Fighting Cancer with Nutrition Kalli Castille, MS, RD, LD Director of Nutritional Support & Culinary Cancer Treatment Centers of America®

Nutrition & Prevention

AICR Guidelines for Cancer Prevention Be as lean as possible without becoming underweight. Be physically active for at least 30 minutes every day. Avoid sugary drinks. Limit consumption of energy-dense foods. Eat more of a variety of vegetables, fruits, whole grains and legumes such as beans. Limit consumption of red meats (such as beef, pork and lamb) and avoid processed meats. If consumed at all, limit alcoholic drinks to 2 for men and 1 for women a day. Limit consumption of salty foods & foods processed with sodium. Don't rely on supplements to protect against cancer.

Healthy Weight Be as lean as possible without being underweight.

Healthy Weight Why does weight matter? Fat (especially abdominal fat) acts as a hormone pump Strong link to colon, pancreas and endometrial cancer, as well as breast cancer (in postmenopausal women). Risk factor for other health issues (diabetes, heart disease, etc) AICR: maintaining a health wt is one of the most important things you can do to reduce your risk of cancer Many health benefits from maintaining a health wt: decrease cancer risk, chronic ds risk (type 2 DM and heart ds) Where you store fat can affect cancer risk: excess fat around our waist acts as hormone pump releasing estrogen into the blood stream as well as raising levels of other hormones in body; stronly linked to colon, pancreatic and endometrial (lining of uterus) as well as breast cancer Source: American Institute for Cancer Research, Second Expert Report, 2007

Physical Activity Be physically active for at least 30 minutes each day.

Physical Activity ADD SUBTRACT REPLACE Three Strategies for Lifestyle Change ADD SUBTRACT REPLACE

Physical Activity ADD Add 30 minutes per day (150 minutes per week) Do something you love! Try tying the activity to something you already have a habit of doing. Phone a friend SET A GOAL… (Try it right now!!) Be specific! What days, for how long, what activity, where, with whom. Is it attainable? Do you have a plan B? (The weather is not always your friend!) ADD

Physical Activity SUBTRACT Subtract TV time from your weekly routine. More likely to eat mindlessly More likely to eat undesirable foods Limit sedentary activities If you can’t peel yourself away, try these tips: Get out of the chair at each commercial break Do some simple exercises during the show (sit-ups, push-ups) Set up a new household rule: only eat at the table! If you want a snack, the TV must be OFF. SUBTRACT

Physical Activity REPLACE Once you get moving, kick it up a notch! Replace your usual moderate-level activity with a vigorous activity twice a week Use the talk test Heart rate: if you want to be more precise Remember, every little bit counts, and ANY activity is better than none. Don’t have 30 minutes to spare? Break it up into two 15 minute sessions, or three 10 minute sessions. REPLACE

Energy Density Avoid sugary drinks. Limit consumption of energy-dense foods.

Carbohydrates Simple vs Complex Carbohydrates Simple carbs: Refined flour, cookies, pastries, white rice, sweeteners, soft drinks, etc High intake of soft drinks and refined carbohydrates linked to pancreatic cancer Empty calories, may promote weight gain. Choose complex carbohydrates more frequently: whole grains, fruits/vegetables, beans, etc. Drink water or unsweetened beverages. Simple CHO: Avoid sugary drinks helps avoid wt gain People tend to drink calories but it does not make us feel full and high in empty calories Sources: American Institute for Cancer Research, 2007 Larsson,S, Bergkvist, L & Wolk, A (2006). Consumption of sugar and sugar-sweetened foods and the risk of pancreatic cancer in a prospective study. American Journal of Clinical Nutrition, 84, 1171-1176.

Guess which side has more calories Energy Density Guess which side has more calories White Refined Products Photos: Dr. Barbara Rolls, Penn State University

Fats Unsaturated Fats (the “good”) Saturated Fats (the “bad”) Liquid at room temperature Plant sources Saturated Fats (the “bad”) Solid at room temperature Animal Sources (mostly) Linked to cancer, heart disease Limited quantity Trans Fats (“the “ugly”) “Hydrogenated Fats” Self stable and frozen products Avoid entirely

Fats (cont’d) Omega-3 (anti-inflammatory) Omega-6 Fish (fatty, cold-water) Walnuts Canola Oil Fortified Foods Flaxseed Omega-6 Fried Foods Animal Meats Grains May benefit from changing ratio of Omega-3 to Omega-6 by increasing Omega-3’s.

Plant Foods Eat more of a variety of vegetables, fruits, whole grains and legumes (such as beans).

Prevention & Diet Move Fruits & Vegetables to the Center of the Plate Goal: Five to Nine Servings a Day Standard serving: ½ cup Prevent at least 20% of all cancers Fiber Don’t count on juice! Vitamins, Minerals, Phytochemicals Primary source of the cancer-preventative properties of fruits and vegetables At least 2/3rds of plate with vegetables, fruits, whole grains, and beans Protects against many cancers including: mouth, larnyx, esophagus, stomach, lung, pancreas, and prostate One reason to increase proportion of vegetables, fruits, and whole grains and beans on your plate is to help reduce risk of cancer and other chronic diseases Second reason is substituting plant based foods for foods rich in fat will help manage your weight Most plant foods contain a lot of fiber and water. They fill you up and make you feel satisfied. They are also low in calories. So when you’ve stopped eating, you’ve consumed fewer calories than if you had eaten fatty foods. So makes your stomach feel full on fewer calories. Source: American Institute for Cancer Research, Second Expert Report, 2007

Phytochemicals Naturally occurring chemicals found in fruits, vegetables, beans, herbs, spices and whole grains Examples: Garlic Flax Hot red peppers Grapes Green tea (polyphenols), tomato (lycopene), ginger, cinnamon, turmeric or curry (curcumin)

Animal food Limit consumption of red meats (such as beef, pork, and lamb) and avoid processed meats.

Animal Food Protein Limit animal sources of protein (meats and dairy) Red Meat: lean cuts & limit 2.5 oz daily; 18 oz per week Avoid processed meats Choose more: Nuts and seeds Beans and legumes Soy Red meats: beef, pork, lamb Diets high in red meats increase risk of colon cancer Heme iron, compound that gives red meat is color, has been shown to damage the lining of the colon When meat is preserved by smoking, curing, or salting, or by the addition of preservatives, cancer causing agents (carcinogens) can be formed. These substances can damage cells in the body, leading to the development of cancer No specific limits set on poultry, fish, and game; keep portions small enough you have room for an abundance of fruits, vegetables, whole grains, and beans Most plant foods contain a lot of fiber and water. They fill you up and make you feel satisfied. They are also low in calories. So when you’ve stopped eating, you’ve consumed fewer calories than if you had eaten fatty foods. So makes your stomach feel full on fewer calories. Source: American Institute for Cancer Research, Second Expert Report, 2007

New American Plate Reverse the traditional American Plate and think of meat as a side dish or condiment rather than the main ingredient Example: prepare your favorite store bought brown rice or grain mix and top with steamed green beans, carrots, yellow squash, and an ounce or two of cooked chicken. Source: American Institute for Cancer Research, Second Expert Report, 2007

Alcohol If consumed at all, limit alcoholic drinks to 2 for men and 1 for women a day.

Cancer & Alcohol Drink alcohol only in moderation, if at all Can cause cancer Mouth, esophageal, laryngeal, pharyngeal, breast, and liver cancers 75-80% of oral cancers frequently used alcohol Men: 2 drinks a day; Females: 1 drink per day) More alcohol = Higher risk Higher risk if use tobacco Empty calories Increase appetite Alcohol is also the primary cause of liver cancer; increase risk of pharynx, larynx, esophagus, colorectal, and breast cancer Death from liver cancer are higher among heavy alcohol users than those that do not drink By altering the livers ability to metabolize some carcinogenic substances into harmless compounds or to disable certain existing carcinogens, alcohols effects may influence not only liver cancer but other cancers as well. May also directly damage DNA increasing risk of cancer Particularly harmful when combined with smoking Source: American Cancer Society, 2007

Sodium Limit consumption of salty foods and foods processed with salt (sodium).

Sodium Select foods low in fat and in salt Limit processed foods Linked to most cancers Goal: less than 2.4 g (about a teaspoon) Caution: Don’t rely on taste! Table salt = sodium chloride Taste desensitization Daily intake should be less than 2400 milligrams Salt and salt preserved foods probably increase the chance of developing stomach cancer One way may cause stomach cancer is high salt can damage the lining of the stomach Most of the salt in our diets comes from processed foods; we are not always aware they have salt because they may not taste salty so make sure to check the sodium content on the Nutrition Facts label Watch out for breakfast cereals, bread, frozen meals, pizza, and chips; check sodium content of canned foods such as soups and sauces and avoid processed meats Even sweet foods like cookies contain high levels of salt Check food labels; long list of ingredients not desirable

Supplements Don’t rely on supplements to protect against cancer. Supplements do have a place (ex: vitamin deficiency, inadequate intake, etc) Problem: They are often used indiscriminately Get an expert opinion! (Hint: Registered Dietitians) Bottom line: Food comes first! There is absolutely NO substitute for a healthy diet!

Lymphoma Survival  Quercetin- a flavanoid found in dark leafy greens, apple skins, onions, tea, and berries. A study showed it may help inhibit lymphocyte proliferation by blocking an event that stimulates it.

Lymphoma Survival (Cont’d) Resveratrol- has been shown in research in combination with treatment may help induce apoptosis(cell death) in lymphoma and myeloma cell lines.

Lymphoma Survival (Cont’d) Genistein- an isoflavone found in soy may help sensitize diffuse large cell B-Lymphoma to CHOP chemotherapy.

Lymphoma Survival (Cont’d) Garlic- A sulfur rich compound purified from garlic may help induce apoptosis (cell death) in Hodgkin’s lymphoma cells.

Myeloma Survival Curcumin- a compound found in the spice turmeric may work to kill myeloma cells and prevent them from multiplying.

Myeloma Survival (Cont’d) Papaya- Papain along with other enzymes may weaken myeloma cells and increase the likelihood of responding to conventional chemotherapy. Anecdotal evidence suggests drinking papaya juice, which is rich in papain, may also be helpful in cancer therapy.

Myeloma Survival (Cont’d) Green tea- A compound found in green tea may aid in killing myeloma cells and prevent myeloma cells from multiplying. Research shows that green tea can interact with the treatment Velcade. The recommendation is to avoid green tea while on this treatment.

Myeloma Survival (Cont’d) Resveratrol- a compound that may help kill myeloma cells, prevent myeloma cells from multiplying, and enhance the effects of some common chemotherapies. Food sources include grapes, purple grape juice, red wine, peanuts, blueberries, and cranberries.

Resources American Cancer Society: www.cancer.org American Institute for Cancer Research: www.aicr.org Cancer Treatment Centers of America: www.cancercenter.com