nausea, mouth sores, decreased appetite, taste changes, cold sensitivity, low blood counts, peripheral neuropathy Surgery diarrhea, constipation, anastomotic leak, abdominal adhesions, paralytic ileus
After Treatment Where Do We Go From Here? Adjust to new bowel function When settled into new norm, adopt diet recommendations for cancer survivorship
Red / Processed Meats Red meats beef, pork, lamb Processed meats bacon, sausage, lunchmeat, pepperoni, bologna Cured with nitrates contain N-nitroso compounds Celery salt no nitrates or nitrites added lunchmeats Risk thought to be due to: heme iron content in red meat, high-fat content Grilling/cooking at high temps increases HCA and PAH formation Dose-response effects AICR/WCRF limit red meat to no more than 12-18oz per week and limit/avoid processed meat
Safe Grilling Methods Utilize antioxidant marinades Start cooking meat in the microwave then transfer to the grill to finish Choose lean meats Line grill with foil; poke holes for fat to drip Do not eat charred, black, or burned meats 7
Alcohol Mechanisms Unknown how alcohol consumption affects mortality with continued consumption after diagnosis Follow standard recommendations Two or more drinks daily increases risk One drink = 12oz beer, 5oz wine, 1.5oz 80-proof liquor
Weight Management Inadequate energy balance Increased weight, particularly with central adiposity, associated with increased risk Due to insulin resistance and increased IGF levels, inflammatory cytokine production
Dairy AICR/WCRF report probable reduction Proposed mechanisms: May be due to conjugated linoleic acid (CLA) presence Due to protective effect of calcium and possibly vitamin D Recommend non-fat or low-fat dairy
Calcium Evidence that intake <700-1000mg/day increases risk for CRC Food preferred over supplements Food Choice Serving Size Calcium Content (in mg) Milk 1 cup 300 Calcium-fortified oj ¾ cup (6oz) 260 Yogurt 1 cup 300 Cheese, cheddar 1 oz 204 Cottage cheese ½ cup 105 Cheese, Swiss 1 oz 272 Broccoli 1 cup, cooked 60 Almonds 1 oz 75 Canned salmon 3 oz 180 11
Fiber Increases stool bulk Fermented in the colon to produce short chain fatty acids Encourages gut motility, so carcinogens have less exposure to the colon/rectum Can bind and excrete potential carcinogens Found in: Whole grains, fruits, vegetables, beans, nuts, seeds (insoluble) Oats, beans, apples, citrus, barley, carrots (soluble)
Physical Activity Prospective observational studies indicate exercise after diagnosis decreases risk of colorectal-cancer specific and all-cause mortality Considered to be safe and feasible Recommendations: 150 minutes per week of aerobic activity Resistance training 2 days per week Minimize sedentary behavior 13
Probiotics / Prebiotics Probiotics healthy bacteria added to the gut via foods or supplements Bifidobacterium, Lactobacillus, Saccharomyces boulardii Yogurt, sourdough bread, kefir, sauerkraut, kombucha, miso May help regulate irregular stooling patterns May help reduce risk of C. diff recurrence Prebiotics food for probiotics Asparagus, bananas, apples, onions, garlic, leeks, barley, oats
Pulling This All Together Substitute chicken, turkey, fish, or plant-based proteins for red meats Limit or avoid processed meats Aim for at least 5-9 servings of fruits + veggies per day Consume alcohol in moderation Maintain a healthy weight Work toward a plant-based diet
Ideas for Adopting a Plant-Based Diet Start to incorporate plant-based meals in throughout the week Slowly work on building fruits/veggies in Think about how you can replace/reduce meats from favorite dishes Incorporate veggies into the meal rather than as side dishes Snack on dried fruits, nuts, trail mixes, yogurt with berries/nuts mixed in, whole grain crackers and bean dips Use avocadoes in place of mayo as spreads on sandwiches 16
Example of a Plant-Based Diet Breakfast oatmeal with banana, walnuts; glass of milk Snack 1 container of yogurt, ½ cup raspberries Lunch bowl of black bean soup, ½ tuna sandwich, apple, water Snack ½ cup of trail mix Dinner 5oz salmon, 1 cup broccoli, whole wheat dinner roll, 1 clementine, glass of milk
Use Insert > Header & Footer to change footers or date 2/22/2019 18