Eating Well After Cancer

Kate Ueland, MS, RD Medical Nutrition Therapy at Seattle Cancer Care Alliance

How Healthy Is Your Diet?

Take 2 minutes to write down all the whole plant foods you ate over the last two days

Answer to your best ability the following multiple choice questions: 1. Breakfast is usually:

A. Egg white omelet and sausages

B. A muffin and orange juice

C. A bowl of oatmeal or cereal with fresh or dried fruit

2. Thinking about the amount of meat in your diet, do you:

A. Always include a large portion of red or processed meat with your meals

B. Have a medium-sized portion of red or processed meat 5 or more times week

C. Usually fill at least two thirds or more of your plate with plant foods and one third or less with lean meat

www.aicr.org

How Healthy Is Your Diet?

3. If you think about the meals and snacks you've eaten over the past week, your choices of plant foods (vegetables, fruits, whole grains and beans) have included:

A. Less than 10 different kinds

B. 10 - 20 different kinds

C. More than 20 different types of these foods

4. You eat take out or fast food:

A. Almost every day

B. A few times a week

C. Occasionally as a treat

5. The number of portions of fruit and vegetables you have in a typical day is:

A. One or less

B. Between two and four

C. Five or more

What Can You Do to Minimize Risk of Recurrence?

Eat a Plant Focused Diet

• In cell and animal studies, nutrients and phytochemicals found in plant foods show effects on

– Cell cycle regulation

– Processes of angiogenesis (blood vessel growth)

– Apoptosis (programed cell death)

– DNA repair

– Inflammation

Plant Focused Diet

• In laboratory studies, plant compounds influence

– Histone acetylation

– DNA methylation

– RNA transcription

• These changes either silence or promote expression of genes such as tumor suppressor genes

Plant Focused Diet is High in Fiber

• Plant foods are higher in fiber so there is decreased absorption of carbohydrate and lower circulating insulin and related growth factors (IGF-1).

• Higher fiber will decrease circulating estrogen levels because of decreased reabsorption from the digestive tract.

Plants are Antioxidants

• Antioxidants protect DNA from damage

– Carotenoids

– Flavonoids

– Sulfur compounds

– Carotenoids are known to promote cell-to-cell communication that helps control cell growth

Eat the Rainbow!

• 2/3 of your plate from plant foods.

• Eat at least 25 grams of fiber daily. More is better!

• Consume at least 3 cups of non-starchy vegetables

• Enjoy 1.5 cups fruit daily

Tips for Eating a Plant Based Diet

Eat More Plant Proteins

• Legumes are a great source of plant proteins and also provide antioxidants, fiber, vitamins and minerals.

www.meatlessmonday.com

Plants and Intestinal Bacteria

• Gut bacteria comprise 70% of our immune system.

– Increased fermentable fiber and resistant starches produce butyrate which may reduce inflammation.

Spices and Herbs are Plants

Maintain a Healthy Weight

Adiposity and Influence on Cancer Risk

• Excess body fat is associated with insulin resistance and increased insulin growth factor (IGF-1). This can stimulate cancer growth pathways, promoting growth and reproduction of cancer cells and inhibiting programmed cell death.

• Adipose tissue is the main site of estrogen production in post menopausal women

Adiposity and Cancer Risk

• Fat cells produce hormones including leptin. Increased leptin may promote cell proliferation and blood vessel development while inhibiting programed cell death.

• Reduced amount of hormone adiponectin which is protective and decreases insulin resistance and inflammation. It also promotes programmed cell death

Adiposity and cancer risk

• Overweight and obesity are associated with a constant state of low-grade chronic inflammation that can promote cancer development.

• Abdominal adiposity has clear associations with increased risk of breast, pancreas, colon and endometrial cancers

Maintain a Healthy Weight

Alcohol – Less is Better

• 1 Drink a day for women

• 2 Drinks a day for men

Why Limit Alcohol ?

• Alterations in blood hormone levels, especially elevated estrogen-related hormones, have been reported in humans

• Increased estrogen levels may increase the risk of breast cancer through increases in cell proliferation and alterations in estrogen receptors.

Oyesanmi O, Alcohol consumption and cancer risk: understanding possible causal mechanisms for breast and colorectal cancers. 2010

Alcohol and Colon Cancer

• Intestinal mucosal damage after ethanol consumption.

– Increased degradation of folate.

– Stimulation of rectal carcinogenesis.

– Increased cancer cell proliferation.

– Increased effect of carcinogens

Hypothesized nonlinear relation between folate status and breast cancer risk.

Ulrich C M Am J Clin Nutr 2007;86:271-273

Eat More Omega 3 Fatty Acids

•alpha-linolenic acid (ALA)

•eicosapentaenoic acid (EPA)

•docosahexaenoic acid (DHA)

Benefits of Omega 3 Fatty Acids

Types of Fats That Contribute to Inflammation

• A recent study of healthy men and women found

that the ratio of omega-6/omega-3 fatty acids

showed the strongest positive correlations with

increased levels of most inflammation markers,

suggesting that this ratio may constitute a

predictor of low-grade, chronic inflammation.

• Omega 6 fatty acids are high in soy, corn, sunflower and cottonseed oils. Eat less of these.

Omega 3’s and Anti-Aging

• Omega 3 fatty acids may protect against the shortening of the telomeres at the ends of chromosomes which is a process that has been identified as a marker of cell aging and associated with cancer risk.

Eat Foods Rich in Omega 3 Fatty Acids

• Dark green leafy vegetables

• Wild cold-water fish such as wild salmon, sardines, mackerel, bluefin tuna, albacore tuna, bluefish

• Walnuts, macadamia nuts

• Soybeans, edamame and tofu

• Flaxseed, chia and pumpkin seeds

• Flaxseed, walnut, wheat germ and hemp oils

• Game meat or grass-fed meats, dairy products from grass-fed animals

• Omega 3 eggs

Eat Nuts and Seeds

• Consume in moderation.

– 1 serving = ¼ cup

• Excellent source of fiber minerals and healthy fats.

• As a snack; measure out a small handful and close the container to avoid mindless or over-eating.

• Quality matters and rancid nuts and seeds should be avoided. Keep them in the freezer.

Drink More Fluids

Your Body’s Detox

• Water hydrates your cells and flushes out waste products from food, medications and the environment

• Aim for 8 cups daily

• Drink more on hot days and with exercise

Limit Consumption of Red Meat

• Red meat includes; beef, lamb, and pork

• Red meats generally contain a higher amount of fat than fish or skinless poultry.

• Thus, the recommendation to limit red meats will help to limit fat intake.

• Recommendation: Limit red meat intake to less than or equal to 18 oz per week. • 3 oz = deck of cards

Limit Salt Intake

• Avoid highly processed foods such as: – Chips

– Crackers

– Breads

– Baked goods

– Canned soups, vegetables

– Cured meats

– Deli meats

• Salting food at the table and normal salting during cooking does not contribute to excessive salt intake

Soy Consumption

• Soy is rich source of isoflavones, a category of phytoestrogens (plant estrogens)

• Based on recent epidemiological studies, soy is considered safe to eat for breast cancer survivors in whole soy food forms.

• Traditional, whole forms of soy foods include edamame, roasted soybeans, tofu, tempeh, and miso.

• Recommendation: Consume soy foods in moderation. Soy foods may be consumed as part of a general diet.

• Avoid processed foods made from soy isolates, such as soy analogs (“fake” meats) and textured vegetable protein.

Flaxseeds

• Flaxseeds contain Lignans and alpha-linolenic acid (ALA).

• Research has focused on breast, colon and prostate cancers.

• Recommendation: a small amount of ground flaxseed (1-4 Tablespoons) is safe and may provide general heart healthy benefits.

• If consuming flaxseed oil, do not cook with it and use 1 tablespoon drizzled over vegetables after cooking or use in salad dressings.

• Store flaxseed and flaxseed oil in refrigerator.

Bone Health

• Treatments against cancer and having menopausal hormone changes may result in loss of bone density.

• This can lead to osteopenia and osteoporosis.

• It is important to consume enough calcium and vitamin D to help keep your bones strong.

• Exercise is also important in preventing osteoporosis

Calcium and Vitamin D Requirements

Age and Gender: Calcium

Adequate Intake

Vitamin D

Adequate Intake

Males and Females: 1-3 years

4-8 years

≥ 9-18 years

19-50 years

50-70 years

Over 70 years

700 mg

1000 mg

1300 mg

1000 mg males

1200 mg females

1200 mg

1200 mg

600 IU

600 IU

600 IU

600 IU

600 IU

600 IU

800 IU

Post-menopausal females not receiving hormone replacement

therapy

1500 mg 600-800 IU

Children receiving steroid therapy

1-5 years

6-8 years

≥ 9-18 years

1000 mg

1200 mg

1500 mg

600 IU

600 IU

800 IU

Adults diagnosed with osteopenia, osteoporosis or receiving

steroid therapy

1500 mg 1000 IU

Organic vs. Non Organic

Easy Ways to Add Healthy Foods to Your Diet

• Add ground flaxseeds to oatmeal or yogurt

• Add chopped chard, kale or dark leafy greens to soups and salads

• Make variations of hummus using white beans, edamame or lentils

• Snack on roasted pumpkin seeds instead of chips

• Add chopped walnuts to salad or hot cereal

• Make homemade salad dressings using olive or flaxseed oils

• For meat-eaters, use grass-fed meats and wild fish or eat less animal protein

Recommendations from American Institute for Cancer

Research • Be as lean as possible without becoming underweight.

• Be physically active for at least 30 minutes every day.

• Avoid sugary drinks, and limit consumption of energy-dense foods (particularly processed foods high in added sugar, low in fiber or high in fat).

• Eat a variety of vegetables, fruits, whole grains and legumes such as beans.

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

• If consumed at all, limit alcoholic drinks to two for men and one for women a day.

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

• Do not rely on supplements to protect against cancer.

• And always remember – do not smoke or chew tobacco.

Resources

• American Institute for Cancer Research www.aicr.org

– Cancer specific diet and lifestyle recommendations

• Cookbooks

– The Cancer Fighting Kitchen – Rebecca Katz

– Feeding the Whole Family – Cynthia Lair

• Talk to a dietitian in your area

Eat food, mostly plants and not too much.

Michael Pollen

Questions?

Kate Ueland, MS, RD 206-288-1116

kueland@seattlecca.org