4/3/2018

Goals

• Review the 2017 summary of global evidence on diet, weight and physical activity on cancer prevention and Can What We Eat Cause or survival. • Describe strong evidence on what increases your risk of cancer. Prevent Cancer? • Describe strong evidence on what decreases your risk of cancer. • List practical ways to add benefits or Chandy Lockman Hoke, MS, RD, decrease risks from your lifestyle. CSO, LMNT Methodist Estabrook Cancer Center

• Low grade chronic inflammatory sate • Production inflammatory response • Increased levels of insulin • Increased levels of leptin • Upregulated production of hormones

• Salted fish dried in natural conditions outdoors • Fermentation process • Increased risk for 30 grams per day or • High nitrate and nitrosamines above • Involved in traditional processing for • Induce oxidative stress pickling vegetables- both with and • May act as a solvent to dietary or without salt environmental carcinogens • Both processes have formation of N- • May affect hormone metabolism nitrosamines • Interfere with DNA repair (reduces the • High salt intakes damage lining of the amount of folate absorbed) stomach • Women metabolize slower than men • Increased inflammation and atrophy • Increased risk H. pylori colonization

• Natural deposits, agricultural, industrial processes. Increased inflammation and atrophy • Carcinogenic substance absorbed by GI tract, excreted in urine

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• Red meat= beef, pork, lamb, goat • 17% increased risk with 20 mg/day • Iron content dietary supplement in smokers • Formation of N-nitroso • Supplement mechanisms increased compounds risk unclear • Causes oxidative stress • Possible protective dietary • DNA damage lost/reversed by high levels of • Contain high levels of salt, nitrites supplement and nitrates • React with degrading proteins • Regularly consumed in South • Damage stomach/intestinal America mucosa • Scalding hot yerba mate tea • Smoked meats consumed though metal straw • React with degrading proteins = • Repeated thermal damage polycyclic aromatic hydrocarbons (PAHs)

• High carbohydrate (glycaemic) load results in hyperinsulinemia • Increased bioavailablity IGF-1, promotes cell growth, decreases cell death • Increases oxidative stress • Studies from developed counties, large portion from highly processed foods and sugar

• Inappropriate storage • Causes DNA damage

• Stimulate the immune system • Can decrease excessive body • Block substances we eat, drink and weight breathe from becoming carcinogens • Improve insulin sensitivity • Reduce the kind of inflammation that • Reduce fasting insulin makes cancer growth more likely • Decrease levels of circulating • Prevent DNA damage and help with DNA hormones repair • Improved innate and required • Reduce the kind of oxidative damage to immune response cells that can spark cancer • Slow the growth rate of cancer cells • Trigger damaged cells to commit suicide before they can reproduce • Help to regulate hormones

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• Lactation decreases lifetime exposure menstrual cycles, altering hormone • Reduction of intestinal transit time levels and increased fecal bulk • Strong exfoliation of breast tissue • Lessen interaction with colon during lactation wall • Massive apoptosis at end of • Reduce secondary bile acid lactation. production • Possible epigenetic changes that • Fermentation within bowel forms exert lasing impact on cancer SCFA Butyrate reduction. • Anti-proliferation effects

• Reduce insulin resistance • Significant decreased risk with 1 cup • Rich source of various bioactive per day compounds • Coffee induces body’s defense system • Stimulate anti-oxdiative activity • Reduces DNA damage • Binding carcinogins • Reduce expression of genes involved • Regulating glycemic reponse with inflammation • Improved insulin sensitivity

• Lactic acid-producting bacteria may protect • Excessive body weight protective • Casein and lactose in milk may increase mechanisms unclear calcium bioavailability • Decreases adolescent growth • Bioactive componds may provide protective rate, possible lower Insulin-like function growth factor activity • Lactoferrin • Early breast differentiation= less • Vitamin D susceptible to tumorigenesis. • SCFA Butyrate

• Alcohol protective mechanisms unclear • Possibly reduce hyperinsulinemia • Possibly related to diuretic effect

• Recommend less than 2,400 mg sodium day So now what...... • Read labels- look for less than 140 mg of sodium per serving

• Use fresh/dried herbs instead

• If you do use a salt shaker, cut back slowly

• Limit high sodium food • Pickled vegetables, salted/dried fish, breakfast cereal, bread, frozen meals, pizza, chips, canned foods, and processed meats

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• Avoid Cantonese-style fish! • UN/WHO tolerable weekly intake of 0.015 mg arsenic per kg body weight

• Regions with arsenic contaminated drinking • Asia (Bangladesh, Cambodia and India, some parts of China) and South America (Argentina, Chile)

• The Clean Water Act and regulation of drinking water contaminants fall under the EPA’s authority; state and municipal water systems must comply with the standards set by the EPA to make sure that levels of chemicals and contaminants meet safe standards

• https://www.epa.gov/sdwa • http://www.aicr.org/healthyrecipes/entre es-seafood.html

• Opt for the smallest serving size; dilute drinks with water, ice and/or club soda as The National Weight Control Registry- much as possible. Lost average 66 lbs & kept off for 5.5 yrs

• Sip slowly and avoid pressure from others • 45% lost with on their own, 55% lost to drink faster. with help of a program • 98% modified their food intake • Alternate between alcoholic and non- • Low calorie, low fat diet alcoholic drinks • 98% increased physical activity • like club soda or low-sodium tomato or • 90% exercised 1 hr per day vegetable juice with lemon and a couple • 78% eat breakfast every day drops of hot sauce. • 75% weigh at least once per week • 62% watch less than 10 hrs of TV per • Aim to keep some days each week alcohol- week free. • http://napchallenge.org • Stock your refrigerator with plenty of alternative beverages like sparkling or spring water flavored with citrus slices and seltzers

• 6% risk reduction in risk per 200 ml calcium • Don’t use supplements to protect per day against cancer. • Goal 1000 ml daily • There are some situations when supplements are recommended, • 15% risk reduction per 400 gm (~2 cups) however, talk to your doctor or dairy products per day. registered dietitian before starting. • Food Sources • http://www.aicr.org/assets/docs/pdf • Calcium-fortified orange juice, calcium- /fact-sheets/factsheet-on- fortified soymilk, tofu, calcium-fortified supplements.pdf bread/waffles, milk, cheese, yogurt, Chinese cabbage, kale, bok choy, • Don’t drink hot beverages through a broccoli and spinach metal straw!

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• Benefits for mom and baby • Limit consumption of highly processed • Recommend 6 months or longer foods and added sugars • 2% risk reduction per 5 month • Sugary drinks – Regular sodas, increase in breastfeeding lemonade and sweet tea also add duration. calories without filling you up. • Processed foods – Refined grains like white bread and white rice are stripped of their fiber and nutrients

• Rare in the U.S. • Benefits with regular and decaffeinated. • 14% lower risk with 1 cup per day • Coffee consumption (up to 6 cups/day) does not increase risk of cancer.

• All types of activity have benefit • Limit red meat consumption to 18 oz • Aim for 30 minutes of activity of cooked weight per week. daily • Consider meat- free days • Smaller portions when you do eat • Avoid processed meats • Not everyday foods, saving them for special occasions

• https://store.aicr.org/collections/ physical-activity

• Goal 25-30 grams of dietary fiber • Look for 100% whole grain on the each day. package. • ~5 servings of vegetables & • Words like multi-grain or wheat fruit plus at least 3 small do not necessarily mean the servings of whole grains. product contains whole grains. • 1 serving = 1 slice of • You may see products with a whole-wheat bread, or ½ Whole Grain Stamp, which cup of oatmeal, or ½ cup signifies a half to a full serving of brown rice. •Each 90 grams (~3 servings) whole grains whole grains per labeled serving. • Add some whole grains or beans link to % 17 risk reduction • Store them in airtight containers in most meals. cool places. Whole grains can spoil • Snack on foods like bananas, •Some examples of whole grains: whole- faster than refined grains. whole grain cereals, and nuts. wheat flour, oats, brown rice (also red or • You can store unmilled whole • Add fiber-rich foods to your diet black), corn, whole barley, bulgur, sorghum, grains in a cabinet away from heat slowly, and drink plenty of water. whole farro, millet and teff. and direct light for up to 6 months. They will keep for one year in the •Add wild rice, brown rice, sorghum, freezer. quinoa, farro or barley to salads and soups: • You can keep whole-grain flours or Use your leftover cooked grains in a soup cornmeal in the refrigerator or you can heat up quickly, or let the grains freezer for 2 to 6 months. cook right in your homemade soup.

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• Steam, microwave, stir-fry or sauté to retain glucosinolates, folate and • Top cereal or yogurt with fresh or dried vitamin C. berries. • Boiling greens in a pot of water • Buy frozen berries too. These also are can cut content of these high in nutrients and antioxidant substances in half. phytochemicals. • Cook just until tender-crisp, with • Berries play well with other fruits! greens still bright. Overcooking makes Alone or in combinations, try in them smelly and unattractive. muffins, pancakes, and fruit crumble or • Many are also delicious roasted or crisp desserts baked, especially turnips, Brussels • Bake or stew apples with vegetables • • 3 ½ to 6 cups per day sprouts, broccoli and cauliflower. 3 ½ to 6 cups per day such as carrots, winter squash and vegetables/fruit • Add to soup, or make them the star vegetables/fruit sweet potatoes. on their own. • Substitute applesauce for up to 1/2 of • Enjoy the depth of flavor they add to the oil to lower calories and fat in green salads. baked goods such as quick breads and • Try broccoli sprouts on salads or in cakes. sandwiches.

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