TAKE THE WHEEL: Healthy lifestyle changes that may reduce the risk of a colorectal cancer recurrence
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This document summarizes a webinar on lifestyle changes that may reduce the risk of colorectal cancer recurrence. The webinar discusses managing common side effects like fatigue, bowel issues, and weight changes through diet and exercise. Nutritional recommendations include maintaining a healthy weight, limiting red and processed meats, increasing fiber intake, and being mostly plant-based. Physical activity guidelines suggest 150 minutes per week of moderate exercise. Resources for nutrition coaching and support are also provided.
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TAKE THE WHEEL: Healthy lifestyle changes that may reduce the risk of a colorectal cancer recurrence
- 1. Welcome! TAKE THE WHEEL: Healthy lifestyle changes that may reduce the risk of a colorectal cancer recurrence Part of Fight Colorectal Cancer’s Monthly Patient Webinar Series Our webinar will begin shortly www.FightColorectalCancer.org 877-427-2111
- 2. Fight Colorectal Cancer 1. Tonight’s speaker: Jessica Iannotta MS, RD, CSO, CDN 2. Archived webinars: FightColorectalCancer.org/Webinars 3. Follow up survey to come via email. Get a free Blue Star of Hope pin when you tell us how we did tonight. 4. Ask a question in the panel on the right side of your screen and look for hyperlinks during throughout the presentation. 5. Or call the Fight Colorectal Cancer Answer Line at 877-427-2111
- 3. Fight Colorectal Cancer www.FightColorectalCancer.org 877-427-2111 Jessica Iannotta MS, RD, CSO, CDN Meals to Heal, Chief Operating Officer
- 4. Objectives • Symptom Management – Fatigue – Bowel management – Involuntary weight changes • Nutritional Recommendations – Weight management – Meat – Alcohol intake • Physical Activity Recommendations
- 5. Colorectal Cancer • The 3rd most common cancer in the US • CRC is the 2nd most common cause of cancer death in the US • As obesity rates have increased, the number of cases has increased • Overall, there is evidence that incidence is decreasing
- 6. Fatigue • Fatigue is the most common treatment- related side effect • Encourage hydration, exercise – Stretching, yoga, tai-chi, walking • Keep naps to 20-30 minutes, avoid long naps • Adequate diet (protein), avoid sugary foods, • Avoid high-dose vitamin/mineral supplements • Encourage ways to manage stress
- 7. Constipation • Caused by – decreased motility – inadequate fluids/fiber – medications (antidepressants, opioids, sleep medication) – inactivity – cancer tx – cancer • Encourage increased fluid/fiber intake, activity, prune juice, probiotics • Routine habits • Avoid more binding foods
- 8. Good Sources of Dietary Fiber • Fruits • Vegetables • Grains • Beans/legumes • Nuts • Fiber supplements as needed • Be sure to consume adequate fluids
- 9. Partial Bowel Obstruction • Focus on a low fiber/low residue diet – Food choices <2gm fiber/serving – Avoid gas-producing foods - cruciferous vegs, onions, melons, carbonated drinks • Adequate fluid intake • Increase activity, if able • Stool softeners/laxatives as prescribed by medical team
- 10. Diarrhea • Talk with physician about your laxatives, stool softeners • Clears if diarrhea is severe (>7stools/day) • Replace each loose stool with 1 cup of liquid (Gatorade, broth, diluted juices) • Small, frequent meals, soluble fibers, and limit dairy products/caffeine • Chronic diarrhea – encourage soluble fiber foods, probiotics, OTC or prescription medications
- 11. Gas and Bloating • Avoid gas producing foods • Avoid carbonated beverages, drinking through a straw, chewing gum • Daily probiotics (yogurt, kefir, supplement) • OTC meds (Gas-X, Beano) prescribed by medical team • Other options: – Peppermint oil – Fennel – Ginger – Parsley – Anise – Caraway seed
- 12. Involuntary Weight Changes • For weight loss – Oral nutrition supplements • Creamy vs clear liquid, CIB, non-fat dry milk – Small, frequent meals – High calorie snacks – Pleasant, calm surroundings • For weight gain – Encourage activity – Decrease high calorie choices – Thought that “all cancer patients lose weight”
- 13. Risk Factors for CRC • Increased body weight • Inactivity • Diets high in beef, pork, and lamb • Processed meats • Alcohol intake • Age http://www.aicr.org/learn-more-about-cancer/colorectal-cancer/ http://www.dietandcancerreport.org/expert_report/report_overview.php
- 14. Red Meat and Processed Meat • Why red meat and not white meat? – Heme iron damages the lining of the colon – People who eat a lot of red meat eat less plant-based foods • Limit red meat to <18 ounces/week • Avoid Processed Meats – Smoking, curing, salting or the addition of preservatives can create carcinogens • Heterocyclic amines (HCAs) • Polycyclic aromatic hydrocarbons (PAHs) • Nitrosamines – from nitrates and nitrites – Calcium and alpha tocopherol may help reduce the effect Egeberg, R. Associations between Red Meat and Risk for Colon and Rectal Cancer Depend on the Type of Red Meat Consumed. J Nutr. 2013:143;464-472.
- 15. Be Smart About Meat Consumption • Grilling – Marinade, cook at lower temperatures • Include cruciferous vegetables • Replace red meat with fish, shellfish, chicken, turkey, yogurt, bea ns, tofu, nuts • Choose lean cuts – Sirloin, loin, round, and mignon • Replace processed meats in sandwiches with: – Nut butters, hummus, baked chicken or turkey, egg, chicken or tuna salad, low-fat cheese Berjia, F. Burden of diseases estimates associated to different red meat cooking practices. Food and Chem Toxic. 2014;66:237-244.
- 16. Weight and CRC • Overall, after not smoking being a healthy weight is the most important thing you can do • Weight gain in adult life appears to increase risk for CRC – Specifically abdominal weight gain (apple shape) • Increases pro-inflammatory components • Control weight – Portion sizes, increase dietary fiber, decrease calorie dense foods, increase physical activity Aleksandrova, K. Adult weight change and risk of CRC in the EPIC and Nutrition. Euro J Cancer. 2013;49:3526-3536.
- 17. Dietary Fiber • There is convincing evidence that foods containing fiber decrease risk • Every 10 grams reduces risk by 10% • Fiber recommendations – 25g/d women – 38g/d men • Soluble vs insoluble – Increase transit time, removes harmful substances • Start slowly Food, Nutrition, Physical Activity, and the Prevention of Cancer: a Global Perspective and the 2012 CUP Report on Colorectal Cancer
- 18. Garlic and Cruciferous Vegetables • Garlic may be protective for CRC – Contain substances that have anti-cancer effects • Quercetin • Allixin • Allicin • Cruciferous vegetables – High in antioxidants, fiber, folate – Help decrease inflammation – Broccoli, Brussels sprouts, cabbage, etc Tse, G. Cruciferous vegetables and risk of CRC neoplasms: A systematic review and meta-analysis. Nutr and Cancer. 2014;66(1):128-139.
- 19. Nutritional Recommendations • Focus on the whole picture • We know… – Keeping a healthy weight – Eating a mostly plant-based diet – Avoiding processed meats, limiting red meat – Avoiding energy dense foods – Avoiding supplements as a protection from cancer – Limiting alcohol consumption – Increasing daily physical activity decreases cancer risk
- 20. Mostly Plant-Based Diet • Increase fruit and vegetable consumption – 7 to 9 servings per day – Colorful choices • Focus on whole grains – At least ½ of grains should be whole grains • Consume beans, lentils, and legumes – Good alternative to meats • Meat is the “side dish” • Avoid sugary beverages – Flavor beverages with fruits/vegetables/herbs
- 21. Physical Activity • ACSM recommendations for cancer survivors – 150mins/wk moderate-vigorous exercise – Strength training 2x per week for each major muscle group – Stretch major muscle groups when participating in activity • Caution with morbidly obese, lower limb lymphedema • Start with light-intensity, progress slowly, and allow cancer-related symptoms be the guide
- 23. Resources • YMCA LiveSTRONG program • Referral to RD – Insurance coverage is limited • Meals to Heal Nutrition Coaching – Affordable, easy • New American Plate Challenge – Free, cancer-specific – www.napchallenge.org • Fight Colorectal Cancer – www.Fightcolorectalcancer.org
- 24. References • http://www.aicr.org/learn-more-about-cancer/colorectal-cancer/ • http://www.dietandcancerreport.org/expert_report/report_overview.p hp • http://www.livestrong.org/What-We-Do/Our-Actions/Programs- Partnerships/LIVESTRONG-at-the-YMCA • Egeberg, R. Associations between Red Meat and Risk for Colon and Rectal Cancer Depend on the Type of Red Meat Consumed. J Nutr. 2013:143;464-472. • Helmus, D. Red meat-derived heterocyclic amines increase risk of colon cancer. Nutr and Cancer. 2014;65(8):1141-1150. • Berjia, F. Burden of diseases estimates associated to different red meat cooking practices. Food and Chem Toxic. 2014;66:237-244. • Keum, N. Folic acid fortification and CRC risk. Am J Prev Med.2014;46(3S1):S65-S72. • Tse, G. Cruciferous vegetables and risk of CRC neoplasms: A systematic review and meta-analysis. Nutr and Cancer. 2014;66(1):128-139. • Aleksandrova, K. Adult weight change and risk of CRC in the EPIC and Nutrition. Euro J Cancer. 2013;49:3526-3536.
- 25. Fight Colorectal Cancer CONTACT US Fight Colorectal Cancer 1414 Prince Street, Suite 204 Alexandria, VA 22314 (703) 548-1225 Toll-Free Answer Line: 1-877-427-2111 www.FightColorectalCancer.org Email us: Info@FightColorectalCancer.org
Editor's Notes
- Antidepressants, opioids, sleep medication, anti-nausea meds, diuretics, general anesthesia
- Benefiber, fiberCon, Metamucil, Citrucel
- Weight – as you gain body fat, your risk for colorectal ca increasesRegular physical activity protects against CRC, but a sedentary lifestyle increases your riskDiets high in beef, pork, and lamb increase CRC risk, which is why it is recommended to limit red meat to 18 ounces or less per weekRegular intake of even small amounts of col cuts, bacon, sausage, and hot dogs have been shown to increase CRC risk, which is why it is recommended to avoid these foods.Risk of CRC increases as alcohol intake increasesThe older you are, the greater your risk.
- Research has found that risk of CRC increases significantly with red meat consumption above 18 ounces per week. Red meat contains heme iron, the compound that gives red meat its color, which may damage the lining of the colon. Heme iron highest in beef, lamb and less in veal, porkStudies also show that people who eat a lot of red meat tend to eat less plant-based foods, so they benefit less from their cancer-preventive propertiesWhy do we need to avoid processed meats altogether? The research shows strong, convincing evidence that eating processed meat increases the chances of CRC and that cancer risk starts to increase with any portion. When meat is preserved by smoking, curing or salting, or by the addition of preservatives, cancer-causing substances called carcinogens can be formed. These substances can damage cells in the body, leading to the development of cancer. Dietary exposure is primarily through meats cooked at high temperatures for a prolonged period of time. In meat, the high cooking temperatures turn creatine or creatinine, amino acids and sugars into HCAs (1), and incomplete combustion of organic materials creates PAHs (2). HCAs are formed on the surface of food with high protein content, such as meat exposed to high-temperature cooking [113]. Cooking over a direct flame also produces HCAs on the surface of meat [114]. More than 20 HCAs have been identified so far [115]. Since prolonged cooking at high temperatures produces more HCAs, consumption of well-done grilled meat has been reported to be associated with the highest risk for CRC in a number of case-control studies Polycyclic aromatic hydrocarbons (PAHs) are a group of over 100 different chemicals formed when organic substances like tobacco or meat are burnt incompletely. Grilling (broiling) and barbecuing (charbroiling) meat, fish, or other foods with intense heat over a direct flame results in fat dropping on the hot fire; this produces PAHs that stick to the surface of food. The more intense the heat, the higher the level of contamination; using wood creates more PAHs than charcoal. NOCs can be formed via nitrosation of organic compounds in meat by nitrite, one of the methods of preservation. Endog- enous N-nitrosation of amines forms nitrosamines [105]. Several NOCs are known carcinogens and can alkylate DNA leading to G-to-A mutations [106,107]. NOCs are synthesized endogenously in the gastrointestinal tract [108] and found in foods containing nitrites and nitrates, as well as in food that has been exposed to nitrogen oxide (such as processed meats) [109]. Heme iron, abundantly present in red meat, also has a catalytic effect on the endogenous formation of NOCs Data suggest that the addition of calcium carbonate to the diet or a-tocopherol to cured meat may reduce colorectal cancer risk associated with cured-meat intake. This article also suggests that the curing process might be changed to reduce cancer promoting properties of cured meat. This effect could lead to protective strategies to decrease the colorectal cancer burden in individuals who are the most exposed by changing the food, not the consumer.
- Cruciferous vegetables may decrease the effect of HCAs and PAHs
- In this large prospective cohort study, weight change in middle life years (from age 20 to 50) was associated with higher risk of colon cancer in both men and women, but not with rectal cancer, independent of weight at age 20 and other established CRC risk factors. As visceral adiposity increases so does the release of pro- inflammatory adipokines including IL-6, leptin and TNF-a. This is accompanied by decreased release of anti-inflammatory adipo- kines, including adiponectin [12]. It is hypothesized that elevated inflammatory adipokines contribute to the process of carcinogen- esis [13]. Several studies link higher consumption of legumes with lower risk of colon cancer or the benign adenomas (polyps) that are the beginning of most colon cancer.
- Fiber in the diet also:Regulates sugars, helps with insulin sensitivity,Helps remove cholesterol from the body slows digestion, so you feel full longerincreases the bulk and weight of stool, diluting harmful substances and speeding their elimination from the bodyprotects the lining of the colonhelps control body weight
- Moreover, the evidence in the report shows that garlic, in particular, probably decreases one’s chances of developing colorectal cancer.The protective effect of garlic was shown to have a dose response relationship. In other words, highest exposure to the food showed the greatest decrease in risk.These allium vegetables contain many substances now being studied for their anti-cancer effects, such as quercetin, allixinand a large group of organosulfur compounds that includes allicin, alliinand allyl sulfides. In laboratory studies, components of garlic have shown the ability to slow or stop the growth of tumors in prostate, bladder, colon and stomach tissue.Laboratory research has also shown that one garlic component, called diallyl disulfide, exerts potent preventive effects against cancers of the skin, colon and lung. Recently, this compound proved able to kill leukemia cells in the laboratory. A compound derived from garlic called ajoene has displayed similar activity.Earlier population studies found a strong link between greater consumption of cruciferous vegetables and lower risk of lung, colorectal, stomach, breast, prostate and other cancers. Among more recent, well-designed studies, the specific link between cruciferous vegetables and reduced cancer risk is not as consistent or strong. One reason may have to do with specific gene-diet interactions that are only now coming to light. For example, scientists recently found that about half of the population does not carry a specific gene involved in determining how long the body retains -- and utilizes -- protective cruciferous compounds from the diet. More research is underway, including intervention trials investigating the possibility that isothiocyanates might interfere with prostate cancer progression.Quite a few studies link consuming too little dietary folate with increased risk of colorectal cancer or pre-cancerous polyps. Recent studies also show a link between relatively high amounts of folic acid -- the form of folate found in supplements and fortified foods -- and increased risk of colorectal cancer. There is no evidence that consuming high amounts of foods naturally high in folate increases cancer risk.
- Do not focus on one dietary component like a dietary supplement – focus on the WHOLE picture. Start working on improving your lifestyle and then begin to focus on details
- Oncology professionals should feel comfortable prescribing exercise to cancer survivors, with advice to start with light-intensity exercises, to progress slowly, and to allow the survivors' symptoms to guide the process.