Colleen Gill, MS RD CSO University of Colorado Cancer Center

colleen.gill@uchealth.org

720-848-0300 11/2/13

STRESS = Novel Unexpected Threat to self or ego Sense of lack of control

Keep diet empowering, Not a new stress

The Big Picture = Plate Demystify controversies www.aicr.org

Two Goals at a time 1 diet, 1 exercise

Advice from friends and family Out of concern, but stressful

Thank them, then talk with your team Concrete ideas keep friends off the internet

Walks, laundry, meals (with recipes) mealtrain.com; lotsofhelpinghands.com

Interpreting Research

We are all eating “Shades of gray”

We are all unique! Genetics matters

Human studies Long timelines, expensive

No licensure in Colorado RD/RDN = BS/MS + internship

Check training/experience with the disease/condition

Internet and Magazines?

Free appointments at UCCC 720-848-0300

Symptom management

Survivorship, supplements Overviews: Brain, Breast, Prostate, Pancreatic,

Lung, Colon, Ovarian, Kidney

Classes: 720-848-0316

Watch Your Weight,

Exercise Regularly,

Eat a Healthy Diet

Rates higher in Westernized countries; and climb in those that adopt our dietary patterns

Migrants moving from low to high risk areas assume the host country rates within one to two generations

Increased Risk/Limit Diets high in calcium Processed meats Milk and dairy products

Decreased Risk/Include Foods containing lycopene or selenium

(Selenium*) Legumes, including soy Foods containing vitamin E (E*) *no longer supported by SELECT research;

www.aicr.org

Increased Risk/Limit

Foods with iron, animal fat, sugar

Red meat, processed meats, alcohol, cheese

Abdominal fat, body fat

Decreased Risk/Include

Fiber, garlic, fruits/vegetables, fish, milk

Foods with folate, selenium, vitamin D

Calcium, selenium

Physical Activity www.aicr.org

Breast, CRC, endometrial, esophagus, kidney, liver, pancreas, GB, ovarian, NHL, MM, aggressive PC

2 – 3.6 times at BMI > 40

1.5 times at BMI’s of 27 - 30

More advanced disease, recurrence, death Obesity 14% cancer deaths M; 20% of F

Waist Circumference = Abdominal fat

Increased inflammatory messages

Insulin resistance

Estrogen levels increase with number of fat cells

Slow down! After ~ 4 - 5 bites, taste declines

Study: 646 calories/9 minutes; 579 in 29 minutes

Listen to your body (and journal) Keep hunger on a scale between 3 – 7 Small meals/snacks with protein controls appetite

Avoid fluids with calories! Starbucks? Adults don’t compensate

Eat out less often 2+ times a week 10# gain www.tcme.org

Exercise 30 minutes/day 20–50% ↓ heart disease, osteoporosis, stroke, cancer,

diabetes, kidney disease, depression

In Treatment: Eliminated weight gain 2 kg wt loss, 1.3% decrease in body fat Controls with 2.2 kg gain and 1.8% increase in fat

Just Walk! 1 mile/2000 steps/100 calories 18% ↓ Br Ca with < 2.5 hours/week walking

JAMA, 290: 1331 – 36; 2003

3 – 5 hours/week reduced recurrence by over 1/3 WHEL: 3 hr exercise + f/v ↓ recurrence 50%

Required both; worked in obese/normal weight!

Controls weight

↓ blood pressure,

stress, Insulin resistance, fatigue, cancer

Increases HDL, ↓ LDL

© 2010 Sports Cardiovascular and Wellness Nutrition (SCAN)

Pedometers offer great feedback! (When used)

Fitbit www.digiwalker.com

Break it up! •Start slow 5” •10 – 20 ” bouts •F.I.T.T.

Filling your 9” plate ¼ Carbohydrates

Whole-grain breads, cereals, rice, potatoes, pasta

¼ Lean Protein Low fat milk, lean fish/poultry/red meat Eggs; Nuts

½ vegetables, 1 fist size fruit, beans

Light on

(Saturated/trans) fat

Sugar, salt and alcohol

Fluids Dairy Organic?

Fruits/vegetables Meats…

Fats Omega 6 Flax Oil

Carbs Sugar Proteins

Red Meat Processed Meat Soy

Probable/suggestive benefits

Primarily those in the GI tract

Head/neck, esophageal, lung, stomach, pancreatic, colorectal, liver, prostate

Benefits of adding plant based foods

was not equal to that

gained from cutting the

amount of meat

Is fresh best? Try 50/50 Different absorption from fresh and cooked

Organic? Risk: increased cost buying less

Stressed plants make more phytochemicals Limits impact to wildlife, farm workers, soil/water Wash well to limit pesticides, needn’t avoid non-organic

www.ewg.org

Include a range of colors, herbs count too!

Alkaline Diet = Plant Based/Plate Model The wrong rationale, but the right result?

http://www.denvernaturopathic.com/alkalineash.htm

• The fastest growing sector in the food marketplace, but…organic junk food is still junk food

• Beware of the “health halo” effect

• Do pesticides cause cancer? Yes and no

• Definitely with large exposures: farm workers

• Other reasons to go organic?

• Antibiotic resistance from use in meat industry

• Farming practices that are environmentally friendly

No matter how you eat your plant foods, more is better,

and conventional provides benefit Wan-Chen Lee J. Experimental Biology April 2011, Washington, D.C. Food, Nutrition, Physical Activity and the Prevention of Cancer: a Global Perspective Bhat AR, et al. Indian J Occup Environ Med. 2010;14:78-86 Cockburn M, et al. Am J Epidemiol. Mar 2011; Published online before print.

Lower fat diet was associated with lower blood levels of inflammatory markers linked to cancer progression

? Due to low fat or associated weight loss Limit Saturated Fat

Fat itself, or red meat/ high-fat dairy? Tripled PC mortality: >13% of cal vs < 10.8% Saturated fat = link to PC progression Cholesterol levels associated with PC risk Increases bile acids toxic to colon

Substitute Monounsaturated Fats

Cardiac benefits clear, and important 3x as many men died of CVD than PC

While enrolled in PC studies

Finding: 9% fewer breast cancers

Borderline significant

Compliance differed, generally poor WHI: 37% fat 29% ( 22%)

WINS: 34% 22% ( 36% )

Compliant WHI participants = WINS 22% lower risk ( = WINS at 24% less)

JAMA 295 (6): 629, 2006

Hay, JADA 109 (4): 688; 2009

Meat Bake, broil, or poach, limit frying/ charbroiling

Choose fish, poultry, or beans more often than beef, pork, and lamb (lean cuts).

Limit red meat to < 18 oz/week; NO processed

Grill safely; avoid well-done meat

Eggs, limit to 7 yolks/week Add 1 egg white, per egg yolk

Dairy and cancer risk

• Breast cancer: No clear effect on risk

• Colon cancer: Probably decreases risk

• Prostate cancer: Possibly increases risk (calcium related)

• Ovarian Cancer: Possibly increases risk, but only if you are a “slow galactose metabolizer”

Benefits

• Yogurt, source of probiotics

• Low glycemic index carb, good protein source

• Provides the bulk of calcium in Americans’ diet

• CLA, conjugated linoleic acid may protect Select low fat cheese, yogurt, BHT free milk

Dong JY, et al. Breast Cancer Res Treat. 2011;127:23-31. Huncharek M, et al. Nutr Cancer. 2009;61:47-69. Newmark HL et al. Nutr Cancer. 2010;62:297-99. Larsson SC, et al. Int J Cancer. 2006;118:431-41.

Example: Dairy & Risk of Breast Cancer

Decreased Risk

Increased Risk

RR = 1.0 (null value)

Tumors with 0-6 hormones support growth and metastases

Replace vegetable oils with olive and canola oil Olive oil also decreases production of bile acids (toxic

to colon)

Limit processed and convenience food Consider balsalmic oil/vinegar for salad dressings Include more vegetarian meals

Food supply has shifted Omega 6:3 ratio Goal: Move from ~20x Omega 6 to < 4x Include more Omega 3

O-3 Eggs, fatty fish, supplements

Avoid alpha-linolenic acid in PC Studies showed increased PC risk ***

Flax spoils easily Grind, refrigerate/freeze

Ground seeds can be used in baking

Oil is unstable at the high temperatures for frying

Flax seed maximum: 3 – 4 T/day

Compounds in uncooked flax are toxic in large amts

Include 4 – 8 ounces of water/T (fiber)

Flax can bind meds; separate thyroid, bisphosphonates

Lowered PSA levels, testosterone, cholesterol, proliferation rates

Increased Sex Hormone Binding Globulin, limited cell division and Her2/neu protein in breast cancer

Structure, enzymes, stabilizing blood sugars

Immune function/healing

Whey (Dairy protein)

Antiviral, antifungal, antibacterial

Damages pathogenic bacteria

Limits “sticking” to GI wall

Glutamine source glutathione, intracellular

antioxidant that protects normal cells

Increases immunoglobulin levels

Stimulates the immune system

Inhibits growth signals, promotes cell death

Limits angiogenesis

cell differentiation; less cells at risk

Especially during periods of growth (10 -15yo)

11 g soy protein in teens 50% ↓ Br Ca

GUTS (Growing Up Today Study); NHS kids

Inhibits aromatase (synergistic with AI)

Antioxidant

Blocks activity of enzymes converting androstenedione to testosterone

Han H, et al. Nutr Cancer. 2010;62:641-47.

Yu X, et al. Med Oncol. Dec 2010; published online before print. Barnes S. Lymphat Res Biol. 2010;8:89-98.

3 recent large-scale, population studies

Different ethnic groups (two US, one Chinese) and varying levels/type of soy food consumption

All 3 - no adverse effect, potentially protective

Average Asian isoflavone levels, ~ 35 - 40 mg (max 100), with soy food

0.2 – 0.4 mg/g of soy food, 3 mg/g soy protein

40 – 50 mg = ½ cup beans/tofu/tempeh; ½ - 1 c soy drinks; www.soyfoods.org

Soy is food and should be treated like food

Enjoy soy if you like it, avoid if you don’t Caan BJ, et al. Cancer Epidemiol Biomarkers Prev. Feb 2011

Cancer cells like sugar as “fuel” Basis of PET scans to detect tumor activity Tumors can and will make their own glucose for fuel

Stimulates growth directly and through IGF1 Increases inflammatory hormones Suppresses immune function, limits normal cell death

Real Concern

“Quick Carbs” or large volumes

Higher blood sugars

More Insulin ( if IR)

The Right Amounts ¼ carbohydrate sources

bread, pasta, potatoes, rice, cereals ¼ protein (and fat) sources ~ ½ F/V fruit, vegetables, beans

The Right Mix No Naked Carbs Eat sweets as part of a mixed meal With protein/fat, fiber to slow stomach emptying; rescue

With The Right Type Limit processed foods, high glycemic index options

With Sleep, Exercise, Healthy Weight!

29

16 oz rib eye steak 12 oz baked potato with: 2 T of butter 4 T of sour cream ½ c squash with butter

6 oz grilled chicken 1½ c greens ½ c carrots & green beans ½ c brown rice

1355 vs. 475

© 2010 Sports Cardiovascular and Wellness Nutrition (SCAN)

Omega 3/fish oil for inflammation/cardiac

Multivitamin, Maybe? Adequacy vs. Excess

Pick lowest dose, business side is making up the difference

Folic acid at 400 mcg/100%

Government fortification adequacy

Concern that excess may promote cancer/recurrence

Beta carotene: Studies in smokers stopped early; limit to 100%

Selenium: SELECT trial showed no benefit

Average intakes now keep levels sufficient

Iron: only if menstruating, or documented iron deficiency

D (1000+ IU); levels ~ 40 ng/ml, <70 Genetics v. environment change: computers, sunscreen 1000+ maintains, but may not replete 1/3; Re-check

Normal levels limited risk: 85% vs deficient

Calcium: 12-1500; Diet: 300/dairy; oj, cereal, Tums

Binds bile salts, limits colon cancer (PC patients higher risk)

Excess down-regulates D3 formation; higher PC growth

With Magnesium: 250 mg + (helps constipation too)

Bone study in elderly ↓ cancers

3% compared to 8% over 4 years

Diggers > Fillers

Blocks Bone Density Supports Density

Alcohol; limit to 1/day Calcium; 1,500 mg/total!

Caffeine; limit to 2 c/day Vit D; 1000+ IU/day*

Smoking; stop Protein, Vitamins C, K

Sodium; processed foods Potassium, Magnesium

Excess Vitamin A Sunlight

Weight bearing exercise*

Eat Food

Not too much

Mostly plants

Michael Pollan

Questions?

Are you leaving less stressed?