do nutrition and exercise play a role in cancer prevention? · pdf filegreen / black tea...

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Do Nutrition and Exercise Play a Role in Cancer Prevention?

Nancy Rogers, MS, RD, CWWSRegistered Dietitian

Certified Worksite Wellness Specialist

University of Arizona

CancerDr. David Alberts, Director AZ Cancer Center, 2005

Cancer is not just one disease; there are >100 kinds and each has its own Cause Natural history Preventative strategies treatments

American Cancer Society 2012For most Americans, cancer deaths: 1/3 of deaths – tobacco products 1/3 diet, physical activity and body

weight 1/3 genetic and other causes

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Stages of Cancer FormationNormal cell

Mild (initiated) Moderate dysplagia

Severe dysplagia

Cancer

Post cancer

Dr. Alberts: Ideal Preventive Agent

IdealAgent

Known mechanism

No/low toxicity

High efficacy

Human acceptance

Low cost Oral consumability

Dr. Alberts: Ideal Preventive Agent

Known mechanism

No/low toxicity

High efficacy

Human acceptance

Low cost Oral consumability

FOOD

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Cancer Prevention

Food

Physical Activity Weight

“The most effective cancer prevention therapy can’t be found in a miracle pill or through an expensive series of medical procedures. The best treatment can be found in the produce section of your local supermarket.

Many of the compounds and bioactive chemicals that occur naturally in vegetables and fruit act to protect us against cancer. Many of the medicines we use to treat people are derived from these foods.”

Cynthia Thomson, PhD, RD, CSO AZ Cancer Center, Food as Medicine, 2012

Nutrition and Cancer PreventionDr. John Milner, Nat’l Cancer Institute, 2005

25,000 bio-active ingredients in foods have been identified with a preventative role: Animals Plants Fungus Bacteria

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Superfoods Blueberries Sweet Potatoes Nuts Fish Dried beans Pomegranates Dark, leafy greens Garlic Green / black tea Coffee Tart cherries Cruciferous vegetables

Whole Grains Reduce Cancer RiskAmaranth Barley Buckwheat Polenta

Corn millet Oats QuinoaBrown rice Rye Teff Triticale

Wheat Kamut Spelt Farro Emmer

High intake of dietary fiber from whole grains reduced risk for colorectal cancer and other cancers.

Limit refined carbs and high sugar foods and drinks.

Tufts Health and Nutrition Letter 2/2012American Cancer Society 2012

Food: Cancer Prevention Guidelines

Eat at least 2 ½ cups of vegetables and fruit a day

Choose whole grains instead of refined carbs

Primarily a plant-based diet Limit processed meats and red meats Choose foods that help you maintain a

healthy weightAmerican Cancer Society 2012

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Cancer and Coffeepolyphenols – chlorogenic acid

Lower rates of cancer of the oral cavity and pharynx, and basal cell cancers

Cancer Research 2012, Annuals of Oncology 2011, Tufts Health & Nutrition Letter 8/2011Cancer Epi. Biomarkers Prev. 2010

Green TeaPolyphenols

a broad class of anti-oxidantsCatechins

associated with anti-carcinogenic, anti-viral, anti-inflammatory properties

Catechins – Green TeaVary with processing before dryingSoil and climateFertilizersBrew timeTemperatureType of tea (instant,

ready to drink, etc)Amount is 4-5 cups a day

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Help from Spices: TurmericJournal of Cancer Research, January 2006

Turmeric is found in curry powder Active ingredient is curcumin Worldwide, lowest incidence of prostate cancer

is in India and China

Cruciferous VegetablesPhytochemicals – cancer prevention Brassica genus: Broccoli, Brussel sprouts,

cabbage, cauliflower, collard greens, kale, kohlrabi, mustard, rutabaga, turnips, bokchoy, Chinese cabbage

Raphnus genus: radish, daikon radish Nasturtium genus: watercress Eruca genus: arugula Armoracia genus: horseradish Wasabia genus: wasabi

Fermented Foods Ancient beginnings: 6000

years ago in the Fertile Crescent.

China, Korea, Rome, Viet Nam, Japan, Laos, Bulgaria

Most common lacto-fermentation using lactobacilli (lactic acid and

H2O2) Bifidobacteria (acetic acid)

Wild Fermentation2003. Chelsea Green Publishing

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Nutrition Summary Whole grains Fruits, vegetables, and beans Limit red meats, processed meat Avoid charred meats Enjoy coffee and teas Limit alcohol Eat Food not supplements

Nutrition and Cancer PreventionDr. John Milner, Nat’l Cancer Institute, 2005

Individuals vary in how they respond to the bio-active ingredients in foods

Responders and non-responders Genetic testing

Cancer Research Donato F. Romagnolo, Ph.D., MSc.

Professor, Nutritional and Cancer Biology

Department of Nutritional Sciences University of Arizona Cancer Center

University of Arizona, 2013

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Epigenetics Definition Genetics: the study of heritable changes in gene

function that occur with a change in the DNA sequence

Epigenetics: the study of heritable changes in gene function that occur without a change in DNA sequence. Study of the regulation of gene activity that is not

dependent on gene sequence Can be reversible

Donato F. Romagnolo

Diet and Epigenetics Inappropriate diets can contribute to

chronic diseases and cancer formation Important to uncover the molecular

mechanisms to develop interventions Of bioactive factors in foods Of environmental factors

Nutrition and Health: Bioactive Compounds and Cancer. 2010DOI 10.1007/978-1-60761-627-6_5

Epigenetics - CuesIn the DNA coding process

Transcriptural Cell silencing Transcriptural Cell activationActivating something that should be silent, or silencing something that should be active.

May overcome a predisposition to tumor development

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Nutrients from our food are turned into methyl groups along a pathway: the pathway is made up of many players that manipulate molecules into methyl groups and ultimately put them on our DNA.

http://learn.genetics.utah.edu/content/epigenetics/nutrition/

Current epigenetic animal research Effect of maternal nutrition BRCA-1 on fetus –

possibly prevent cancer in offspring

Mediterranean type diet, high in folate Mediterranean Diet and Disease Prevention, 2014

Dr. Donato Ramagnolo Resveratrol – grapes, blueberries, red wine, peanuts

Nutritional Supplements

Should they be routinely prescribed???

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Supplements may be Harmful –including Fortification of Foods

Food not supplements Some concern of supplemental folic acid over

1400 mcg / day in increased risk of colorectal cancer

High levels of supplemental Vitamin A in smokers increased lung cancer

Supp. Vitamin E is not recommended Supp. Selenium is not recommended

American Cancer Society 2012

Cancer Prevention

Food


Body weight and Cancer Risk In the U.S. excess body weight may contribute

to 1 out of 5 of all cancer-related deaths.

Increased risk of cancers: Breast (among women who have gone through

menopause) Colon and rectum Endometrium (lining of the uterus) Esophagus Kidney Pancreas


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Being overweight or obese likely raises the risk of other cancers:

Gallbladder Liver Non-Hodgkin lymphoma Multiple myeloma Cervix Ovary Aggressive forms of prostate cancer High belly fat is linked with an increased risk of

colorectal cancer; probably higher risk of cancers of the pancreas, endometrium and breast cancer in women past menopause.


American Cancer Society Summary

Be as lean as possible throughout life without being underweight

Avoid excessive weight gain at any age Even a small amount of weight loss is

helpful Engage in regular physical activity Limit consumption of high calorie foods

and beverages

Cancer Prevention

Food


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Physical Activity Limit sedentary behavior Moderate to vigorous physical activity

>5 days/week 150 minutes moderate level 75 minutes vigorous

Do exercise beyond usual activities.


Medscape 3/15/2013 John Marshall MD 150,000 people in survey 860 got colon cancer 2300 people met physical activity

guidelines – 150 minutes/week Risk reduction by .5% - better outcome

than chemotherapy BMI, physical activity, and cancer –

may have a epigenetic component

Specific Site Recommendations

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Cancer Survivors and Nutrition 1° plant based diet High in fruits / vegetables Low in fat / saturated fat

J. Am Dietetic Assoc. Dec 2011

Esophageal Cancer and Obesity Increased gastro-esophageal reflux Acid breaks down squamous cell lining in

esophagus - Increased risk for cancer

Preventative measures: Decrease obesity to a healthy weight Control reflux

Society of Thoracic Surgeons, 43rd annual meeting: Abstract 77. Presented 1/30/07

Stomach Cancer Prevention

2 ½ cups of fruits / vegetables daily Reduce salt-preserved

foods and salt Reduce processed meats Be physically active Maintain a healthy body

weight


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Prostate Cancer Prevention Most common cancer in men 2 1/2cups vegetables/fruits a day Healthy weight and physical activity ~ avoid Vitamin E, selenium and calcium

supplements

Localized prostate cancer Research ~4,000 men Conclusion: No need to avoid dairy products Avoid whole milk Choose nonfat or 1% milk

Cancer Epidemiology, Biomarkers & Prevention, doi 2012

Black tea and Prostate Cancer

Netherlands Cohort study Amer. J. of Epidemiology 2012

~58,000 men Higher intake of black tea had a

decreased risk of advanced stage prostate cancer

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Colon Cancer Prevention Consume a diet rich in fiber: vegetables,

fruits, whole grains and beans

Get sufficient calcium

Limit red meats to 18 oz a week

Avoid high cooking temperatures (charring) / use marinades

Limit processed meats

American Institute for Cancer Research, 12/2011

Colorectal Cancer Prevention

Analysis of 41 studies Most fish eaten had 12% reduction of

cancerThe American J. of Medicine June 2012

Choose fish low on the food chain

Colorectal cancer Modify microbiome in the gut

Use of probiotics Various bifido and lactobacillus species

Use of prebiotics Dietary fiber, various sources

Synergistic effect of using prebiotics and probiotics to reduce cancer risk

January 2013 webinar: Frontiers in Nutrition and cancer Prevention, NIH, DHHS, NCI

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Prebiotics Non-digestible food ingredients that

stimulate the growth and/or activity of bacteria in the digestive system in ways claimed to be beneficial to health.

A prebiotic should increase the number and/or activity of bifido and lactic acid bacteria

Food sources: onion, garlic, Jerusalem artichoke, jicama, chicory root, whole wheat

Probiotics Yogurt Kefir Fermented foods

Physical Activity and Breast Cancer Helps control weight May reduce circulating levels of

hormones associated with cell and tumor growth

Include daily exercise


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Breast Cancer Estrogen receptor negative cancers only

Pooled analysis of 18 prospective cohort studies, over 1 million women; 13% lower risk for Er neg. breast cancer tumors

**Include foods high in a-carotene, b-carotene, lutein/zeaxanthin –dark green and orange fruits and vegetables

Am. J. of Clinical Nutrition doi 2012

Breast Cancer

T AICR/WCRF Report: Breastfeeding lowers the risk for both pre- and

post-menopausal breast cancer. Protection against all-age breast cancer risk:

avoid alcohol. Regular physical activity protects against

post-menopausal breast cancer, A healthy weight is also associated with lower

risk for post-menopausal breast cancer.American Institute for Cancer Research, 2012

Breast Cancer Prevention BMJ. Published online June 27, 2013 The meta-analysis involved 26 publications, 20,905

cases of breast cancer, and 883,585 participants from 21 independent prospective cohort studies.

This study provides solid and robust evidence that marine n-3 PUFA are inversely associated with risk of breast cancer. The protective effect of fish or individual n-3 PUFA warrants further investigation of prospective studies.

Tuna, salmon, sardines, herring, mackerel

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Endometrial Cancer Prevention Top 2:

Maintain a healthy body weight Regular physical activity


UA Life & Work Connections, Human Resource Department

What’s in the Future? Genetic testing for individual’s risks New research on plants and their active

ingredients to help prevent cancers New medications to treat or cure cancers Ongoing research and collaborations

What Can You Change?Lifestyle / epigenetic Factors:

Appropriate screenings

Foods you eat

Physical activity

Healthy weight

Tobacco use

Alcohol use

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Cancer Prevention

Food


Resources•American Cancer Society: www.cancer.org

• http://cacancerjournal.com

•Centers for Disease Control and Prevention: www.cdc.gov

•American Institute for Cancer Research: www.aicr.org

•National Cancer Institute: www.cancer.gov

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