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Using food as your medicine

  By Jo Gamble BA (hons) Dip CNM
          MFNTP MBANT
Let food be your medicine and medicine
                be your food




                          Hippocrates
The need for action
• As a cause of death in the developed world, cancer is
  only surpassed by cardiovascular disease

• Globally the number of people with cancer is
  projected to double by 2030

• Currently, more than one in 3 people will develop
  cancer in their lives!

(WCRF 1997, WCRF 2007, NS 2008)
Understanding Cancer
• Before understanding the impact of nutrition
  on cancer, it is first important to understand
  the biochemical and physiological
  determinants of the disease.
• Cancers are as a result of the interaction of
  genetics, epigenetics and environment of the
  individual.
• Cancer is a chronic disease
What is cancer?
• Healthy cells: balance between growth and
  programmed cell death is tightly regulated

  Cancer cells are cells that grow and divide at
  an unregulated pace.
Environmental and chemical
               carcinogens
• People are continuously exposed exogenously to
  varying amounts of chemicals that have been shown to
  have carcinogenic or mutagenic properties.
• In the case of a solid tumour there is a 20-40 year
  interval from the time of exposure of an individual to a
  chemical or viral carcinogen until the clinical detection
  of a tumour.
• By the time a tumour is apparent, cancer cells have
  aquired the ability to divide where normal cells ought
  not, to invade adjacent cellular architectures, to
  metastasize and to kill the host.
Cancer is a preventable disease
• Only 5-10 % of all cancer cases can be attributed
  to genetic defects, whereas the remaining 90-
  95% have their roots in the environment and
  lifestyle.
• The lifestyle factors include smoking, diet,
  alcohol, obesity, infectious agents, environmental
  pollutants and radiation
• Of all cancer-related deaths; 25-30% are due to
  tobacco, 30-35% diet, 15-20% infections, 10-20%
  obesity, 4-6% alcohol, 10-15% others, which
  includes environmental and radiation.
Good news we are in control
World Cancer Research Fund: high fruit and vegetable intake may
  reduce cancer incidence by 40- 64 %
  US National Research Council: high fruit and vegetable intake may
  reduce US cancer rates and mortality by 1/3, roughly equivalent to
  the reduction in mortality from infectious diseases brought about
  by improved hygiene and better healthcare during the 19th century


  In the November 2010 issue of Nutrition and cancer, a study
  indicated that women who consumed a greater amount of
  vegetables and seafood were 86% less likely to be diagnosed with
  breast cancer
Good news we are in control
• Newest Research:
  through good nutrition we can also improve
  survival rates of people with some cancers by
  calming down the genes responsible for
  cancer growth!



(Ornish et al. 2005, Ornish et al. 2008, Saxe et al. 2006)
Support goals
Primary goals
• Support tumourcidal effects of treatment
• Reduce side effects of treatments
• Support overall wellness
Secondary goals
• Support immunity
• Reduce tumour promoting factors
• Inhibit metastasis and tumour progression
• Promote appropriate apoptosis
How diet can affect cancer
Initiation-dietary carcinogens
- aflatoxins (found in mouldy food)
- heterocyclic amines (meat cooked at very high temperatures)

- N-nitroso compounds (in some spoiled foods, protein foods,
cured meat)

- polycyclic aromatic hydrocarbons (PAH) (products of combustion
found in cooked foods, smoked foods and dark beer)

these chemicals can start a cancer process by creating cancer
                             cells
(World Cancer Research Fund 1997; NRC 1982)
Diet-red meat
• Heavy consumption of red meat is a risk factor
  for several cancers, especially those of the
  gastrointestinal tract, but also for colorectal,
  prostate, bladder, breast, gastric, pancreatic and
  oral cancers.
• The hetrocyclic amines produced during the
  cooking of meat are carcinognic. Charcoal
  cooking and/or smoke curing of meat produces
  harmful carbon compounds such as pyrolysates
  and amino acids which have a strong cancerous
  effect.
                    Anand P et al, Cancer is a preventable disease that requires major
                    lifestyle changes. 2008
Diet: Fats and sugars
• Saturated fatty acids, trans fatty acids and
  refined sugars and flour present in most foods
  have also been associated with various cancers                                                    (1)

• Epidemiologic studies suggested a positive
  association between dietary fat and colon cancer.
  (2)

• Frequent consumption of sugar and high-sugar
  foods may increase the risk of pancreatic cancer
  by inducing frequent postprandial hyperglycemia,
  increasing insulin demand, and decreasing insulin
  sensitivity.
             (3)




                       (1)   Anand P et al, Cancer is a preventable disease that requires major lifestyle changes. 2008
                       (2)   Reddy, B Dietary Fat & Colon cancer. Chemistry & material science vol 27 no 10 807-813
                       (3)   American Journal of Clinical Nutrition Vol 84 No 5 1171-1176 Nov 06
Dietary Tumour Promoters:

                                            -
-excess fat - ↑ insulin, ↑ estrogens, ↑ oxidative stress, ↑ inflammation

-excess protein -↑ insulin, ↑ IGF-1,

-excess calories- ↑ insulin, ↑ IGF-1, ↑ oxidative stress, ↑ inflammation

- excess Omega 6 EFA- ↑ oxidative stress, ↑ inflammation

 (Becci et al, 1979; Wood et al, 1983; Newberne and Rogers, 1986; Poirier et al, 1986;
Kritchevsky and Klurfeld, 1987; Pariza, 1987; Sawada et al, 1990; Birt et al, 1992; Newmark and
Lipkin, 1992; Wattenberg, 1992; Yuspa, 1994; Heber et al. 2006 )




                           © CNM; by Gosia Desmond MA, MBS, BSc
                            Nut Med Jo Gamble BA (hons) Dip CNM
Metabolic Tumour Promoters:
                                      -
- insulin- promotes cancer cell proliferation and decreases
apoptosis
- estrogens- induces cancer cell proliferation
- oxidative stress- can act as cancer initiator and promoter
- inflammation- strong association between chronic inflammation
and cancer (mechanisms: promoting proliferation of cancer cells,
formation of cancer blood vessels?-not entirely understood)
- IGF-1- potent growth factor for many cancer lines
(Heber et al 2006)




                     © CNM; by Gosia Desmond MA, MBS, BSc
                      Nut Med Jo Gamble BA (hons) Dip CNM
Alcohol

Colon Cancer Risk-increases by 10% if you drink 1
glass of wine daily

Colon Cancer Risk-increases by 25% if you drink 2
glasses of wine or 1 pint of beer daily

Drinking as little as one pint of beer or one large glass of wine a day
increases risk of breast cancer by more than 7%.

Mouth, Oesophagus, Larynx, Throat Cancer-↑ 168% risk with 1 glass of
wine/d


(World Cancer Research Fund 2007; Riboli et al 2002; American Cancer Society 2007; Cancer
Research UK 2009a)
Obesity/Excess Body Fat and
          Cancer
Increase in Risk Cancer Associated with Obesity
    (Source: National Cancer Policy Board 2003; Pan et al 2004)



Convincing Evidence Colon, Prostate, Breast
                              Endometrial, Kidney, Esophageal
                              Ovary, Non-Hodgkin’s
                              Lymphoma,
                              Leukemia, Multiple myeloma ,
                              Pancreas, Oesophagus ,
Possible                      Gallbladder
Dairy and Cancer-Possible Mechanisms


  
 consumption of milk increases blood levels of IGF-1, which
 has been associated with increased prostate and breast
 cancer risk




(Chan et al. 1998)
Tumour Anti- Promoters:

-folic acid (reducing likelihood of DNA damage)

-antioxidants (preventing oxidative damage and lipid peroxidation, which
compound DNA damage in tumor promotion)

-phytochemicals (various mechanisms)

- low-fat plant-based diet (various mechanisms, see above)
(World Cancer Resarch Fund 1997, Wattenberg 1985)




                       © CNM; by Gosia Desmond MA, MBS, BSc
                       © Gosia Desmond MA, MBS, BSc Nut Med
                        Nut Med Jo Gamble BA (hons) Dip CNM
Promotion-Protection
low fat; high fibre

                                           estrogens;
adequate protein                           Insulin
                                           growth factors (IGF-1)
adequate calories
                                           inflammation
whole plant foods                          downregulation of oncogenes
                                           upregulation of tumour
O6: O3 ratio 2:1                           suppressor genes

Physical activity



                                © CNM; by Gosia Desmond MA, MBS, BSc
(World Cancer Research Fund   2007; Heber 2006; Ornish et alCNM
                                 Nut Med Jo Gamble BA (hons) Dip 2008;   Saxe 2006)
promote synthesis of
                                                         detoxification enzymes

          antioxidants
                                      Phytonutrients



                                                                        act as
                 immune                                                 antiproliferative
                 stimulants              angiogenesis                   agents
                                         inhibitors

(Omenn 1995; Talalay et al 1995; Wattenberg 1970; Engwerda et al 2001; Zawa and Duve 1997; Fotsis
et al 1993)
Phytonutrients
• new evidence: official guidelines –’5 a day’
  is not enough!!!
• US National Cancer Institute: five is just the
  bare minimum.
• men-at least 9 servings
• women –at least 7 servings
• children-at least 5 servings
Phytonutrients –Flavonoids:


-onions
-kale
-grape
-citrus fruit
-apple
-pear

-powerful inhibitors of many cancers including
human breast cancer cells

(So et al 1996; Guthrie and Carroll 1998)
Phytonutrients –Flavonoids:


broccoli,
brussel sprouts,
cabbage,
cauliflower,
Chinese cabbage,
cress,
daikon,
kale
kohlrabi
turnip
potent carcinogen detoxifiers –inducers of detoxification enzymes

(Zhang and Callaway 2002)
Other anti-cancer nutrients:


Other anticancer substances:

-sulphur compounds of garlic (tumour growth inhibition;
cancer formation inhibition)

-folic acid (fruits and vegetables; DNA protection)

-beta sitosterol (fruits and vegetables; tumour growth
inhibition)


(Fleischauer and Arab 2001; Awad et al 1996; Duthie 1999)
Low Fat Vegan Diet Full of Unprocessed Plants
                                           promotes synthesis of
                      lowers estrogens     detoxification enzymes

     full of
     antioxidants                                   lowers AGE,
                          Low fat plant             oxidative damage
minimizes                  based diet
carcinogen exposure

         stimulates
                                                lowers IGF-1
         immune           lowers insulin
         response

                                                  creates powerful
               low in Omega 6                        anti-cancer
                                                    environment
Balancing Your Plate
Divide your plate into 3 sections:
  50% is vegetables, salad
  25% is mixed whole grains or starch
  25% is protein source – poultry, fish, beans, soy
   products

                          Whole
                          grains
                Veggies
                          Protein
Lifestyle Change is a Journey
It takes 45 days to change a habit
or incorporate a new one




     5   10   15   20   25   30   35   40   45

Live your life as if your health depends on it…
because it does!
What are the main components of
          a wellness diet?
• Water 2 liters of hydrating fluid daily
• Well balanced macro nutrients throughout the
  day
• High levels of micro nutrients
• Avoidance of anti-nutrients
Macro nutrients
• Complex carbohydrates
• Protein
• Essential fats
Complex carbohydrates
•   Whole meal bread
•   Whole meal pasta
•   Brown rice
•   Oats
•   Beans and lentils
•   Root vegetables
Protein
•   Eggs
•   Fish
•   Poultry
•   Meat
•   Beans and lentils
•   Nuts and seeds
•   Tofu
•   Quinoa
Essential fats
•   Oily fish
•   Nuts and seeds
•   Avocados
•   Cold pressed oils
•   Olives
Anti-oxidants
• Have been studied individually and collectively
  for their potential to enhance physical
  performance.
• Prevent exercise induced muscle tissue
  damage
• Fight against chronic diseases such as cancer,
  cardio-vascular disease, strokes
Hydrating fluid

2 litres of hydrating fluid each day:
      * Water
      * Herbal tea

Avoid dehydrating fluids
    * tea/coffee
    * Alcohol
    * fizzy drinks
Avoid anti-nutrients
•   Aspartame
•   Trans fats
•   Refined carbohydrate
•   Processed foods
•   Sugar
"The wise man should consider that health is the
  greatest of human blessings. Let food be your
  medicine." - Hippocrates
Jo Gamble BA (hons) Dip CNM mBANT

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Cancer & Nutrition

  • 1. Using food as your medicine By Jo Gamble BA (hons) Dip CNM MFNTP MBANT
  • 2. Let food be your medicine and medicine be your food Hippocrates
  • 3. The need for action • As a cause of death in the developed world, cancer is only surpassed by cardiovascular disease • Globally the number of people with cancer is projected to double by 2030 • Currently, more than one in 3 people will develop cancer in their lives! (WCRF 1997, WCRF 2007, NS 2008)
  • 4. Understanding Cancer • Before understanding the impact of nutrition on cancer, it is first important to understand the biochemical and physiological determinants of the disease. • Cancers are as a result of the interaction of genetics, epigenetics and environment of the individual. • Cancer is a chronic disease
  • 5. What is cancer? • Healthy cells: balance between growth and programmed cell death is tightly regulated Cancer cells are cells that grow and divide at an unregulated pace.
  • 6. Environmental and chemical carcinogens • People are continuously exposed exogenously to varying amounts of chemicals that have been shown to have carcinogenic or mutagenic properties. • In the case of a solid tumour there is a 20-40 year interval from the time of exposure of an individual to a chemical or viral carcinogen until the clinical detection of a tumour. • By the time a tumour is apparent, cancer cells have aquired the ability to divide where normal cells ought not, to invade adjacent cellular architectures, to metastasize and to kill the host.
  • 7. Cancer is a preventable disease • Only 5-10 % of all cancer cases can be attributed to genetic defects, whereas the remaining 90- 95% have their roots in the environment and lifestyle. • The lifestyle factors include smoking, diet, alcohol, obesity, infectious agents, environmental pollutants and radiation • Of all cancer-related deaths; 25-30% are due to tobacco, 30-35% diet, 15-20% infections, 10-20% obesity, 4-6% alcohol, 10-15% others, which includes environmental and radiation.
  • 8. Good news we are in control World Cancer Research Fund: high fruit and vegetable intake may reduce cancer incidence by 40- 64 % US National Research Council: high fruit and vegetable intake may reduce US cancer rates and mortality by 1/3, roughly equivalent to the reduction in mortality from infectious diseases brought about by improved hygiene and better healthcare during the 19th century In the November 2010 issue of Nutrition and cancer, a study indicated that women who consumed a greater amount of vegetables and seafood were 86% less likely to be diagnosed with breast cancer
  • 9. Good news we are in control • Newest Research: through good nutrition we can also improve survival rates of people with some cancers by calming down the genes responsible for cancer growth! (Ornish et al. 2005, Ornish et al. 2008, Saxe et al. 2006)
  • 10. Support goals Primary goals • Support tumourcidal effects of treatment • Reduce side effects of treatments • Support overall wellness Secondary goals • Support immunity • Reduce tumour promoting factors • Inhibit metastasis and tumour progression • Promote appropriate apoptosis
  • 11. How diet can affect cancer
  • 12. Initiation-dietary carcinogens - aflatoxins (found in mouldy food) - heterocyclic amines (meat cooked at very high temperatures) - N-nitroso compounds (in some spoiled foods, protein foods, cured meat) - polycyclic aromatic hydrocarbons (PAH) (products of combustion found in cooked foods, smoked foods and dark beer) these chemicals can start a cancer process by creating cancer cells (World Cancer Research Fund 1997; NRC 1982)
  • 13. Diet-red meat • Heavy consumption of red meat is a risk factor for several cancers, especially those of the gastrointestinal tract, but also for colorectal, prostate, bladder, breast, gastric, pancreatic and oral cancers. • The hetrocyclic amines produced during the cooking of meat are carcinognic. Charcoal cooking and/or smoke curing of meat produces harmful carbon compounds such as pyrolysates and amino acids which have a strong cancerous effect. Anand P et al, Cancer is a preventable disease that requires major lifestyle changes. 2008
  • 14. Diet: Fats and sugars • Saturated fatty acids, trans fatty acids and refined sugars and flour present in most foods have also been associated with various cancers (1) • Epidemiologic studies suggested a positive association between dietary fat and colon cancer. (2) • Frequent consumption of sugar and high-sugar foods may increase the risk of pancreatic cancer by inducing frequent postprandial hyperglycemia, increasing insulin demand, and decreasing insulin sensitivity. (3) (1) Anand P et al, Cancer is a preventable disease that requires major lifestyle changes. 2008 (2) Reddy, B Dietary Fat & Colon cancer. Chemistry & material science vol 27 no 10 807-813 (3) American Journal of Clinical Nutrition Vol 84 No 5 1171-1176 Nov 06
  • 15. Dietary Tumour Promoters: - -excess fat - ↑ insulin, ↑ estrogens, ↑ oxidative stress, ↑ inflammation -excess protein -↑ insulin, ↑ IGF-1, -excess calories- ↑ insulin, ↑ IGF-1, ↑ oxidative stress, ↑ inflammation - excess Omega 6 EFA- ↑ oxidative stress, ↑ inflammation (Becci et al, 1979; Wood et al, 1983; Newberne and Rogers, 1986; Poirier et al, 1986; Kritchevsky and Klurfeld, 1987; Pariza, 1987; Sawada et al, 1990; Birt et al, 1992; Newmark and Lipkin, 1992; Wattenberg, 1992; Yuspa, 1994; Heber et al. 2006 ) © CNM; by Gosia Desmond MA, MBS, BSc Nut Med Jo Gamble BA (hons) Dip CNM
  • 16. Metabolic Tumour Promoters: - - insulin- promotes cancer cell proliferation and decreases apoptosis - estrogens- induces cancer cell proliferation - oxidative stress- can act as cancer initiator and promoter - inflammation- strong association between chronic inflammation and cancer (mechanisms: promoting proliferation of cancer cells, formation of cancer blood vessels?-not entirely understood) - IGF-1- potent growth factor for many cancer lines (Heber et al 2006) © CNM; by Gosia Desmond MA, MBS, BSc Nut Med Jo Gamble BA (hons) Dip CNM
  • 17. Alcohol Colon Cancer Risk-increases by 10% if you drink 1 glass of wine daily Colon Cancer Risk-increases by 25% if you drink 2 glasses of wine or 1 pint of beer daily Drinking as little as one pint of beer or one large glass of wine a day increases risk of breast cancer by more than 7%. Mouth, Oesophagus, Larynx, Throat Cancer-↑ 168% risk with 1 glass of wine/d (World Cancer Research Fund 2007; Riboli et al 2002; American Cancer Society 2007; Cancer Research UK 2009a)
  • 19. Increase in Risk Cancer Associated with Obesity (Source: National Cancer Policy Board 2003; Pan et al 2004) Convincing Evidence Colon, Prostate, Breast Endometrial, Kidney, Esophageal Ovary, Non-Hodgkin’s Lymphoma, Leukemia, Multiple myeloma , Pancreas, Oesophagus , Possible Gallbladder
  • 20. Dairy and Cancer-Possible Mechanisms   consumption of milk increases blood levels of IGF-1, which has been associated with increased prostate and breast cancer risk (Chan et al. 1998)
  • 21.
  • 22. Tumour Anti- Promoters: -folic acid (reducing likelihood of DNA damage) -antioxidants (preventing oxidative damage and lipid peroxidation, which compound DNA damage in tumor promotion) -phytochemicals (various mechanisms) - low-fat plant-based diet (various mechanisms, see above) (World Cancer Resarch Fund 1997, Wattenberg 1985) © CNM; by Gosia Desmond MA, MBS, BSc © Gosia Desmond MA, MBS, BSc Nut Med Nut Med Jo Gamble BA (hons) Dip CNM
  • 23. Promotion-Protection low fat; high fibre estrogens; adequate protein Insulin growth factors (IGF-1) adequate calories inflammation whole plant foods downregulation of oncogenes upregulation of tumour O6: O3 ratio 2:1 suppressor genes Physical activity © CNM; by Gosia Desmond MA, MBS, BSc (World Cancer Research Fund 2007; Heber 2006; Ornish et alCNM Nut Med Jo Gamble BA (hons) Dip 2008; Saxe 2006)
  • 24. promote synthesis of detoxification enzymes antioxidants Phytonutrients act as immune antiproliferative stimulants angiogenesis agents inhibitors (Omenn 1995; Talalay et al 1995; Wattenberg 1970; Engwerda et al 2001; Zawa and Duve 1997; Fotsis et al 1993)
  • 25. Phytonutrients • new evidence: official guidelines –’5 a day’ is not enough!!! • US National Cancer Institute: five is just the bare minimum. • men-at least 9 servings • women –at least 7 servings • children-at least 5 servings
  • 26. Phytonutrients –Flavonoids: -onions -kale -grape -citrus fruit -apple -pear -powerful inhibitors of many cancers including human breast cancer cells (So et al 1996; Guthrie and Carroll 1998)
  • 27. Phytonutrients –Flavonoids: broccoli, brussel sprouts, cabbage, cauliflower, Chinese cabbage, cress, daikon, kale kohlrabi turnip potent carcinogen detoxifiers –inducers of detoxification enzymes (Zhang and Callaway 2002)
  • 28. Other anti-cancer nutrients: Other anticancer substances: -sulphur compounds of garlic (tumour growth inhibition; cancer formation inhibition) -folic acid (fruits and vegetables; DNA protection) -beta sitosterol (fruits and vegetables; tumour growth inhibition) (Fleischauer and Arab 2001; Awad et al 1996; Duthie 1999)
  • 29. Low Fat Vegan Diet Full of Unprocessed Plants promotes synthesis of lowers estrogens detoxification enzymes full of antioxidants lowers AGE, Low fat plant oxidative damage minimizes based diet carcinogen exposure stimulates lowers IGF-1 immune lowers insulin response creates powerful low in Omega 6 anti-cancer environment
  • 30. Balancing Your Plate Divide your plate into 3 sections: 50% is vegetables, salad 25% is mixed whole grains or starch 25% is protein source – poultry, fish, beans, soy products Whole grains Veggies Protein
  • 31. Lifestyle Change is a Journey It takes 45 days to change a habit or incorporate a new one 5 10 15 20 25 30 35 40 45 Live your life as if your health depends on it… because it does!
  • 32. What are the main components of a wellness diet? • Water 2 liters of hydrating fluid daily • Well balanced macro nutrients throughout the day • High levels of micro nutrients • Avoidance of anti-nutrients
  • 33. Macro nutrients • Complex carbohydrates • Protein • Essential fats
  • 34. Complex carbohydrates • Whole meal bread • Whole meal pasta • Brown rice • Oats • Beans and lentils • Root vegetables
  • 35. Protein • Eggs • Fish • Poultry • Meat • Beans and lentils • Nuts and seeds • Tofu • Quinoa
  • 36. Essential fats • Oily fish • Nuts and seeds • Avocados • Cold pressed oils • Olives
  • 37. Anti-oxidants • Have been studied individually and collectively for their potential to enhance physical performance. • Prevent exercise induced muscle tissue damage • Fight against chronic diseases such as cancer, cardio-vascular disease, strokes
  • 38. Hydrating fluid 2 litres of hydrating fluid each day: * Water * Herbal tea Avoid dehydrating fluids * tea/coffee * Alcohol * fizzy drinks
  • 39. Avoid anti-nutrients • Aspartame • Trans fats • Refined carbohydrate • Processed foods • Sugar
  • 40. "The wise man should consider that health is the greatest of human blessings. Let food be your medicine." - Hippocrates
  • 41. Jo Gamble BA (hons) Dip CNM mBANT