lifestyle medicine & cancer risk

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Lifestyle Medicine& Cancer RiskKara Markin, MD, dipABLMAssistant ProfessorUniversity of Nebraska Medical Center

Disclosures

I have no financial disclosures or conflicts of interest.

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Objectives

1. Define Lifestyle Medicine

2. Recognize the significance of epigenetics in cancer risk

3. List the 10 evidence-based Cancer Prevention Recommendations of the Continuous Update Project of the American Institute for Cancer Research (AICR)

Lifestyle Medicine Defined

Lifestyle Medicine is the use of a whole food, plant-predominant dietary lifestyle, regular physical activity, restorative sleep, stress management, avoidance of risky substances and positive social connection as a primary therapeutic modality for treatment and reversal of chronic disease.

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Field Characteristics

Conventional Use of medications and surgical procedures to treat diseases thought to be caused by pathogens, environmental exposures, genetic predisposition

Lifestyle Use of evidence-based lifestyle recommendations to “treat the cause”

Complementary / Alternative

Uses complementary with conventional medicine or alternative in place of conventional medicine

Integrative Addresses whole person (physical, social, emotional, mental, environmental, spiritual) through combination of conventional, complemental and alternative means.

Functional Focuses on physiologic and biochemical functions of the body and investigates the balances and processes of cellular metabolism, digestive function, detoxification and control of oxidative stress.

Mind-Body Investigates interactions between mind and body – behaviorally, emotionally, mentally, socially and spiritually. Uses modalities like relaxation, hypnosis, visual imagry, meditation, yoga, biofeedback, tai chi

Preventative Includes all aspects of prevention of morbidity and mortality, often on a public health level, including immunizations and screening tests

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Simple, Powerful Therapy

• NUTRITION: Choose predominantly whole, plant-based foods that are fiber-filled, nutrient dense, health-promoting and disease-fighting.

• SLEEP: Lack of, or poor-quality sleep can lead to a strained immune system. Identify and alter environmental habits that may hinder healthy sleep.

• EXERCISE: Regular and consistent physical activity is an essential piece of an optimal health equation.

• SUBSTANCE USE: The well-documented dangers of any addictive substance use can increase risk for many cancers and heart disease.

• STRESS MANAGEMENT: Identify both positive and negative stress responses with coping mechanisms and reduction techniques for improved wellbeing.

• SOCIAL CONNECTION: Being connected to others is essential to emotional resiliency and overall health.

Am J Clin Nutr, Volume 96, Issue 1, July 2012, Pages 150–163, https://doi.org/10.3945/ajcn.111.031674

Adherence to World Cancer Research Fund guidelines and risk of cancer at 13 sites.- 386,355 participants- 11y follow-up

Measured Factors1. Weight2. Physical Activity3. Nutrition4. Alcohol Use5. Breastfeeding

Decreased Risk Increased Risk

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Am J Clin Nutr, Volume 101, Issue 3, March 2015, Pages 558–569, https://doi.org/10.3945/ajcn.114.094854

Adherence to American Cancer Society lifestyle guidelines and risk of cancer at 25 sites.- 476,396 participants- 13.6y follow-up

Measured Factors1. Weight2. Physical Activity3. Nutrition4. Alcohol Use

Decreased Risk Increased Risk

Cancer incidence for selected cancers in Japanese women by generation in Hawaii and Japan, 1968-1977

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Epigenetics is the study of the molecular mechanisms that modify chromatin – usually in a stable or heritable way – that may bring about changes in gene expression without altering the DNA sequence.

Source: https://www.whatisepigenetics.com/fundamentals/

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Dai, Z. Nature Reviews Genetics 21, 737-753

Dai, Z. Nature Reviews Genetics 21, 737-753

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Disease

Lifestyle

Epigenetics

This material has been reproduced from the World Cancer Research Fund/American Institute for Cancer Research. Diet, Nutrition, Physical Activity and Cancer: a Global Perspective. Continuous Update Project Expert Report 2018. Available at dietandcancerreport.org.

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dietandcancerreport.org

CUP evidence: Increased risk of 12

cancers

IARC*: Increased risk of thyroid cancer, multiple myeloma, meningioma

Overweight and obesity in childhood and early life tend to track into adulthood

Greater body fatness increases the risk of other diseases such

as heart disease

*IARC, International Agency for Research on Cancer

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Strong evidence for recommendations

CUP evidence: Reduced risk of

bowel, breast and womb cancers

Indirect: Other cancers via effect on

obesity

Moderately physically active

Follow or exceed national guidelines

Role of sedentary behaviours

Dietary fibre and wholegrains

protective against bowel cancer

Dietary fibre decreases risk of weight gain and

obesity

Non-starchy veg and fruit help

protect against aerodigestive

cancers*

30g fibre per day

“5-a-day” (400g) fruit and veg

Most meals

* ‘Aerodigestive cancers’ include: mouth and throat; nasopharynx; oesophagus; lung; stomach; and bowel.

wcrf.org/dietandcancer/recommendations/be-physically-activewcrf.org/dietandcancer/recommendations/wholegrains-veg-fruit-beans

Be physically activeBe physically active as part of every day life – walk more

and sit less

Eat a diet rich in wholegrains, vegetables, fruit and beans

Make wholegrains, vegetables, fruit and pulses (legumes) such as beans and lentils a major part of your usual diet




CUP evidence:‘Fast foods’ and a

‘Western type’* diet increase the risk of

weight gain, overweight and

obesity

CUP evidence: Glycaemic load

increases the risk of womb cancer

Relevant for prevention of other

diseases

CUP evidence: Sugar sweetened

drinks increase the risk of weight gain,

overweight and obesity

Provide energy but may not influence

appetite in the same way as food

does so can promote

overconsumption of calories leading to

weight gain

Type 2 diabetes

Dental caries and poor oral health

wcrf.org/dietandcancer/recommendations/limit-fast-foods-fat-sugarwcrf.org/dietandcancer/recommendations/limit-sugar-sweetened-drinks

Limit consumption of ‘fast foods’ and other processed foods high in fat, starches or sugars

Limiting these foods help control calorie intake and maintain a healthy weight

Limit consumption of sugar sweetened drinksDrink mostly water and unsweetened drinks

*A 'Western type’ diet is characterised by high intakes of free sugars, meat, and dietary fat


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CUP evidence: High-dose beta-carotene

increases risk of lung cancer (current and

former smokers)

For most people, it is possible to obtain

adequate nutrition from a healthy diet

that includes the right foods and drinks

Supplementation may be needed to achieve adequate nutrient intake for

some people

CUP evidence: Red meat and processed meat both increase

the risk of bowel cancer

Three portions per week (350-500g cooked weight)

Balancing the advantages and

disadvantages of eating red meat

CUP evidence: Increased risk of six

cancers

But…decreased risk of kidney cancer

Heavy drinking associated with

increased risk of liver disease, pancreatitis

and CVD*

Effect of moderate drinking on non-

cancer outcomes?

*Cardiovascular disease

wcrf.org/dietandcancer/recommendations/limit-alcohol-consumptionwcrf.org/dietandcancer/recommendations/limit-red-processed-meat

wcrf.org/dietandcancer/recommendations/dont-rely-supplements

Limit alcohol consumptionFor cancer prevention, it’s best not to drink alcohol

Do not use supplements for cancer preventionAim to meet nutritional needs through diet alone

Limit consumption of red and processed meatEat no more than moderate amounts of red meat, such as beef,

pork and lamb. Eat little, if any, processed meat




CUP evidence:

Mothers: Decreases risk of breast cancer

Children: Having been breastfed

decreases risk of obesity

Aligns with WHO recommendation

for exclusive breastfeeding for six

months

Other benefits of breastfeeding,

including lower risk of infections for the

infant

Nutritional and physical activity

factors can reliably predict outcomes for breast cancer

Quality…?

Likely to help prevent other

diseases and help manage co-existing

disease

After acute stage of treatment, with input from trained

professionals

wcrf.org/dietandcancer/recommendations/breastfeed-your-babywcrf.org/dietandcancer/recommendations/during-after-cancer

For mothers: breastfeed your baby, if you canBreastfeeding is good for both mother and baby

After a cancer diagnosis: follow our Recommendations, if you can

Check with your health professional what is right for you


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Objectives




Lifestyle Medicine Defined

Lifestyle Medicine is the use of a whole food, plant-predominant dietary lifestyle, regular physical activity, restorative sleep, stress management, avoidance of risky substances and positive social connection as a primary therapeutic modality for treatment and reversal of chronic disease.

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Objectives




Disease

Lifestyle

Epigenetics

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Objectives





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Life happens outside of clinic

References1. Geoffrey C Kabat, Charles E Matthews, Victor Kamensky, Albert R Hollenbeck, Thomas E Rohan, Adherence to cancer

prevention guidelines and cancer incidence, cancer mortality, and total mortality: a prospective cohort study, The American Journal of Clinical Nutrition, Volume 101, Issue 3, March 2015, Pages 558–569

2. Romaguera D, Vergnaud AC, et a. Is concordance with World Cancer Research Fund/American Institute for Cancer Research guidelines for cancer prevention related to subsequent risk of cancer? Results from the EPIC study, The American Journal of Clinical Nutrition, Volume 96, Issue 1, July 2012, Pages 150–163

3. Kolonel LN. Cancer incidence among Filipinos in Hawaii and the Philippines. J Natl Cancer Inst Monogr 69: 93–98.4. Dai, Z., Ramesh, V. & Locasale, J.W. The evolving metabolic landscape of chromatin biology and epigenetics. Nat Rev

Genet 21, 737–753 (2020).5. World Cancer Research Fund/American Institute for Cancer Research. Diet, Nutrition, Physical Activity and Cancer: a

Global Perspective. Continuous Update Project Expert Report 2018. Available at dietandcancerreport.org6. Sapienza C, Issa JP. Diet, nutrition and cancer epigenetics. 2016. Annu. Rev. Nutr. 36:665-681.7. American College of Lifestyle Medicine. https://www.lifestylemedicine.org

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Thank you!Contact me: [email protected]

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lifestyle medicine & cancer risk

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