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Tuesday
Nov012011

Nutrition & Cancer

The Dolder Grand

Health Care &
Rejuvenation

 

PD Dr. Rainer Arendt
Internal Medicine & Cardiology FMH
Prevention & Regenerative Medicine 

 

 

 

 

 

 

 

 

SUMMARY - HEALTHY CANCER DIET

• Eat 8 to 10 colorful fruit and vegetable servings daily

o Two to three pieces of fruit

o One cup or more of vegetables with lunch and dinner

o 8 fl oz vegetable juice

• Consume 30 to 45 grams of fiber daily

o You will likely meet your fiber goal if you eat 8 to 10 servings of fruits and vegetables plus one serving of beans/legumes or at least two servings of whole grains daily.

• Avoid processed and refined grains/flours/sugars

o Keep WHITE off your plate: bread, pasta, rice, cream sauces, cakes, and more.

• Limit meats and whole milk dairy products

• Include healthy fats like cold-water fish, flaxseed, walnuts, soybeans, olive oil, avocados

• Eat 2 Tbsp ground flax daily

• Limit alcohol consumption

• Drink 1 to 4 cups of green tea daily

• Maintain serum 25 (OH)-vitamin D levels above 50 ng/mL

• Drink plenty of fluids, water or non-caffeinated beverages, daily to help meet fluid needs

• Engage in daily physical activity to help achieve and maintain a healthy weight

 

WORDS OF WISDOM

“Let food be your medicine.”

 -Hippocrates

 

   

 

Excerpts with amendments (ra) from the original article "Nutrition & Breast Cancer" by Natalie Ledesma, 
Ida & Joseph Friend Cancer Resource Center, UCSF Helen Diller Family Comprehensive Cancer Center
University of California, San Francisco

 

Good nutrition may reduce the incidence of cancer and the risk of cancer progression or recurrence. There are many studies in progress to help further understand how diet and cancer are related. We do know, however, that improved nutrition reduces risk of chronic diseases, such as diabetes, obesity, hypertension and heart disease, and also enhances overall quality of life. It is estimated that one third of cancer deaths in the U.S. can be attributed to diet in adulthood [1].

 

Guidelines for a Healthy Diet

• Plant-based diet

o Plenty of fruits and vegetables

o High fiber – whole grains and beans/legumes

• Emphasis on healthy fats

• Exclude processed and refined grains/flours/sugars

• Drink plenty of fluids

• Be physically active to help achieve and maintain a healthy weight

 

Plant based diet

A lifelong commitment to a plant based diet may lower a person’s risk of developing cancer and may also reduce the risk of recurrent cancer. A plant based diet consists primarily of fruits, vegetables, whole grains, beans/legumes, and other plant protein sources.

 

FRUITS AND VEGETABLES

• Contain vitamins, minerals, fiber, and various cancer-fighting phytonutrients (for example: carotenoids, lycopene, indoles, isoflavones, flavonols).

• Vibrant, intense COLOR is one indicator of phytonutrient content.

• There is extensive and consistent evidence that diets high in fruits and vegetables are associated with decreased risks of many cancers, and while results for breast cancer risk are not yet conclusive, they are promising [2-12].

• A Korean case-control study reported that a high intake of certain fruits and vegetables resulted in a significantly lower risk of breast cancer in premenopausal (tomatoes) and postmenopausal women (grapes and green peppers) [6].

• A study assessing plasma or blood carotenoids as a marker for fruit and vegetable intake reported that individuals in the top 1/4 had a 43% lower risk of breast cancer recurrence when compared to those in the lowest 1/4 [17].

• Breast cancer survivors significantly reduced mortality by following a diet low in fat, high in vegetables, high in fiber, and high in fruit [19].

• The combination of consuming five or more daily servings of vegetables and fruits, and accumulating 540+ metabolic equivalent tasks-min/wk (equivalent to walking 30 minutes 6 d/wk) decreased mortality by nearly 50% [11].

 

Beta-Carotene

• Beta-carotene is one of the 600 carotenoids that can be partially converted into vitamin A in the body.

• Carotenoids have a protective role for certain sites of cancer, including breast cancer [7, 21-24].

• Cartenoid intake was significantly associated with reduced mortality in breast cancer survivors [19].

• In vitro research indicates that carotenoids may inhibit the production of breast cancer cells [30-31].

• Beta-carotene may hinder the development of breast cancer cells by inducing apoptosis*, or programmed cell death [32].

• Research indicates that dietary sources of beta-carotene are likely much more protective than supplemental sources against the risk of cancer [33-35].

 

Cruciferous Vegetables

• Some evidence suggests that the cruciferous vegetables, in particular, are associated with a reduced risk of breast cancer [36-40].

• A Swedish study of postmenopausal women reported one to two daily servings of cruciferous vegetables to reduce the risk of breast cancer, possibly by as much as 20-40% [37].

• Women who ate more turnips and Chinese Cabbage, in particular, significantly reduced the risk of postmenopausal breast cancer [40].

• Consumption of cruciferous vegetables, particularly broccoli, was inversely, though not statistically significant, associated with breast cancer risk in women [36].

• The U.S. component of the Polish Women’s Health Study found that women who consumed raw- or short-cooked cabbage and sauerkraut 3 or more times weekly had a significantly reduced risk of breast cancer [39].

o Cabbage that was cooked for a long time had no effect on breast cancer risk.

o Researchers suggested that glucosinolates, compounds in cabbage, may affect both the initiation phase of carcinogenesis*, cell mutation*, and inhibit apoptosis*.

• Indole-3-carbinol (I3C) is a compound found in cruciferous vegetables that has anticancer properties and anti-proliferative effects on breast cancer cells [47].

o I3C may inhibit the growth of blood vessels that the tumor needs to grow (anti-angiogenesis) [48].

• I3C and diindolylmethane (DIM) induce apoptosis, or cell death, in breast cancer cells [41,49] for both ER+ and ER- tumor cells [50].

• Dietary I3C may have effects that bolster immune function [52].

 

Nutrient Dietary Sources Recommendation

Beta-carotene: Carrots, sweet potatoes, winter squash, cantaloupe, and mango, include these fruits and

Cruciferous vegetables: Arugula, broccoli, Brussels sprouts, cabbage, cauliflower, collard greens, horseradish, kale, kohlrabi, mustard greens, radishes, rutabaga, turnips and turnip greens, and watercress, include these vegetables daily.

 

Organic Produce

• Organic fruits and vegetables have fewer pesticides, lower levels of total pesticides, and less overall pesticide toxicity than fruits and vegetables grown with chemicals. Although more research is needed, recent evidence indicates a significant increase in antioxidants in organic and sustainably grown foods versus conventionally grown foods [54-58].

o Organic vegetables contained a greater concentration of phytonutrients* (phenolic acids) when compared to conventionally grown vegetables [57,58].

• Consuming organic foods appears to increase salicylic acid, which may contribute to a lower risk of cancer [57].

• Choosing organic produce will help you reduce your levels of pesticide exposure and will most likely increase your phytonutrient* consumption.

o Although washing and peeling your non-organic fruits or vegetables may help to reduce pesticide residues, it will not eliminate them.

• Listed below are produce with the most and least pesticide contamination, both in terms of number of pesticides used and the level of pesticide concentration on an average sampling. Thus, for the fruits and vegetables shown on the most contaminated list, it is wise to buy organic. Alternatively, if organic choices are not available, you may want to consider substituting with produce that tends to contain the least amount of pesticides.

Produce most contaminated by pesticides:

Peaches, Apples, Bell peppers, Celery, Nectarines, Strawberries, Cherries, Lettuce, Grapes–imported, Pears, Spinach, Potatoes.

Produce least contaminated by pesticides:

Onions, Avocado, Sweet corn, Pineapples, Mango, Sweet peas, Asparagus, Kiwi, Bananas, Cabbage, Broccoli, Eggplant.

 **Adapted from Environmental Working Group – A Shopper’s Guide to Pesticides in Produce

 

• It is most important, however, to eat fruits and vegetables – organic or conventional. If the availability or cost of organic produce is a barrier, you may wish to avoid those fruits and vegetables that have the highest pesticide residue content.

 

Pomegranate (Punica granatum; Punicaceae)

• Various parts of the pomegranate fruit (for example: seed oil, juice, fermented juice and peel extract) have expressed the suppressive effects on human breast cancer cells in laboratory research [65].

• Pomegranate seed oil and fermented juice block the cancer cells’ oxygen supply, slow cell growth, and promote cell death [66].

• Fermented pomegranate juice polyphenols* appear to have twice the anti-proliferative effect as fresh pomegranate juice polyphenols* [67].

• Furthermore, one study suggests that pomegranate seed oil may have the greatest preventive activity (87% reduction in lesions) compared to fermented pomegranate juice (42% reduction) [68].

 

FIBER – A PLANT-BASED DIET IS NATURALLY HIGH IN FIBER

• A diet rich in natural fiber obtained from fruits, vegetables, legumes (for example: lentils, split peas, black beans, pinto beans), and whole-grains may reduce cancer risk and/or reduce risk of cancer progression.

• Fiber binds to toxic compounds and carcinogens, which are then later eliminated from the body [69].

• A high fiber diet is also associated with less obesity [72].

• Women who ate beans and lentils at least twice a week had a 24% lower risk of developing breast cancer than women who ate them less than once a month [86].

 

High-Fiber Sources

FRUITS:

Table: Food Serving Size Fiber Grams/ Serving

Apple 1 medium 3.7

Banana 1 medium 2.8

Blackberries 1/2 cup 1.9

Blueberries 1 cup 1.3

Cantaloupe 1/2 cup 6.0

Figs (dried) 1/4 cup 6.0

Grapefruit 1 medium 3.4

Grapes 1 cup 1.6

Guava 1 medium 4.9

Kiwi 1 medium 2.6

Orange 1 medium 3.1

Pear 1 medium 4.0

Persimmon 1 medium 6.0

Prunes 1/4 cup 3.1

 

GRAINS & OTHER PRODUCTS:

Table: Food Serving Size Fiber Grams/ Serving

Amaranth 1/4 cup dry 7.4

Barley 1/2 cup cooked 3.0

Beans, black 1/2 cup cooked 8.3

Beans, red kidney 1/2 cup cooked 8.2

Beans, garbanzo 1/2 cup cooked 5.0

Bran cereals 3/4 cup Check labels (5.0-22.0)

Brown rice 1/2 cup cooked 1.4

Bulgur 1/2 cup cooked 4.0

Cream of wheat 1/2 cup cooked 0.5

Oatmeal 1/2 cup cooked 2.0

Peanuts 1/4 cup 2.9

Quinoa 1/4 cup dry 2.5

White rice 1/2 cup cooked 0.3

 

VEGETABLES:

Table: Food Serving Size Fiber Grams/ Serving

Artichokes 1 medium 6.9

Beets 1/2 cup cooked 1.7

Broccoli 1/2 cup cooked 2.3

Brussel sprouts 1/2 cup cooked 2.0

Carrots 1/2 cup cooked 2.6

Kale 1/2 cup cooked 1.3

Lima beans 1/2 cup cooked 4.5

Peas, green 1/2 cup cooked 4.4

Spinach 1/2 cup cooked 2.2

Squash, winter-type 1/2 cup cooked 3.4

Sweet potatoes (yams) 1/2 cup cooked 2.7

 

SUGARS AND THE ROLE OF INSULIN*

• High sugar foods are usually highly processed and refined, low in nutrient value, and also low in dietary fiber. In addition, these foods appear to increase serum insulin* and serum IGF-I levels [87], which appear to stimulate cancer cell growth.

o In premenopausal women, women in the highest quartile of serum glucose had a 280% increased risk of breast cancer compared with women in the lowest quartile.

• Hyperinsulinemia may contribute to the development of breast cancer in overweight or obese women [103].

• A recent case-control* study reported that carbohydrate intake significantly increased risk of breast cancer; sucrose (table sugar) imparted the greatest risk [105]. This risk was lessened considerably with a higher fiber intake.

• The consumption of sweet foods with a high glycemic index (GI) and glycemic load (GL) have been implicated as a risk factor for breast cancer due to their effects on insulin and IGF-I [107-110].

• Adding credence to the idea that blood sugar levels may affect disease progression, women who consumed a high GI and GL diet had a 57% and 253% increased risk of breast cancer, respectively [108].

 

INSULIN HIGH TIDE. The observed link between obesity and cancer may be explained by the growthpromoting activities of insulin and IGF-1. One theory posits that excess weight sets off a biochemical cascade that increases insulin and, in turn, IGF-1 levels. Both hormones may activate IGF-1 receptors on cells, which can spur cell growth and inhibit cell death pathways that usually protect against tumor development.
E. Roell/Source: Nature Reviews Cancer, 2004

 

Sugars & Insulin* – Bottom Line

• To help control your insulin* level:

o Eat a high-fiber diet with limited refined/processed foods

o Follow an only plant fat diet rich in omega-3 fatty acids

o Exercise

o Maintain a healthy body weight

 

LOW FAT DIET

Several studies have investigated the relationship of fat and the risk of breast cancer, but the results remain inconsistent.

 

Saturated Fats

• Several studies indicate a positive association between saturated fat intake from meat and dairy products (animal sources) and cancer [114-117]. The breast cancer research, however, is inconclusive.

 

Trans-Fatty Acids

• Preliminary research indicates that these fatty acids may be associated with an increased risk of cancer [123-126].

• These fats may disrupt hormonal systems that regulate healing, lead to the destruction of defective membranes, and encourage the development of cancer.

• One study reported a 40% increased risk of breast cancer in postmenopausal women who had higher tissue levels of trans-fatty acids [128].

• Women who consumed greater amounts of trans-fatty acids significantly increased their risk of breast cancer [126].

o Women in the highest quintile of trans-fatty acid consumption had a 75% increased risk compared with women in the lowest quintile.

 

Omega-9 Fatty Acids (Monounsaturated Fats)

• Most research at this time indicates a neutral relationship [120,126] or a slightly protective effect [122,129-131] between these fats and risk of breast cancer.

• Several case-control* studies reported that olive oil consumption, rich in omega-9 fats, resulted in a 13-34% reduction in breast cancer risk [132-135].

o One study found that women who consumed =8.8 g/day of olive oil had a 73% lower risk of breast cancer [131].

 

Essential Fatty Acids (EFA)

Essential fatty acids are necessary for the formation of healthy cell membranes, the proper development and functioning of the brain and nervous system, and for the production of hormone like substances called eicosanoids* (thromboxanes, leukotrienes, prostaglandins). Among other body functions, these chemicals regulate immune and inflammatory responses.

Eicosanoids* formed from the omega-6 fatty acids have the potential to increase blood pressure, inflammation, platelet aggregation, allergic reactions and cell proliferation. Those formed from the omega-3 fatty acids have opposing affects. Current research suggests that the levels of essential fatty acids and the balance between them may play a critical role in the prevention and treatment of cancer.

Omega-3 Fatty Acids

• Research is growing supporting a protective relationship between omega-3 fatty acids [alpha linolenic acid (ALA), eicosapentanoic acid (EPA), and docosahexanoic acid (DHA)] against the risk of breast cancer [118,120,135-141].

• Studies show that omega-3 fatty acids inhibit breast cancer tumor growth and metastasis. Additionally, these fats are immune enhancing.

• Fish and plant-based foods, however, contain different types of omega-3 fatty acids.

o Fish contains EPA and DHA, two specific fatty acids that have shown promising results in the research literature [135,140,144].

o Fish consumption in general has been associated with a protective effect against breast cancer [136,138,140,145].

o The plant-based omega-3 fatty acid sources, such as flaxseed and others listed in the table below, contain ALA. In an ideal environment, ALA is converted to EPA and DHA, however, this process is inefficient [69,142,146]. On the positive side, the conversion process is enhanced by following a diet that is low in saturated fats and low in omega-6 fatty acids [142,147].

 

Omega-6 Fatty Acids

• Recent studies indicate that a high intake of omega-6 fatty acids (linoleic acid, which can be converted to arachidonic acid) promote breast tumor development and metastasis [117,137,138,148,149].

• A meta-analysis* of 3 cohort* studies found palmitic acid, a type of omega-6 fatty acid, to be significantly associated with an increased risk of breast cancer [118].

• Additionally, researchers reported that arachidonic acid, an omega-6 fatty acid almost exclusively from meat, significantly increased oxidative damage as measured by urinary biomarkers [150].

• A very interesting finding was reported in a prospective study that found no overall association between omega-6 fatty acids and risk of breast cancer [120]. However, omega-6 fat consumption increased risk by 87% in women who consumed 25 g or less of marine omega-3 fatty acids. This effect was even greater for advanced breast cancer.

o Thus, the balance between omega-6 and omega-3 fatty acids may be of paramount importance. This was further supported by other studies [137,138,151,152].

 

Fat – Bottom Line

• Less animal fat is better.

• Avoid hydrogenated fats.

• Extra-virgin olive oil, canola oil, macadamia nut oil or almond oil is preferred for salads and cooking.

• Increase omega-3 fatty acids.

Fatty Acid Dietary Sources Recommendation

Saturated fatty acids from: Meats, poultry skin, baked goods, and whole milk dairy products, including butter, cheese, and ice cream

Reduce or eliminate meat and whole milk dairy products.

 

Trans fatty acids from: Margarine, fried foods, commercial peanut butter, salad dressings and various processed foods including breads, crackers, cereals, and cookies

Avoid trans or hydrogenated fats. Products may be labeled “trans fat free” if they contain less than 0.5 mg per serving.

 

Omega-9 fatty acids from: Extra-virgin olive oil, almond oil, canola oil, macadamia nut oil, almonds, and avocados, include these healthy fats daily.

 

Omega-3 fatty acids:

Include these healthy fats

EPA and DHA Cold-water fish (for example: salmon, sardines, black cod, trout, herring), daily through diet and/or supplements.

It may be wise to consume cold water fish, algae or fish oil, ALA Flaxseeds, chia seeds, walnuts, hempseeds, and pumpkin seeds supplements at least twice weekly to obtain an adequate amount of EPA and DHA.

If you choose to use a supplement, opt for one that is highest in EPA and DHA concentration.

Omega-6 fatty acids: Reduce or eliminate meat, reduce butter.

Limit consumption of linoleic acid-rich oils. Linoleic acid Common vegetable oils, such as corn oil, safflower oil, sunflower oil, and cottonseed oil, and processed foods made with these oils

Substitute an omega-9 fatty acid-rich oil for your current cooking oil or fat.

 

Meat

• In a study of over 35,000 women, meat consumption significantly increased the risk of breast cancer in both premenopausal and postmenopausal women [153].

• Consumption of red and fried meat quadrupled the risk of breast cancer in a case-control study in Brazil [12].

• Meat consumption increased the risk of breast cancer risk by 56% for each additional 100 g (3.5 oz) daily of meat consumption in a French case-control study [135].

• Regular consumption of fatty red meat and pork fat increased the risk of breast cancer by 348% and 632%, respectively in a small Brazilian study [154].

• A large case-control* study found that women who consumed very well-done meat for hamburger, bacon, and steak had a 54%, 64%, and 221% increased risk for breast cancer, respectively [155].

o Frequent consumers of these well-done meats had a 462% greater risk of breast cancer.

 

Food Category Summary Recommendation

Fruits and vegetables: At least 5, preferably 8-10 servings total

½ cup fruit or vegetable servings daily [156]

1 cup raw leafy greens

¼ cup dried fruit or vegetable

6 oz fruit or vegetable juice

Eat 1 cup or more vegetables with lunch and dinner.

5 or more vegetable servings

3 fruit servings

Fiber Choose breads with 3 or more grams of fiber per slice. First ingredient on the label should be whole or sprouted grain flour, not white flour, unbleached white flour, or enriched wheat flour.

Whole grains include, among others, oats, barley, brown rice, quinoa, amaranth, bulgur, millet, buckwheat, spelt, wild rice, and teff.

30-45 grams daily

This goal can be achieved by meeting your fruit and vegetable goal plus one serving of legumes or at least two servings of whole grains.

Refined carbohydrates and Dietary sources: Limit or avoid consumption of all sugars, refined flours (for example: white bread, white rice, white pasta) or refined grains, alcohol, sodas, drinks containing added sugars, and desserts, such as candy, cookies, cakes, and pastries.

Reduce or eliminate meat consumption. Avoid processed, grilled or fried meats.

 

GENOTOXINS:

Heterocyclic Amines (HCAs) & Polycyclic Aromatic Hydrocarbons (PAHs)

• Natural components in meat, such as amino acids, creatine*, and polysaccharide precursors, are converted to HCAs during high-temperature cooking. HCAs are known to cause cancer in laboratory animals [157,158].

• While human research is forthcoming, the majority of studies [155,157-162] although not all [163,164] have observed a significant association between HCAs and breast cancer.

• Carcinogenic activity of HCA’s is affected by various dietary factors [165]:

o Factors that enhance carcinogenesis* when combined with HCAs include:

• High-fat diet

• Caffeine

o Factors that inhibit carcinogenesis* when combined with HCAs include:

• DHA

• Conjugated linoleic acid (CLA)

• Isoflavones

• Diallyl Sulfides (found in the allium family, such as garlic, onions, leaks, and shallots)

• Green tea catechins*

• Indole-3 carbinol

• Probiotics

• Gamma-tocopherol

• The most important variables contributing to the formation of HCAs are:

o Cooking temperature (greater than 300°F)

o Cooking time (greater than 2 minutes)

o Cooking method (frying, oven grilling/broiling, barbecuing)

• Charring of food (charcoal-broiled or smoked foods) contribute to PAHs [166].

• Meat can potentially be made “safer” to eat by being cooked in a way that does not lead to HCA formation.

o Choose lean, well-trimmed meats to grill.

o Using marinades significantly reduces the amount of HCAs.

o Brief microwave preheating substantially reduces HCA content of cooked meat.

o Small portions require less time on the grill.

• Additionally, the type of protein cooked can also affect the concentration of HCAs. It has been reported, for example, that chicken has more than 100 times the number of HCAs than salmon [165]. London broiled steak had more than 600 times the amount of HCAs when compared to salmon.

• Grill vegetables or meat alternatives that do not lead to the formation of HCAs or PAHs.

 

ALCOHOL

• Regular consumption of alcohol may increase the risk for breast cancer [167-176].

o A recent review study reported that data from many well-designed studies consistently shows a small rise in breast cancer risk with increasing consumption of alcohol [172].

o Furthermore, 1-2 drinks a day increased risk by 21% and 2 or more drinks a day increased risk by 37%.

• Women who drank two or more alcoholic drinks daily in the five years prior to diagnosis had an 82% increased risk of breast cancer compared to non drinkers [173].

o Greatest risk was among heavy drinkers who were also postmenopausal and had a history of benign breast disease or who used hormone replacement therapy (HRT) [168].

• Similarly, a French study found that drinking 10-12 g wine (~ 1-1.5 drinks) daily lowered the risk of breast cancer, but when intake increased above 12 g daily, the risk of breast cancer increased [180].

• These differing findings between pre- and postmenopausal women are likely related to the effect of alcohol on estrogen levels. Alcohol appears to increase endogenous* estrogen levels [183-187].

• Folate, a B vitamin, may be of even greater significance with alcohol consumption. It has been observed that women with low folate and high alcohol consumption had a 43% greater risk of breast cancer when compared with nondrinkers with adequate folate intake [188].

Alcohol – Bottom Line

• It is best to limit or avoid alcohol.

 

ADEQUATE FLUIDS

The functions of water in the body include the following:

o Carries nutrients and waste products.

o Participates in chemical reactions.

o Acts as a lubricant and cushion around joints.

o Acts as a shock absorber in the eyes and spinal cord.

o Aids in the body’s temperature regulation.

o Maintains blood volume.

• Increased fluid intake is needed for a high fiber diet.

• Drink plenty of water daily to help meet fluid needs.

 

CALORIC INTAKE

• The risk of breast cancer is much higher in industrial countries than in developing countries where women are characterized by lower energy intake and higher energy expenditure.

• Modest caloric restriction has been shown to inhibit tumor growth in animal models decrease oxidative DNA damage [189].

 

BODY MASS

• Epidemiologic evidence suggests a positive association between body mass and postmenopausal breast cancer [193-196].

o Increasing BMI was associated with a 40% increased incidence and mortality of breast cancer in postmenopausal women [197].

o Women with a BMI of =25 had a 58% increased risk of breast cancer [5].

• Eating foods high in vitamin C, such as fruits and vegetables, may provide a protective effect from breast cancer for overweight women (BMI>25) [215].

 

PHYSICAL ACTIVITY

• Low levels of physical exercise appear to be associated with the risk of breast cancer [172,195,216-218].

• Lifetime total physical activity has been associated with a decreased risk of breast cancer [219-221].

o Exercise between the years of 14-20 appears to be the most beneficial in reducing risk of breast cancer [219].

• Women who engaged in regular strenuous physical activity at age 35 had a 14% reduced risk of breast cancer compared with less active women [217]. A similar trend was observed for regular strenuous activity at age 18 and at age 50. These findings were consistent with women who did and did not use HRT.

• Furthermore, a prospective observational study reported that physical activity after a breast cancer diagnosis may reduce the risk of death from this disease [216]. The greatest benefit occurred in women who performed the equivalent of walking 3 to 5 hours per week at an average pace. The benefit of physical activity was particularly apparent among women with hormone-responsive tumors.

• As noted earlier, the combination of consuming five or more daily servings of vegetables and fruits, and accumulating 540+ metabolic equivalent tasks-min/wk (equivalent to walking 30 minutes 6 d/wk) decreased mortality by nearly 50% [11].

• Increased physical activity following breast cancer diagnosis significantly decreased the risk of dying from breast cancer and improved overall survival when compared with women who exercised <2.8 MET-h/wk [224].

• Physical activity can help ease cancer-related fatigue during and following cancer treatment [228,229].

Additional Nutritional and Lifestyle Factors for Breast Cancer Survivors

ANTIOXIDANTS* – Found in abundance in fruits and vegetables!

• Prevent oxidative damage in body cells.

o Research indicates a link between oxidant damage and breast carcinogenesis*.

• Examples of antioxidant* nutrients and non-nutrients include vitamins A, C, and E, selenium, lycopene, and beta-carotene.

• Note that patients may be advised to NOT consume high-dose antioxidant* supplements during chemotherapy or radiation therapy. Antioxidant* consumption via food sources and a basic multivitamin supplement are very safe.

 

Selenium

• Antioxidant* that scavenges free radicals and suppresses damage due to oxidation. Also is essential for the immune system.

• Promising evidence indicates that selenium may decrease the risk of breast cancer [234-239].

o Inhibits cell proliferation and induces apoptosis* [238,239].

• A recent study suggested the combination of selenium and iodine, typical of a Japanese diet, act synergistically in decreasing breast cancer risk [241]. It is known that iodine plays an important role in thyroid function. Thus, selenium status may affect both thyroid hormone status and iodine availability.

• Selenium is a precursor to the glutathione* (GSH) antioxidant* system. GSH is the principal protective mechanism of the cell and is a crucial factor in the development of the immune response by the immune cells [242].

 

Turmeric (Curcumin)

• Curcumin, the yellow pigment and active component of turmeric and many curries, is a potent antioxidant*, that exhibits chemopreventive and growth inhibitory activity in several tumor cell lines [243-246].

• Evidence suggests that curcumin may suppress tumor initiation, promotion and metastasis [245,247].

• Additionally, curcumin promotes detoxification in the liver and possesses anti-inflammatory activity, possibly by inhibiting COX-2 activity [248,249].

 

Vitamin C

• Most research [250-255], although not all [7,19,256,257], has shown no protective relationship between vitamin C and the risk of breast cancer.

o Vitamin C induces apoptotic effects on breast cancer cells [257].

• Low plasma levels of vitamin C have been associated with a greater risk of breast cancer [258].

• Dietary vitamin C has been significantly associated with reduced mortality in breast cancer survivors [19].

• Furthermore, risk of recurrence and mortality was reduced in women who consumed vitamin C supplements for more than three years [259].

 

Vitamin E

• Vitamin E acts as a cellular antioxidant* and an anti-proliferating agent. It consists of both tocopherols and tocotrienols.

o Some research indicates that tocotrienols are the components of vitamin E responsible for growth inhibition in human breast cancer cells [260].

• Research is inconsistent on the protective effects of vitamin E and breast cancer. Data from most prospective studies have not revealed a protective relationship between vitamin E and risk of breast cancer [250].

• Supplemental vitamin E does not consistently appear to offer protection against breast cancer [150] although taking vitamin E for more than three years has been associated with a modest protective effect [259]. Additionally, these researchers reported a decreased risk of recurrence and mortality associated with long-term use of vitamin E supplements.

• It was demonstrated recently that dietary vitamin E, unlike supplemental sources of vitamin E, significantly reduced oxidative damage as measured by urinary biomarkers [150].

• Note that findings suggest that vitamin E supplements may interfere with the therapeutic effects of tamoxifen [261].

 

Resveratrol

• Resveratrol is a polyphenol found primarily in red grape skins with known antioxidant and antiinflammatory properties, and is emerging as a potent chemopreventive and anticancer drug [262].

• Resveratrol has exhibited potential anticarcinogenic activities in several studies.

o Reduced tumor growth, decreased angiogenesis, and induced apoptosis in mice [263].

 

Nutrient/Phytonutrient Summary Recommendation

Selenium Dietary sources include Brazil nuts, seafood, enriched brewer’s yeast, and grains. Selenium content depends somewhat on the amount of selenium in the soil in which the products are grown. 200 mcg selenium daily through diet and/or supplements. Two Brazil nuts provide 200 mcg selenium.

Turmeric (curcumin) A deep orange-yellow spice commonly used in curries and Indian cuisine. Eat liberally.

Vitamin C Dietary sources include various fruits and vegetables, including papaya, citrus fruits, kiwi, cantaloupe, mango, strawberries, bell peppers, broccoli, and tomatoes.

Include these fruits and vegetables daily.

Vitamin E Dietary sources include vegetable oils, wheat germ, sweet potatoes, nuts, seeds, and avocados. Eat vitamin E-rich foods regularly.

More research is needed to assess whether or not supplements would be beneficial.

Resveratrol Dietary sources include grapes, grape products, peanuts, soy, mulberries, and cranberries. Eat resveratrol-rich foods regularly.

More research is needed to assess whether or not supplements would be beneficial.

 

Flax

• Flax may also work to block tumor growth, inhibit angiogenesis*, and enhance the immune system [268].

• A recent study indicates that flaxseed (25 g daily) and its metabolites, such as lignans*, reduced tumor growth in patients with breast cancer [271].

• An animal study reported that flaxseed inhibited established human breast cancer growth and reduced incidence of metastasis by 45% [272].

 

GREEN TEA

• Tea contains phytonutrients* known as polyphenols* (flavonoids) that provide antioxidant* and anticancer properties [277].

o May block the formation of cancer-causing nitrosamines* [278].

o Prevents DNA damage [279].

o May inhibit tumor growth and induce apoptosis* [280-282].

o Increase immune response [281].

o Epigallocatechin gallate (EGCG) alters gene expresssion to lower the risk of breast cancer [283].

• There is a significant amount of in vitro and in vivo evidence suggesting tea polyphenols* have chemopreventive agents against various cancers [280,284,285]. More human data is needed.

• Research suggests that while green tea did significantly decrease tumor mass, when green tea was combined with soy phytonutrients*, the tumor mass decreased even further [294]. Further evidence indicates a possible synergistic relationship between soy and green tea consumption [288].

• Similarly, a synergistic effect of green tea and Ganoderma lucidum extracts on the suppression of growth and invasiveness of metastatic breast cancers was observed [295].

• Additionally, green tea increased the inhibitory effect of tamoxifen on the proliferation of ER + breast cancer cells [296].

 

SOY

• Associated with reduced rates of heart disease [297-299], protection against osteoporosis [300,301], and certain types of cancer, including breast cancer [302,303].

• While there has been contention regarding soy and breast cancer, research findings are predominantly neutral [304], if not protective [6,305,306].

• Soy consumption has been suggested to exert potential cancer-preventive effects in premenopausal women, such as increased menstrual cycle length and SHBG* levels and reduced estrogen levels.

• Furthermore, vegan protein sources, such as soy, appear to decrease circulating IGF-I activity, which may impede cancer induction [298,314,315].

Source Amount of Soy

Protein (gm)

Amount of Soy

Isoflavones (mg)

Miso (1 tbsp) 2 7-10*

Soybeans, edamame (1/2 cup) 11 35*

Soymilk (8 fl oz) 10 23*

Soy nuts (1/4 cup) 19 40-50*

Tempeh (1/2 cup) 19.5 36*

Tofu (4 oz) 13 39*

* Isoflavone content varies by brand

 

Vitamin D

• Epidemiological studies suggest an inverse relationship between sun exposure, serum levels of 25(OH)-vitamin D, and vitamin D intake and the risk of developing and/or surviving cancer [318].

o Possible mechanisms that may explain the protective effects of vitamin D may be its role as a nuclear transcription factor that regulates cell growth, differentiation, apoptosis and a wide range of cellular mechanisms central to the development of cancer.

o Furthermore, breast density, a factor that may increase the risk of breast cancer, was inversely associated with vitamin D intake [319].

• The women in the Nurses’ Health Study observed a 30% reduction in risk of breast cancer comparing the highest with lowest quintiles of 25(OH)-vitamin D levels. [320].

• Post-menopausal breast cancer risk was significantly inversely associated with serum 25(OH)vitamin D levels [321].

o Risk decreased as women’s levels increased from 30 nM (12 ng/ml) to = 75 nM (30 ng/ml), [which is still very low, ra].

• It is now believed that the recommended vitamin D dose should be much higher, between 2’000 and 8’000 IU per day (ra).

o Research indicates that vitamin D3 (cholecaciferol) is better absorbed than vitamin D2 (ergocalciferol) [322].

• Due to the likelihood of a biochemical deficiency without clinical symptoms or signs, a serum 25(OH)-vitamin D level is recommended.

o Optimal serum 25-hydroxy vitamin D levels have not been established though research suggests 50-90 ng/ml (ra) may be ideal. Some believe the normal level of vitamin D is 50-60 ng/ml.

o While supplementation may be recommended, more appropriate dosing of vitamin D supplementation can be made once a serum 25(OH)-vitamin D level has been established.

 

Food or Beverage Summary Recommendation

Flaxseed: Good source of omega-3 fatty acids and fiber, contains protein, calcium, potassium, B vitamins, iron, and boron. Opt for ground flax seeds rather than whole flax seeds, flax seed oil, flax supplements to increase bioavailability. Flax seeds may be ground in a coffee grinder, blender, or food processor. 2 Tbsp ground flaxseed daily, Flax can have a laxativelike effect, thus, it is wise to gradually increase consumption. Sprinkle into various foods and beverages, including hot cereals, tomato sauces, fruit smoothies, brown rice or other grains. Store flax in the refrigerator or freezer.

Green tea: Green tea contains does contain caffeine though much less than coffee or black tea. Avoid decaffeinated teas or coffee, typical caffeine extraction results in a significant loss of phytonutrients. 1-4 cups daily.

Soy: Contains various nutrients, including protein, fiber, calcium, and B vitamins. Rich in antioxidants*, known as isoflavones, namely genistein and daidzein. Among others, dietary sources include soybeans, edamame, tofu, soymilk, tempeh, miso, and soy nuts. Unless soy has been a part of your diet for years, postmenopausal individuals with ER+ breast cancer may be advised to limit soy consumption to 1-3 daily servings. Soy supplements or isoflavone extracts are not recommended.

Vitamin D: A fat-soluble vitamin that we generate through skin synthesis of sunlight (ultraviolet rays). Dietary sources include cold-water fish, eggs, and fortified products, such as milk, soy milk, and cereal. Maintain serum 25 (OH)-vitamin D >50 ng/mL.

 

MELATONIN

• Melatonin is a hormone produced by the pineal gland. Its primary function involves the regulation of the body’s circadian rhythm, endocrine secretions, and sleep patterns.

• Some research indicates that individuals with low levels of melatonin are at greater risk for breast cancer.

• The risk of breast cancer was reduced by 33% in postmenopausal women who slept 9+ hours compared to those who slept =6 hours daily [324].

o Melatonin levels were 42% higher in those who slept 9+ hours vs =6 hours daily.

o In vitro and animal research has supported the protective effect of melatonin against breast cancer [328].

• Melatonin may act by:

o Inhibiting cell proliferation [330,331].

o Inducing apoptosis* [332].

o Enhancing the immune system [330,333].

• May improve survival in cancer patients by protecting the immune system from damage caused by chemotherapy [332].

o Reducing IGF-I [334,335].

o Decreasing the number and activity of estrogen receptors, thus reducing ways that the cancer cell connects to estrogen [336].

• Furthermore, the combination of melatonin and retinoids* [339] as well as the combination of melatonin and vitamin D3 [340] appear to work synergistically to inhibit the growth of breast cancer cells.

• Melatonin does have blood thinning properties, thus it is recommended to not use supplemental melatonin 7-10 days prior to surgery.

 

FOOD SAFETY

• Especially important for those with weakened or impaired immune systems and while on chemotherapy

• The following recommendations have been adapted from guidelines provided by the American Cancer Society.

o Wash foods thoroughly before eating.

o Keep all aspects of food preparation meticulously clean.

o Use special care in handling raw meats, poultry, and eggs.

• Thoroughly clean all utensils, countertops, cutting boards, and sponges that contacted raw meat.

• Thaw meats and fish in the refrigerator.

o Transfer large volumes of leftovers, such as soup, rice, or casseroles, to shallow containers and place in refrigerator. This process ensures proper cooling.

o Do not eat perishable foods that have been left out of the refrigerator for more than two hours.

o Store foods at low temperatures (less than 40oF) to minimize bacterial growth.

o When eating in restaurants, avoid foods that may have bacterial contamination, including sushi, salad bars, buffets, unpasteurized beverages or food products, and raw or undercooked meat, poultry, fish, and eggs.

 

SUMMARY - HEALTHY CANCER DIET

• Eat 8 to 10 colorful fruit and vegetable servings daily

o Two to three pieces of fruit

o One cup or more of vegetables with lunch and dinner

o 8 fl oz vegetable juice

• Consume 30 to 45 grams of fiber daily

o You will likely meet your fiber goal if you eat 8 to 10 servings of fruits and vegetables plus one serving of beans/legumes or at least two servings of whole grains daily.

• Avoid processed and refined grains/flours/sugars

o Keep WHITE off your plate: bread, pasta, rice, cream sauces, cakes, and more.

• Limit meats and whole milk dairy products

• Include healthy fats like cold-water fish, flaxseed, walnuts, soybeans, olive oil, avocados

• Eat 2 Tbsp ground flax daily

• Limit alcohol consumption

• Drink 1 to 4 cups of green tea daily

• Maintain serum 25 (OH)-vitamin D levels above 50 ng/mL

• Drink plenty of fluids, water or non-caffeinated beverages, daily to help meet fluid needs

• Engage in daily physical activity to help achieve and maintain a healthy weight

 

WORDS OF WISDOM

“Let food be your medicine.”

 -Hippocrates

 

This blog is designed for educational purposes only and is not intended to replace the advice of your physician or health care provider, as each patient’s circumstances are individual. We encourage you to discuss with your physician or us any questions and concerns that you may have.

 

Nutrition Resources

 

Books

How to Prevent & Treat Cancer with Natural Medicine – written by Michael Murray (2002)

The Color Code – written by James Joseph, Daniel Nadeau, & Anne Underwood (2002)

Ultra Metabolism – written by Mark Hyman (2006)

 

Cookbooks

Cancer Lifeline Cookbook - written by Kimberly Mathai & Ginny Smith (2004)

Fat-Free and Easy: Great Meals in Minutes – written by Jennifer Raymond (vegetarian cookbook) (1997)

Lickety-Split Meals – written by Zonya Foco (1998)

One Bite at a Time – written by Rebecca Katz, Marsha Tomassi, & Mat Edelson (2004)

The Peaceful Palate – written by Jennifer Raymond (vegetarian cookbook) (1996)

12 Best Foods Cookbook: Over 200 Recipes Featuring the 12 Healthiest Foods – written by Dana Jacobi (2005)

 

Newsletters/Magazines

Cooking Light www.cookinglight.com Fax: (205) 445-6600

Environmental Nutrition http://www.environmentalnutrition.com (800) 829-5384

Nutrition Action Health Letter http://www.cspinet.org/nah/ Fax: (202) 265-4954

 

Websites

American Cancer Society http://www.cancer.org (415) 394-7100

American Institute for Cancer Research http://www.aicr.org (800) 843-8114

Caring4Cancer - Provides up-to-date & comprehensive information on the connection between

nutrition & cancer – http://www.caring4cancer.com

Center for Informed Food Choices - Offer cooking classes in the Bay Area that emphasize plantbased

foods. http://www.informedeating.org

Consumer Lab - Evaluates quality of over-the-counter supplements http://www.consumerlab.com

Diana Dyer, MS, RD – Breast cancer survivor & dietitian http://www.cancerrd.com

Ida & Joseph Friend Cancer Resource Center – UCSF Mt.Zion http://cancer.ucsf.edu/crc

National Cancer Institute http://www.nci.nih.gov/ (800) 4-CANCER (800-422-6237)

Oncolink – Provides information regarding clinical trials, newsgroups, psychosocial support, & more.

http://oncolink.upenn.edu

San Francisco Vegetarian Society – Monthly restaurant outings & pot-luck dinners; call 415-273-5481.

http://www.sfvs.org

The Vegetarian Resource Group - Provides vegetarian nutrition information & vegetarian recipes

http://www.vrg.org

WebMD http://my.webmd.com

 

Glossary

Angiogenesis – The formation of new blood vessels.

Antioxidant – A substance that inhibits oxidation or inhibits reactions promoted by oxygen or peroxides.

Apoptosis – Programmed cell death.

Carcinogenesis – Beginning of cancer development.

Case-Control Studies – An epidemiological study in which a group of, say, cancer patients (cases) is compared to a similar but cancer-free population (controls) to help establish whether the past or recent history of a specific exposure such as smoking, alcohol consumption and dietary intake, etc. are causally related the risk of disease.

Catechin – One of the tannic acids; phytonutrient, specifically, one of the flavonoids found in green tea.

Creatine – An amino acid that is formed in the muscle tissue of vertebrates; supplies energy for muscle contraction.

Cohort Studies – Follow-up study of a (usually large) group of people, initially disease-free. Differences in disease incidence within the cohort are calculated in relation to different levels of exposure to specific factors, such as smoking, alcohol consumption, diet and exercise, that were measured at the start of the study and, sometimes, at later times during the study.

Eicosanoids – Biologically active compounds that regulate blood pressure, blood clotting, and other body functions. They include prostaglandins, thromboxanes, and leukotrienes.

Endogenous – Originating from within, as within the body.

Estradiol – A naturally occurring powerful estrogen secreted by the mammalian ovary.

Estrone – A naturally occurring weak estrogen secreted by the mammalian ovary.

Glutathione – A polypeptide produced primarily in the liver; involved in DNA synthesis and repair, protein and prostaglandin synthesis, amino acid transport, metabolism of toxins and carcinogens, immune system function, prevention of oxidative cell damage, and enzyme activation.

Insulin - Insulin is a hormone produced by the pancreas in the body that regulates the metabolism of carbohydrates and fats, especially the conversion of glucose to glycogen, which lowers the body’s blood sugar level.

Lignans - Phytoestrogens that have a similar chemical structure to estradiol and tamoxifen; appear to offer protection against breast cancer.

Meta-analysis – The process of using statistical methods to combine the results of different studies.

Mutation – Abnormal cell development.

Nitrosamines – Derivatives of nitrites that may be formed in the stomach when nitrites combine with amines; carcinogenic in animals.

Phytonutrients – Plant compounds that appear to have health-protecting properties.

Polyphenols – Phytonutrients that act as an antioxidant; compounds that protects the cells and body chemicals against damage caused by free radicals, reactive atoms that contribute to tissue damage in the body.

Retinoids – Chemically related compounds with biological activity similar to that of retinol; related to vitamin A.

Sex hormone-binding globulin (SHBG) – A protein in the blood that acts as a carrier for androgens and estradiol; inhibits the estradiol-induced proliferation of breast cancer cells.

 

For References see:
http://cancer.ucsf.edu/_docs/crc/nutrition_breast.pdf

 

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