the cancer project: healthy eating for life_update

8/8/2019 The Cancer Project: Healthy Eating for Life_Update

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Food Choices for Cancer

Prevention and Survival

Healthy EatingforLife


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More than 1 million people are diagnosed with cancer in the United States each year, and thereis an urgent need or a new direction in battling this disease. Tats why physicians, researchers,nutritionists, and cancer specialists have joined together to orm Te Cancer Project.

Te Cancer Project has two main goals. First, we aim to make cancer prevention a top priority.Second, and just as important, we want to improve survival aer cancer has been diagnosed by

oering comprehensive inormation about the role o dietary actors in keeping people healthy.

Te Cancer Project provides classes, books, television and video programs, Web-based inormationat www.CancerProject.org, brochures, and other educational materials on cancer prevention andsurvival. Te Cancer Project also conducts clinical research studies to investigate dietary issuesand publicizes the need or cancer prevention in hard-hitting television messages spotlighting thevalue o healthy diet changes. Our hands-on nutrition classes, which help cancer survivors and theiramilies learn new tastes and easy ood preparation skills, have become incredibly popular. Troughregular media interviews, our sta members provide important inormation to the public aboutcancer prevention.

Let me encourage you to support Te Cancer Project. With your help, well make cancer preventiona priority and help people diagnosed with cancer have the tools they need. Trough our detailedand user-riendly Web site (www.CancerProject.org), printed materials, television public serviceannouncements, and hands-on services, were able to spread a lie-saving message ar and wide.Since the Cancer Project is a non-prot 501(c)(3) organization, all contributions are tax-deductibleto the ull extent allowed by law.

Tank you or your interest and support.

Neal D. Barnard, M.D.

Physician, researcher, and author Neal D. Barnard is one o Americas leading ad-vocates or health, nutrition, and higher standards in research. Dr. Barnard is theounder and president o the Physicians Committee or Responsible Medicine. Healso initiated Te Cancer Project, an organization dedicated to cancer prevention,research, and nutritional assistance to cancer patients.

HEALHY EAING FOR LIFE: FOOD CHOICES FOR CANCER PREVENION AND SURVIVAL is pub-lished by Te Cancer Project, 5100 Wisconsin Ave., NW, Suite 400, Washington, DC 20016, 202-244-5038,www.CancerProject.org.

HEALHY EAING FOR LIFE is not intended as individual medical advice. Always discuss any diet change withyour personal physician. In some cases, diet changes may alter your need or medication. Persons who ollow a veg-etarian diet should be sure to include a source o vitamin B12 in their daily routine, such as ortied cereals, ortiedsoymilk, or any common multiple vitamin.

Readers are welcome to reproduce articles rom this publication or personal or educational use without addi-tional permission. Material should not be reproduced or resale without prior arrangement with Te Cancer Project. Te Cancer Project, 2004.


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Table of Contents

The CanCer ProjeCT healThy eaTing For liFe 3

Food Choices for Cancer Preventionand Survival p 4

Building Your Strength Against Cancer

Defending Your DNA from Harm p 5

Foods and Immunity p 5

Foods and Hormones p 7

Breast Cancer: Prevention p 7

Fat and Hormonal Effects p 7

How Much Fat Is Too Much? p 7

Carcinogenic Compounds in Cooked Meat p8

Cancers of the Uterus and Ovary: Prevention p 9

Prostate Cancer: Prevention p 9

Colon Cancer: Prevention p 10

Vegetarian Foods: Powerful for Health p 10

Try the New Four Food Groups p 11

Setting Blame Aside p 11

Steps to Cancer Prevention p 11

Surviving Cancer

Breast Cancer: Survival p 11

Cancers of the Uterus and Ovary: Survival p 12

Prostate Cancer: Survival p 12

Colon Cancer: Survival p 13

Making Healthy Diet Changes

The Three-Step Way to Go Vegetarian p 13Tips for Making the Switch to a Vegetarian Diet p 14

Affordable Eating p 14

Top Five Foods You Cant Live Without p 14

References p 15

Recipes p 16


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Food Choices for CancerPrevention and Survival

4 The CanCer ProjeCT healThy eaTing For liFe

Approximately 80 percent o cancers are due to actorsthat have been identied and can potentially be con-trolled, according to the National Cancer Institute. Not

only do we have the potential to prevent most cancers, we canalso improve the survival rates o people who have cancer.

Cancer starts when one cell begins to multiply out o control. Itbegins to expand into a lump that can invade healthy tissues andspread to other parts o the body. But this deadly disease canoen be prevented, and when it occurs, it can oen be stoppedin its tracks.

At least one-third o annual cancer deaths in the United Statesare due to dietary actors.1 A recent review o diet and cancer

shows that much o our risk or colon, breast, and prostatecancer, among other types, is due to dietary actors. 2,3

Te link between diet and cancer is not new. In January o1892, Scientic American printed the observation that can-cer is most requent among those branches o the human racewhere carnivorous habits prevail. Numerous research studieshave since shown that cancer is much more common in popu-lations consuming diets rich in atty oods, particularly meat,and much less common in countries with diets rich in grains,

vegetables, and ruits. One reason is that oods aect the actiono hormones in the body. Tey also aect the strength o the im-mune system. While ruits and vegetables contain a variety o

vitamins, minerals, antioxidants, and phytochemicals that pro-tect the body, research shows that, by contrast, animal productscontain potentially carcinogenic compounds that may contrib-

ute to increased cancer risk.

Established or SuspectedObesity-Related Cancers4

Breast (postmenopausal)

Prostate (advanced)

Pancreas

Esophagus (adenocarcinoma)

Gastric Cardia (adenocarcinoma)

Endometrium

Colon and Rectum

Liver

Gallbladder

Kidney (renal cell)

Non-Hodgkins Lymphoma

Multiple Myeloma

Leukemia

Stomach (men)

Ovary

UterusCervix

Another 30 percent o cancers are caused by tobacco. Lungcancer is the most obvious example, but it is by no means theonly one. Cancers o the mouth, throat, kidney, and bladder arealso caused by tobacco. Other actors, including physical activ-ity, reproductive and sexual behavior, bacterial and viral inec-tions, and exposure to radiation and chemicals, may also con-tribute to the risk o certain orms o cancer.


5/20The CanCer ProjeCT healThy eaTing For liFe 5

Building Your StrengthAgainst Cancer

Some dietary changes have a preventive eect or many typeso cancer. Boosting your intake o vitamin-rich vegetables andruits, or example, strengthens your immune system and helpsknock out cancer cells. o help prevent cancer, it is also smartto avoid meats, dairy products, and ried oods. Choosing ber-

rich legumes, grains, vegetables, and ruits helps keep manytypes o cancer at bay. Plant oods also contain a wide variety ocancer-ghting substances called phytochemicals.

Tese acts all point to choosing a vegetarian diet to help pre-vent cancer and improve cancer survival. Studies o vegetariansshow that death rates rom cancer are only about one-hal tothree-quarters o those o the general population. Breast can-cer rates are dramatically lower in countries such as China andJapan, where diets are typically based on rice, vegetables, andbean products, with very little use o meat, dairy products, oroily oods. When people rom those countries adopt a Western,meat-based diet, their breast cancer rates soar.

Are you ready to start enjoying the powerul benets o a veg-etarian diet? See Te Tree-Step Way to Go Vegetarian onpage 13.

Defending Your DNA From HarmLets look at the steps we can take to build our general deenses.

Oxygen is essential to lie. But as oxygen is used in the body, someo the oxygen molecules become very unstable. Tese unstablemolecules, called ree radicals, can attack cell membranes andeven damage the DNA (our genetic code) in the nucleus o thecell. Damage to DNA is the beginning o cancer.

Fortunately, the oods we eat can help protect our bodies.

Antioxidants, including vitamin C, vitamin E, beta-carotene,

selenium, lycopene, and others, can neutralize the damagingeects o oxygen. Tese powerul natural chemicals come tous in vegetables, ruits, grains, and beans. People who includeruits and vegetables in their daily diets have lower rates o manyorms o cancer.

Smokers have provided dramatic demonstrations o the powero vegetables and ruits. A 55-year-old male smoker whose diet

is low in vitamin C has a one-in-our risk o dying o lung can-cer in the next 25 years. But i the smoker has a high intake o

vitamin C, either through diet or supplements, his risk drops to7 percent. Eects o antioxidants have even been seen in child-hood. When children with brain tumors were studied, it wasound that their mothers consumed less vitamin C during preg-nancy, compared to other women.7

o step up the antioxidant power o your menus, try a bakedsweet potato, Easy Bean Salad, or baked corn chips with Colorul

Corn Salsa (recipes on pages 17 and 18).

Even with vegetables and ruits in the diet, damage to the cellsDNA will occasionally occur, so the body has built-in repair

machinery. Fixing damaged DNA, which could otherwise causecancer, requires a B vitamin called olic acid, which is ound indark green leay vegetables, ruits, peas, and beans. Recent evi-dence suggests that olic acid may be particularly important inpreventing HPV-related cervical cancer.8

Te Dietary Reerence Intake or olic acid or adult womenand men is 400 micrograms per day and increases to 600 mi-crograms per day or pregnant women. Beans and vegetables

are rich in olic acid. Asparagus, black beans, black-eyed peas,

chickpeas, lentils, pinto beans, and cooked spinach all havemore than 200 micrograms in a one-cup serving.

We are all exposed to cancer-causing chemicals despite our e-orts to avoid them. Some people are smokers, and, o course,quitting smoking is a vital step or them. But all o us are ex-posed to chemicals in the air, water, ood, and household prod-ucts in addition to the carcinogens produced within our bodiesas a part o our metabolic processes. While trying to minimizeour exposure to carcinogens, we can also shore up our deensesagainst these assaults by including generous amounts o vegeta-bles and ruits in our diet.

Foods and ImmunityEven i we ollow healthy liestyles, cancer cells will arise in

the body rom time to time. Luckily, we have white blood cellsthat roam our bloodstreams looking or these troublemakers.Some white blood cells, called natural killer cells, seek out anddestroy cancer cells and bacteria. Tey engul and destroy aber-rant cells beore they can cause damage. Te unction o naturalkiller cells and other white blood cells is improved by as littleas 30 milligrams o beta-carotene per daythe amount in twolarge carrots.

Although beta-carotene is sae, even in airly substantial

amounts, the best way to get beta-carotene is not in pills, butin carrots, winter squash, spinach, kale, and the other packagesin which nature supplies it. Beta-carotene is only one o per-haps two dozen related substances called carotenoids that occurnaturally in vegetables and ruits and have varying degrees obiological activity.

In a recent research review, cancer experts ound signi-cant evidence suggesting that carotenoids help protect againstesophageal, lung, and mouth cancers.3

In addition to their antioxidant eects, vitamins C and E and

Estimated Percentages of CancerDue to Selected Factors5,6

Diet 35 to 60%

obacco 30%

Air and water pollution 5%

Alcohol 3%

Radiation 3%

Medications 2%


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selenium bolster immune unction, but the importance othese eects in protecting against cancer is not yet clear.

Fats impair immunity, and cutting at out o the diet helpsstrengthen the immune deenses against cells that turn can-cerous. Researchers in New York tested the eect o low-atdiets on immunity.12 Tey put healthy volunteers on a dietthat limited at content to 20 percent, reducing all ats andoilsnot just saturated or unsaturated ats. Tree monthslater, the researchers took blood samples rom the volunteers

and examined their natural kil ler cells. Te natural killer cellactivity was greatly improved.

Although vegetable oils are ar superior to animal ats orheart patients, when it comes to the immune system, vege-table oils are no better than animal ats. In experiments, re-searchers have ound that when they inuse soybean oil intra-

venously into volunteers, the white blood cells no longer workas well.13 est tube experiments show similar results.

Similarly, omega3 atty acids, which are ound in sh oils,green vegetables, and soybean, ax seed, and canola oils, alsocompromise immune unction. Te bottom line on ats andoils: greatly reduce your intake o all o them.

It should come as no surprise that vegetarians have stron-ger immune systems than meat-eaters. Studies o white bloodcell samples rom vegetarians have shown them to have morethan double the cancer cell-destroying ability o their non-

vegetarian counterparts.15 Te immune-boosting power ovegetarian diets is partly due to their vitamin content, low atcontent, and perhaps other contributors, such as reduced ex-posure to toxic chemicals and animal proteins.

Dietary at intake can also contribute to weight gain, whichcan impair immune unction. Studies show that overweightindividuals are at increased susceptibility to various inec-tions and to certain orms o cancer, especially postmeno-

pausal breast cancer.16

Cutt t

ut t

dt ps

stt

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dss

st cs

tt tu

ccus.

Antioxidants in Foods9,10,11 Vit C B-carotene Vit E

(mg) (mg) (mg)

Apple (1 medium) 8 0.04 0.44

Broccoli 116 1.30 1.32

Brown rice 0 0.00 4.00

Brussels sprouts 96 0.67 1.33

Carrot (1 medium) 7 12.00 0.28

Cauliower 54 0.01 0.05

Chickpeas 2 0.02 0.57

Corn 10 0.22 0.15

Graperuit (pink, 1/2) 47 0.19 0.31

Navy beans 2 0.00 4.10

Orange (1 medium) 75 0.16 0.31

Orange juice 124 0.30 0.22

Pineapple 24 0.02 0.16

Soybeans 3 0.01 3.35

Fresh spinach 16 2.30 0.57

Strawberries 84 0.02 0.23

Sweet potato(1 medium with skin) 28 15.00 0.32

Sv szs cup (8 z.), xcpt s tws td.



Foods and HormonesSeveral o the most common orms o cancer are linked to sex

hormones. Tis is true o cancers o the breast, uterus, ovary,prostate, and perhaps other sites. Te amount o hormones inour bodies and their actions are determined, in large part, bythe oods we eat.

Breast Cancer: PreventionAs long ago as 1982, the National Research Council in a re-

port called Diet, Nutrition, and Cancer, showed the evidencealready available linking specic dietary actors to cancer o thebreast and other organs.

International comparisons oer a good illustration. Asiancountries, such as Japan, have low rates o breast cancer, whileWestern countries have cancer rates many times higher. How-ever, when Japanese girls are raised on Westernized diets, theirrates o breast cancer increase dramatically.

Te traditional Japanese diet is much lower in at, especiallyanimal at, than the typical Western diet. In the late 1940s, when

breast cancer was particularly rare in that country, less than 10percent o the calories in the Japanese diet came rom at. TeAmerican diet, o course, is centered on animal products, whichtend to be high in at and low in other important nutrients. Teat content o the average American diet is well above 30 percento calories.

It has long been known that countries with a higher intake oat, especially animal at, have a higher incidence o breast can-cer. Even within Japan, auent women who eat meat daily havean 8.5 times higher risk o breast cancer than poorer womenwho rarely or never eat meat. wo decades ago, the SurgeonGenerals Report on Nutrition and Health stated, Indeed, acomparison o populations indicates that death rates or cancerso the breast, colon, and prostate are directly proportional toestimated dietary at intakes.

Fat and Hormonal Effects

Fatty oods have a strong inuence on hormonal activity in thebody. First, high-at diets increase the amount o estrogens, theemale sex hormones, in the blood. Tis is a problem, becauseit is well known that many breast tumors are ueled by es-trogens. Estrogens are normal and essential hormones or bothwomen and men, but the more estrogen present, the greater thedriving orce behind some kinds o breast cancer. On high-at

diets, estrogen levels increase. When women adopt low-at diets,their estrogen levels drop noticeably in a very short time. Veg-etarians have signicantly lower estrogen levels than non-vege-tarians, in part because o the lower at content o their diet. Inaddition, they have more o certain carrier molecules, called sexhormonebinding globulin, that circulate in the blood and havethe job o holding onto sex hormones, keeping them inactiveuntil they are needed. Fatty oods do the reverse: they increaseestrogens and reduce the amount o the carrier molecule that issupposed to keep estrogens in check.

Animal ats are apparently a bigger problem than vegetableoils. Paolo oniolo o the New York University Cancer Insti-tute compared the diets o 250 women with breast cancer to 499women without cancer rom the same province in northwesternItaly. Te two groups ate about the same amount o olive oil andcarbohydrates. What distinguished the cancer patients was thatthey had eaten more meat, cheese, butter, and milk. Women whoconsumed more animal products had as much as three times thecancer risk o other women.17

A 2003 Harvard University study that included more than90,000 women showed that the women who had eaten the mostanimal at had signicantly higher risk o breast cancer com-pared with women who ate the least.18

Even though cross-cultural comparisons have pointed a ngerat animal at as the principal problem, vegetable oil is also un-der some suspicion. Vegetable oils can probably aect estrogenlevels and, as we will see, can increase the production o cancer-causing ree radicals. So it is no good just replacing ried chickenwith ried onion rings. Te best diet eliminates animal productsand keeps vegetable oils to a minimum as well.

Certain oods have special benets. Soybeans, or example,

contain natural compounds called phytoestrogens. Tese arevery weak estrogens that can occupy the estrogen receptors onbreast cells, displacing normal estrogens. Te result is less estro-gen stimulation o each cell. Soybeans are a mainstay o Asiandiets and may be an additional reason why these countries havelow cancer rates.

How Much Fat Is Too Much?Te National Cancer Institute has long recommended that at

be limited to less than 30 percent o calories and that the attiestmeats be replaced by leaner meat, poultry, sh, and vegetables.Tese recommendations, however, are much too weak to prevent

cancer or to increase survival or those already diagnosed withthe disease. A large study o American nurses showed that thosewho limited at to 27 percent o their calories were not any bet-ter o in preventing cancer than those consuming more at.19

Some have interpreted this to mean that diet has nothing to dowith breast cancer. A more reasonable conclusion is that the dietsthese women ollowed were still high-risk diets. Aer all, a dietincluding regular consumption o animal products and drawingnearly 30 percent o calories rom at is nothing like the tradi-tional plant-based Asian diets associated with low cancer risk.

Favoring FiberGrains, vegetables, ruits, and legumes ensure plenty o ber,

but chicken breasts, bee, pork, eggs, cheese, and all other ani-mal products contain no ber at all.

Getting the at o your plate is importantbut that is just therst step. Other ood choices play important roles in cancerprevention. Vegetables, ruits, grains, and beans provide ber,which helps the body dispose o excess estrogen.

One way the body rids itsel o sex hormones is through thedigestive tract. Te liver pulls sex hormones rom the blood,chemically alters them, and sends them down the bile ducts into



the intestinal tract. Tere, the ber rom grains, vegetables,ruits, and beans ushers sex hormones through the intestineand out the door as wastes. At least, that is how the system

is supposed to work. But chicken breasts, bee, eggs, cheese,and all other animal products contain no ber at all. As theseproducts have taken up more and more space on the Ameri-

can plate, they have displaced grains, vegetables, beans, andruits. Without adequate ber to hold them in the digestive

tract, sex hormones are reabsorbed into the bloodstream,

where they once again become biologically active. Te hor-mones your body was trying to eliminate are thus put back

into circulation.

Building your diet rom grains, vegetables, ruits, and le-

gumes ensures plenty o ber or the bodys needs. o increaseyour daily ber intake, start your day with oatmeal and ruit,and try adding delicious, low-at, ber-rich recipes such as

Tree-Bean Chili or Easy Bean Salad to your weekly menu(see recipes on page 18).

Carcinogenic Compounds in Cooked Meat

Not only is meat devoid o ber and other nutrients thathave a protective eect, but it also contains animal protein,

saturated at, and, in some cases, carcinogenic compoundsormed during the process o cooking meat. Tese carcino-

genic compounds may be to blame or part o the correlationbetween meat intake and increased cancer risk. Meat intakehas been shown to be a risk actor or breast cancer even when

researchers controlled or conounding actors such as totalat and calorie intake.20

Heterocyclic AminesHeterocyclic amines (HCAs) are DNA-damaging com-

pounds that are produced as meat cooks. Grilling, rying, or

oven-broiling meat produces large quantities o these mu-tagens. Te longer and hotter the meat is cooked, the more

o these compounds orm. In some studies, grilled chickenormed higher concentrations o these cancer-causing sub-

stances than other types o cooked meat.21

Te major classes o HCAs are ormed rom creatine or crea-tinine, specic amino acids, and sugars. All meats, includingsh, are high in creatine. HCA ormation is greatest when

meat is cooked at high temperatures, as is most common withgrilling or rying. Consumption o well-done meat has been

associated with increased risk o breast cancer and colon can-cer.

Polycyclic Aromatic HydrocarbonsGrilling or broiling meat over a direct ame results in

at dropping on the hot re and the production o ames

containing polycyclic aromatic hydrocarbon (PAH). PAHsadhere to the surace o ood; the more intense the heat, the

more PAHs are present. Tey are believed to play a signicantrole in contributing to human cancers. A airly consistentassociation between grilled or broiled, but not ried, meat

consumption and stomach cancer implies that dietary

exposure to PAHs may play a role in the development ostomach cancer in humans.

Other Factors

Aside rom diet, other actors increase breast cancer risk,including the ollowing:

Hormones: Supplemental hormones given to women aermenopause increase breast cancer risk. Oral contraceptives

may also increase risk slightly. Although newer birth-controlpills contain less estrogen and progesterone than older ver-sions, evidence suggests some increase in risk.

Overweight: Higher body weight increases the risk o breastcancer aer menopause.

Radiation: O all the dierent parts o the body, the breast isprobably the most sensitive to X-ray damage, and there is nodoubt that X-rays to the breast can cause cancer.

Tis raises obvious concerns about mammograms, which,aer all, are X-rays. Annual mammograms are clearly ben-ecial or women over 50. But women should schedule mam-mograms only at modern acilities that do them regularly and

maintain new equipment, which keeps radiation doses to aminimum. For women under 50, it is unclear whether rou-tine mammograms are benecial. Many cancers are missedon mammograms, and women have sometimes been alselyreassured by a negative mammogram, leading to delays in di-agnosis and treatment. All women (especially those under 50)should do regular sel-exams and ollow their physicians rec-ommendations regarding mammogram screening.

Genetics: About 5 percent o breast cancer cases are purelyattributable to genetics. In such cases, cancer is passed romparent to child as a dominant trait, and the amily tree isriddled with the disease. For a larger group o individuals,

genetics probably makes a contribution in subtle ways. Forexample, it may well be that dierent genes inuence onessusceptibility to carcinogens, the strength o the immunesystem, body weight, and other actors. Each o these is alsoinuenced by diet.

Toxic Chemicals: Populations in areas near toxic waste sitestend to have higher than average rates o breast cancer. Tatis true or other orms o cancer, too. And you dont have tolive near a chemical waste site to be concerned about toxicexposures. oxic chemicals are available at any grocery store.Chemical contaminants requently end up in meats and dairyproducts, because pesticides are sprayed on grains ed to cows,chickens, pigs, and other livestock. In storage bins, eed grainsare sprayed again. Animals concentrate these chemicals intheir tissues. races o pesticides can also be ound on non-organic produce. Fortunately, organic produce is now morewidely available.

Women who avoid eating animal products have much lowerconcentrations o pesticides in their breast milk. Pesticidessuch as DD, chlordane, hepatochlor, and dieldrin, and poly-chlorinated biphenyls (PCBs) have been measured at mark-edly lower levels in vegetarians than in omnivores. In a 1981



study, vegetarians had only 1 to 2 percent o the national averagelevels o certain pesticides and industrial chemicals comparedto levels in average Americans.22 Te exception was polychlori-nated biphenyls (PCBs), or which vegetarians had levels compa-rable to meat-eaters. PCBs in the body oen reect past sh con-sumption, and levels drop slowly aer people adopt a vegetariandiet. Once PCBs are in the body tissues, avoiding contaminatedsh will reduce PCB levels only very slowly.

Time between Puberty and First Pregnancy: Te younger a

girl is when puberty occurs, the higher her risk o breast can-cer. Also, the later the age o her rst pregnancy, the higher herrisk. However, it may be that the early age o puberty simplyindicates elevated hormone levels, as described above. As high-at, low-ber diets have spread rom the wealthy to most o thepopulation, the age o puberty has dropped dramatically rom17 in 1840 to 12.5 today. Similarly, as Japans diet has Western-ized since World War II, the age o puberty has dropped rom15 to 12.5. It may be that early puberty and cancer are both theresult o a hormonal aberration.

Cancers 0f the Uterus and Ovary: Prevention

Te uterus and ovary, o course, are reproductive organs, andactors that aect hormone unction can be expected to aectthese organs as well. Te risk o cancer o the uterus and ovaryis higher in populations that have more breast cancer incidences,suggesting that they may be caused by similar actors. Uterinecancer is linked to atty diets and obesity, although other actors,including hormone supplements, also play an important role.23

Some researchers have suggested that a higher intake o dairyproducts may be linked to ovarian cancer. I this nding holdstrue, the culprit may be a product o the breakdown o the milksugar lactose. Lactose breaks down in the body to orm anothersugar called galactose, which appears to be able to damage the

ovary. Te problem is the milk sugar, not the milk at, so it is notsolved by using non-at products. Further research in this areais needed.

Prostate Cancer: Prevention

Like women, men on high-at Western diets have more estro-gens circulating in their blood and a higher risk o cancer o re-productive organs. High-at diets alter the amounts o testoster-one, estrogen, and other hormones in both men and women.

Te prostate gland, located just below the bladder in men, pro-duces semen to be mixed with sperm cells. Cancer o the pros-tate, which occurs primarily in older individuals, is the mostcommon orm o cancer in American men.

Cancer cells are ound in the prostates o about 20 percent omen over 45 years old. In most cases, these cancer cells do notdevelop into cancerous tumors that aect the overall health orlie span o the individual. However, in some cases, the cancerdoes grow, invade surrounding tissues, and spread to otherparts o the body. Although the disease varies greatly rom oneperson to the next, the average patient loses nine years rom hisnormal lie span. One in 10 men will develop prostate cancer at

some point in his lie.

Asian and Latin American countries have a much lower prev-

alence o prostate cancer, but the disease is very common inEurope and North America. en men die o prostate cancer inWestern Europe or every one who dies o the disease in Asia.

Cancer o the prostate is strongly linked to what men eat.Again, animal products are requently indicted: milk, meat,eggs, cheese, cream, butter, and ats are ound, in one researchstudy aer another, to be linked to prostate cancer.24

And it is not just dairy products and meats. Some studies havealso pointed a nger at vegetable oils.25,26 More recently, milkconsumption has been linked to prostate cancer due to high lev-els o the compound insulin-like growth actor (IGF-I), which isound both in dairy products and in increased levels in the bod-ies o those who consume dairy on a regular basis. A Harvard

University study showed that men who had the highest levelso IGF-I had more than our times the risk o prostate cancercompared with those who had the lowest levels.27 In addition,two major Harvard studies have shown that milk-drinking menhave 30 to 60 percent greater prostate cancer risk than men whogenerally avoid dairy products.28,29

Who has a lower risk? Countries with more rice, soybeanproducts, or green or yellow vegetables in the diet have ar ewerprostate cancer deaths. Diets rich in lycopene, the bright red



pigment ound in tomatoes, watermelon, and pink graperuit,have also been shown to prevent prostate cancer. A study at Har-

vard University showed that men who had just two servings otomato sauce per week had a 23 percent lower risk o prostatecancer, compared with those who rarely ate tomato products.30It is not surprising that vegetarians have low rates o prostatecancer. Becoming a vegetarian in adulthood is helpul, but menraised as vegetarians have the lowest risk.

Men who consume diets based on animal products tend to

have higher levels o testosterone compared with men who eatplant-based diets. Tis increase may be due to overproduction othese hormones in the body. Also, ber in the diet helps removeexcess hormones with body wastes. Tose who eat meats anddairy products miss out on a substantial amount o ber, be-cause animal products have no ber at all. Tis hormonal boostcan aect the prostate, which is the likely reason or increasedcancer risk among men on meat-based diets.

Colon Cancer: PreventionTe colon is another name or the large intestine, which makes

up the second hal o our digestive tract. Strong links have beenound between colon cancer and the consumption o alcohol,meat, and other atty oods.3

o absorb the ats we eat, our liver makes bile and stores it inthe gallbladder. Aer a meal, the gallbladder squirts bile acidsinto the intestine, where the acids chemically modiy the ats sothey can be absorbed. Unortunately, bacteria in the intestineturn these bile acids into cancer-promoting substances calledsecondary bile acids. Meats contain a substantial amount o at,and they also oster the growth o bacteria that cause carcino-genic secondary bile acids to orm. When meat is cooked, car-cinogens can orm on the surace o the ood. As with breast

cancer, requent consumption o meatparticularly red meat

is associated with an increased risk o colon cancer.31

High-ber diets oer a measure o protection. Fiber greatly

speeds the passage o ood through the colon, eectively remov-

ing carcinogens. And ber actually changes the type o bacteria

present in the intestine, which reduces production o carcino-

genic secondary bile acids. Fiber also absorbs and dilutes bile

acids.

Even people at particular risk or cancer can be helped by high-

ber diets. Jerome J. DeCosse, M.D., a surgeon at Cornell Medical

Center, gave bran to patients with recurrent polyps o the colon.

Tese are small growths that have a tendency to become can-

cerous. Dr. DeCosse ound that, within six months, the polyps

became smaller and ewer in number. He believes that pentose

ber, which is plentiul in wheat, is the key to brans power.32

Obesity may also inuence cancer risk. In a recent study, 1,252

women were screened or colon cancer and classied accord-

ing to age, smoking history, amily history o colorectal cancer,

and body mass index or BMI. BMI was ound to be the greatest

risk actor or colon cancer.33 Fiber is also important or helping

maintain a healthy body weight.

Vegetarian Foods: Powerful for Health

wo themes consistently emerge rom cancer research: Veg-

etables and ruits help reduce risk, while animal products and

other atty oods are requently ound to increase risk.

When the terms ber and at are used, it is easy to orget

the oods rom which they come. When you hear about the dan-

gers o at, think meat- and- dairy-based diets, aided and abetted

by oily oods. Fiber is ound in whole grains, vegetables, ruits,

and beans. Tere is no ber in any product rom an animal.

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A vegetarian menu is a powerul and pleasurable way to achievegood health. Te vegetarian eating pattern is based on a wide

variety o oods that are satisying, delicious, and healthul. Areyou ready to get started?

Setting Blame Aside

Occasionally people who have cancer report eeling that, iood plays a role in cancer, then they are somehow to blame ortheir disease. As such, guilt and blame oen become concernsor people dealing with cancer. However, these eelings are bur-dens that help no one. Besides, it makes no sense to blame any-one or things they had no way o knowing. Until major publiceducation programs spread the word about the role o dietary

actors and help people to change, cancer will remain an epi-demic.

Steps to Cancer Prevention

Donotusetobaccoinanyform.

Eatavariedmenu(wholegrains,vegetables,fruits,andbeans,without added ats), which supplies generous amounts o -ber, vitamins, and minerals and derives less than 10 percento its calories rom at.

Havemorethanonevegetableateachmeal andvetonineruits and vegetables each day.

Consumeatleast40gramsofberperday. Avoidanimalproductsandminimizeaddedvegetableoils.

Minimizealcoholintake.

Engageinregularphysicalactivity.

Maintainyourweightatornearyourideallevel.

AvoidexcessivesunlightandunnecessaryX-rays.

Besuretotakeadailymultiplevitaminorotherreliablesourceo vitamin B12.

Surviving CancerFoods are important, not only in preventing cancer, but also in

improving survival or those who already have cancer.

Breast Cancer: Survival

Not all cancers o the breast are the same. Some have a rela-tively good prognosis, and others have a very poor prognosis.For example, a tumor that is small and has not spread to thelymph nodes or other organs is less dangerous than a tumor that

is larger and has already spread. (Lymph nodes are pea-sizedcollections o cells near the breast and other organs; they areimportant to immune unction.) Hospital laboratories also de-termine whether a breast tumor has receptors or estrogen orprogesterone hormones. I it does, the tumor is slightly less ag-gressive than a tumor lacking receptors.

Tese prognostic actors are not due to chance alone. Tirtyyears ago, Ernst Wynder o the American Health Foundationin New York observed that Japanese women are much less likelythan American women to get breast cancer; in addition, whenJapanese women do get the disease, they tend to survive lon-ger.34 Teir improved survival is independent o age, tumor size,estrogen receptor status, the extent o spread to lymph nodes,

Try the New Four Food Groupsand Discover a Healthier Way To Live!

Vegetables (4 or more servings a day)

Vegetables are packed with nutrients, including vitaminC, beta-carotene, riboavin, iron, calcium, ber, and oth-er nutrients. Dark-green leay vegetables, such as broccoli,collards, kale, mustard and turnip greens, chicory, andbok choy, are especially good sources o these importantnutrients. Dark-yellow and orange vegetables such as car-rots, winter squash, sweet potatoes, and pumpkin provideextra beta-carotene. Include generous portions o a vari-ety o vegetables in your diet.

Serving size: 1 cup raw vegetables 1/2 cup cooked vegetables

Whole Grains (5 or more servings a day)

Tis group includes bread, rice, pasta, hot or cold cereal,corn, millet, barley, bulgur, buckwheat groats, and torti-llas. Build each o your meals around a hearty grain dish.Grains are rich in ber and other complex carbohydrates,as well as protein, B vitamins, and zinc.

Serving size: 1/2 cup hot cereal 1 ounce dry cereal1 slice bread

Fruit (3 or more servings a day)

Fruits are rich in ber, vitamin C, and beta-carotene. Besure to include at least one serving each day o ruits highin vitamin Ccitrus ruits, melons, and strawberriesare all good choices. Choose whole ruit over ruit juices,which do not contain very much ber.

Serving size: 1 medium piece of fruit 1/2 cup cooked fruit4 ounces juice

Legumes (2 or more servings a day)

Legumes, including beans, peas, and lentils, are all good

sources o ber, protein, iron, calcium, zinc, and B vita-mins. Tis group also includes chickpeas, baked and re-ried beans, soymilk, tempeh, and texturized vegetableprotein.

Serving size: 1/2 cup cooked beans 4 ounces tofu or tempeh8 ounces soymilk

Be sure to include a good source o vitamin B12, such as ortiedcereals or vitamin supplements.



and the microscopic appearance o the cancer cells. And itis not that Japanese women have better health care, becausethe same pattern has been observed in Hawaii and Caliornia,where Japanese women live near other ethnic groups and haveessentially the same health-care system.

Researchers have begun to look at whether diet plays a role

in survival. It does. Our old enemy, at in oods, rears its uglyhead once againthe more at in the diet, the shorter the sur-

vival time. In one Canadian research study, women with can-

cer were more likely to have lymph node involvement i theyhad a higher at intake. Tis eect was ound only or saturatedat and only or postmenopausal women.35 Fat seems to have ameasurable eect when cancer has spread to other parts o thebody and little or no eect when the disease is localized.

Researchers in Bualo, New York, calculated what they be-lieve to be the degree o risk posed by at in the diet: For awoman with metastatic breast cancer (cancer that has alreadyspread at the time o diagnosis), the risk o dying rom the dis-ease at any point increases 40 percent or every 1,000 gramso at consumed monthly.36 o understand what this means,compare three dierent diets, each o which contains 1,800

calories per day:

Ona low-fatvegetariandiet,about10percentof caloriescome rom at. Tis type o diet contributes about 20 gramso at per day, or 600 grams per month.

Ona typical American diet, 35 percentofcalories comerom at. Tis means about 70 grams o at per day, or 2,100grams per month.

Onadietwithmorefatthanaverage,say50percentofcalo-ries, at intake would be 100 grams per day, or 3,000 gramsper month.

I the researchers nding holds, the typical American diet

would lead to about a 60 percent higher risk o dying o breastcancer at any given point, compared to the low-at vegetariandiet, and the high-at diet would lead to a more than 95 per-cent increase in risk o dying. Tese gures do not mean thata womans risk o dying is 60 percent or 95 percent. Tey meanthat the risk is 60 percent or 95 percent higher than it wouldotherwise have been, assuming the individual is comparableto those studied.

Te Womens Intervention Study (WINS) evaluated dietaryat intake breast cancer recurrence in postmenopausal womenpreviously treated or breast cancer. A total o 2,437 womenwere enrolled in the study and were assigned either to a low-at

diet (20 percent energy rom at), or to a control group with nodiet changes. Aer a 5-year ollow-up, participants who hadpreviously been treated or estrogen-receptor-negative breastcancer, and who then reduced their at intake to 33 gramsdaily, had a 42 percent reduced risk in breast cancer recur-

rence compared with women who did not change their diets.Women who had been previously treated or estrogen-recep-tor-positive breast cancer and who then changed their dietshad a 15 percent reduced risk or breast cancer recurrencecompared with women who did not change their diets. 37

Other parts o the diet play important roles. Diets high inber, carbohydrate, and vitamin A seem to help the progno-sis, while alcohol slightly worsens it.38 Patients who have moreestrogen receptors on their tumors(which indicates a betterprognosis)tend to be those who had consumed more vita-min A. (Beta-carotene becomes vitamin A in the body.) Forreasons that are not entirely clear, vegetables and ruits (andthe vitamins they contain) help keep the cells o the body inbetter working orderone sign o which, or breast cells, is

the presence o estrogen receptors. So vegetables and ruitsare not only important in helping to prevent cancer, they alsohelp improve survival or those who have cancer.

Higher body weight increases the risk o dying o breastcancer.39 Among postmenopausal women with breast cancer,slimmer women tend to have less lymph node involvement.Heavier women have more lymph node involvement, higherrates o recurrence, and poorer survival rates. Even amongrelatively slim women, it pays to avoid extra weight. A 2006study rom Shanghai, China, showed that women who hadpreviously been diagnosed with breast cancer had greatersurvival rates i they were at the slimmer part o the normal

weight range (body mass index below 23), compared witheven slightly heavier women.40

Cancers of the Uterus and Ovary: Survival

Te uterus and ovary, like the breast, are strongly inuencedby sex hormones. Again, a low-at vegetarian diet is the bestprescription or preventing the hormonal elevations that en-courage cancer. In addition, as mentioned earlier, galactosea product o the breakdown o the milk sugar lactosemayincrease the risk o ovarian cancer.

One might assume that the actors that improve breast can-cer survival could do the same or cancers o the uterus and

ovary. Unortunately, researchers have not yet tackled this is-sue. Until more inormation is available, it seems most pru-dent or those with ovarian or uterine cancer to ollow thesame diet that helps prevent cancer in these organs and thatkeeps the immune system in good working order: a low-at

vegetarian diet rich in vegetables and ruits.

Maintaining a healthy weight and ollowing a low-at veg-etarian diet is the best prescription or preventing the hor-monal elevations that encourage cancer.41,42

Prostate Cancer: Survival

Diet may help improve survival in prostate cancer as well.When pathologists conduct autopsies o men who die romaccidents or other causes, they nd cancer cells in the pros-tates o about 20 percent. Tese men did not know they hadcancer and had no symptoms whatsoever. Te prevalence osuch latent cancers actually varies with location: the lowestrates are in Singapore (13 percent) and Hong Kong (15 per-cent) and the highest are in Sweden (31 percent).43 In mostmen, the cells never grow into a large tumor, never spread,and never aect lie or health in any way. However, just as the



prevalence o latent cancers varies rom one country to another,the likelihood that they wil l turn into symptomatic cancer var-ies in precisely the same way, suggesting that the same actorsthat cause cancer cells to orm in the rst place also encouragethem to grow and spread. So while a Swede is twice as likely as aman rom Hong Kong to have cancerous cells in his prostate, heis more than eight times more likely to die o prostate cancer.

A low-at, high-ber diet can help eliminate the hormonal ab-errations that are known to be linked with prostate cancer and

may help improve survival among those who have the disease.44In a 2002 study o men with prostate cancer, Dr. Dean Ornish

tested a low-at vegan diet accompanied by regular exerciseand stress management. In the 42 men in the control group,the amount o prostate-specic antigen (PSA, which is used asan indicator o cancer advancement) levels rose over the three-month study period, and seven required additional treatment.But in the 42 men assigned to the vegan diet and liestyle inter-

vention, the average PSA level dropped rom 6.3 to 5.8, and nonerequired urther treatment.45

Colon Cancer: SurvivalColon cancer is encouraged by diets containing animal at and

discouraged by diets rich in vegetables. A low-at, plant-baseddiet is important both or those seeking to prevent cancer andthose who have already been treated or it. In a recent prospec-tive study evaluating 1,009 colon cancer patients, researchersound that survival depended to a great extent on dietary habits.Te participants had completed initial cancer treatment. Tosewho consumed more red and processed meats, sweets, and re-ned grains were more likely to have a recurrence or die romthe disease aer a median 5.3-year ollow-up, compared withthose who consumed more ruits, vegetables, whole grains, andless red and processed meats and rened oods.46

Researchers at the University o Arizona ound that peoplewho have been treated or colon or rectal cancer have less risko recurrence when their diets are rich in ber. Tey ound ben-ets rom daily supplements o 13.5 grams o wheat bran ber(the amount in a hal-cup o bran cereal), but they speculate thatother orms o ber might have the same eect. A vegetariandiet can easily boost ber intake by 10 to 29 grams per day. Iyou have bran cereal, topping it with soymilk rather than cowsmilk allows you to avoid animal at, cholesterol, lactose, andanimal proteins.

Colon cancer typically develops rom polyps in the colon wall.Tese polyps become smaller and ewer in number within six

months on a high-ber diet.It is clear that much more needs to be learned about the power

o oods to prevent cancer or to improve cancer survival. Tegood news is that the diet that helps protect against cancer is thesame one that keeps cholesterol low and waistlines slim. Elimi-nating animal products rom the diet, keeping oils to a mini-mum, and including generous amounts o vegetables, grains,beans, and ruits is a powerul prescription.

Making Healthy Diet Changes

The Three-Step Way to Go VegetarianI you are making the switch to a vegetarian diet or its health

benets, youll be pleased to discover a wonderul additionalbenet to vegetarian eating: Its a delicious and un way to ex-plore new oods. A vegetarian meal can be as amiliar as spa-

ghetti with marinara sauce, as comorting as a bowl o rich po-tato soup, or as rereshing as Cucumber, Mango, and SpinachSalad (see the recipe on page 16).

Te switch to a vegetarian diet is easier than you might think.Most people, whether vegetarians or meat-eaters, typically usea limited variety o recipes; the average amily eats only eight or



nine dierent dinners repeatedly. You can use a simple, three-step method to come up with nine vegetarian dinner menus thatyou enjoy and can prepare easily.

First, think o three vegetarian meals you already enjoy. Com-mon ones are pasta primavera, vegetable stir-ry, and vegetablestew.

Second, think o three recipes you prepare regularly that caneasily be adapted to a vegetarian menu. For example, a avoritechili recipe can be made with almost the same ingredients; just

replace the meat with beans or texturized vegetable protein.Prepare bean burritos (using canned vegetarian reried beans)instead o bee burritos, veggie burgers instead o hamburgers,and grilled eggplant and roasted red peppers instead o grilledchicken in sandwiches. Many soups, stews, and casseroles alsocan be made into vegetarian dishes with a ew simple changes.

Tird, check out some vegetarian cookbooks rom the libraryand experiment with the recipes or a week or so until you ndthree new recipes that are delicious and easy to make. You canalso explore the many recipes oered on our Web site, www.CancerProject.org. Just like that, with minimal changes to yourmenus, you will have nine vegetarian dinners.

Aer that, coming up with vegetarian options or breakastand lunch is easy. ry mufns with ruit spread, cholesterol-reeFrench toast, or cereal or breakasts. Sandwiches, with spreadslike hummus or white bean pt with lemon and garlic, pastasalads, or even dinner leovers make great lunches.

Tips for Making the Switchto a Vegetarian DietConveniencefoodscutcookingtime.Supermarketsandnat-

ural oods stores stock a huge array o instant soups and main-dish vegetarian convenience items. Many canned soups, such as

minestrone, black bean, or vegetable, are vegetarian. Flavoredrice or other grain mixes, like curried rice or tabouli salad, canbe stretched into an entre with a can o beans. Visit the ro-zen ood section or internationally inspired vegetarian rozenentres such as corn and bean enchiladas, lentil curry, or veg-etarian pad thai. Or try vegetarian baked beans, reried beans,sloppy joe sauce, and meatless spaghetti sauce rom the cannedgoods aisle.

Askforit!Evenrestaurantsthatdontoervegetarianentrescan usually whip up a meatless pasta or vegetable plate i youask. I attending a catered aair, catch the waiter beore youare served and ask him or her to remove the chicken breast

rom your plate and slip on an extra baked potato. Whenyourediningout,thebestbetsforndingvegetarian

ood are international restaurants. Italian, Chinese, Mexican,Tai, Japanese, and Indian restaurants all oer a wide varietyo vegetarian dishes.

Summerbarbecuesarehealthyandfunwithmeatlesshotdogsand burgers, which are now available in most supermarkets.Or, or a real change o pace, grill thick slices o marinated

vegetables like eggplant, zucchini, or tomatoes.

Affordable EatingSurprisingly, choosing healthy oods over high-at and pro-

cessed oods is a much more economical way to eat. Below arethe costs comparing a chicken and cheese tortilla to a vegetariantortilla. As you can see, the healthier vegetarian version costsnearlyhalfasmuch!

Chicken and Cheese Tortilla (Serves 4):Nutrition facts: 690 calories, 56 grams protein, 44 grams fat,17 grams carbohydrate (per serving)

8 small corn tortillas: $1.29

1 pound Kra shredded cheddar cheese: $3.29

1 pound chicken breast: $3.48

1 4-ounce jar salsa: $1.50

Total Cost for Chicken and Cheese Tortilla Meal:$9.56 ($2.39 per serving)

Vegetarian Tortilla (Serves 4):

Nutrition facts: 485 calories, 12 grams protein, 7.6 grams fat,93 grams carbohydrate (per serving)

8 small corn tortillas: $1.29

16 ounces brown rice: $1.19

1 15-ounce can o vegetarian reried beans: $0.69

1 4-ounce jar o salsa: $1.50

(1/2 head) resh shredded lettuce: $0.99

Total for Vegetarian Tortilla: $5.66 ($1.42 per serving)

Top Five Foods You Cant Live Without1. Beans and lentils add heartiness to soups, stews, chili, and

other recipes. Plus, theyre loaded with cancer-ghting berand healthy plant protein.

2. Broccoli and other crucierous vegetables such as kale, cau-liower, collard greens and Brussels sprouts contain potentcancer-ghting compounds and have been shown to help ridthe body o excess hormones.

3. Berries such as blueberries and blackberries are ul l o pow-erul antioxidants that help stop ree radical damage whichcan otherwise lead to cancer.

4. Carrots and other orange-colored ruits and vegetables suchas sweet potatoes, mango, cantaloupe, pumpkin, and squashare incredible sources o beta-carotene, which is crucial orcancer prevention and survival. Just 1 large carrot a day helpsyoumeetyourdailyrequirement!

5. Whole grains such as brown rice, quinoa, oats, and milletare rich sources o ber and B vitamins, essential or health.Plus, theyre loaded with complex carbohydrates to keep youull and help you avoid unhealthy snacking.


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References

The CanCer ProjeCT healThy eaTing For liFe 15

1 American Cancer Society. Cancer Facts and Figures2007. Atlanta, GA: 2007.

2 Minamoto , Mai M, Ronai Z. Environmental actors as regulators and eectors omultistep carcinogenesis. Carcinogenesis. 1999;20(4):519527.

3 World Cancer Research Fund / American Institute or Cancer Research. Food, Nutri-tion, Physical Activity, and the Prevention o Cancer: a Global Perspective. WashingtonDC: AICR, 2007.

4 Presidents Cancer Panel, National Cancer Institute, U.S. Department o Health and

Human Services. Promoting Healthy Liestyles: Policy, Program, and Personal Recom-mendations or Reducing Cancer Risk, 2006-2007Annual Report. August 2007.

5 National Cancer Institute. Cancer Rates and Risks. Washington, DC: 1985.

6 Doll R, Peto R. Te causes o cancer: quantitative estimates o avoidable risks o cancerin the United States today.J Natl Cancer Inst. 1981;66:11911308.

7 Block G. Epidemiologic evidence regarding vitamin C and cancer. Am J Clin Nutr.1991;54(6 Suppl):1310S1314S.

8 GarciaClosas R, Castellsague X, Bosch X, Gonzalez CA. Te role o diet and nutri-tion in cervical c arcinogenesis: a review o recent evidence. Int J Cancer. 2005;117:629637.

9 Penning ton JA. Bowes and Churchs Food Values o Portions Commonly Used. NewYork, Lippincott, 1998.

10 Messina M, Messina V. Te Dietitians Guide to Vegetarian Diets. Gaithersburg (MD),Aspen, 1996.

11 USDA Nutrient Database or Standard Reerence, Release 12, last updated April 7,1999

12 Barone J, Hebert JR, Reddy MM. Dietary at and natural killer cell activit y.Am J Clin

Nutr. 1989;50:861867.13 Nordenstrom J, Jarstrand C, Wiernik A. Decreased chemotactic and random migra-

tion o leukocytes during intralipid inusion.Am J Clin Nutr. 1979;32:24162422.

14 Hawley HP, Gordon GB. Te eects o long chain ree atty acids on human neutrophilunction and structure. Lab Invest. 1976;34:216222.

15 Malter M, Schriever G, Eilber U. Natural killer cell s, vitamins, and other brood com-ponents o vegetarian a nd omnivorous men. Nutr Cancer. 1989;12:271278.

16 Lamas O, Marti A, Martinez JA. Obesity and immunocompetence.Eur J Clin Nutr.2002 Aug;56 Suppl 3:S42-S45. Review.

17 oniolo P, Riboli E, Protta F, Charrel M, Cappa AP. Calorie providing nutrients andrisk o breast cancer.J Natl Cancer Inst. 1989;81:278286.

18 Cho E, Spiegelman D, Hunter DJ, et al. Premenopausal at intake and risk o breastcancer.J Natl Cancer Inst. 2003 Jul 16;95(14):10791085.

19 Willett WC. Dietary at and risk o breast cancer. N Engl J Med. 1987a;316:2228.

20 De Steani E, Ronco A, Mendilaharsu M, Guidobono M, Deneo-Pellegrini H. Meatintake, heterocyclic amines, and risk o breast cancer: a c ase-control study in Uruguay.Cancer Epidemiol Biomarkers Prev. 1997;6(8):573581.

21 Sinha R, Rothman N, Brown ED, et al. High concentrations o the carcinogen 2-ami-no-1-methyl-6-phenylimidazo-[4,5] pyridi ne [PhlP] occur i n chicken but are depen-dent on the cooking method. Cancer Res. 1995;55:45164519.

22 Hergenrather J, Hlady G, Wallace B, Savage E. Pollutants in breast milk o vegetarians.Lancet. 1981;304:792.

23 Engeland A, retli S, Bjorge . Height, body mass index, and ovarian cancer: a ollow-up o 1.1 million Norwegia n women.J Natl Cancer Inst. 2003: 95: 1244-1248.

24 Park Y, Mitrou PN, Kipnis V, Hollenbeck A, Schatzkin A, Leitzmann MF. Calcium,dairy oods, and risk o incident and atal prostate cancer: Te NIH-AARP Diet andHealth Study.Am J Epidemiol. 2007 Dec 1;166(11):1270-1279. Epub 2007 Oct

25 Blair A, Fraumeni JF, Jr. Geographic patterns o prostate cancer in the United States.JNatl Cancer Inst. 1978;61:13791384.

26 Armstrong B, Doll R. Environmental actors and cancer incidence and mortal-ity in dierent countries, with special reerence to dietary practices. Int J Cancer.1975;15:617631.

27 Chan JM, Stamper MJ, Giovannucci E, et al. Plasma insulin-like growth actor-I andprostate cancer risk: a prospective study. Science. 1998;279:563565.

28 Giovannucci E, Rimm EB, Wolk A, et al. Calcium and ructose intake in relation torisk o prostate cancer. Cancer Res. 1998a;58:442447.

29 Chan JM, Stamper MJ, Ma J, Gann PH, Gaziano JM, Giovannucci E. Dairy products,calcium, and prostate cancer risk in the Physicians Health Study. Am J Clin Nutr2001;74:549554.

30 Giovannucci E, Rimm EB, Liu Y, Stamper MJ, Willett WC. A prospective study otomato products, lycopene, and prostate cancer risk.J Natl Cancer Inst. 2002;94:391398.

31 Lewin MH, Bailey N, Bandaletova ., et al. Red meat enhances the colonic ormationo the DNA adduct O6-carboxylmethyl guanine: implications or colorectal cancer.Cancer Res. 2006;66:1859-1865.

32 DeCosse JJ, Miller HH, Lesser ML. Eect o wheat ber and vitamins C and E onrectal polyps in patients with amilial adenomatous polyposis. J Natl Cancer Inst.1989;81:12901297.

33 Elsevier (2007, October 5). Studies Lend Insights Into Colorectal Cancer Screening.ScienceDaily.

34 Wynder EL, Kajitani , Kuno J, Lucas JC, Jr, DePalo A, Farrow J. A comparison osurvival rates between American and Japanese patients with breast cancer. Surg Gynec

Obstet. 1963;117:196200.35 Verreault R, Brisson J, Deschenes L, Naud F, Meyer F, Belanger L. Dietary at in rela-

tion to prognostic indicators in breast cancer.J Natl Cancer Inst. 1988;80:81925.

36 Newman SC, Miller AB, Howe CR. A study o the eect o weight and dietary at onbreast cancer survival time.Am J Epidemiol. 1986;123:767774.

37 R Chlebowski, GL Blackburn, RE Elasho et al. Dietary at reduction in postmeno-pausal women with primary breast cancer. J Clin Oncol. 2005: 23 (supp 16): 10.

38 Holm LE, Callmer E, Hjalmar ML, Lidbrink E, Nilsson B, Skoog L. Dietary habits andprognostic actors in breast cancer.J Natl Cancer Inst. 1989;81:12181223.

39 Colleen Doyle, Lawrence H. Kushi, im Byers et al. Nutrition and physical activityduring and aer cancer treatment: an American Cancer Society guide or inormedchoices. CA Cancer J Clin. 2006;56;323-353.

40 ao MH, Shu XO, Ruan ZX, Gao Y, Zheng W. Association o overweight with breastcancer survival.Am J Epidemiol. 2006;163:101-107.

41 Faireld KM, Willett WC, Rosner BA, Manson JE, Speizer FE, Hankinson SE. Obesity,weight gain, and ovarian cancer. Obstet Gynecol. 2002;100:288296.

42 Reeves GK, Pirie K, Beral V, Green J, et al. Cancer incidence and mortality in relationto body mass index i n the Mil lion Women Study: cohort study. BMJ2007; publishedonline November 6, 2007.

43 Breslow N, Chan CW, Dhom G, et al. Latent carcinoma o prostate at autopsy in sevenareas. Int J Cancer. 1977;20:680688.

44 Berkow SE, Bernard ND, Saxe GA, Ankerberg-Nobis . Diet and survival aer prostatecancer diagnosis. Nutr Rev. 2007 Sep;65(9):391-403.

45 Annual Meeting o the American Urological Association, Chicago, April 26May 1,2003. Dean Ornish, MD, University o Caliornia, San Francisco. Philip Belitsky, MD,Dalhousie University, Haliax, Nova Scotia, Canada.

46 Meyerhardt JA, et al. Association o dietary pattern with cancer recurrence and sur-vival in patients with stage III colon cancer. JAMA. 2007;298:754-764.


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RecipesTe ollowing recipes are rom Te Cancer Survivors Guide: Foods that help you fght back!

Youllbesurprisedhowsimple,delicious,andnutritioustheyare!

16 The CanCer ProjeCT healThy eaTing For liFe

Roasted Red Pepper Hummus

Makes about 2 cups (8 -cup servings)Spread hummus on whole-wheat pita bread or serve as a dip or

vegetables. Tis version is lower in at than most commercial varieties, which is important when it comes to reducing hor-mone-dependent cancer risk and keeping your immune systemoperating smoothly.

1 15-ounce can garbanzo beans, or 1 cups o cookedgarbanzo beans

1 tablespoon tahini (sesame seed butter) cup lemon juice3 green onions, chopped1 tablespoon chopped garlic (about 3 cloves)

1 teaspoon ground cumin teaspoon black pepper cup roasted red peppers, packed in water

I using canned garbanzo beans, drain them, reserving liquid,and rinse beans. Place beans, tahini, lemon juice, green onions,garlic, cumin, black pepper, and roasted peppers in ood pro-cessor or blender and process until smooth. Add reserved beanliquid, or i using cooked beans, water or vegetable broth, asneeded or a smoother consistency.

Per -cup serving: 80 calories; 2.1 g at; 0.3 g saturated at ; 23.3% caloriesrom at; 0 mg cholesterol; 3.9 g protein; 12.5 g carbohydrate; 1.4 g sugar; 2.8 gber; 32 mg sodium; 36 mg calcium; 1.6 mg iron; 23.5 mg vitamin C; 299 mcg

beta-carotene; 0.4 mg vitamin ERecipe by Jennier Reilly, R.D.

Cucumber, Mango, and Spinach Salad

Makes 10 to 12 servingsTis salad boasts beta-carotene rom the mango and lutein romthe spinach, which are cousins in the carotenoid amily andimportant antioxidants. Aside rom cancer prevention and sur-

vival, lutein is recognized or its key role in eye health.

1 bag or bunch resh spinach1 mango, peeled and cut into bite-size pieces1 large cucumber, peeled and sliced6 green onions, thinly sliced cup chopped resh basil

juice o 1 lime cup seasoned rice vinegar

reshly ground black pepper, or to taste

Wash and drain spinach, tear into bite-size pieces, i necessary,and put into a large serving bowl. oss mango, cucumber, greenonions, and basil in a medium bowl. Add lime juice and vin-egar and stir to mix. Arrange mango mixture on spinach andsprinkle with black pepper.

Per serving (1/10 of recipe): 45 calories; 0.3 g at; 0 g saturated at ; 5.5% calo-ries rom at; 0 mg cholesterol; 1.5 g protein; 10.9 g carbohydrate; 7.4 g sugar;1.7 g ber; 219 mg sodium; 50 mg calcium; 1.3 mg iron; 19.1 mg vitamin C;2134 mcg beta-carotene; 1 mg vitamin E

Recipe by Amy Lanou, Ph.D.

Any Veggie Coconut CurryMakes 6 servings

Te vegetables listed below are avorites, but any vegetables youhave on hand can be used along with the coconut milk and spices.I you decide to use coconut milk, it is important to note that thisproduct has a high at content and should be used in moderation.ry lite coconut to get the sweet nutty coconut avor without allthe at. Cauliower, squash, and sweet potatoes are other tastychoices. Tis is a great way to use up going-bad resh or rozenvegetables!Serveoverriceoryourfavoritewholegrain.

1 cup dry (uncooked) brown rice

2 cups water1 large onion, sliced4 garlic cloves, chopped (about 4 teaspoons)3 large carrots, chopped cup vegetable broth or water1 tablespoons curry powder1 teaspoon ground cumin teaspoon turmericpinch cayenne pepper1 medium potato, chopped (peeling optional)3 cups chopped kale



2 cups chopped broccoli orets, or 1 10-ounce package rozenchopped broccoli orets

8 mushrooms, sliced

1 15-ounce can garbanzo beans, drained and rinsed, or 1 cupo cooked garbanzo beans

1 cup resh or rozen green peas1 cup lite coconut milk, or 1 cup non-dairy milk + 1 teaspoon

coconut extract

3 tablespoons reduced-sodium soy sauceBring rice and water to a boil in a medium saucepan. Lower heatand simmer, covered, until all the water is absorbed (about 30minutes).

In a large saucepan, saut onion, garlic, and carrots in vegetablebroth or water on medium-high heat until onion becomes trans-lucent. Add curry, cumin, turmeric, and cayenne. Cook or 2to 4 minutes, stirring oen. Add potato, kale, broccoli, mush-rooms, beans, peas, and coconut milk or non-dairy milk mix-ture. Cover and reduce heat to medium-low. Simmer or 10 to 20minutes, stirring occasionally, until potato can be pierced easilywith a ork. Sprinkle with soy sauce beore serving.

Per serving (1/6 o recipe): 320 calories; 5.2 g at; 2.5 g saturated at ; 14.7%calories rom at; 0 mg cholesterol; 12.3 g protein; 59.3 g carbohydrate; 5.9g sugar; 12.3 g ber; 407 mg sodium; 115 mg calcium; 4.7 mg iron; 37.7 mg

vitamin C; 6312 mcg beta-carotene; 1.7 mg vitamin E

Recipe by Jennier Reilly, R.D.

Colorful Corn SalsaMakes 4 cups (18 -cup servings)

Corn adds ber, onions supply allyl suldes, and tomatoes bringlycopene to this nutrient-rich salsaall are cancer-ghting in-gredients. Enjoy it with baked chips, stued in a burrito, or atopa bed o resh greens.

1 cup resh or rozen corn kernels2 medium tomatoes, chopped cup chopped red onion (about medium red onion) cup chopped green bell pepper (about medium bell

pepper) cup chopped orange bell pepper (about medium bell

pepper)10 resh basil leaves, chopped

juice o 1 lime3 tablespoons rice or cider vinegar

I using resh corn, blanch in boiling water or 3 minutes andrinse in cold water. I using rozen corn that isnt thawed com-pletely, either blanch it in boiling water or 2 minutes and drain,or microwave until thawed.

In a large bowl, combine all ingredients and set aside or 15 to20 minutes to allow the avors to develop. Serve at room tem-perature.

Per -cup serving: 13 calories; 0.1 g at; 0 g saturated at ; 7.5% calories romat; 0 mg cholesterol; 0.4 g protein; 3 g carbohydrate; 1.1 g sugar; 0.5 g ber;1 mg sodium; 4 mg calcium; 0.1 mg iron; 13.6 mg vitamin C; 88 mcg beta-carotene; 0.1 mg vitamin E


Low-Fat Guacamole

Makes 2 cups (10 -cup servings)

Te peas in this guacamole help to lower the at content and theyare also rich in cancer-ghting ber. Fiber helps your body getrid o excess cholesterol and cancer-causing compounds whichare otherwise reabsorbed back into your bloodstream. Despitethe addition o peas, this guacamole derives a good portion o itscalories rom at. However, the total at grams and calories arestill quite low and when eaten with baked chips and as part oa low-at, plant-based diet, overall at intake will be within therecommended range.

1 cup drained and rinsed canned green peas, or 1 cup resh orrozen green peas

1 ripe avocado cup mild salsa (commercial variety, or Colorul Corn Salsa

p.17)1 garlic clove, nely chopped, or 1 teaspoon chopped garlic1 green onion, chopped (optional)

juice o 1 lemon teaspoon ground cumin1 tablespoon chopped resh cilantro (optional) teaspoon salt, or to taste teaspoon black pepper, or to taste

I using resh or rozen peas, blanch peas by placing them inboiling water or 2 minutes to soen, then cool with cold waterand drain. Peel avocado and cut into large chunks. Mash avo-cado and peas together using a potato masher or ork, or, i a

very creamy texture is desired, in a ood processor. Mix in salsa,garlic, green onion (i using), lemon juice, cumin, and cilantro(i using). Add salt and black pepper or to taste.

Per -cup serving: 45 calories; 2.7 g at; 0.4 g saturated at ; 53.5% caloriesrom at; 0 mg cholesterol; 1.3 g protein; 4.9 g carbohydrate; 1.3 g sugar; 2.1 gber; 227 mg sodium; 12 mg calcium; 0.5 mg iron; 6.1 mg vitamin C; 118 mcgbeta-carotene; 0.5 mg vitamin E




Tree Bean ChiliMakes about 8 1-cup servings

Tis multicolor chili takes just 30 minutes to prepare, and itschock ull o ber which enhances immune unction but alsorids the body o excess circulating hormones and carcinogens,thus lowering cancer risk. Serve it with brown rice or warmedtortillas and a green salad.

2 cups water, divided ( cup plus cup plus 1 cup)1 large onion, chopped (about 2 cups)1 teaspoon cumin seeds

6 garlic cloves, minced or pressed1 green bell pepper, seeded and chopped1 cup crushed tomatoes or tomato sauce2 tablespoons chili powder1 15-ounce can black beans, undrained, or 1 cups o cooked

black beans with cup o added water or vegetable broth1 15-ounce can great Northern beans, undrained,

or 1 cups o cooked Northern beans with cup o addedwater or vegetable broth

1 15-ounce can red beans, undrained, or 1 cups o cooked redbeans with cup o added water or vegetable broth

Heat cup water in a large pot. Add onion and cumin seeds and

cook over high heat, stirring oen, until onion is so, 3 to 5 min-utes. Add a bit more water i onion begins to stick.

Stir in garlic, bell pepper, and cup water. Reduce heat to me-dium and cook 3 minutes, stirring occasionally.

Add tomatoes or tomato sauce, chili powder, and remaining 1cup water. Cover and simmer 5 minutes.

Add beans and their liquid. Cover loosely and simmer 15 min-utes.

Per 1-cup serving: 174 calories; 1 g at; 0.2 g saturated at ; 5.1% calories romat; 0 mg cholesterol; 10.8 g protein; 32.5 g carbohydrate; 3.7 g sugar; 8.3 g ber;395 mg sodium; 96 mg calcium; 3.9 mg iron; 16.8 mg vitamin C; 328 mcg beta-carotene; 1.3 mg vitamin E

Recipe by Jennier Raymond, M.S., R.D.

Easy Bean SaladMakes about 10 1-cup servings

Te simplicity and widespread enjoyment o this salad have made

it a Cancer Project classic. Plus, it has tons o ber to help movecarcinogens, and excess cholesterol and hormones out o yourbody to improve overall health.

cup low-at Italian salad dressing1 15-ounce can kidney beans, drained and rinsed,

or 1 cups cooked kidney beans1 15-ounce can pinto beans, drained and rinsed,

or 1 cups cooked pinto beans1 15-ounce can black-eyed peas, drained and rinsed,

or 1 cups cooked peas1 10-ounce package rozen lima beans (preerably ordhook

lima beans), thawed completely, 1 cups cooked lima beans,

or 1 cups cooked green soybeans (shelled edamame)1 cup rozen corn, thawed completely,

or cooked resh corn, chilled1 large red bell pepper, seeded and chopped medium purple onion, chopped1 teaspoon salt, or to taste1 teaspoon black pepper, or to taste

oss all ingredients together. Serve cold or at room temperature.May be covered and stored in rerigerator or several days.

Per serving (1/10 of recipe): 183 calories; 3 g at; 0.5 g saturated at ; 14.6%calories rom at; 0 mg cholesterol; 9.9 g protein; 31 g carbohydrate; 2.9 g sugar;8 g ber; 539 mg sodium; 43 mg calcium; 2.7 mg iron; 36.7 mg vitamin C; 311mcg beta-carotene; 0.8 mg vitamin E


Penne with Kale, omatoes, and OlivesMakes 4 servings

Te kale in this avorul combination provides highly absorb-able calcium and isothiocyanates, which have strong anti-cancereects.

1 medium onion, chopped cup vegetable broth or water1 bunch kale, cut or torn into approximately 1-inch pieces

(about 5 cups chopped)

2 14.5-ounce cans chopped, preerably re-roasted, tomatoes,undrained, or 3 cups o reshly chopped tomatoes plus cupwater or vegetable broth

cup pitted and sliced Kalamata olives1 tablespoon chopped resh parsley8 ounces dry whole-wheat penne pasta cup dairy-ree (vegan) parmesan cheese substitute or

nutritional yeast (optional)

Saut onion with vegetable broth or water over medium heat or



3 minutes. Add kale and tomatoes and their liquid. Bring to aboil and then reduce heat, cover, and simmer or 20 minutes.Add olives and parsley. Cook an additional 5 minutes.

Meanwhile, cook pasta according to package directions. Drainand transer to a serving bowl. Add kale mixture and toss gently.Serve immediately. Sprinkle vegan parmesan substitute or nutri-tional yeast over top, i using.

Per serving ( o recipe): 281 calories; 3.3 g at; 0.5 g saturated at ; 10.5% calo-ries rom at; 0 mg cholesterol; 12 g protein; 57.6 g carbohydrate; 8.3 g sugar;

8.7 g ber; 497 mg sodium; 166 mg calcium; 5 mg iron; 53.9 mg vitamin C;6796 mcg beta-carotene; 2.9 mg vitamin E


Berry ApplesauceMakes 4 -cup servings

Serve this applesauce hot or cold. Berries give this applesauce adeep red or purple color and add a hey dose o anthocyanins,potent cancer-ghting antioxidants.

2 cups peeled, cored, and chopped apples2 cups resh or rozen (unsweetened) strawberries, blueberries,

or raspberries cup rozen apple juice concentrate1 teaspoon cinnamon

Combine all ingredients in a medium saucepan. Bring to a sim-mer, then cover and cook over very low heat or about 25 minutes,or until apples are tender when pierced with a ork. Mash lightlywith a potato masher or pure in a ood processor, i desired.

Per -cup serving: 108 calories; 0.4 g at; 0 g saturated at ; 3.5% calories romat; 0 mg cholesterol; 0.8 g protein; 26.9 g carbohydrate; 20.1 g sugar; 2.7 g ber;11 mg sodium; 29 mg calcium; 0.9 mg iron; 49.2 mg vitamin C; 13 mcg beta-carotene; 0.4 mg vitamin E

Recipe by Jennier Raymond, M.S., R.D.

Chocolate Mousse or Chocolate Mousse PieMakes 10 servings

When consumed in moderation, this is a healthier version o thehigh-at, high-calorie French delicacy. Chocolate contains thephenolic compounds gallic acid and epicatechin, which are im-portant antioxidants or cancer prevention. Cornell researchershave ound that cocoa has nearly twice the antioxidants o redwine and up to three times those ound in green tea.

1 cup semi-sweet chocolate chips1 cup non-dairy milk, such as soymilk or rice milk2 12.3-ounce packages low-at silken tou

1 teaspoon vanilla extract1 ready-made graham cracker pie crust (optional)10 strawberries, chopped10 mint sprigs or garnish (optional)

Place chocolate chips and non-dairy milk in a microwave-saebowl and microwave or 1 minute. Let sit or 2 minutes.

Place tou, vanilla, and chocolate chip/non-dairy milk mixturein a ood processor or blender and process until smooth. rans-er into a graham cracker pie crust, i using, or small individual

serving dishes and chill or 2 hours in the rerigerator or 30 min-utes in the reezer. Serve topped with strawberries and garnishedwith mint, i using.

Variation: Add a chopped banana to the blender or ood proces-sor when you process the tou and chocolate together.

Per serving (1/10 o recipe): 125 calories; 6 g at; 3.1 g saturated at ; 43.5% calo-ries rom at; 0 mg cholesterol; 6 g protein; 14.1 g carbohydrate; 10.5 g sugar;1.5 g ber; 75 mg sodium; 63 mg calcium; 1.4 mg iron; 7.2 mg vitamin C; 7 mcgbeta-carotene; 0.5 mg vitamin E


Mixed Berry Banana SmoothieMakes 4 servings

Frozen berries in smoothies add ber, taste, and iciness, not tomentiontheheydoseofcancer-ghtingcompounds!

1 banana1 cup rozen mixed berries (raspberries, blueberries,

strawberries)1 cup ortied vanilla soy- or other non-dairy milk2 tablespoons maple syrup (optional)

2 tablespoons calcium-ortied orange juice concentratePlace all ingredients in a blender. Blend at high speed untilsmooth, stopping the blender occasionally to move the unblend-ed ruit to the center with a spatula.

Per serving ( o recipe): 107 calories; 1.4 g at; 0.2 g saturated at; 11.5% calo-ries rom at; 0 mg cholesterol; 3.3 g protein; 22.3 g carbohydrate; 12.9 g sugar;3.7 g ber; 36 mg sodium; 130 mg calcium; 1 mg iron; 33.1 mg vitamin C; 24mcg beta-carotene; 1.3 mg vitamin E



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About The Cancer ProjectWith more than one million people being diagnosed with cancer in the United States each yearand many more

cases in other countries across the globethere is an urgent need for a new direction in battling this disease. TheCancer Project is a collaborative effort of physicians, researchers, and nutritionists who have joined together to educatethe public on how a healthy diet can protect us from cancer and help us regain our health once cancer has beendiagnosed.

The Key Is Information

Most Americans do not yet have the facts about the relationship between nutrition and cancer. Surveys conductedby Opinion Research Corporation International have found that most people are unfamiliar with the link between dietand cancer.

Getting the Word OutThe Cancer Project distributes information on reducing cancer risk and, when cancer has been diagnosed, how diet

and other factors may help improve survival. Vital information has reached millions of individuals and families throughbrochures, television advertisements, Web-based information, and nutrition and cooking classes.

The Cancer Project also conducts clinical research, hosts a national conference, and provides literature andresources to thousands of health professionals. Public service announcements, often featuring celebrities like SirAnthony Hopkins, Lisa Edelstein, Jennifer Landon, and Dorothy Hamill, are released nationally twice a year. TheCancer Projects Food for Life nutrition and cooking class series for cancer prevention and survival is being taughtin more than 80 cities across the country to help individuals understand the power of their plates. The classes reachthousands of people per year, providing not only nutrition education, but also serving as a support group for thosewho have been touched by cancer in some way. The Cancer Survivors Guide: Foods That Help You Fight Backbookand the companion video, Eating Right for Cancer Survival, were developed to accompany the class series, but they

can also be used on their own to help cancer survivors or individuals interested in cancer prevention have access tothis vital information at home.

Your Help Makes It Possible!

The success of our efforts depends entirely on the resources available for producing and distributing printedinformation, funding our research, working with the media, stafng booths at medical conferences, and teaching ourFood for Life nutrition and cooking classes. Both large and small contributions make an enormous difference.

If you wish to support our work to advance cancer prevention and survival through nutrition education and research,you may donate online at www.CancerProject.org. If you prefer, you can mail or phone in your contribution to:

The Cancer Project

Help Us Win the Battle Against Cancer

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