eating patterns to lower cancer risk: more than one … · eating patterns to lower cancer risk:...

Eating Patterns to Lower Cancer Risk:

More than One Route to a Plant-Based Diet

Karen Collins, MS, RDN, CDN Sharon Palmer, RDN

October 29, 2013

Thank You!

Learning Objectives

At the conclusion of this presentation, the participant will be able to: • Identify, compare and contrast several different

predominantly plant-based eating patterns. • Explain current research findings regarding each of

these patterns and the potential to reduce cancer risk.

• Describe practical steps for making various cancer-protective eating patterns practical and enjoyable.

• Translate lessons learned from different eating patterns to steps that can be applied to any eating pattern to enhance its healthfulness and flavor.

How to Receive CPE Credit

1. Participate in the full webinar.

2. Complete the post-webinar evaluation.

3. Receive your certificate.

About Today’s Presenters

Karen Collins, MS, RDN, CDN Sharon Palmer, RDN

Disclosures

Karen Collins, MS, RDN, CDN: Honorarium, National Berry Crops Initiative

Sharon Palmer, RDN: Consultant, Tomato Products Wellness Council, Oldways Vegetarian Network, Daisy Brand Low-Fat Cottage Cheese, Silk



Karen Collins, MS, RDN, CDN Nutrition Advisor, AICR

KarenCollinsNutrition.com

Why eating patterns?

Carbohydrate

Fat

Protein

Vitamins

Minerals

Electrolytes

Fiber

Phytochemicals

Foods

“Good food”

“Bad food”

“Super foods” _____

Calorie Balance

Health

Important Questions

• Healthy compared to what?

• Who is in the study?

• How is the eating pattern defined?

♦ Percentiles within a specific group?

♦ Based on what standards?

Combining Strategies into

Healthy Eating Patterns

The whole can be greater than the sum of its parts

Vegetarian Eating Patterns

• Vegan

• Lacto-ovo-

• Pesco-

• Semi-

Vegetarian Diets & Health

Adventist Health Study-2 (AHS-2):

(HR compared to meat-eaters)

All-Cause Mortality Cancer Incidence

Vegetarian .88* .92**

Vegan .85 .84**

Lacto-ovo .91 .93

Pesco- .81* .88

Semi- .92 .98

*p<.05 only in total group & men; not women

**p<.05 only in men & women combined, not separately

Orlich, JAMA Int Med 2013 Tantamango-Bartley, Cancer Epid Biom Prev 2013

Vegetarian Diets & Health

Huang, Ann Nutr Metab 2012

Meta-analysis of 7 studies – 10-23 yr follow-up

Vegetarian: Vegan + L-O + Meat/fish <1/wk

Vegetarians: 18% lower Cancer Incidence

Vegetarian Diets & Specific Cancers

Adventist Health Study-2 (AHS-2):

(Vegetarian vs Non-vegetarian after BMI adjustment)

HR Cancer Diet Types

Incidence Significant

GI Tract .77* Lacto-ovo (.76*)

Respiratory tract .75 --

Urinary tract 1.21 --

Male cancer .94 --

Female cancer .97 Vegan (.71*) (breast, endometrial, ovarian, cervical, other)

*p<.05 Tantamango-Bartley, Cancer Epid Biom Prev 2013

Vegetarian Diets: Cancer-Protective Elements

• Lower average BMI • Higher dietary fiber • Higher plant foods’ phytochemicals,

vitamins, minerals • Less red and processed meat • Observational studies: Less alcohol Lacto-ovo vegetarians • Higher dairy

Very Low-Fat Vegan Diet & Prostate Cancer

*as part of multi-factor lifestyle*

After dx with early stage, non-aggressive prostate cancer

At 1 year:

• Serum PSA 4% decrease

(control group increase 6%)

• Serum on LNCaP cells ~70% decrease growth

(control group ~9% decrease)

• Change PSA & LNCaP Growth significant link

to change in lifestyle index

Ornish, J Urol 2005



3-month study: (Ornish, PNAS 2008)

• Change Gene Expression in healthy prostate cells

♦ 48 up-regulated, 453 down-regulated

5-year study: (Ornish, Lancet Oncol 2013)

• Telomere length increase vs decrease in control group

• Telomere lengthening linked to lifestyle adherence

• Increased telomerase activity not the whole answer

Program: Diet

+ Exercise (3 hr/wk)

+ Stress Management (1 hr/day)

+ Group Support



Ornish, J Urol 2005; Dewell, J Am Diet Assoc 2008

Very Low-Fat Vegan Diet

(Preventive Medicine Research Institute)

• Very Low Fat (11%)

• High Carbohydrate* (75%)

*avoid simple sugars; high complex CHO

• High Fiber - average 59 g/day

• Moderate Protein (20%*)

*with daily soy protein isolate drink

• Additional Supplements: vit E, Selenium, vit C,

3 gm Fish oil (900 mg n-3)

Dewell, J Am Diet Assoc 2008

Implementing Vegetarian Diets

• AHS-2 vs EPIC-Oxford:

What to eat as well as what to avoid

Vegetables, Fruits, Whole Grains

Beans (and Nuts, Seeds)

• Learning to use new protein sources

• Questions: Iron, B-12, omega-3, Vit D

• Calories matter

• Multi-behaviors & Adherence tied to benefits:

More intervention, longer follow-up

DASH Diet Eating Pattern

DASH Diet: Origins

Change in BP vs Control Diet (mm Hg)

Fruit & Veg DASH

Hypertensive -7.2*/-2.8* -11.4*/-5.5*

Non-Hypertensive -0.8 /-0.3 -3.5*/-2.1*

*p<.001 or .003 Appel, N Engl J Med 1997; 336:1117-1124

DASH and Colorectal Cancer Risk

High vs Low Category/Quintile DASH Diet Index

HR Colorectal Cancer Men: all 4 index scores 0.75 – 0.81* Women: 3 index scores 0.79 – 0.84* Dixon index score 1.01 *p<.05

NIH-AARP Diet and Health Study

Cross, Am J Clin Nut 2013;98(3):794

The DASH Diet • Low Fat (27%) • Low Saturated Fat (6%) • High Carbohydrate (55%) • Moderate Protein (18%) •Sodium: 2300 mg unless otherwise specified At 2000 Kcal level: • High Fiber 30 gm • High Potassium 4700 mg • High Calcium 1250 mg • High Magnesium 500 mg

At 1600-2600 Calories Daily High Vegetables & Fruit 7-12 svgs

High Grains* 6-11 svgs

Recent versions:

Whole Grains: >1/2 grains or >4-5 svgs/day

Dairy (low-fat or fat-free) 2-3 svgs

Fish, Poultry, Lean Meat up to 3-6 oz

Nuts, Seeds, Legumes 4-7 svgs/week

Low added fat 2-3 tsp oil

Limited Sweets (< 5 small/wk except at high kcal)

The DASH Diet

DASH and Colorectal Cancer Risk: A Closer Look

Significant Components of DASH Diet Index Score Multivariate HR Whole grains/High-fiber grains1 .79-.82* Low-fat Dairy (Calcium) .64-.76*(.80-88)* Red & processed meat (limiting) .82* Alcohol2 (limiting, Dixon index) .81* 1Except in women per all-or-nothing Dixon std 2Men only

Cross, Am J Clin Nut 2013;98(3):794

DASH & Cancer Risk

• Weight management: low calorie density

• May decrease oxidative stress? Variable results

• May decrease inflammation? 8-wk crossover trial in T2Diabetes: Decrease CRP: DASH diet 26.9% vs Control diet 5.1%

• May increase insulin sensitivity?? *Even after adjust for BMI, Wt loss, Kcal intake,

Activity

Azadbakht, J Nutrition 2011; Shirani, Nutrition 2013

DASH & Insulin?

ENCORE trial: DASH + Decreased Calories + Exercise vs. DASH alone

• Weight loss 19 lbs vs < 1 lb

• Decrease in Fasting Insulin

• Increase Insulin Sensitivity

Blumenthal, Hypertension 2010

DASH & OmniHeart Optimal Macronutrient Intake Trial

to Prevent Heart Disease

• DASH High-CHO

58% CHO, 15% Protein, 27% Fat

• DASH + Plant Protein

48% CHO, 25% protein:

3 svg legumes & nuts/day, 2.5 Dairy

• DASH + Unsaturated Fat

48% CHO, 37% fat, 21% MUFA, 10% PUFA

Appel, JAMA 2005

Swain, J Am Diet Assoc 2008

DASH & OmniHeart Optimal Macronutrient Intake Trial

to Prevent Heart Disease

Protein & Unsat Fat vs. CHO-DASH: • Systolic BP - greater decrease • TG – greater decrease • 10-yr CHD Risk – greater decrease

• Fasting Insulin - no significant effect • Insulin Sensitivity – increase with

Unsat Fat

Appel, JAMA 2005 Gadgil, Diabetes Care 2013

Implementing DASH

• T2 Diabetes, Metabolic Syndrome, Obese

- need calorie adjustment;

- consider CHO, protein, fat choices

• Ethnic Cultural Adaptations

local stores, cooking classes (Whitt-Glover, Prev Chronic Dis Jan 2013; DASH of Soul: Rankins, Ethn Dis. 2007)

• DASH Tracker – apps or NHLBI website form

http://www.nhlbi.nih.gov/health/public/heart/hbp/dash/dash_brief.pdf

Mediterranean Eating Pattern

©2010 by American Society for Nutrition

Mediterranean Diet & Health All-Cause Mortality

Each 2-point incr. Med Diet score: 8% all-cause mortality

Sofi, Am J Clin Nutr 2010

©2010 by American Society for Nutrition

Mediterranean Diet & Health Cancer Incidence or Mortality

Sofi, Am J Clin Nutr 2010

Each 2-point incr. Med Diet score: 6% Cancer Incid / Mortality

Mediterranean Diet & Biomarkers

Consistent*

Inflammation (esp. CRP) decreased

Moderately Consistent **

Insulin & Insulin Resistance decreased

Emerging Question***

Effect on Telomere Length

* **Nordmann, Am J Med 2011; *Panagiotakos, Int J Epid 2009; **Esposito, Diab Resrch & Clin Pract 2010

*** Boccardi, Plos One 2013; García-Calzón, Int J Obesity 2013

Mediterranean Eating Pattern

• Not Low Fat (30-38%)

• Low Saturated Fat (<10%)

• Moderate Carbohydrate (39-47%)

• Moderate Protein (15-18%)

At 2000 Kcal level:

• Fiber varies 20-30 gm

• Sodium varies; may not be <2500 mg

• High Potassium 4600 mg

• Variable Calcium 1000 mg or less

• High Magnesium 500 mg

©2009 Oldways Preservation and Exchange Trust

A Mediterranean

Diet

Mediterranean “Scores”

Considerations:

Compared to what other eating?

Who and where?

U.S. studies often use aMed score*:

• 1 pt each above average vegetables (not potatoes), legumes, fruits, nuts, whole grains

• 1 pt above average fish

• 1 pt below average red & processed meat

• 1 pt moderate alcohol

• 1 pt above-average ratio MUFA : Sat Fat

Range of scores: 0-9

*Fung, Amer J Clin Nutr 2005

Going Mediterranean: Olive Oil

Extra Virgin Olive Oil

♦ MUFA ♦ Polyphenols ♦ Tocopherols ♦ Squalene

• Animal studies –

Decrease mammary tumor growth

Change cell signaling pathways, gene expression

• Limited Short human interventions –

Decrease plasma oxidative stress & DNA oxidation

Change signaling pathways & gene expression

• Observational - Southern Europe, high vs lower use

? lower risk esophageal, colon, breast cancers

Machowetz, FASEB J 2007; Escrich, Pub Hlth Nutr 2011; Pelucchi, Curr Pharm Des. 2011

http://www.ncbi.nlm.nih.gov/pubmed/21443483

Going Mediterranean: Nuts

♦ MUFA, ALA (walnuts) ♦ Ellagitannins

♦ Flavonoids ♦ Gamma-Tocopherol

• Limited animal studies – Walnuts decrease growth of prostate, colon, breast tumors

• Observational (PREDIMED)-

Total nuts >3 oz/wk 40% lower cancer mortality

Walnuts >3 oz/wk 54% lower cancer mortality

Guasch-Ferré, BMC Med 2013

Mediterranean Diet & Weight

• Mediterranean vs Low-fat Diets among Overweight

♦ Not linked with wt gain; Allows wt loss ♦ May decrease waist

• % calories from fat does not produce weight loss

• Reducing calorie density for weight management:

♦ Calorie density of overall diets

♦ High vegetables makes low calorie density,

even if >35% calories from fat

Romaguera, Am J Clin Nutr 2010; Beunza, Amer J Clin Nutr 2010;

Esposito, Met Syn Rel Dis 2011; Nordmann, Am J Med 2011

Japanese/Okinawan Diet

Japanese Diet & Cancer

• Age-standardized international data:

♦ Stomach cancer high

♦ Breast & Prostate cancers low

♦ Low BMI & Adult weight gain minimal

• Observational studies in present-day Japan

♦ Prudent pattern: Veg, Fruit, Seafood, Soy

High vs low: 21% less colorectal cancer

♦ Healthy pattern: Veg, Fruit, Fish, Soy, Yogurt

High vs low: 13-17% lower CRP (p<.001)

GLOBOCAN 2008, IARC; Kurotani, Br J Nutr 2010; Nanri, Amer J Clin Nutr 2008

Japanese Eating Pattern • Very Low Fat (6-8%)

• Very Low Saturated fat (2%)

• High Carbohydrate (80-85%)

• Moderately Low Protein (9-15%)

At 2000 Kcal level:

• Moderate Fiber varies 20-36 gm

• Sodium may be high (esp. outside Okinawa)

Soy sauce, Pickled vegetables, Salted fish

• Potassium can be high 2600-5800 mg

• Low Calcium 300-600 mg

Asian Eating Pattern

©2000 Oldways Preservation and Exchange Trust

Eating Asian Style

• Fish and soy – re-thinking uses, learning how to prepare

• Reducing calorie density with broth soups and abundant vegetables

• Hara hachi bu

New Nordic Diet

New Nordic Diet

Olsen, Nutrition 2011; Kyrø , Brit Nutr Jrnl 2012

Healthy Eating Patterns: Lessons Learned

The whole can be greater than the sum of its parts

What Makes a Healthy Eating Pattern?

• Predominantly Plant-focused vs Western Diet ♦ Vegetables, Fruits, Whole Grains, Beans, Nuts, Seeds ♦ Type of Carbohydrate ♦ Limiting Red & Processed Meat ♦ Fat: Type (Amount??) • Calorie Balance for a Healthy Weight • Alcohol only in limited amounts • Long-term habit • Part of a Lifestyle: Exercise, Stress mgmt

Individual Differences Is there a BEST eating pattern?

• Genetics

♦ Insulin sensitivity

♦ Enzymes that metabolize phytochemicals

• Microbiota

• Body composition

• Physical activity

• Medical conditions & medications

• “Doability” - fit with lifestyle, preferences

Resources

• Smart Bytes® blog & website

by Karen Collins, MS, RDN, CDN

www.karencollinsnutrition.com/SmartBytes

• Vegetarian & Vegan Diet Pyramid (& materials) by Oldways

http://oldwayspt.org/resources/heritage-pyramids/vegetarian-diet-pyramid/overview

• PMRI (Dean Ornish & colleagues) research

http://www.pmri.org/about.html#research-highlights

• Dietary Approach to Stop Hypertension (DASH) http://www.nhlbi.nih.gov/health/public/heart/hbp/dash/index.htm

http://www.karencollinsnutrition.com/SmartBytes









http://www.pmri.org/about.html



http://www.nhlbi.nih.gov/health/public/heart/hbp/dash/index.htm




More Resources

• Mediterranean Diet Pyramid (& materials) by Oldways

http://oldwayspt.org/resources/heritage-pyramids/mediterranean-pyramid/overview

• Mediterranean Diet Recipes & Shopping List from California Walnuts

http://www.walnuts.org/recipes/mediterranean-diet/

http://www.walnuts.org/walnuts/assets/File/Recipe%20Shopping%20List%20-%20CA%20Walnuts%20Mediterranean%20Diet%281%29.pdf

• Asian Diet Pyramid (& materials) by Oldways

http://oldwayspt.org/resources/heritage-pyramids/asian-diet-pyramid











http://www.walnuts.org/walnuts/assets/File/Recipe Shopping List - CA Walnuts Mediterranean Diet(1).pdf












More Resources From the American Institute for Cancer Research (AICR) http://aicr.org

• Recommendations for Cancer Prevention

http://www.aicr.org/reduce-your-cancer-risk/recommendations-for-cancer-prevention/index.html

• New American Plate http://www.aicr.org/new-american-plate/

• AICR’s Foods that Fight Cancer http://www.aicr.org/foods-that-fight-cancer/

• From the AICR Test Kitchen http://www.aicr.org/reduce-your-cancer-risk/diet/reduce_diet_recipes_test_kitchen.html

• Health-e-Recipes http://preventcancer.aicr.org/site/PageServer?pagename=her_current_issue

http://aicr.org/















http://www.aicr.org/new-american-plate/






http://www.aicr.org/foods-that-fight-cancer/








http://www.aicr.org/reduce-your-cancer-risk/diet/reduce_diet_recipes_test_kitchen.html







http://preventcancer.aicr.org/site/PageServer?pagename=her_current_issue

http://preventcancer.aicr.org/site/PageServer?pagename=her_current_issue

Thank You!

http://karencollinsnutrition.com



Sharon Palmer, RDN

Indigenous, Traditional Diets

Common Features:

• Local whole grain

• Local legumes

• Seasonal cultivated and foraged fruits and vegetables

• Seeds and nuts

• Minimally processed

• Low use of animal foods

Image: Sharon Palmer

Plant-Based Eating Around the Globe: Peru

Image: Wikicommons, McKay Savage

• Potatoes • Quinoa • Peppers • Butter

Beans • Maize • Potato-like

tubers (oca, mashua, ulluco)

• Tomatoes • Tawri

(legume) • Fruits

Plant-Based Eating Around the Globe: Central America

• Maize • Tomatoes • Spices • Beans • Rice • Plantains • Avocados • Coconut • Squashes • Pumpkins • Mango • Bananas • Cocoa • Coffee


Plant-Based Eating Around the Globe:

India

• Millet • Lentils • Pigeon peas • Mung bean • Chickpeas • Spices • Rice • Green leafy

vegetables • Pickles • Gourds • Cucumbers • Potato • Cauliflower • Eggplant • Pepper • Mango

Image: Wikicommons, Ananth BS

Plant-Based Eating Around the Globe:

West Africa

Image: Wikicommons, Marco_Schmidt

• Chili peppers • Tomatoes • Peanuts • Corn • Cassava • Plantains • Black-eyed

Peas • Okra • Onions • Spices • Baobob fruit • Millet • Sorghum • Sesame • Eggplant • Pumpkin • Green leafy

vegetables

Mediterranean Plant-Based Patterns

• Abundance of fruits, vegetables

• Whole grains • Legumes • Nuts, seeds • Lower in

meat • Seafood • Moderate

dairy • Moderate

wine

Images: Sharon Palmer

The Flavors of the Mediterranean: Italy


• Pasta Dishes • Pesto • Risotto • Salads • Caprese • Ciaki Ciuka • Soups • Pizzas • Antipasti • Couscous • Bean dishes

The Flavors of the Mediterranean: Italy

Ingredients: • Capers • Olives • Olive oil • Citrus • Almonds • Herbs • Potatoes • Tomatoes • Pasta • Rice • Beans • Lentils • Eggplant • Greens • Grapes


The Flavors of the Mediterranean: Spain

Dishes: • Bean stew • Gazpacho • Olives,

nuts snacks

• Samfaina • Wrinkled

potatoes • Vegetable

soups • Paella • Tapas

Image: Wikicommons, Tamorian

Images: Wikicommons, Centerbuilder


The Flavors of the Mediterranean: Spain

Ingredients: • Olives • Olive oil • Fruits

(peaches, citrus, grapes)

• Beans • Potatoes • Rice • Vegetables

(eggplant, peppers, onions, garlic, tomatoes)

• Spices • Herbs

Image: Wikicommons

Image:Wikicommons, Luis Miguel Bugallo Sánchez

Image: Wikicommons, Oyvind Holmstad

Image: Wikicommons, Adam Jones, PhD

The Flavors of the Mediterranean: France

Dishes: • Salads • Socca • Ratatouille • Soupe au

pistou • Tarte aux

blettes • Vegetable

soup • Gnocchi

with chard • Pissaldiere • Fried

zucchini flowers

• Pasta dishes


Image: Wikicommons, Ian L

Image: Wikicommons, Patrice Semeria

Image: Wikicommons

The Flavors of the Mediterranean: France

Ingredients: • Vegetables

(onions, zucchini, eggplant, tomatoes, green leafy vegetables)

• Fruits (grapes, citrus, stone fruit)

• Olive oil • Herbs

(lavender, basil, rosemary)

• Chickpeas

Image: Wikicommons, Marek Gehrmann

Image: Wikicommons, fretless88

Image: Wikicommons, David Monniaux

Image: Wikicomons, Agne27

The Flavors of the Mediterranean: Greece

Dishes: • Chaniotiko

Boureki • Tiganita • Dakos • Stuffed grape

leaves • Fava • Greek Salad • Horta • Stuffed

Zucchini Flowers

• Spanakopita • Artichokes in

olive oil

Image: Wikicommons, Lemur12

Image: Wikicommons, Stu-spivack

Image: Wikicommons, Tanya Bakogiannis Image: Wikicommons, John Sullivan

The Flavors of the Mediterranean: Greece


(artichokes, greens, peppers, eggplants, zucchini)

• Legumes (beans, peas, lentils)

• Olive oil • Herbs • Fruits

(grapes, figs, citrus)

• Wheat

Image: Wikicommons, Badseed

Image: Wikicommons, H Zell

Image: Wikicommons, Evelyn Simak

Image: Wikicommons, Lina Waters

The Flavors of the Mediterranean: Lebanon

Dishes: • Mezze • Tabbouleh • Fattoush • Hummus • Baba

Ghanoush • Stuffed

Grape Leaves

• Flat bread • Falafel • Mujaddara • Tahini


Image: Wikicommons


Image: Wikicommons, Jerem

The Flavors of the Mediterranean: Lebanon


(tomatoes, onions, greens, cucumbers, olives)

• Spices/Herbs • Sesame seeds • Olive oil • Rice • Buckwheat • Legumes (beans,

chickpeas) • Fruits (figs,

melons, cherries)

Image: Wikicommons, Russavia

Image: Wikicommons

Image: Wikicommons, Elgarrd

The Flavors of the Mediterranean ….More: • Turkey • Morocco • Syria • Tunisia • Israel • Egypt • Croatia


The Flavors of Japan and Okinawa Dishes:

• Goya champuru

• Umi budo • Tofu • Tempura • Miso

soup • Green

leaf salads

• Rice • Noodles • Shabu

shabu • Green tea • Pickles


The Flavors of Japan and Okinawa

Ingredients: • Vegetables (cabbage, greens,

radish) • Sea Vegetables • Mushrooms • Tofu • Rice • Buckwheat • Seasonings • Fermented Foods • Seeds • Fruits (citrus, pear)


Traditional Nordic Diet Dishes: • Pea Soup • Rye breads • Jansson’s

Temptation • Open-face

Sandwich • Pancakes • Boiled

Potatoes • Beet Salad • Strawberry

Cake • Apple Cake • Whole grain

breads and crisp breads


Image: Wikicommons, Pieter Kuiper

Image: Wikicommons, Leo Johannes

Image: Wikicommons, Roger Wollstadt

Traditional Nordic Diet Ingredients: • Root

vegetables, cabbage, kale, mushrooms

• Grains (rye, wheat, oats)

• Legumes (peas, beans)

• Fruits (berries, apples, pears)

Image: Wikicommons, Sharon Palmer

Image: Wikicommons

Image: Wikicommons, David Baird

Image: Wikicommons, Anne-Sophie Ofrim

Plant-based Traditions in US

Dishes: • Black-eyed

Peas and Greens

• Beans and Rice

• Porridge • Waffles,

pancakes • Chili and

Cornbread • Stews • Lasagna • Slaws,

Salads


Making New Plant-based Traditions Images: Sharon Palmer

Making New Plant-based Traditions


Tips for a Healthy Plant-Based Eating Style

Start the day right. Go veggie at breakfast.

Join the Meatless Monday bandwagon.

Shop for plants first. Instead of planning your menu around meat, plan it around plants.


If you eat meat, use it as a seasoning. Cut down on animal food intake while pushing plants by using meat as a flavoring in dishes instead of the main event.

Create a plant-based pantry list. Many plant-based foods like beans and whole grains are shelf-stable, convenient, and economical.

Get cooking! Plan at least one night a week to try a new vegetarian recipe.


Keep it simple. Not every meal has to involve cookbooks and cutting boards; it can be as easy as black bean burritos, vegetarian chili, or hummus pita sandwich.

Try ethnic flair. Some cultures know how to do vegetarian meals right!

Convert your favorite dishes. Turn your favorite meat-based recipes veggie for an easy dinner solution.


Dust off your slow-cooker. Just throw in veggies, herbs, vegetable broth, canned tomatoes, whole grains, and dried beans; then turn the dial on.

Try plant-based dairy products. Try more plant-based alternatives for milk, yogurt, and cheese.

Think “yes”. Don’t dwell on what you can’t have, think about what you can have!

Thank You

Sharon Palmer, RD [email protected]

Questions & Answers

eating patterns to lower cancer risk: more than one … · eating patterns to lower cancer risk:...

Documents