27563575 healthy eating for life

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HEALTHYEATINGFORLIFE

FOODCHOICESFORCANCERPREVENTIONANDSURVIVAL



Morethan1millionpeoplearediagnosedwithcancerintheUnitedStateseachyear,andthereisanurgentneedforanewdirectioninbattlingthisdisease.That’swhyphysicians,researchers,nutritionists,andcancerspecialistshavejoinedtogethertoformTheCancerProject.TheCancerProjecthastwomaingoals.First,weaimtomakecancerpreventionatoppriority.Second,andjustasimportant,wewanttoimprovesurvivalaftercancerhasbeendiagnosedbyoeringcomprehensiveinformationabouttheroleofdietaryfactorsinkeepingpeoplehealthy.TheCancerProjectprovidesclasses,books,televisionandvideoprograms,Web-basedinformationatwww.cancerproject.org,brochures,andothereducationalmaterialsoncancerpreventionandsurvival.TheCancerProjectalsoconductsclinicalresearchstudiestoinvestigatedietaryissuesandpublicizestheneedforcancerpreventioninhard-hittingtelevisionmessagesspotlightingthevalueofhealthydietchanges.Ourhands-onnutritionclasses,whichhelpcancersurvivorsandtheirfamilieslearnnewtastesandeasyfoodpreparationskills,havebecomeincrediblypopular.Throughregularmediainterviews,ourstamembersprovideimportantinformationtothepublicaboutcancerprevention.LetmeencourageyoutosupportTheCancerProject.Withyourhelp,we’llmakecancerpreventionapriorityandhelppeoplediagnosedwithcancerhavethetoolstheyneed.Throughourdetailedanduser-friendlyWebsite(www.CancerProject.org),printedmaterials,televisionpublicserviceannouncements,andhands-onservices,we’reabletospreadalife-savingmessagefarandwide.SincetheCancerProjectisanon-prot501(c)(3)organization,allcontributionsaretax-deductibletothefullextentallowedbylaw.Thankyouforyourinterestandsupport.NealD.Barnard,M.D.

Physician,researcher,andauthorNealD.BarnardisoneofAmerica’sleadingadvocatesforhealth,nutrition,andhigherstandardsinresearch.Dr.BarnardisthefounderandpresidentofthePhysiciansCommitteeforResponsibleMedicine.HealsoinitiatedTheCancerProject,anorganizationdedicatedtocancerprevention,research,andnutritionalassistancetocancerpatients.

HEALTHYEATINGFORLIFE:FOODCHOICESFORCANCERPREVENTIONANDSURVIVALispublishedbyTheCancerProject,5100WisconsinAve.,NW,Suite400,Washington,DC20016,202-244-5038,www.CancerProject.org.HEALTHYEATINGFORLIFEisnotintendedasindividualmedicaladvice.Alwaysdiscussanydietchangewithyourpersonalphysician.Insomecases,dietchangesmayalteryourneedformedication.PersonswhofollowavegetariandietshouldbesuretoincludeasourceofvitaminB12intheirdailyroutine,suchasfortiedcereals,fortiedsoymilk,oranycom

monmultiplevitamin.Readersarewelcometoreproducearticlesfromthispublicationforpersonaloreducationalusewithoutadditionalpermission.MaterialshouldnotbereproducedforresalewithoutpriorarrangementwithTheCancerProject.©TheCancerProject,2004.



FOODCHOICESFORCANCERPREVENTIONANDSURVIVAL

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pproximately80percentofcancersareduetofactorsthathavebeenidentiedandcanpotentiallybecontrolled,accordingtotheNationalCancerInstitute.Notonlydowehavethepotentialtopreventmostcancers,wecanalsoimprovethesurvivalratesofpeoplewhohavecancer.Cancerstartswhenonecellbeginstomultiplyoutofcontrol.Itbeginstoexpandintoalumpthatcaninvadehealthytissuesandspreadtootherpartsofthebody.Butthisdeadlydiseasecanoftenbeprevented,andwhenitoccurs,itcanoftenbestoppedinitstracks.Atleastone-thirdofannualcancerdeathsintheUnitedStatesareduetodietaryfactors.1Arecentreviewofdietandcancershowsthatmuchofourriskforcolon,breast,andprostatecancer,amongothertypes,isduetodietaryfactors.2Thelinkbetweendietandcancerisnotnew.InJanuaryof1892,ScienticAmericanprintedtheobservationthat“cancerismostfrequentamongthosebranchesofthehumanracewherecarnivoroushabitsprevail.”Numerousresearchstudieshavesinceshownthatcancerismuchmorecommoninpopulationsconsumingdietsrichinfattyfoods,particularlymeat,andmuchlesscommonincountrieswithdietsrichingrains,vegetables,andfruits.Onereasonisthatfoodsaecttheactionofhormonesinthebody.Theyalsoaectthestrengthoftheimmunesystem.Whilefruitsandvegetablescontainavarietyofvitamins,minerals,antioxidants,andphytochemicalsthatprotectthebody,researchshowsthat,bycontrast,animalproductscontainpotentiallycarcinogeniccompoundsthatmaycontributetoincreasedc

ancerrisk.Another30percentofcancersarecausedbytobacco.Lungcanceristhemostobviousexample,butitisbynomeanstheonlyone.Cancersofthemouth,throat,kidney,andbladderarealsocausedbytobacco.Otherfactors,includingphysicalactivity,reproductiveandsexualbehavior,bacterialandviralinfections,andexposuretoradiationandchemicals,mayalsocontributetotheriskofcertainformsofcancer.

EstimatedPercentagesofCancerDuetoSelectedFactors3,4DietTobaccoAirandwaterpollutionAlcoholRadiationMedications35to60%30%5%3%3%2%

andfruits,forexample,strengthensyourimmunesystemandhelpsknockoutcancercells.Tohelppreventcancer,itisalsosmarttoavoidmeats,dairyproduct

s,andfriedfoods.Choosingber-richlegumes,grains,vegetables,andfruitshelpskeepmanytypesofcanceratbay.Plantfoodsalsocontainawidevarietyofcancer-ghtingsubstancescalledphytochemicals.Thesefactsallpointtochoosingavegetariandiettohelppreventcancerandimprovecancersurvival.Studiesofvegetariansshowthatdeathratesfromcancerareonlyaboutonehalftothree-quartersofthoseofthegeneralpopulation.BreastcancerratesaredramaticallylowerincountriessuchasChinaandJapan,wheredietsaretypicallybasedonrice,vegetables,andbeanproducts,withverylittleuseofmeat,dairyproducts,oroilyfoods.WhenpeoplefromthosecountriesadoptaWestern,meat-baseddiet,theirbreastcancerratessoar.Areyoureadytostartenjoyingthepowerfulbenetsofavegetariandiet?See“TheThree-StepWaytoGoVegetarian”onpage9.

DEFENDINGYOURDNAFROMHARM

BUILDINGYOURSTRENGTHAGAINSTCANCER

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omedietarychangeshaveapreventiveeectformanytypesofcancer.Boostingyourintakeofvitamin-richvegetables



et’slookatthestepswecantaketobuildourgeneraldefenses.Oxygenisessentialtolife.Butasoxygenisusedinthebody,someoftheoxygenmoleculesbecomeveryunstable.Theseunstablemolecules,calledfreeradicals,canattackcellmembranesandevendamagetheDNA(ourgeneticcode)inthenucleusofthecell.DamagetoDNAisthebeginningofcancer.THECANCERPROJECT•HEALTHYEATINGFORLIFE1



Fortunately,thefoodsweeatcanhelpprotectourbodies.Antioxidants,includingvitaminC,vitaminE,beta-carotene,selenium,lycopene,andothers,canneutralizethedamagingeectsofoxygen.Thesepowerfulnaturalchemicalscometousinvegetables,fruits,grains,andbeans.Peoplewhoincludefruitsandvegetablesintheirdailydietshavelowerratesofmanyformsofcancer.Smokershaveprovideddramaticdemonstrationsofthepowerofvegetablesandfruits.A55-year-oldmalesmokerwhosedietislowinvitaminChasaone-in-fourriskofdyingoflungcancerinthenext25years.ButifthesmokerhasahighintakeofvitaminC,eitherthroughdietorsupplements,hisriskdropsto7percent.Eectsofantioxidantshaveevenbeenseeninchildhood.Whenchildrenwithbraintumorswerestudied,itwasfoundthattheirmothersconsumedlessvitaminCduringpregnancy,comparedtootherwomen.5Tostepuptheantioxidantpowerofyourmenus,tryabakedsweetpotato,Hoppin’JohnSalad,orbakedcornchipswithTomatoCornSalsa(recipesonpages11and12).Evenwithvegetablesandfruitsinthediet,damagetothecells’DNAwilloccasionallyoccur,sothebodyhasbuilt-inrepairmachinery.FixingDNArequiresaBvitamincalledfolicacid,whichisfoundindarkgreenleafyvegetables,fruits,peas,andbeans.TheDietaryReferenceIntakeforfolicacidforadultwomenandmenis400microgramsperdayandincreasesto600microgramsperdayforpregnantwomen.Beansandvegetablesarerichinfolicacid.Asparagus,blackbeans,blackeyedpeas,chickpeas,lentils,pintobeans,andcookedspinachallhavemorethan200microgramsinaone-cupserving.Weareallexposedtocancer-causingchemicals,despiteoureortstoavoidthem.Somepeoplearesmokers,and,ofcourse,quittingsmokingisavitalstepforthem.Butallofusareexposedtochemicalsintheair,water,food,andhous

eholdproductsinadditiontothecarcinogensproducedwithinourbodiesasapartofourmetabolicprocesses.Whiletryingtominimizeourexposuretocarcinogens,wecanalsoshoreupourdefensesagainsttheseassaultsbyincludinggenerousamountsofvegetablesandfruitsinourdiet.

AntioxidantsinFoodsApple(1medium)BroccoliBrownriceBrusselssproutsCarrot(1medium)CauliowerChickpeasCornGrapefruit(pink,1/2)NavybeansOrange(1medium)OrangejuicePineappleSoybeansFreshspinachStrawberriesSweetpotato(1mediumwithskin)

VitC(mg)811609675421047275124243168428

B-carotene(mg)0.041.300.000.6712.000.010.020.220.190.000.160.300.0

20.012.300.0215.00

VitE(mg)0.441.324.001.330.280.050.570.150.314.100.310.220.163.350.570.230.32

Servingsizesareonecup(8oz.),exceptasotherwisenoted.Sources:PenningtonJAT.BowesandChurch’sFoodValuesofPortionsCommonlyUsed.NewYork,Lippincott,1998.MessinaM,MessinaV.TheDietitian’sGuidetoVegetarianDiets.Gaithersburg(MD),Aspen,1996.USDANutrientDatabaseforStandardReference,Release12,lastupdatedApril7,1999.

FOODSANDIMMUNITY

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venifwefollowhealthylifestyles,cancercellswillariseinthebodyfromtimetotime.Luckily,wehavewhitebloodcellsthatroamourbloodstreamslookingforthesetroublemakers.Somewhitebloodcells,callednaturalkillercells,seekoutanddestroycancercellsandbacteria.Theyengulfanddestroyaberrantcellsbeforetheycancausedamage.Thefunctionofnaturalkillercellsandotherwhitebloodcellsisimprovedbyaslittleas30milligramsofbeta-caroteneperday—theamountintwolargecarrots.Althoughbeta-caroteneissafe,eveninfairlysubstantial



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amounts,thebestwaytogetbeta-caroteneisnotinpills,butincarrots,wintersquash,spinach,kale,andtheotherpackagesinwhichnaturesuppliesit.Beta-caroteneisonlyoneofperhapstwodozenrelatedsubstancescalledcarotenoidsthatoccurnaturallyinvegetablesandfruitsandhavevaryingdegreesofbiologicalactivity.Inadditiontotheirantioxidanteects,vitaminsCandEandseleniumbolsterimmunefunction,buttheimportanceoftheseeectsinprotectingagainstcancerisnotyetclear.Fatsimpairimmunity,andcuttingfatoutofthediethelpsstrengthentheimmunedefensesagainstcellsthatturncancerous.ResearchersinNewYorktestedtheeectoflow-fatdietsonimmunity.6Theyputhealthyvolunteersonadietthatlimitedfatcontentto20percent,reducingallfatsand



Womenwhoconsumedmoreanimalproductshadasmuchasthreetimesthecancerriskofotherwomen

oils—notjustsaturatedorunsaturatedfats.Threemonthslater,theresearcherstookbloodsamplesfromthevolunteersandexaminedtheirnaturalkillercells.Thenaturalkillercellactivitywasgreatlyimproved.Althoughvegetableoilsarefarsuperiortoanimalfatsforheartpatients,whenitcomestotheimmunesystem,vegetableoilsarenobetterthananimalfats.Inexperiments,researchershavefoundthatwhentheyinfusesoybeanoilintravenouslyintovolunteers,thewhitebloodcellsnolongerworkaswell.7Test-tubeexperimentsshowsimilarresults.8Similarly,omega3fattyacids,whicharefoundinshoils,greenvegetables,andsoybean,axseed,andcanolaoils,alsocompromiseimmunefunction.Thebottomlineonfatsandoils:greatlyreduceyourintakeofallofthem.Itshouldcomeasnosurprisethatvegetarianshavestrongerimmunesystemsthanmeat-eaters.Studiesofwhitebloodcellsamplesfromvegetarianshaveshownthemtohavemorethandoublethecancercell–destroyingabilityoftheirnon-vegetariancounterparts.9Theimmune-boostingpowerofvegetariandietsispartlyduetotheirvitamincontent,lowfatcontent,andperhapsothercontributors,suchasreducedexposuretotoxicchemicalsandanimalproteins.

ticularlyrareinthethatcountry,lessthan10percentofthecaloriesintheJapanesedietcamefromfat.TheAmericandiet,ofcourse,iscenteredonanimalproducts,whichtendtobehighinfatandlowinotherimportantnutrients.ThefatcontentoftheaverageAmericandietiswellabove30percentofcalories.

Countrieswithahigherintakeoffat,especiallyanimalfat,haveahigherincidenceofbreastcancer.EvenwithinJapan,auentwomenwhoeatmeatdailyhavean8.5timeshigherriskofbreastcancerthanpoorerwomenwhorarelyornevereatmeat.The1988SurgeonGeneral’sReportonNutritionandHealthstates,“Indeed,acomparisonofpopulationsindicatesthatdeathratesforcancersofthebreast,colon,andprostatearedirectlyproportionaltoestimateddietaryfatintakes.”

FATANDHORMONALEFFECTS

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FOODSANDHORMONES

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everalofthemostcommonformsofcancerarelinkedtosexhormones.Thisistrueofcancersofthebreast,uterus,ovary,prostate,andperhapsothersites.Theamountofhormonesinourbodiesandtheiractionsaredetermined,inlargepart,bythefoodsweeat.

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slongagoas1982,theNationalResearchCouncil,inareportcalledDiet,Nutr

ition,andCancer,showedtheevidencealreadyavailablelinkingspecicdietaryfactorstocancerofthebreastandotherorgans.Internationalcomparisonsoeragoodillustration.Asiancountries,suchasJapan,havelowratesofbreastcancer,whileWesterncountrieshavecancerratesmanytimeshigher.However,whenJapanesegirlsareraisedonWesternizeddiets,theirrateofbreastcancerincreasesdramatically.ThetraditionalJapanesedietismuchlowerinfat,especiallyanimalfat,thanthetypicalWesterndiet.Inthelate1940s,whenbreastcancerwaspar-

attyfoodshaveastronginuenceonhormonalactivityinthebody.First,high-fa



tdietsincreasetheamountofestrogens,thefemalesexhormones,intheblood.Thisisaproblem,becauseitiswellknownthatmanybreasttumorsare“fueled”byestrogens.Estrogensarenormalandessentialhormonesforbothwomenandmen,butthemoreestrogenpresent,thegreaterthedrivingforcebehindsomekindsofbreastcancer.Onhigh-fatdiets,estrogenlevelsincrease.Whenwomenadoptlow-fatdiets,theirestrogenlevelsdropnoticeablyinaveryshorttime.Vegetarianshavesignicantlylowerestrogenlevelsthannon-vegetarians,inpartbecauseofthelowerfatcontentoftheirdiet.Inaddition,theyhavemoreofcertaincarriermolecules,calledsexhormone–bindingglobulin,thatcirculateinthebloodandhavethejobofholdingontosexhormones,keepingtheminactiveuntiltheyareneeded.Fattyfoodsdothereverse:theyincreaseestrogensandreducetheamountofthecarriermoleculethatissupposedtokeepestrogensincheck.Animalfatsareapparentlyabiggerproblemthanvegetableoils.PaoloToniolooftheNewYorkUniversityCancerInstitutecomparedthedietsof250womenwithbreastcancerto499womenwithoutcancerfromthesameprovinceinnorthwesternItaly.Thetwogroupsateaboutthesameamountofoliveoilandcarbohydrates.Whatdistinguishedthecancerpatientswasthattheyhadeatenmoremeat,cheese,butter,andmilk.Womenwhoconsumedmoreanimalproductshadasmuchasthreetimesthecancerriskofotherwomen.10A2003HarvardUniversitystudythatincludedTHECANCERPROJECT•HEALTHYEATINGFORLIFE3



morethan90,000womenshowedthatthewomenwhohadeatenthemostanimalfathadsignicantlyhigherriskofbreastcancercomparedwithwomenwhoatetheleast.11Eventhoughcross-culturalcomparisonshavepointedangeratanimalfatastheprincipalproblem,vegetableoilisalsoundersomesuspicion.Vegetableoilscanprobablyaectestrogenlevelsand,aswewillsee,canincreasetheproductionofcancer-causingfreeradicals.Soitisnogoodjustreplacingfriedchickenwithfriedonionrings.Thebestdieteliminatesanimalproductsandkeepsvegetableoilstoaminimumaswell.Certainfoodshavespecialbenets.Soybeans,forexample,containnaturalcompoundscalledphytoestrogens.Theseareveryweakestrogensthatcanoccupytheestrogenreceptorsonbreastcells,displacingnormalestrogens.Theresultislessestrogenstimulationofeachcell.SoybeansareamainstayofAsiandietsandmaybeanadditionalreasonwhythesecountrieshavelowcancerrates.

HOWMUCHFATISTOOMUCH?

Onewaythebodyridsitselfofsexhormonesisthroughthedigestivetract.Theliverpullssexhormonesfromtheblood,chemicallyaltersthem,andsendsthemdownthebileductsintotheintestinaltract.There,theberfromgrains,vegetables,fruits,andbeansusherssexhormonesthroughtheintestineandoutthedooraswastes.Atleast,thatishowthesystemissupposedtowork.Butchickenbreasts,beef,eggs,cheese,andallotheranimalproductscontainnoberatall.AstheseproductshavetakenupmoreandmorespaceontheAmericanplate,theyhavedisplacedgrains,vegetables,beans,andfruits.Withoutadequatebertoh

oldtheminthedigestivetract,sexhormonesarereabsorbedintothebloodstream,wheretheyonceagainbecomebiologicallyactive.Thehormonesyourbodywastryingtoeliminatearethusputbackintocirculation.Buildingyourdietfromgrains,vegetables,fruits,andlegumesensuresplentyofberforthebody’sneeds.Toincreaseyourdailyberintake,startyourdaywithoatmealandfruit,andtryaddingdelicious,low-fat,ber-richrecipessuchasLentilBarleySteworQuickBeanBurritostoyourweeklymenu(seerecipesonpage12).

Vegetables,fruits,grains,andbeansprovideber,whichhelpsthebodydisposeofexcessestrogen.

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heNationalCancerInstitutehaslongrecommendedthatfatbelimitedtolessthan30percentofcaloriesandthatthefattiestmeatsbereplacedbyleanermeat,poultry,sh,andvegetables.Theserecommendations,however,aremuchtooweaktopreventcancerortoincreasesurvivalforthosealreadydiagnosedwiththedisease.AlargestudyofAmericannursesshowedthatthosewholimitedfatto27percentoftheircalorieswerenotanybetteroinpreventingcancerthanthoseconsumingmorefat.12Somehaveinterpretedthistomeanthatdiethasnothingtodowithbreastcancer.Amorereasonableconclusionisthatthedietsthesewomenfollowedwerestillhigh-riskdiets.Afterall,adietincludingregularconsumptionofanimalproductsanddrawingnearly30percentofcaloriesfromfatisnothinglikethetraditionalplant-basedAsiandietsassociatedwithlowcancerrisk.

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otonlyismeatdevoidofberandothernutrientsthathaveaprotectiveeect,butitalsocontainsanimalprotein,saturatedfat,and,insomecases,carcinogeniccompoundsformedduringtheprocessofcookingmeat.Thesecarcinogeniccompoundsmaybetoblameforpartofthecorrelationbetweenmeatintakeandincreasedcancerrisk.Meatintakehasbeenshowntobeariskfactorforbreastcancerevenwhenresearcherscontrolledforconfoundingfactorssuchastotalfatandc



alorieintake.13

HeterocyclicAminesHeterocyclicamines(HCAs)areDNA-damagingcompoundsthatareproducedasmeatcooks.Grilling,frying,oroven-broilingmeatproduceslargequantitiesofthesemutagens.Thelongerandhotterthemeatiscooked,themoreofthesecompoundsform.Insomestudies,grilledchickenformedhigherconcentrationsofthesecancer-causingsubstancesthanothertypesofcookedmeat.14ThemajorclassesofHCAsareformedfromcreatineorcreatinine,specicaminoacids,andsugars.Allmeats,includingsh,arehighincreatine.HCAformationisgreatestwhenmeatiscookedat

FavoringFiberGrains,vegetables,fruits,andlegumesensureplentyofber,butchickenbreasts,beef,pork,eggs,cheese,andallotheranimalproductscontainnoberatall.Gettingthefatoyourplateisimportant—butthatisjusttherststep.Otherfoodchoicesplayimportantrolesincancerprevention.Vegetables,fruits,grains,andbeansprovideber,whichhelpsthebodydisposeofexcessestrogen.4THECANCERPROJECT•HEALTHYEATINGFORLIFE



hightemperatures,asismostcommonwithgrillingorfrying.Consumptionofwell-donemeathasbeenassociatedwithincreasedriskofbreastcancerandcoloncancer.

PolycyclicAromaticHydrocarbonsGrillingorbroilingmeatoveradirectameresultsinfatdroppingonthehotreandtheproductionofamescontainingpolycyclicaromatichydrocarbon(PAH).PAHsadheretothesurfaceoffood;themoreintensetheheat,themorePAHsarepresent.Theyarebelievedtoplayasignicantroleincontributingtohumancancers.Afairlyconsistentassociationbetweengrilledorbroiled,butnotfried,meatconsumptionandstomachcancerimpliesthatdietaryexposuretoPAHsmayplayaroleinthedevelopmentofstomachcancerinhumans.

OTHERFACTORSAsidefromdiet,otherfactorsincreasebreastcancerrisk,includingthefollowing:Hormones:Supplementalhormonesgiventowomenaftermenopauseincreasebreastcancerrisk.Oralcontraceptivesmayalsoincreaseriskslightly.Althoughnewerbirth-controlpillscontainlessestrogenandprogesteronethanolderversions,evidencesuggestssomeincreaseinrisk.Overweight:Higherbodyweightincreasestheriskofbreastcanceraftermenopause.Radiation:Ofallthedierentpartsofthebody,thebreastisprobablythemostsensitivetoX-raydamage,andthereisnodoubtthatX-raystothebreastcancausecancer.Thisraisesobviousconcernsaboutmammograms,which,afterall,areX-rays.Annualmammogramsareclearlybenecialforwomenover50.Butwomenshouldschedulemammogramsonlya

tmodernfacilitiesthatdothemregularlyandmaintainnewequipment,whichkeepsradiationdosestoaminimum.Forwomenunder50,itisunclearwhetherroutinemammogramsarebenecial.Manycancersaremissedonmammograms,andwomenhavesometimesbeenfalselyreassuredbyanegativemammogram,leadingtodelaysindiagnosisandtreatment.Allwomen(especiallythoseunder50)shoulddoregularself-examsandfollowtheirphysicians’recommendationsregardingmammogramscreening.Genetics:About5percentofbreastcancercasesarepurelyattributabletogenetics.Insuchcases,cancerispassedfromparenttochildasadominanttrait,andthefamilytreeisriddledwiththedisease.Foralargergroupofindividuals,geneticsprobablymakesacontributioninsubtleways.Forexample,itmaywellbethatdierentgenesinuenceone’ssusceptibilitytocarcinogens,thestrengthoftheimmunesystem,bodyweight,andotherfactors.Eachoftheseisalsoinuencedbydiet.

ToxicChemicals:Populationsinareasneartoxicwastesitestendtohavehigherthanaverageratesofbreastcancer.Thatistrueforotherformsofcancer,too.Andyoudon’thavetolivenearachemicalwastesitetobeconcernedabouttoxicexposures.Toxicchemicalsareavailableatanygrocerystore.Chemicalcontaminantsfrequentlyendupinmeatsanddairyproducts,becausepesticidesaresprayedongrainsfedtocows,chickens,pigs,andotherlivestock.Instoragebins,feedgrainsaresprayedagain.Animalsconcentratethesechemicalsintheirtissues.Tracesofpesticidescanalsobefoundonnonorganicproduce.Fortunately,organicproduceisnowmorewidelyavailable.Womenwhoavoideatinganimalproductshavemuchlowerconcentrationsofpesticidesintheirbreastmilk.PesticidessuchasDDT,chlordane,hepatochlor,anddieldrin,andpolychlorinatedbiphenyls(PCBs)havebeenmeasuredatmarkedlylowerlevelsinvegetariansthanin

omnivores.Ina1981study,vegetarianshadonly1to2percentofthenationalaveragelevelsofcertainpesticidesandindustrialchemicalscomparedtolevelsinaverageAmericans.15Theexceptionwaspolychlorinatedbiphenyls(PCBs),forwhichvegetarianshadlevelscomparabletomeat-eaters.PCBsinthebodyoftenreectpastshconsumption,andlevelsdropslowlyafterpeopleadoptavegetariandiet.OncePCBsareinthebodytissues,avoidingcontaminatedshwillreducePCBlevelsonlyveryslowly.TimebetweenPubertyandFirstPregnancy:Theyoungeragirliswhenpubertyoccurs,thehigherherriskofbreastcancer.Also,thelatertheageofherrstpregnancy,thehigherherrisk.However,itmaybethattheearlyageofpubertysimplyindicateselevatedhormonelevels,asdescribed



above.Ashigh-fat,low-berdietshavespreadfromthewealthytomostofthepopulation,theageofpubertyhasdroppeddramaticallyfrom17in1840to12.5today.Similarly,asJapan’sdiethasWesternizedsinceWorldWarII,theageofpubertyhasdroppedfrom15to12.5.Itmaybethatearlypubertyandcancerareboththeresultofahormonalaberration.

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heuterusandovary,ofcourse,arereproductiveorgans,andfactorsthataecthormonefunctioncanbeexpectedtoaecttheseorgansaswell.Theriskofcanceroftheuterusandovaryishigherinpopulationsthathavemorebreastcancerincidences,suggestingthattheymaybecausedbysimilarfactors.Uterinecancerislinkedtofattydietsandobesity,althoughotherfactors,includinghormonesupplements,alsoplayanimportantrole.Ovariancancerisalsomorecommonwherepeopleeathigh-fatdiets.THECANCERPROJECT•HEALTHYEATINGFORLIFE5



Someresearchershavesuggestedthatahigherintakeofdairyproductsmaybelinkedtoovariancancer.Ifthisndingholdstrue,theculpritmaybeaproductofthebreakdownofthemilksugarlactose.Lactosebreaksdowninthebodytoformanothersugarcalledgalactose,whichappearstobeabletodamagetheovary.Theproblemisthemilksugar,notthemilkfat,soitisnotsolvedbyusingnon-fatproducts.Furtherresearchinthisareaisneeded.

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ikewomen,menonhigh-fatWesterndietshavemoreestrogenscirculatingintheirbloodandahigherriskofcancerofreproductiveorgans.High-fatdietsaltertheamountsoftestosterone,estrogen,andotherhormonesinbothmenandwomen.Theprostategland,locatedjustbelowthebladderinmen,producessementobemixedwithspermcells.Canceroftheprostate,whichoccursprimarilyinolderindividuals,isthemostcommonformofcancerinAmericanmen.Cancercellsarefoundintheprostatesofabout20percentofmenover45yearsold.Inmostcases,thesecancercellsdonotdevelopintocanceroustumorsthataecttheoverallhealthorlifespanoftheindividual.However,insomecases,thecancerdoesgrow,invadesurroundingtissues,andspreadtootherpartsofthebody.Althoughthediseasevariesgreatlyfromonepersontothenext,theaveragepatientlosesnineyearsfromhisnormallifespan.Onein10menwilldevelopprostatecanceratsomepointinhislife.AsianandLatinAmericancountrieshaveamuc

hlowerprevalenceofprostatecancer,butthediseaseisverycommoninEuropeandNorthAmerica.TenmendieofprostatecancerinWesternEuropeforeveryonewhodiesofthediseaseinAsia.Canceroftheprostateisstronglylinkedtowhatmeneat.Again,animalproductsareconsistentlyindicted:Milk,meat,eggs,cheese,cream,butter,andfatsarefound,inoneresearchstudyafteranother,tobelinkedtoprostatecancer.16–25Anditisnotjustdairyproductsandmeats.Somestudieshavealsopointedangeratvegetableoils.17,26Morerecently,milkconsumptionhasbeenlinkedtoprostatecancerduetohighlevelsofthecompoundinsulin-likegrowthfactor(IGF-I),whichisfoundbothindairyproductsandinincreasedlevelsinthebodiesofthosewhoconsumedairyonaregularbasis.AHarvardUniversitystudyshowedthatmenwhohadthehighestlevelsofIGF-Ihadmorethanfourtimestheriskofprostatecancercomparedwiththosewhohadthelowestlevels.27Inaddition,twomajorHarvardstudieshaveshownthat

milkdrinkingmenhave30to60percentgreaterprostatecancerriskthanmenwhogenerallyavoiddairyproducts.28,29Whohasalowerrisk?Countrieswithmorerice,soybean6THECANCERPROJECT•HEALTHYEATINGFORLIFE

products,orgreenoryellowvegetablesinthediethavefarfewerprostatecancerdeaths.Dietsrichinlycopene,thebrightredpigmentfoundintomatoes,watermelon,andpinkgrapefruit,havealsobeenshowntopreventprostatecancer.AstudyatHarvardUniversityshowedthatmenwhohadjusttwoservingsoftomatosauceperweekhada23percentlowerriskofprostatecancer,comparedwiththosewhorarelyatetomatoproducts.30Itisnotsurprisingthatvegetarianshavelowratesofprostatecancer.Becomingavegetarianinadulthoodishelpful,butmenraisedasvegetarianshavethelowestrisk.Menwhoconsumedietsbasedon

animalproductstendtohavehigherlevelsoftestosteronecomparedwithmenwhoeatplant-baseddiets.Thisincreasemaybeduetooverproductionofthesehormonesinthebody.Also,berinthediethelpsremoveexcesshormoneswithbodywastes.Thosewhoeatmeatsanddairyproductsmissoutonasubstantialamountofber,becauseanimalproductshavenoberatall.Thishormonalboostcanaecttheprostate,whichisthelikelyreasonforincreasedcancerriskamongmenonmeat-baseddiets.

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hecolonisanothernameforthelargeintestine,whichmakesupthesecondhalfofourdigestivetract.Stronglinkshavebeenfoundbetweencoloncancerandtheconsumptionofmeatsandotherfattyfoods.Toabsorbthefatsweeat,ourlivermakesbileandstoresitinthegallbladder.Afterameal,thegallbladdersquirtsbileacidsintotheintestine,wheretheacidschemicallymodifythefatssotheycanbeabsorbed.Unfortunately,bacteriaintheintestineturnthesebileacidsintocancer-promotingsubstancescalledsecondarybileacids.Meatscontainasubstantialamountoffat,andtheyalsofosterthegrowthofbacteriathatcausecarcinogenicsecondarybileacidstoform.Whenmeatiscooked,carcinogenscanformonthesurfaceofthefood.Aswithbreastcancer,frequentconsumptionofmeat—particularlyredmeat—isassociatedwithanincreasedriskofcoloncancer.High-berdietsoerameasureofprotection.Fibergreatlyspeedsthepassageoffoodthroughthecolon,eectivelyremovingcarcinogens.Andberactuallychangesthetypeofbacteriapresentintheintestine,whichreducesproductionofcarcinogenicsecondarybileacids.Fiberalsoabsorbsanddilutesbileacids.Evenpeopleatparticularriskforcancercanbehelpedbyhigh-berdiets.JeromeJ.DeCosse,M.D.,asurgeonatCornellMedicalCenter,gavebrantopatientswithrecurrentpolypsofthecolon.Thesearesmallgrowthsthathaveatendencytobecomecancerous.Dr.DeCossefoundthat,withinsixmonths,thepolypsbecamesmallerandfewerinnumber.Hebelievesthatpentoseber,whichisplentifulinwheat,isthekeytobran’spower.31



Stronglinkshavebeenfoundbetweencoloncancerandtheconsumptionofmeatsandotherfattyfoods.

Vegetables,particularlycruciferousonessuchasbroccoli,cauliower,Brusselssprouts,andcabbage,alsolowertheriskofcoloncancer.

Fruit(3ormoreservingsaday)Fruitsarerichinber,vitaminC,andbeta-carotene.BesuretoincludeatleastoneservingeachdayoffruitshighinvitaminC—citrusfruits,melons,andstrawberriesareallgoodchoices.Choosewholefruitoverfruitjuices,whichdonotcontainverymuchber.Servingsize:1mediumpieceoffruit•1/2cupcookedfruit•4ouncesjuice

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wothemesconsistentlyemergefromcancerresearch:Vegetablesandfruitshelpreducerisk,whileanimalproductsandotherfattyfoodsarefrequentlyfoundtoincreaserisk.Whentheterms“ber”and“fat”areused,itiseasytoforgetthefoodomwhichtheycome.Whenyouhearaboutthedangersoffat,thinkmeat-and-dairy-baseddiets,aidedandabettedbyoilyfoods.Fiberisfoundinwholegrains,vegetables,fruits,andbeans.Thereisnoberinanyproductfromananimal.Avegetarianmenuisapowerfulandpleasurablewaytoachievegoodhealth.Theve

getarianeatingpatternisbasedonawidevarietyoffoodsthataresatisfying,delicious,andhealthful.Areyoureadytogetstarted?

Legumes(2ormoreservingsaday)Legumes,includingbeans,peas,andlentils,areallgoodsourcesofber,protein,iron,calcium,zinc,andBvitamins.Thisgroupalsoincludeschickpeas,bakedandrefriedbeans,soymilk,tempeh,andtexturizedvegetableprotein.Servingsize:1/2cupcookedbeans•4ouncestofuortempeh•8ouncessoymilkBesuretoincludeagoodsourceofvitaminB12,suchasfortiedcerealsorvitaminsupplements.

SETTINGBLAMEASIDE

TRYTHENEWFOURFOODGROUPSANDDISCOVERAHEALTHIERWAYTOLIVE!Vegetables(4ormoreservingsaday)Vegetablesarepackedwithnutrients,includingvitaminC,beta-carotene,riboavin,iron,calcium,ber,andothernutrients.Dark-greenleafyvegetables,suchasbroccoli,collards,kale,mustardandturnipgreens,chicory,andbokchoy,areespeciallygoodsourcesoftheseimportantnutrients.Darkyellowandorangevegetablessuchascarrots,wintersquash,sweetpotatoes,andpumpkinprovideextrabeta-carotene.Includegenerousportionsofavarietyofvegetablesinyourdiet.Servingsize:1cuprawvegetables•1/2cupcookedvegetables

O

ccasionally,peoplewhohavecancerreportfeelingthat,iffoodplaysarolein

cancer,theyaresomehowtoblamefortheirdisease.Guiltandblamethussometimesbecomeconcernsforpeopledealingwithcancer.However,thesefeelingshelpnoone,anditmakesnosensetoblamepeopleforlackinginformationaboutthingstheyhadnowayofknowing.Untilmajorpubliceducationprogramsspreadthewordabouttheroleofdietaryfactors,cancerwillremainanepidemic.

STEPSTOCANCERPREVENTION•Donotusetobaccoinanyform.•Eatavariedmenuofwholegrains,vegetables,fruits,andbeans,withoutaddedfats,thatsuppliesgenerousamountsofber,vitamins,andminerals,andderiveslessthan10percentofitscaloriesfromfat.•H



avemorethanonevegetableateachmealandvetoninefruitsandvegetableseachday.•Avoidanimalproductsandminimizeaddedvegetableoils.•Minimizealcoholintake.•Engageinregularphysicalactivity.•Maintainyourweightatornearyourideallevel.•AvoidexcessivesunlightandunnecessaryXrays.THECANCERPROJECT•HEALTHYEATINGFORLIFE7

WholeGrains(5ormoreservingsaday)Thisgroupincludesbread,rice,pasta,hotorcoldcereal,corn,millet,barley,bulgur,buckwheatgroats,andtortillas.Buildeachofyourmealsaroundaheartygraindish.Grainsarerichinberandothercomplexcarbohydrates,aswellasprotein,Bvitamins,andzinc.Servingsize:1/2cuphotcereal•1ouncedrycereal•1slicebread



SURVIVINGCANCERFoodsareimportant,notonlyinpreventingcancer,butalsoinimprovingsurvivalforthosewhoalreadyhavecancer.

means,comparethreedierentdiets,eachofwhichcontains1,800caloriesperday:•Onalow-fatvegetariandiet,about10percentofcaloriescomefromfat.Thistypeofdietcontributesabout20gramsoffatperday,or600gramspermonth.•OnatypicalAmericandiet,35percentofcaloriescomefromfat.Thismeansabout70gramsoffatperday,or2,100gramspermonth.•Onadietwithmorefatthanaverage,say50percentofcalories,fatintakewouldbe100gramsperday,or3,000gramspermonth.Iftheresearchers’ndingholds,thetypicalAmericandietwouldleadtoabouta60percenthigherriskofdyingofbreastcanceratanygivenpoint,comparedtothelow-fatvegetariandiet,andthehigh-fatdietwouldleadtoamorethan95percentincreaseinriskofdying.Theseguresdonotmeanthatawoman’sriskofdyingis60percentor95percent.Theymeanthattheriskis60percentor95percenthigherthanitwouldotherwisehavebeen,assumingtheindividualiscomparabletothosestudied.Otherpartsofthedietplayimportantroles.Dietshighinber,carbohydrate,andvitaminAseemtohelptheprognosis,whilealcoholslightlyworsensit.35Patientswhohavemoreestrogenreceptorsontheirtumors—(whichindicatesabetterprognosis)—tendtobethosewhohadconsumedmorevitaminA.(Beta-carotenebecomesvitaminAinthebody.)Forreasonsthatarenotentirelyclear,vegetablesandfruits(andthevitaminstheycontain)helpkeepthecellsofthebodyinbetterworkingorder—onesignofwhich,forbreastcells,isthepresenceofestrogenreceptors.Sovegetablesandfru

itsarenotonlyimportantinhelpingtopreventcancer,theyalsohelpimprovesurvivalforthosewhohavecancer.Higherbodyweightincreasestheriskofdyingofbreastcancer.Amongpostmenopausalwomenwithbreastcancer,slimmerwomentendtohavelesslymphnodeinvolvement.Heavierwomenhavemorelymphnodeinvolvement,higherratesofrecurrence,andpoorersurvivalrates.

Alow-fatvegetariandietisthebestprescriptionforpreventingthehormonalelevationsthatencouragecancer.

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otallcancersofthebreastarethesame.Somehavearelativelygoodprognosis,andothershaveaverypoorprognosis.Forexample,atumorthatissmallandhasnotspreadtothelymphnodesorotherorgansislessdangerousthanatumorthatislargerandhasalreadyspread.(Lymphnodesarepea-sizedcollectionsofcellsnearthebreastandotherorgans;theyareimportanttoimmunefunction.)Hospitallaboratoriesalsodeterminewhetherabreasttumorhasreceptorsforestrogenorprogesteronehormones.Ifitdoes,thetumorisslightlylessaggressivethanatumorlackingreceptors.Theseprognosticfactorsarenotduetochancealone.Thirtyyearsago,ErnstWynderoftheAmericanHealthFoundationinNewYorkobservedthatJapanesewomenaremuchlesslikelythanAmericanwomentogetbreastcancer,inaddition,whenJapanesewomendogetthedisease,theytendtosurvivelonger.32Theirimprovedsurvivalisindependentofage,tumorsize,estrogenreceptorstatus,theextentofspreadtolymphnodes,andthemicros

copicappearanceofthecancercells.AnditisnotthatJapanesewomenhavebetterhealthcare,becausethesamepatternhasbeenobservedinHawaiiandCalifornia,whereJapanesewomenlivenearotherethnicgroupsandhaveessentiallythesamehealth-caresystem.Researchershavebeguntolookatwhetherdietplaysaroleinsurvival.Itdoes.Ouroldenemy,fatinfoods,rearsitsuglyheadonceagain.Themorefatinthediet,theshorterthesurvivaltime.InoneCanadianresearchstudy,womenwithcancerweremorelikelytohavelymphnodeinvolvementiftheyhadahigherfatintake.Thiseectwasfoundonlyforsaturatedfatandonlyforpostmenopausalwomen.33Fatseemstohaveameasurableeectwhencancerhasspreadtootherpartsofthebodyandlittleornoeectwhenthedisease



islocalized.ResearchersinBualo,NewYork,calculatedwhattheybelievetobethedegreeofriskposedbyfatinthediet:Forawomanwithmetastaticbreastcancer(cancerthathasalreadyspreadatthetimeofdiagnosis),theriskofdyingfromthediseaseatanypointincreases40percentforevery1,000gramsoffatconsumedmonthly.34Tounderstandwhatthis8THECANCERPROJECT•HEALTHYEATINGFORLIFE

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heuterusandovary,likethebreast,arestronglyinuencedbysexhormones.Again,alow-fatvegetariandietisthebestprescriptionforpreventingthehormonalelevationsthatencouragecancer.Inaddition,asmentionedearlier,galactose—a



productofthebreakdownofthemilksugarlactose—mayincreasetheriskofovariancancer.Onemightassumethatthefactorsthatimprovebreastcancersurvivalcoulddothesameforcancersoftheuterusandovary.Unfortunately,researchershavenotyettackledthisissue.Untilmoreinformationisavailable,itseemsmostprudentforthosewithovarianoruterinecancertofollowthesamedietthathelpspreventcancerintheseorgansandthatkeepstheimmunesystemingoodworkingorder:alow-fatvegetariandietrichinvegetablesandfruits.

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ietmayhelpimprovesurvivalinprostatecanceraswell.Whenpathologistsconductautopsiesofmenwhodiefromaccidentsorothercauses,theyndcancercellsintheprostatesofabout20percentofthem.36Thesemendidnotknowtheyhadcancerandhadnosymptomswhatsoever.Theprevalenceofsuchlatentcancersactuallyvarieswithlocation:thelowestratesareinSingapore(13percent)andHongKong(15percent)andthehighestareinSweden(31percent).36Inmostmen,thecellsnevergrowintoalargetumor,neverspread,andneveraectlifeorhealthinanyway.However,justastheprevalenceoflatentcancersvariesfromonecountrytoanother,thelikelihoodthattheywillturnintosymptomaticcancervariesinpreciselythesameway,suggestingthatthesamefactorsthatcausecancercellstoformintherstplacealsoencouragethemtogrowandspread.SowhileaSwedeistwiceaslikelyasamanfromHongKongtohavecancerouscell

sinhisprostate,heismorethaneighttimesmorelikelytodieofprostatecancer.Alow-fat,high-berdietcanhelpeliminatethehormonalaberrationsthatareknowntobelinkedwithprostatecancerandmayhelpimprovesurvivalamongthosewhohavethedisease.Ina2002studyofmenwithprostatecancer,Dr.DeanOrnishtestedalow-fatvegandiet,alongwithregularexerciseandstressmanagement.Inthe42meninthecontrolgroup,theamountofprostate-specicantigen(PSA,whichisusedasanindicatorofcanceradvancement)levelsroseoverthethree-monthstudyperiod,andsevenrequiredadditionaltreatment.Butinthe42menassignedtothevegandietandlifestyleintervention,theaveragePSAleveldroppedfrom6.3to5.8,andnonerequiredfurthertreatment.37

ventcancerandthosewhohavealreadybeentreatedforit.ResearchersattheUniversityofArizonafoundthatpeoplewhohavebeentreatedforcolonorrectal

cancerhavelessriskofrecurrencewhentheirdietsarerichinber.Theyfoundbenetsfromdailysupplementsof13.5gramsofwheatbranber(theamountinahalf-cupofbrancereal),buttheyspeculatethatotherformsofbermighthavethesameeect.Avegetariandietcaneasilyboostberintakeby10to29gramsperday.Ifyouhavebrancereal,toppingitwithsoymilkratherthancow’smilkallowsyoutoavoidanimalfat,cholesterol,lactose,andanimalproteins.Coloncancertypicallydevelopsfrompolypsinthecolonwall.Thesepolypsbecomesmallerandfewerinnumberwithinsixmonthsonahigh-berdiet.Itisclearthatmuchmoreneedstobelearnedaboutthepoweroffoodstopreventcancerortoimprovecancersurvival.Thegoodnewsisthatthedietthathelpsprotectagainstcanceristhesameonethatkeepscholesterollowandwaistlinesslim.Eliminatinganimalproductsfromthediet,keepingoilstoaminimum,andincludinggenerousamountsofvegetables,grains,beans,andfruitsisapowerfulprescription.

THETHREE-STEPWAYTOGOVEGETARIAN

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oloncancerisencouragedbydietscontaininganimalfatanddiscouragedbydiet



srichinvegetables.Alow-fat,plant-baseddietisimportantbothforthoseseekingtopre-

fyouaremakingtheswitchtoavegetariandietforitshealthbenets,you’llbepleasedtodiscoverawonderfuladditionalbenettovegetarianeating:it’sIt’sadeliciousandfunwaytoexplorenewfoods.Avegetarianmealcanbeasfamiliarasspaghettiwithmarinarasauce,ascomfortingasabowlofrichpotatosoup,orasunusualasRootin’Tootin’Salad(seetherecipeonpage12).Theswitchtoavegetariandietiseasierthanyoumightthink.Mostpeople,whethervegetariansormeat-eaters,typicallyusealimitedvarietyofrecipes;theaveragefamilyeatsonlyeightorninedierentdinnersrepeatedly.Youcanuseasimple,three-stepmethodtocomeupwithninevegetariandinnermenusthatyouenjoyandcanprepareeasily.First,thinkofthreevegetarianmealsyoualreadyenjoy.Commononesarepastaprimavera,vegetablestir-fry,andvegetablestew.Second,thinkofthreerecipesyouprepareregularlythatcaneasilybeadaptedtoavegetarianmenu.Forexample,afavoritechilirecipecanbemadewithalmostthesameingredients;justreplacethemeatwithbeansortexturizedvegetableprotein.Preparebeanburritos(usingcannedvegetarianrefriedbeans)insteadofbeefburritos,veggieburgersinsteadofhamburgers,andgrilledeggplantandroastedredpeppersinsteadofgrilledchickeninsandwiches.Manysoups,stews,andcasserolesalsocanbemadeintovegetariandisheswithaTHECANCERPROJECT•HEALTHYEATINGFORLIFE9



fewsimplechanges.Third,checkoutsomevegetariancookbooksfromthelibraryandexperimentwiththerecipesforaweekorsountilyoundthreenewrecipesthataredeliciousandeasytomake.YoucanalsoexplorethemanyrecipesoeredonourWebsite,www.cancerproject.org.Justlikethat,withminimalchangestoyourmenus,youwillhaveninevegetariandinners.Afterthat,comingupwithvegetarianoptionsforbreakfastandlunchiseasy.Trymunswithfruitspread,cholesterolfreeFrenchtoast,orcerealforbreakfasts.Sandwiches,withspreadslikehummusorwhitebeanpâtéwithlemonandgarlic,pastasalads,orevendinnerleftoversmakegreatlunches.

TIPSFORMAKINGTHESWITCHTOAVEGETARIANDIET•Conveniencefoodscutcookingtime.Supermarketsandnaturalfoodsstoresstockahugearrayofinstantsoupsandmain-dishvegetarianconvenienceitems.Manycannedsoups,suchasminestrone,blackbean,orvegetable,are

vegetarian.Flavoredriceorothergrainmixes,likecurriedriceortaboulisalad,canbestretchedintoanentréewithacanofbeans.Visitthefrozenfoodsectionforinternationallyinspiredvegetarianfrozenentréessuchascornandbeanenchiladas,lentilcurry,orvegetarianpadthai.Ortryvegetarianbakedbeans,refriedbeans,sloppyjoesauce,andmeatlessspaghettisaucefromthecannedgoodsaisle.•Askforit!Evenrestaurantsthatdon’toervegetarianentréescanusualywhipupameatlesspastaorvegetableplateifyouask.Ifattendingacateredaair,catchthewaiterbeforeyouareservedandaskhimorhertoremovethechickenbreastfromyourplateandsliponanextrabakedpotato.•Whenyou’redining

out,thebestbetsforndingvegetarianfoodareinternationalrestaurants.Italian,Chinese,Mexican,Thai,Japanese,andIndianrestaurantsalloerawidevarietyofvegetariandishes.•Summerbarbecuesarehealthyandfunwithmeatlesshotdogsandburgers,whicharenowavailableinmostsupermarkets.Or,forarealchangeofpace,grillthickslicesofmarinatedvegetableslikeeggplant,zucchini,ortomatoes.

REFERENCES1.AmericanCancerSociety.CancerFactsandFigures—1997.Atlanta,GA:1999.2.MinamotoT,MaiM,RonaiZ.Environmentalfactorsasregulatorsandeectorsofmultistepcarcinogenesis.Carcinogenesis.1999;20(4):519–27.3.NationalCancerInstitute.CancerRatesandRisks.Washington,DC:1985.4.DollR,PetoR.Thecausesofcancer:quantitativeestimatesofavoidablerisksofcancerintheUnitedSt

atestoday.JNatlCancerInst.1981;66:1191–308.5.BlockG.EpidemiologicevidenceregardingvitaminCandcancer.AmJClinNutr.1991;54(6Suppl):1310S–4S.6.BaroneJ,HebertJR,ReddyMM.Dietaryfatandnaturalkillercellactivity.AmJClinNutr.1989;50:861–7.7.NordenstromJ,JarstrandC,WiernikA.Decreasedchemotacticandrandommigrationofleukocytesduringintralipidinfusion.AmJClinNutr.1979;32:2416–22.8.HawleyHP,GordonGB.Theeectsoflongchainfreefattyacidsonhumanneutrophilfunctionandstructure.LabInvest.1976;34:216–22.9.MalterM,SchrieverG,EilberU.Naturalkillercells,vitamins,andotherbroodcomponentsofvegetarianandomnivorousmen.NutrCancer.1989;12:271–8.10.TonioloP,RiboliE,ProttaF,CharrelM,CappaAP.Calorieprovidingnutrientsandriskofbreastcancer.JNatlCancerInst.1989;81:278–86.11.ChoE,SpiegelmanD,HunterDJ,etal.Premenopausalfatintakeandriskofbreastcancer.JNatlCancerInst.2003Jul16;95(14):1079–85.12.WillettWC.Dietaryfatandriskofb

reastcancer.NEnglJMed.1987a;316:22–8.13.DeStefaniE,RoncoA,MendilaharsuM,GuidobonoM,Deneo-PellegriniH.Meatintake,heterocyclicamines,andriskofbreastcancer:acase-controlstudyinUruguay.CancerEpidemiolBiomarkersPrev.1997;6(8):573–81.14.SinhaR,RothmanN,BrownED,etal.Highconcentrationsofthecarcinogen2-amino1-methyl-6-phenylimidazo-[4,5]pyridine[PhlP]occurinchickenbutaredependentonthecookingmethod.CancerRes.1995;55:4516–19.15.HergenratherJ,HladyG,WallaceB,SavageE.Pollutantsinbreastmilkofvegetarians.Lancet.1981;304:792.16.HowellMA.Factoranalysisofinternationalcancermortalitydataandpercapitafoodconsumption.BrJCancer.1974;29:328–36.17.BlairA,FraumeniJF,Jr.Geographicpatternsofprostatecancerinthe



UnitedStates.JNatlCancerInst.1978;61:1379–84.18.KolonelLN,HankinJH,LeeJ,ChuSY,NomuraAMY,HindsMW.NutrientintakesinrelationtocancerincidenceinHawaii.BrJCancer.1981;44:332–9.19.RotkinID.Studiesintheepidemiologyofprostaticcancer:expandedsampling.CancerTreatRep.1977;61:173–80.20.SchumanLM,MandelJS,RadkeA,SealU,HalbergF.Someselectedfeaturesoftheepidemiologyofprostaticcancer:MinneapolisSt.Paul,Minnesotacasecontrolstudy,1976–1979.In:MagnusK,ed.TrendsinCancerIncidence:CausesandPracticalImplications.Washington,DC:HemispherePublishingCorp.,1982.21.GrahamS,HaugheyB,MarshallJ,etal.Dietintheepidemiologyofcarcinomaoftheprostategland.JNatlCancerInst.1983;70:687–92.22.RossRK,ShimizuH,Paganini-HillA,HondaG,HendersonBE.Case-controlstudiesofprostatecancerinblacksandwhitesinSouthernCalifornia.JNatlCancerInst.1987;78:869–74.23.SeversonRK,NomuraAM,GroveJS,StemmermannGN.Aprospectivestudyofdemographics,diet,andprostatecanceramongmenofJapaneseancestryinHawaii.CancerResearch.1989;49:1857–60.24.OishiK,OkadaK,YoshidaO,etal.Acasecontrolstudyofprostaticcancerwithreferencetodietaryhabits.Prostate.1988;12:179–90.25.MettlinC,SelenskasS,NatarajanN,HubenR.Beta-caroteneandanimalfatsandtheirrelationshiptoprostatecancerrisk:acase-controlstudy.Cancer.1989;64:605–12.26.ArmstrongB,DollR.Environmentalfactorsandcancerincidenceandmortalityindierentcountries,withspecialreferencetodietarypractices.IntJCancer.1975;15:617–31.27.ChanJM,StampferMJ,GiovannucciE,etal.Plasmainsulin-likegrowthfactor-Iandprostatecancerrisk:aprospectivestudy.Science.1998;279:563–5.28.GiovannucciE,RimmEB,WolkA,etal.Calciumandfructoseintakeinrelationtoriskofprostatecancer.CancerRes.1998a;58:442–7.29.

ChanJM,StampferMJ,MaJ,GannPH,GazianoJM,GiovannucciE.Dairyproducts,calcium,andprostatecancerriskinthePhysicians’HealthStudy.AmJClinNutr.2001;74:549–54.30.GiovannucciE,RimmEB,LiuY,StampferMJ,WillettWC.Aprospectivestudyoftomatoproducts,lycopene,andprostatecancerrisk.JNatlCancerInst.2002;94:391–8.31.DeCosseJJ,MillerHH,LesserML.EectofwheatberandvitaminsCandEonrectalpolypsinpatientswithfamilialadenomatouspolyposis.JNatlCancerInst.1989;81:1290–7.32.WynderEL,KajitaniT,KunoJ,LucasJC,Jr,DePaloA,FarrowJ.AcomparisonofsurvivalratesbetweenAmericanandJapanesepatientswithbreastcancer.SurgGynecObstet.1963;117:196–200.33.VerreaultR,BrissonJ,DeschenesL,NaudF,MeyerF,BelangerL.Dietaryfatinrelationtoprognosticindicatorsinbreastcancer.JNatlCancerInst.1988;80:81925.34.NewmanSC,MillerAB,HoweCR.Astudyoftheeectofweightanddietaryfatonbreastcancersurvivaltime.AmJEpidemiol.1986;123:767–74.35.HolmLE,

CallmerE,HjalmarML,LidbrinkE,NilssonB,SkoogL.Dietaryhabitsandprognosticfactorsinbreastcancer.JNatlCancerInst.1989;81:1218–23.36.BreslowN,ChanCW,DhomG,etal.Latentcarcinomaofprostateatautopsyinsevenareas.IntJCancer.1977;20:680–8.37.AnnualMeetingoftheAmericanUrologicalAssociation,Chicago,April26–May1,2003.DeanOrnish,MD,UniversityofCalifornia,SanFrancisco.PhilipBelitsky,MD,DalhousieUniversity,Halifax,NovaScotia,Canada.

10THECANCERPROJECT•HEALTHYEATINGFORLIFE



RECIPES

1/2cupbuckwheatour1/2cupcornmeal1/2teaspoonsodium-freebakingpowder1/4teaspoonbakingsoda1/4teaspoonsalt1ripebanana,mashed2tablespoonsmaplesyrup1tablespoonvinegar1cupfortiedsoymilkorricemilkMixbuckwheatour,cornmeal,bakingpowder,bakingsoda,andsalt.Inalargebowl,combinemashedbanana,maplesyrup,vinegar,andmilk.Addourmixture,stirringjustenoughtoremoveanylumpsandmakeapourablebatter.Addabitmoremilkifbatterseemstoothick.Preheatanon-stickskilletorgriddle,thenspraylightlywithvegetableoil.Poursmallamountsofbatterontotheheatedsurfaceandcookuntiltopsbubble.Turncarefullywithaspatulaandcookthesecondsidesuntilbrowned,about1minute.Serveimmediately.RecipefromHealthyEatingforLifeforWomenbyKrisKieswer

Hoppin’JohnSalad(Makesabout5cups)Forthesalad:2cupscookedblack-eyedpeas(1cupdry)or115-ouncecan,drained11/2cupscookedbrownrice(1/2cupuncooked)1/2cupnelyslicedgreenonions1celerystalk,thinlysliced(about1/2cup)1tomato,diced2tablespoonnelychoppedparsleyForthevinaigrette:1/4cuplemonjuice1tablespoonoliveoil1/4teaspoonsalt1-2garliccloves,crushedCombinethesaladingredientsinamixingbowl.Mixtogetherthevinaigretteingredientsandpouroversalad.Tossgently.Chill1to2hoursbeforeservingiftimepermits.RecipefromTurnOtheFatGenesbyNealD.Barnard,M.D.;recipebyJenniferRaymond

SpaghettiBalls(Makes36balls)Pour13/4cupsboilingwaterover2cupsdrytexturedvegetableproteinandsoakfor10minutes.Steamtogetherforafewminutes:1/2cupwater1smallonion,dicedMixonionwithtexturedvegetableproteinandstirin:1/2cupunbleachedour1teaspoonsalt1tablespoonlow-sodiumsoysauce1/2teaspoonchilipowder1/2teaspoongarlicpowder1/2teaspoonoregano

BuckwheatCorncakes

(Makes163-inchpancakes)Buckwheataddsawonderful,heartyavortotheseeasilypreparedpancakes.Servethemwithhomemadeapplesauce,freshfruit,ormaplesyrup.

Shapethismixtureintoballsoneinchindiameter,pressingrmly.Sprayvegetableoilintoanon-stickpanandcookballsuntilbrowned.Servewithyourfavoritetomatosauceinwholegrainbunsoroverpasta.RecipefromTheSurvivor’sHandbook:EatingRightforCancerSurvivalbyNealD.Barnard,M.D.THECANCERPROJECT•HEALTHYEATINGFORLIFE11



1clovegarlic,minced,or1teaspoonchoppedgarlic1scallion,minced(optional)juiceof1lemon1/2teaspooncumin1tablespoonfreshcilantro,chopped(optional)saltandpepper,totasteIfusingfrozenpeas,blanchpeasinboilingwaterfor2minutes,thencoolwithcoldwateranddrain.Cutavocadointolargechunks.Mashavocadoandpeastogetherusingapotatomasherorfork,or,ifaverycreamytextureisdesired,inafoodprocessor.Mixinsalsa,garlic,scallion(ifusing),lemonjuice,cumin,andcilantro(ifusing).Addsaltandpeppertotaste.RecipefromTheSurvivor’sHandbook:EatingRightforCancerSurvivalbyNealD.Barnard,M.D.

QuickBeanBurritos(Serves4)4fat-freeourorcorntortillas115-ouncecanfat-freerefriedbeansorblackbeans1cupshreddedromainelettuce2mediumgreenonions,sliced1/2cupTomatoCornSalsa(recipefollows)orothersalsa1/2cupGuacamolePlus(recipefollows)Heatbeansinsmallsaucepanorinmicrowaveuntilwarmedthrough.Inalargeskillet,heatatortillauntilitiswarmandsoft,orwarmtortillasinthemicrowaveifmakingmorethan4tortillas.Spreadabout1/2cupofthebeansdownthecenter,thentopwithlettuce,greenonions,salsa,andtheguacamole.Foldthebottomendtowardthecenter,thenrollthetortillaaroundthelling.Repeatwithremainingtortillasorletthosediningmaketheirown.RecipeadaptedfromFoodsThatFightPainbyNealD.Barnard,M.D.;recipebyJenniferRaymond

Rootin’Tootin’Salad(Serves6)115-ouncecandicedbeets,drained1smalljicama,peeledandcutintothinstripsordiced2mediumcarrots,peeledandcutintothinstripsordiced3tablespoonsoflemonjuice2tablespoonsseasonedricevinegar3teaspoonsstonegroundmustard1/2teaspoondrieddillweedPlacebeets,jicama,andcarrotpiecesintoalargebowl.Mixlemonjuice,vinegar,mustard,anddill;pouroverthesalad.Mix.Servewarmorchilled.RecipefromTheSurvivor’sHandbook:EatingRightforCancerSurvivalbyNealD.Barnard,M.D.

TomatoCornSalsa(Makes31/2cups)1cupfreshorfrozencornkernels,thawed2cupsdicedtomatoes2tablespoonsdicedredonions1/4cupdicedgreenbellpeppers1tablespoonchoppedfreshbasi

l1/2to1freshgreenchile,mincedor1/2to1teaspoonofyourfavoritechilisauce1tablespoonfreshlimejuice1teaspoonriceorcidervinegarIfcornisnotthawedcompletely,eitherblanchitinboilingwatertocoverfor1to2minutes,ormicrowaveituntilthawed.Drain.Inalargebowl,combinealloftheingredientsandsetasidefor15to20minutestoallowtheavorstodevelop.Addsalt,ifdesiredandserveatroomtemperature.RecipefromTheSurvivor’sHandbook:EatingRightforCancerSurvivalbyNealD.Barnard,M.D.

LentilBarleyStew(Makesabout11¤2quarts)1¤2cuplentils,rinsed1¤4cuphulledorpearledbarley1quartvegetablebrothorwater1smallonion,chopped1garlicclove,pressedorminced1carrot,diced1celerystalk,sliced1¤2teaspoonoregano1¤2teaspoongroundcumin1¤4teaspoonred

pepperakes1¤4teaspoonblackpepper1¤2–1teaspoonsaltPlaceallingredientsexceptsaltintoalargepotandbringtoasimmer.Coverandcook,stirringoccasionally,untillentilsandbarleyaretender,about1hour.Addsalttotaste.RecipefromHealthyEatingforLifeforChildrenbyAmyLanou,Ph.D.

GuacamolePlus(Makes21/2cups)Thisguacamoleisenrichedwithberfromthepeasandcancer-ghtingphytochemicalsfromthegarlic,salsa,scallions,andlemon.1cupfrozengreenpeasordrainedandrinsedcannedpeas1ripeavocado,peeled1/2cupmildsalsa12THECANCERPROJECT•HEALTHYEATINGFORLIFE



PennewithFreshSpinach,Tomatoes,andOlives(Serves4)1tablespoonoliveoil1mediumonion,chopped214.5-ouncecanschoppedtomatoes1/2cupkalamataolives,pittedandsliced10-16ouncesfreshspinach,coarselychopped1tablespoonchoppedfreshparsley8ouncespennepasta1/4cupveganparmesancheeseornutritionalyeast(optional)Heatoilinalarge,nonstickskillet.Addonionandsautéovermediumheatfor3minutes.Addchoppedtomatoes.Bringtoaboilandthenreduceheat,cover,andsimmerfor20minutes.Addslicedolives,choppedspinach,andparsley.Cookanadditional5minutes.Meanwhile,cookpastaaccordingtopackagedirections,omittinganyfatorsalt.Drainandtransfertoaservingbowl.Addspinachmixtureandtossgently.Serveimmediately.Sprinkleveganparmesanornutritionalyeastovertop,ifdesired.RecipefromTheBestintheWorld,editedbyNealD.Barnard,M.D.

MixedGreenswithApplesandWalnuts(Makesabout4cups)Usingapre-washedsaladmixmakesiteasytoprepare.6cupssaladmixorwashedandtornbutterlettuce1tartgreenapple(GrannySmith,pippin,orsimilar)1/4cupchoppedwalnuts3-4tablespoonsseasonedricevinegarPlacesaladmixortornleaflettuceintoabowl.Coreanddiceappleandaddtosaladalongwithwalnuts.Sprinklewithseasonedricevinegarandtosstomix.

SummerFruitCompote(Serves4)2cupspeeledandslicedfreshpeaches(peelingisoptional)2cupshulledfreshstrawberries1/2cupwhitegrapejuiceconcentrateorapplejuiceconcentrateI

nalargesaucepan,combineallingredients.Bringtoasimmerandcookforabout5minutes,oruntilfruitjustbecomessoft.Servewarmorcoldbyitself,oroverfruitsorbetorvanillasoyicecream.

MissingEggSandwich(Serves6)Thesesandwicheshavetheavorandappearanceofeggsaladwithoutthesaturatedfatandcholesterol.1/2poundrmreduced-fattofu(1cup)1greenonion,nelychopped,includinggreentop2tablespoonspicklerelish2tablespoonsveganmayonnaise2teaspoonsstone-groundmustard2teaspoonsreduced-sodiumsoysauce1/4teaspooncumin1/4teaspoonturmeric1/4teaspoongarlicpowder12sliceswhole-grainbread6lettuceleaves6tomatoslicesMashtofu,leavingsomechunks.Addgreenonion,picklerelish,veganmayonnaise,mustard,soysauce,cumin,turmeric,andgarlicpowder.Mixwell.Spreadonwhole-grainbreadandgarnishwithlet

tuceandtomatoslices.RecipefromTheSurvivor’sHandbook:EatingRightforCancerSurvivalbyNealD.Barnard,M.D.

RecipefromFoodsThatFightPainbyNealD.Barnard,M.D.;recipebyJenniferRaymond

ChocolateMousseorMoussePie(Serves8)1cupsemi-sweet,non-dairychocolatechips1/2cupsoy-orothernon-dairymilk1packageMori-Nusilkentofu(rmorextrarm)1/3cupsweetenerofyourchoice1/2teaspoonvanillaextractCombinethechocolateandnon-dairymilkinamicrowave-safebowlordoubleboilerandmelt,usinggentleheatandstirringoften.Removefromheat.Crumbletofuinablenderorfoodprocessor.Addmeltedchocola

teandnon-dairymilk,sweetener,andvanillaextract.Processuntilcompletelysmooth,pausingtheblenderorfoodprocessortoscrapedownthesidesandunderthebladeasnecessary.Chillthemixtureinservingbowlsor,ifdesired,agrahamcrackerorcookiecrust,foratleast1hourbeforeserving.Garnishwithfruit.Variation:addachoppedbananatothefoodprocessorwhenyouprocessthetofuandchocolatetogether.RecipefromTheSurvivor’sHandbook:EatingRightforCancerSurvivalbyNealD.Barnard,M.D.THECANCERPROJECT•HEALTHYEATINGFORLIFE13



HelpUsWintheBattleAgainstCancer

AboutTheCancerProjectWithoveronemillionpeoplebeingdiagnosedwithcancerintheUnitedStateseachyear—andmanymorecasesinothercountriesacrosstheglobe—thereisanurgentneedforanewdirectioninbattlingthisdisease.TheCancerProjectisacollaborativeeffortofphysicians,researchers,andnutritionistswhohavejoinedtogethertoeducatethepubliconhowahealthydietcanprotectusfromcancerandhelpusregainourhealthoncecancerhasbeendiagnosed.

TheKeyIsInformationMostAmericansdonotyethavethefactsabouttherelationshipbetweennutritionandcancer.SurveysconductedbyOpinionResearchCorporationInternationalhaverepeatedlyfoundthatmostpeoplehaveneverheardoflinksbetweendietandcancer.Inotherwords,informationhasnotbeengettingtopeoplewhoneedit.ThatiswhyweestablishedTheCancerProject—todisseminatelife-savinginformationaswidelyaspossibleandkeepitfrombeingburiedinmedicallibraries.

GettingtheWordOutTheCancerProjectdistributesinformationonreducingcancerriskand,whencancerhasbeendiagnosed,howdietandotherfactorsmayhelpimprovesurvival.Vitalinformationhasreachedmillionsofindividualsandfamiliesthroughbrochures,televisionadvertisements,Web-basedinformation,andnutritionandcookingclasses.TheCancerProjectalsodistributesthousandsofpiecesofinformation

tohealthprofessionalsatconferencesandconventions.Westresstheneedformoreeffectiveeducationaleffortsonnutritionandcancerprevention.Televisedpublicserviceannouncementsarereleasednationallytwiceayear.TheCancerProject’sFoodforLifenutritionandcookingclassseriesforcancerpreventionandsurvivalisbeingtaughtalloverthecountrytohelpindividualsunderstandhowandwhytocooknutritiously.Theclassesnotonlyhelpindividualsunderstandhowandwhytocooknutritously,theyalsoactasalightheartedsupportgroupforcancersurvivorsorthosewhohavebeentouchedbycancerinsomeway.TheSurvivor’sHandbookandthecompanionvideo,EatingRightforCancerSurvival,weredevelopedtoaccompanytheclassseries,buttheycanalsobeusedontheirowntohelpcancersurvivorsorindividualsinterestedincancerpreventionhaveaccesstothisvitalinformationathome.

YourHelpMakesItPossible!Thesuccessofoureffortsdependsentirelyontheresourcesavailableforproducinganddistributingprintedinformation,fundingourresearch,workingwiththemedia,stafngboothsatmedicalconferences,andteachingourFoodforLifenutritionandcookingclasses.Bothlargeandsmallcontributionsmakeanenormousdifference.Ifyouwishtosupportourworktoadvancecancerpreventionandsurvivalthroughnutritioneducationandresearch,youmaydonateonlineatwww.CancerProject.org.Ifyouprefer,youcanmailorphoneinyourcontributionto:

TheCancerProject5100WisconsinAve.NW,Suite400Washington,DC20016Phone:202-244-5038www.CancerProject.org

Non-ProtOrg.U.S.PostagePAIDWashington,DCPermit#184

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