Nutrition for Cancer Survivors Gretchen Gruender MS, RD, CSO Seattle Cancer Care Alliance
First we eat, then we do everything else. M.F.K. Fischer
On the Menu Review of research Newer studies Food as chemoprevention Making changes The food brain connection Mindful eating
Nutritional considerations after treatment: Changes to body composition / weight changes Loss of bone density / Osteoporosis Diabetes Hyperlipidemia Congestive heart failure Changes in bowel function Taste and smell changes Hot flashes Neuropathies Metabolic syndrome
Cancers of the Colon and Rectum AICR* update May 2011 Decrease Risk Increase Risk Convincing Physical Activity Red / processed meat Alcoholic drinks (men) Body / abdominal fatness Probable Dietary fiber Garlic Milk Calcium Limiting / Suggestive Fruit and non starchy vegetables Diet sources of selenium, vitamin D, and folate Fish Selenium Alcoholic drinks (women) Foods containing iron, animal fats, and sugar Cheese *American Institute for Cancer Research
Colon Cancer Recent study with Folate Indicates high levels of folate from supplementation and fortification are not associated with higher risk of colorectal cancer.» Stevens, VL. Gastroenterology, 2011 From the Latin word folium (foliage) Food sources rich in folate: Legumes, nuts, broccoli, dark leafy green vegetables, asparagus and peanuts
Prostate Cancer Newer study on dietary zinc Higher levels of dietary zinc after diagnosis was associated with a lower risk of death from prostate cancer.» Epstein, MM. Am J Clin Nutr, 2011 Food sources rich in Zinc: Fresh oysters, ginger, lamb, nuts, legumes, and whole grains
Prostate Cancer Newer study around calcium Two fold increased risk associated with a higher intake of milk Decreased risk was seen with higher intake of legumes (dried beans, peas, lentils), nuts, shellfish/finfish and α tocopherol (vitamin E) Not conclusive evidence» Raimondi, S, The Prostate, 70;1054 1065, 2010
Prostate Cancer Plant sources of calcium Broccoli Dark leafy greens Almonds Tofu Bok choy Supplement vs. Diet??
Prostate Cancer New Calcium recommendations from IOM* Estimated Avg. Requirement (mg/day) RDA (mg/day) *Institute of Medicine Upper Level Intake (mg/day) 19 30 years 800 1,000 2,500 31 50 years 800 1,000 2,500 51 70 yrs (males) 800 1,000 2,000 51 70 yrs (female) 1,000 1,200 2,000 >70 years 1,000 1,200 2,000
Prostate Cancer Prostate cancer intensive nutrition & lifestyle change study: Almost vegan diet Very low meat intake High fruit and vegetable intake Reduced fat Lifestyle interventions: yoga, exercise, meditation and support groups After one year, participants had no need for conventional therapies Lower PSA s Greater quality of life Less in vitro prostate cancer cell growth» Dean Ornish, 2005
Breast Cancer Newer study focusing on quality of diet and physical activity Women with better quality diets had: 60% reduced risk of death from any cause 88% reduced risk of death from breast cancer Women with better quality diets and physical activity had: 89% reduced risk of death from any cause 91% reduced risk of death from breast cancer» George, S, Cancer Causes Control, 2010
Breast Cancer Recent study focusing on weight Breast cancer survivors with a BMI >/= 30 kg/m 2 and > 10 years out from treatment: 46% increased risk of developing distant metastases after 10 years 38% increased risk of dying as a result of breast cancer after 30 years» Ewertz, M. J. Clin Onc; 2010
Additional Study RENEW (Reach out to Enhance Wellness in Older Cancer Survivors) Reduced rate of functional decline with survivors who ate more fruit and vegetables, ate less saturated fats and lost more weight» Morey, JAMA 301(18); 1883 1891, 2009
Vitamin D the connection to cancer
Vitamin D HSCT survivors and vitamin D status» Robien, K., Bone Marrow Transplant, 2011 A loss of more than 15% body weight boosts vitamin D levels in overweight women.» McTiernan, A., 2011 Check your vitamin D level before supplementing. 25 hydroxy vitamin D between 30 50 ng/ml
Vitamin D New Vitamin D recommendations from IOM * Estimated Avg. Requirement (IU/day) RDA (IU/day) *Institute of Medicine Upper Level Intake (IU/day) 19 30 years 400 600 4,000 31 50 years 400 600 4,000 51 70 yrs (males) 400 600 4,000 51 70 yrs (female) 400 600 4,000 >70 years 400 800 4,000
Summary of Studies Eat a majority of plant foods The nutrients we receive from our food are essential to our health. Try to get your nutrients primarily from whole food sources. Use supplementation sparingly more is not always better. Our needs for specific nutrients may be more individualized.
Studies Lacking There are many cancer types that are not covered in this review due to lack of available studies. Reasons include: no patent on diets, less financial benefit than for drugs diet intervention studies are difficult to execute and are costly food practices are highly variable and are hard to measure accurately in a study
Nutrition for Wellness: The Basics Plant based diet Variety of colorful vegetables and fruit Legumes (beans/lentils), nuts, seeds, whole grains Include herbs and spices Limit processed and refined foods Less than 5 ingredients on a label Limit enriched or enhanced foods Lower fat diet Focus on healthy fat sources nuts, avocados, seeds/seed oils (sesame oil, grapeseed oil), olive oil, fish
Food as Chemoprevention Green Tea Curcumin
2.7 million deaths are attributable to low fruit and vegetable intake World Health Organization
Percentage of US adults who consumed fruit 2 or more times a day Percentage of US adults who consumed vegetables 3 or more times per day
Cancer Survivors Adherence to Lifestyle Behavior Recommendations and Associations With Health Related Quality of Life Abbreviation: 5 A Day, consumed five servings of fruits and vegetables each day. Results From the American Cancer Society's SCS II» Blanchard, CM. J Clin Onc, 26; 2198 2204, 2008 Cancer Group Physical Activity (%) 5 A Day (%) Smoking (%) Breast 37.1 18.2 88.1 Prostate 43.2 15.6 91.6 Colorectal 35.0 15.9 91.3 Bladder 36.0 16.3 82.6 Uterine 29.6 19.1 91.1 Skin Melanoma 47.3 14.8 89.0
I know what to do, I just don t do it! What are some barriers? Too little time Too little sleep Too much effort Too much food Too much eating out Too much stress Too much anxiety
What influences brain signals?
The Food Brain Connection
Making Changes Changing your cues to food Address stress in your life Know your triggers Find activities that make you happy!
If you go on a diet, you re likely to go off a diet
Mindfulness Physical Hunger Emotional Hunger Sensory Hunger Builds gradually Develops suddenly Eyes (sight of food) Strikes below the neck Strikes above the neck Nose (smell of food) Occurs several hours after a meal Goes away when full Eating leads to feeling of satisfaction Unrelated to time Persists despite fullness Eating leads to feeling of guilt and shame Tongue (taste of food) Touch (mouth s feel of food) Sound (noise of eating, noise present)
Mindful Eating You are in the moment You are eating a food that is pleasing to your senses (taste, smell, flavor, touch, sound, sight) You are aware of your physical hunger and feeling of fullness (satiety) these are cues that guide your decision to begin eating and to stop eating You are NOT being judgmental
What is NOT Mindful Eating when you eat because of feelings above the neck (emotions sad, happy, frustrated, bored, anxious, excited ) if you eat when you are not hungry if you eat even though you feel full (satiated) when you judge your eating this is often associated with shame or guilt
Resources AICR expert report www.dietandcancerreport.org www.whfoods.com www.365daysofkale.com www.cancerlifeline.org The Cancer Fighting Kitchen Rebecca Katz
Let your food be medicine and your medicine be food. Hippocrates