Diet, Exercise and Nutrition in Cancer Prevention and Survivorship Jessica Clague DeHart, PhD, MPH Visiting Professor, Department of Medical Oncology, City of Hope Assistant Professor, Claremont Graduate University September, 20, 2018
Nothing to disclose DISCLOSURE
Outline 1. Cancer Prevention Continuum 2. Why Exercise and Nutrition 3. Exercise, Physical Activity and Sitting Time 4. Nutrition and Diets 5. Future Directions
Cancer Prevention Continuum Disease Initiation Progression/Recurrence Retention of Quality of Life Healthy Stage I-III High-Risk Survivor Progression to Disease Recurrence/Comorbidities Retention of Quality of Life Progression/Comorbidities Retention of Quality of Life Metastatic
Remember Smoking?
Our New Public Health Threat
Energy Balance
Lack of Energy Balance Portions Are UP Activity Is DOWN We Are Headed Here
Obesity and Risk of Cancer
Obesity and Risk of Cancer
Obesity and Cancer Outcomes Cancer Recurrence Quality of Life Death Treatment Effectiveness Comorbidities Treatment-related Symptoms
Why Exercise and Nutrition?
Outline 1. Cancer Prevention Continuum 2. Why Exercise and Nutrition 3. Exercise, Physical Activity and Sitting Time 4. Nutrition and Diets 5. Future Directions
Physical Activity vs Exercise Physical Activity: any movement of the body that is carried out by the muscles and requires energy Exercise: a planned, structured, repetitive movement designed specifically to improve or maintain physical fitness
Moderate vs Vigorous Intensity Talk test Moderate: You can talk, but not sing, during the activity Vigorous: You will not be able to say more than a few words without pausing for a breath
Exercise, Physical Activity and Cancer Risk Exercise Physical Activity Sitting Time
Epidemiologic Evidence Risk of Breast Cancer by 20-40% Risk of Colon Cancer by at least 20% Risk of Endometrial Cancer by 20-30% Risk of Other Cancers https://dceg.cancer.gov/news-events/linkage-newsletter/2015-03/research-publications/physical-activity-cancer
Cancer Prevention Exercise Prescription? Dose? Duration? Type? Effect of Exercise on Cancer Biology Frequency?
Exercise, Physical Activity and Cancer Risk BIOLOGICAL MECHANISMS Hormonal pathways Inflammatory pathways Immune-related pathways Metabolic pathways Physiologic changes Inflammation Genetic predisposition Molecular changes Cell signaling alterations Microenvironment changes Epigenetic changes Omics My research areas: DNA repair Telomeres Metabolism RNA sequencing
Cancer Risk Recommendations Adults: Get at least 150 minutes of moderate intensity or 75 minutes of vigorous intensity activity each week (or a combination of these), preferably spread throughout the week and at least 10 minutes at a time. Children and teens: Get at least 1 hour of moderate or vigorous intensity activity each day, with vigorous activity on at least 3 days each week. Everyone: Limit sedentary behavior such as sitting, lying down, watching TV, and other forms of screen-based entertainment.
Exercise and Cancer Outcomes Cancer Recurrence Quality of Life Death Comorbidities Only 30% of cancer survivors are meeting physical activity recommendations Treatment Effectiveness Treatment-related Symptoms
Myth Busters Exercise is not safe during treatment Being physically active is highly recommended during treatment Patients shouldn t worry about exercising after being diagnosed with metastasis Decreases negative side effects and increases quality of life Exercise exacerbates symptoms of treatment Decreases fatigue, depression, anxiety, nausea, pain Patients should not continue their same level of activity Activity should be a consistent yet dynamic component care Patients cannot stop once they start exercising Breaks are okay flexibility based on tolerance Exercise doesn t make a difference after diagnoses or treatment Increases TX effectiveness and quality of life, decreases risk of recurrence, progression, mortality and morbidity
Current Research Telomere Length & Telomerase Inflammation DNA Damage DNA Repair RNA-Seq To identify and develop exercise interventions that not only elicit biological changes effective in reducing risk but also are feasible for the average person to implement and maintain
Current Research: CURVES Exercise Study (Control group) Post Intervention vs. Baseline No observable clustering of genes correlating to sample time point. (Exercise group) Post Intervention vs. Baseline 197 differentially expressed genes (DEGs) 57 genes down-regulated and 135 up-regulated 5 0 B re a s t C a n c e r S u rv iv o rs : S e d e n ta ry Po s tm e n o p a u s a l Es tro g e n - re c e p to r p o s itiv e ( ER + ) R a n d o m iz a tio n : 16 - w e e k C u rv e s TM e x e rc is e in te rv e n tio n g ro u p W a itlis te d c o n tro l g ro u p P re a n d Po s t In te rv e n tio n : B o d y m e a s u re m e n ts D N A Re p a ir In fla m m a tio n Te lo m e re s a n d te lo m e ra s e R N A - s e q Q u a lity o f life * * * In fla m m a t io n a n d Te lo m e ra s e A s s a y s a re c o rre la t in g w it h t h e R N A - s e q o b s e rv a t io n s Dr. Aditi Vyas, Postdoctoral Fellow
Current Research: CURVES Exercise Study Exercise vs. Control (Post Intervention) 287 differentially expressed genes 133 downregulated and 154 up-regulated in the exercise group compared to control group, postintervention. Reduced gene expression for genes involved in: Inflammatory response pathway Other Cancer-associated pathways Upstream regulator analysis based on target gene expression, showed the greatest association with: lower predicted LDL levels reduced TGFB-1, IL1B and betaestradiol signaling in the exercise vs control group * * * Fu n c t io n a l a s s a y s a re c o rre la t in g w it h o u r R N A - s e q re s u lt s Dr. Aditi Vyas, Postdoctoral Fellow
Current Research: Comorbidities & Quality of Life P ro g ra m ru n s 3 tim e s p e r y e a r 13 - w e e ks lo n g 3 c o h o rts ( M e n a n d W o m e n ) Re q u ire d to a tte n d 2 s e s s io n s / wk En c o u ra g e d to a tte n d m o re o fte n Exe rc is e a n d w e lln e s s Ev e ry th in g is fre e o f c h a rg e Average Significant Percent Changes
Cancer Outcome Recommendations During Treatment Stay as active as possible Will ebb and flow Take your time Consider side-effects and timing Set attainable goals Precautions to prevent falls and infections Post-surgery precautions Aerobic and strength training Try for 30 minutes each day Consider physical and/occupational therapy Post-Treatment Stay as active as possible Precautions to prevent falls Post-surgery precautions AEROBIC:150 minutes (2½ hours) of moderate activity OR 75 minutes (1¼ hours) of vigorous activity per week STRENGTH: 2 days per week At least 10 minutes at a time Spread out throughout the week Increase activity
Million Dollar Questions & Take Away 1. Dose? 2. Translation: Why aren t people doing it? Get Up & Move!
Outline 1. Cancer Prevention Continuum 2. Why Exercise and Nutrition 3. Exercise, Physical Activity and Sitting Time 4. Nutrition and Diets 5. Future Directions
Nutrition vs Diet Nutrition: refers to the act or process of nourishing or being nourished getting appropriate amount of nutrients including protein, fat, carbohydrates, vitamins, minerals and water to survive Diet: refers to the food and drinks one regularly consumes Dieting: refers to restricting oneself to a diet comprised of specific amounts and/or special types of food to lose weight
Popular Diets How many did you come up with?
Nutrition and Cancer Risk A n y n u trit io n o r d ie t p ro g ra m is s a fe a n d e ffe c tiv e a t lo w e rin g c a n c e r ris k a n d re c u rre n c e a s lo n g a s it re s u lts in w e ig h t lo s s FA LS E C o n s u m e a n u tritio u s d ie t, w ith a n e m p h a s is o n p la n t fo o d s : C h o o s e fo o d s a n d b e v e ra g e s in a m o u n t s t h a t h e lp a c h ie v e a n d m a in t a in a h e a lth y w e ig h t Lim it c o n s u m p t io n o f p ro c e s s e d m e a t s a n d re d m e a t s Ea t a t le a s t 2 ½ c u p s o f v e g e t a b le s a n d fru it s e a c h d a y C h o o s e w h o le g ra in s in s te a d o f re fin e d - g ra in p ro d u c t s M O D ERAT IO N!
Nutrition and Cancer Outcomes C o n s u m e a n u tritio u s d ie t, w ith a n e m p h a s is o n p la n t fo o d s : C h o o s e fo o d s a n d b e v e ra g e s in a m o u n t s t h a t h e lp a c h ie v e a n d m a in t a in a h e a lth y w e ig h t Lim it c o n s u m p t io n o f p ro c e s s e d m e a t s a n d re d m e a t s Ea t a t le a s t 2 ½ c u p s o f v e g e t a b le s a n d fru it s e a c h d a y C h o o s e w h o le g ra in s in s te a d o f re fin e d - g ra in p ro d u c t s S p e c ia l d ie ts : V e g e ta ria n o r v e g a n : N o s u b s t a n t ia l e v id e n c e s u g g e s t in g a b e n e fit to a d o p t in g a v e g e t a ria n o r v e g a n d ie t u p o n d ia g n o s is N o e v id e n c e to s h o w t h a t o n e s h o u ld s to p a v e g e t a ria n o r v e g a n d ie t M a c ro b io t ic : N o s u b s t a n t ia l e v id e n c e Ke to g e n ic : S t u d ie s in g lio b la s to m a o n g o in g W e ig h t g a in a n d in a b ilit y t o lo s e w e ig h t
Current Research in Nutrition and Cancer A pilot intervention trial among early-stage postmenopausal breast cancer survivors assessing the effects of a 6-month data-driven and personalized nutritional intervention. Diet was based on the Pancreatic Nutrition Program (Candice Rosen, RN) foods and food combinations are tested and personalized based on the individual s glucose response, with the goal of keeping glucose levels between 70-100 mg/dl. Continuous Glucose Monitor + Personalized Diet Daily Food Log PIs: Drs. Jessica Clague DeHart and Joanne Mortimer; Funded by Circle 1500
Current Research in Nutrition and Cancer A pilot intervention trial among early-stage postmenopausal breast cancer survivors assessing the effects of a 6-month data-driven and personalized nutritional intervention. Diet was based on the Pancreatic Nutrition Program (Candice Rosen, RN) foods and food combinations are tested and personalized based on the individual s glucose response, with the goal of keeping glucose levels between 70-100 mg/dl. Primary Endpoint 10% body-weight loss from baseline to 24 weeks Secondary Endpoints Body measurements (baseline, 12, and 24 weeks) Metabolic markers Physical fitness Quality of life Adverse events Compliance PIs: Drs. Jessica Clague DeHart and Joanne Mortimer; Funded by Circle 1500
Current Research in Nutrition and Cancer Primary Aims: Two women withdrew from the study prior to 12-weeks and one developed a recurrence. Therefore, 18 women were considered evaluable at 12-weeks. Twelve women returned at 24- weeks and were considered evaluable at 24-weeks. Of the 12 evaluable women at 24 weeks: 3 women lost at least 10% 7women lost 5-10% 2 women lost <5% PIs: Drs. Jessica Clague DeHart and Joanne Mortimer; Funded by Circle 1500
Current Research in Nutrition and Cancer Secondary Aims: Body weight, BMI, and waist circumference significantly decreased from baseline to 12 weeks Body weight, BMI, body fat % continued to decrease between 12 and 24 weeks Triglycerides, HDL, LDL, total cholesterol decreased from baseline to 12 weeks Insulin significantly decreased between baseline and 24 weeks, as well as insulin resistance measured by HOMA-IR PIs: Drs. Jessica Clague DeHart and Joanne Mortimer; Funded by Circle 1500
Alcohol Drinking is okay BUT how much is too much??? If you drink alcohol, limit your consumption No more than 1 drink per day for women No more than 2 drinks per day for men A drink = Wine or beer or hard liquor Anything with alcohol in it One drink = 12 ounces of run of the mill beer (5% alcohol) 5 ounces of wine (12% alcohol) 1.5 ounces of 80 proof liquor (40% alcohol) Be aware of over pouring If you do not drink do not start
Alcohol IPA: 9% alcohol 12 ounces = 1.8 drinks Double IPA: 14% alcohol 12 ounces = 2.8 drinks https://rethinking DRINKING NIAAA WEBSITE Typical Margarita = 1.8 drinks Cadillac Margarita = 2.7 drinks
Million Dollar Questions and Take Home 1. How much? 2. What kind? 3. Translation: Why aren t people doing it???? Moderation & Mindfulness
Remember Smoking? 100 s of studies & Time for Translation!
Future Comprehensive Wellness Integrative programs incorporating all aspects of wellness Social behavior theories Special populations with specific needs Prehab Clinical- and community-based Long term survivorship Education I talk to all my patients they won t do it if we don t say it Dedicated Wellness Navigation Dr. Jeffrey Weitzel
Thank You M&Ms Movement, Moderation & Mindfulness
Thank You City of Hope Population Sciences Medical Oncology Breast Surgeons Integrative Genomics Analytical Pharmacology Core Clinical Cancer Genetics UCSF Curves, Zumba, Crossfit, Garmin The Claremont Club Abbott Patients and Families Funders: Kindness Grant, City of Hope Women s Cancers Program, City of Hope Circle 1500, City of Hope