nutrition for cancer survivors - fred hutch€“ mindful eating. ... • loss of bone density /...
TRANSCRIPT
On the Menu
• Review of research– Newer studies
• Food as chemoprevention
• Making changes– The food‐brain connection– Mindful eating
Nutritional considerations after treatment:
• Changes to body composition / weight changes• Loss of bone density / Osteoporosis• Diabetes• Hyperlipidemia• Congestive heart failure• Changes in bowel function• Taste and smell changes• Hot flashes• Neuropathies• Metabolic syndrome
Cancers of the Colon and Rectum ‐
AICR* update May 2011
Decrease Risk Increase Risk
Convincing ‐
Physical Activity ‐
Red / processed meat‐
Alcoholic drinks (men)‐
Body / abdominal fatness
Probable ‐
Dietary fiber‐
Garlic‐
Milk‐
Calcium
‐
Alcoholic drinks (women)
Limiting / Suggestive ‐
Fruit and non‐starchy
vegetables
‐
Diet sources of selenium,
vitamin D, and folate
‐
Fish‐
Selenium
‐
Foods containing iron,
animal fats, and sugar
‐
Cheese
*American Institute for Cancer Research
Colon Cancer
• Recent study with Folate– Indicates high levels of folate
from
supplementation and fortification are not associated with higher risk of colorectal cancer.
» Stevens, VL. Gastroenterology, 2011
• From the Latin word folium (foliage)
• Food sources rich in folate:– Legumes, nuts, broccoli, dark leafy green
vegetables, asparagus and peanuts
Prostate Cancer
• Newer study on dietary zinc– Higher levels of dietary zinc after diagnosis was
associated with a lower risk of death from prostate cancer.
» Epstein, MM. Am J Clin
Nutr, 2011
• Food sources rich in Zinc:– Fresh oysters, ginger, lamb, nuts, legumes, and
whole grains
Prostate Cancer
• Newer study around calcium
• Two‐fold increased risk associated with a higher intake of milk
• Decreased risk was seen with higher intake of legumes
(dried beans, peas, lentils), nuts, shellfish/finfish and α‐
tocopherol
(vitamin E)
• Not conclusive evidence» Raimondi, S, The Prostate, 70;1054‐1065, 2010
Prostate Cancer
• Plant sources of calcium– Broccoli– Dark leafy greens– Almonds
– Tofu– Bok choy
• Supplement vs. Diet ??
Prostate Cancer
• New Calcium recommendations from IOM**Institute of Medicine
Estimated Avg.
Requirement
(mg/day)
RDA (mg/day) Upper Level Intake
(mg/day)
19‐30 years 800 1,000 2,500
31‐50 years 800 1,000 2,500
51‐70 yrs (males) 800 1,000 2,000
51‐70 yrs (female) 1,000 1,200 2,000
>70 years 1,000 1,200 2,000
Prostate Cancer
• Prostate cancer intensive nutrition & lifestyle change study: – Almost vegan diet
• Very low meat intake• High fruit and vegetable intake
– Reduced fat – Lifestyle interventions: yoga, exercise, meditation and support
groups
• After one year, participants had no need for conventional
therapies– Lower PSA’s– Greater quality of life– Less in vitro prostate cancer cell growth
» Dean Ornish, 2005
Breast Cancer
• Newer study focusing on quality of diet and physical activity
• Women with “better quality diets”
had:
– 60% reduced risk of death from any cause
– 88% reduced risk of death from breast cancer
• Women with “better quality diets and physical activity
had:
– 89% reduced risk of death from any cause
– 91% reduced risk of death from breast cancer» George, S, Cancer Causes Control, 2010
Breast Cancer
• Recent study focusing on weight– Breast cancer survivors with a BMI >/= 30 kg/m2
and > 10 years out from treatment:• 46% increased risk of developing distant metastases
after 10 years
• 38% increased risk of dying as a result of breast cancer after 30 years
» Ewertz, M. J. Clin
Onc; 2010
Additional Study
• RENEW (Reach out to Enhance Wellness in Older Cancer Survivors)
– Reduced rate of functional decline with survivors who ate more fruit and vegetables, ate less
saturated fats and lost more weight» Morey, JAMA 301(18); 1883‐1891, 2009
Vitamin D
• HSCT survivors and vitamin D status» Robien, K., Bone Marrow Transplant, 2011
• A loss of more than 15% body weight boosts vitamin D levels in overweight women.
» McTiernan, A., 2011
• Check your vitamin D level before supplementing.
– 25 hydroxy
vitamin D between 30‐50 ng/mL
Vitamin D
• New Vitamin D recommendations from IOM **Institute of Medicine
Estimated Avg.
Requirement
(IU/day)
RDA (IU/day) Upper Level Intake
(IU/day)
19‐30 years 400 600 4,000
31‐50 years 400 600 4,000
51‐70 yrs (males) 400 600 4,000
51‐70 yrs (female) 400 600 4,000
>70 years 400 800 4,000
Summary of Studies
• Eat a majority of plant foods
• The nutrients we receive from our food are essential to our health. Try to get your
nutrients primarily from whole food sources.
• Use supplementation sparingly ‐
more is not always better. Our needs for specific
nutrients may be more individualized.
Studies Lacking
There are many cancer types that are not covered in this review due to lack of available
studies. Reasons include:• no “patent”
on diets, less financial benefit than for
drugs
• diet intervention studies are difficult to execute and are costly
• food practices are highly variable and are hard to measure accurately in a study
Nutrition for Wellness: The Basics
• Plant‐based diet– Variety of colorful vegetables and fruit– Legumes (beans/lentils), nuts, seeds, whole grains – Include herbs and spices
• Limit processed and refined foods– Less than 5 ingredients on a label– Limit enriched or enhanced foods
• Lower fat diet– Focus on healthy fat sources
• nuts, avocados, seeds/seed oils (sesame oil, grapeseed
oil), olive
oil, fish
• Percentage of US adults who consumed vegetables 3 or more times per day
• Percentage of US adults who consumed fruit 2 or more times a day
Cancer Survivors’
Adherence to Lifestyle Behavior Recommendations and Associations With Health‐
Related Quality of Life– Abbreviation: 5‐A‐Day, consumed five servings of fruits
and vegetables each day. Results From the American
Cancer Society's SCS‐II» Blanchard, CM. J Clin
Onc, 26; 2198‐2204, 2008
Cancer Group Physical Activity (%) 5‐A‐Day (%) Smoking (%)
Breast 37.1 18.2 88.1
Prostate 43.2 15.6 91.6
Colorectal 35.0 15.9 91.3
Bladder 36.0 16.3 82.6
Uterine 29.6 19.1 91.1
Skin Melanoma 47.3 14.8 89.0
“I know what to do, I just don’t do it!”
• What are some barriers ?– Too little time– Too little sleep– Too much effort– Too much food– Too much eating out– Too much stress– Too much anxiety
Making Changes
• Changing your cues to food• Address stress in your life• Know your triggers• Find activities that make you happy!
Mindfulness
Physical Hunger Emotional Hunger Sensory Hunger
Builds gradually Develops suddenly Eyes (sight of food)
Strikes below the neck Strikes above the neck Nose (smell of food)
Occurs several hours after
a meal
Unrelated to time Tongue (taste of food)
Goes away when full Persists despite fullnessTouch (mouth’s feel of
food)
Eating leads to feeling of
satisfaction
Eating leads to feeling of
guilt and shame
Sound (noise of eating,
noise present)
Mindful Eating
• You are in‐the‐moment• You are eating a food that is pleasing to your
senses (taste, smell, flavor, touch, sound, sight)
• You are aware of your physical hunger and feeling of fullness (satiety) – these are cues that guide your decision to begin eating and to stop eating
• You are NOT being judgmental
What is NOT
Mindful Eating
• when you eat because of feelings “above the neck”
(emotions…sad, happy, frustrated, bored,
anxious, excited…)
• if you eat when you are not hungry
• if you eat even though you feel full (satiated)
• when you judge your eating – this is often associated with shame or guilt
Resources
• AICR expert report– www.dietandcancerreport.org
• www.whfoods.com• www.365daysofkale.com• www.cancerlifeline.org• The Cancer Fighting Kitchen
– Rebecca Katz