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11/18/2015 Eating to Prevent Cancer Richard Collins, MD “The Cooking Cardiologist” Susan Buckley, RDN, CDE Let’s start with numbers… American Cancer Society predicts lifetime risk for developing cancer: ~1/2 men and little more than 1/3 women Although fewer Americans are dying from cancer (survival rate now 66% vs 50% in the 1970s) 1 11/18/2015 Estimated New Common Types of Cancer Cases 2015 Estimated Deaths 2015 1. Breast Cancer (Female) 231,840 40,290 Lung and Bronchus Cancer 221,200 158,040 220,800 27,540 4. Colon and Rectum Cancer 132,700 49,700 5. Bladder Cancer 74,000 16,000 6. Melanoma of the Skin 73,870 9,940 2. 3. Prostate Cancer 7. Non‐Hodgkin Lymphoma 71,850 19,790 8. Thyroid Cancer 62,450 1,950 61,560 14,080 54,870 10,170 ‐ ‐ ‐ All Cancer Sites 1,658,370 589,430 9. Kidney and Renal Pelvis Cancer 10. Endometrial Cancer Percent of New Cases by Age Group: All Cancer Sites All cancer sites is most frequently diagnosed among people aged 65-74. Median Age At Diagnosis 65 2 11/18/2015 Eating To Prevent Cancer Cancer involves the abnormal division and reproduction of cells that can spread throughout the body Usually thought of as a single disease, actually consists of >100 distinct types 3 11/18/2015 Eating To Prevent Cancer Cancer is the name given to a collection of related diseases. In all types of cancer, some of the body’s cells begin to divide without stopping and spread into surrounding tissues. Cancer can start almost anywhere in the human body, which is made up of trillions of cells. Normally, human cells grow and divide to form new cells as the body needs them. When cells grow old or become damaged, they die, and new cells take their place. When cancer develops, however, this orderly process breaks down. Eating To Prevent Cancer As cells become more and more abnormal, old or damaged cells survive when they should die, and new cells form when they are not needed. These extra cells can divide without stopping and may form growths called tumors. Many cancers form solid tumors, which are masses of tissue. Cancers of the blood, such as leukemias, generally do not form solid tumors. 4 11/18/2015 Apoptosis Apoptosis: A form of cell death in which a programmed sequence of events leads to the elimination of cells without releasing harmful substances into the surrounding area. Apoptosis plays a crucial role in developing and maintaining the health of the body by eliminating old cells, unnecessary cells, and unhealthy cells. The human body replaces perhaps one million cells per second. Too little or too much apoptosis can play a role in many diseases. When apoptosis does not work correctly, cells that should be eliminated may persist and become immortal, for example, in cancer and leukemia. When apoptosis works overly well, it kills too many cells and inflicts grave tissue damage. This is the case in strokes and neurodegenerative disorders such as Alzheimer's, Huntington's, and Parkinson's diseases. Also known as programmed cell death and cell suicide Apoptosis 5 11/18/2015 Cancer cells differ from normal cells in many ways that allow them to grow out of control and become invasive. One important difference is that cancer cells are less specialized than normal cells. Whereas normal cells mature into very distinct cell types with specific functions, cancer cells do not. This is one reason that, unlike normal cells, cancer cells continue to divide without stopping. In addition, cancer cells are able to ignore signals that normally tell cells to stop dividing or that begin a process known as programmed cell death, or apoptosis, which the body uses to get rid of unneeded cells. Data suggests 1/3 of 589,000 cancer deaths may be attributed to nutrition and lifestyle Poor diet, physical inactivity, alcohol use, and overweight and obesity Almost an additional 171,000 deaths are caused by tobacco use 6 11/18/2015 30% of cancer deaths attibuted to poor nutrition! For most Americans who do not use tobacco, the most important cancer risk factors that can be changed are body weight, diet, and physical activity. One‐third of all cancer deaths in the United States each year are linked to diet and physical activity, including being overweight or obese, while another third is caused by tobacco products. GENOMICS Only 5‐10% cancers are result of inherited genetic alteration Even if you were born with healthy genes, some of them can become changed (mutated) over the course of your life. These acquired mutations cause most cases of cancer. Some acquired mutations can be caused by things that we are exposed to in our environment, including cigarette smoke, radiation, hormones, and diet. Other mutations have no clear cause, and seem to occur randomly as the cells divide 7 11/18/2015 NUTRITION AND CANCEROGENESIS Nutrition may modify the carcinogenic process at any stage, including: carcinogen metabolism cellular and host defense cell differentiation tumor growth NUTRITION AND CANCEROGENESIS Diets contain both inhibitors (antioxidants: vit. C, E, A and carotenoids, Se and Zn and phytochemicals) and enhancers of carcinogenesis (polycyclic aromatic hydrocarbons‐PAH, that form with a grilling meat at high heat; alcohol) 8 11/18/2015 What are cancers? Beliefs: causes of cancer Lord et al. (2012) Clinical Oncology. 24, 4‐12 9 11/18/2015 Perceptions about cancer http://www.livestrong.org/pdfs/3‐0/LSGlobalResearchReport Controllable Causes of Cancer Lifestyle Choices Weight Physical Activity Eating Habits Tobacco Use 10 11/18/2015 Relationship Between Lifestyle and Cancer It is possible to prevent: • 35% of cancers by: – Following a healthy diet – Maintaining a healthy weight – Having regular physical exercise • 30% of cancers by: – Not using tobacco American Cancer Society® Guidelines • Achieve and maintain a healthy weight throughout life • Keep physically active • Eat a healthy diet, with an emphasis on plant foods • If you drink alcohol, limit your intake 11 11/18/2015 Achieve and Maintain a Healthy Weight Overweight and inactivity account for one-third of the worldwide cases of these cancers: • Esophagus • • • • • • • Pancreas Colon and rectum Breast (after menopause) Endometrium (lining of the uterus) Kidney Thyroid Gallbladder Achieve and Maintain a Healthy Weight (cont’d) • Stay as lean as possible throughout life without becoming underweight • Avoid excessive weight gain at all ages • Know that losing even a small amount of weight has health benefits 12 11/18/2015 Weight Management Tops the List Evidence for increased risk Body fatness Convincing for esophageal, pancreas, colorectal, breast (post), endometrium, kidney; Probable for gallbladder Abdominal fatness Convincing for colorectal; Probable pancreas, breast, endometrium Adult weight gain Probable for breast Balance caloric intake with physical activity Work towards a healthy BMI (18.5‐24.9) and waist measurement (<31.5” for women/<37” for men) People who are obese have more fat tissue that can produce hormones, such as insulin or estrogen, which may cause cancer cells to grow. Maintain a Healthy Weight Know your body mass index (BMI): • • • • Below 18.5=underweight 18.5 to 24.9=normal weight 25.0 to 29.9=overweight 30.0 and above=obese 13 11/18/2015 Tips for Maintaining a Healthy Weight • Eat plenty of fruits and vegetables • Eat real food – limit processed foods • Limit simple sugars (cakes, cookies, pies, candies, and sweetened drinks) • Get plenty of fiber • Eat smaller portions of everything • Add physical activity to your life • Get plenty of sleep • Practice stress reduction 14 11/18/2015 Stay Physically Active • Adults: Get a least 150 minutes of moderate intensity or 75 minutes of vigorous intensity activity each week, spread throughout the week • Children and adolescents: Get 60 minutes/day of moderate to vigorous physical activity each day, with vigorous activity at least 3 days/week Physical Activity Physical activity may lower the risk of cancer by preventing obesity, reducing inflammation and hormone levels, and improving insulin resistance and immune system function. 15 11/18/2015 Get Moving‐Get Healthy! Evidence for decreased risk Convincing for colon cancer Probable for breast (post), endometrium Limited‐suggestive for lung, pancreas, breast (pre) Adults: • Engage in moderate – vigorous activity for 30‐60 minutes every day / Limit sedentary activities Children and Adolescents: • Engage in 1 hour (60 minutes) or more of physical activity every day / Limit sedentary activities Eat a Healthy Diet Emphasis on Plant Foods • Examples include: – Fruits – Vegetables – Legumes • Packed with vitamins, minerals, antioxidants, and other substances that work together to lower risks of several cancers 16 11/18/2015 Cancers Associated With Low Intake of Plant Foods • • • • • Lung cancer Mouth cancer Esophageal cancer Stomach cancer Colon cancer Evidence probable for a decreased risk of mouth, pharynx, larynx, esophageal, stomach and colorectal cancers Non‐starchy vegetables includes Cruciferous vegetables (broccoli, cabbage) Root vegetables (carrots, beets, turnips) Allium vegetables (garlic, leeks, shallots) Green leafy vegetables (collard and turnip greens) 17 11/18/2015 Cancer Prevention Benefits of Fruit Evidence for decreased risk Probable for mouth, pharynx, larynx, esophagus, lung, stomach Limited‐suggestive for nasopharynx, pancreas, liver, colorectum Includes Citrus fruits General fruits including berries, apples, watermelon, guava and apricots Fruits and Vegetables • Choose colorful fruits and vegetables for the most nutrient content • 2 cups of fruit (3/4 cup juice, ¼ cup dried) • 2 ½ - 3 cups of vegetables: one serving = ½ cup cooked, 1 cup raw, ¾ cup juice • Select a variety of fruits and vegetables • Enjoy fruits and vegetables prepared and served without added fat or sugar 18 11/18/2015 Evidence for decreased risk Probable for colorectal due to fiber Choose whole grains Aim for 3 ounces each day Include whole grain rice, bread, pasta and cereals Limit refined grains Legumes Evidence for decreased risk Probable for colorectal due to dietary fiber Limited‐suggestive for stomach, prostate due to legumes Kidney, black & soy beans, chickpeas and lentils Excellent source of plant protein & fiber Aim for three cups/week 19 11/18/2015 Healthy Plate 2/3 of your plate should be plant based 50% vegetables, legumes; daily cruciferous Fiber sources slow stomach emptying Healthy fats and carbohydrates Less refined, processed foods More fish, olive oil and healthy fats, impacts receptors Less Meat Research shows that vegetarians are about fifty% less likely to develop cancer than those who eat meat. Meat lacks fiber and other nutrients that have been shown to have cancer‐protective properties. What it does have in abundance, however, is fat— often very high levels of saturated fat. High‐fat diets have been linked to higher rates of cancer. In the U.S., non‐organic meat and poultry may also contain antibiotics and hormones and the animals may have been raised on feed containing GMOs. Finally, depending on how it is prepared, meat can develop carcinogenic compounds. 20 11/18/2015 AICR Recommends Limit consumption of red meats and avoid processed meats. Less Meat Evidence for increased risk with regard to red meat and processed meat Convincing for colorectum Recommendations: Limit red meat to less than 18 oz. each week Includes beef, pork and lamb Have little, if any, processed meat Includes bacon, salami, hot dogs, sausages 21 11/18/2015 Less Meat These are some of the ways red meat may increase cancer risk: Red meat contains the heme form of iron. This compound can damage the lining of the colon. Red meat stimulates the production in the gut of N‐nitroso compounds, which are cancer‐ causing agents. Cooking meat at high temperatures (grilling, for example) produces two cancer‐promoters: heterocyclic amines (HCAs) and polycyclic aromatic hydrocarbons (PAHs). Making Protein Choices Choose fish, poultry, or beans as an alternative to beef, pork, and lamb When eating meat, select lean cuts and smaller portions: deck of cards Bake, broil, or poach meat, rather than frying or charbroiling Save processed meats for special occasions only 22 11/18/2015 Grilling Evidence for increased risk is limited‐suggestive for stomach cancer For safer grilling: Marinate and/or pre‐cook meats before grilling Use lean meats Remove charred meat portions Grill vegetables and fruits AICR Recommendation Limit consumption of salty foods and foods processed with salt. Probable evidence for increased risk of stomach cancer Intake of sodium should be less than 2400mg per day Avoid processed foods Check food labels Gradually reduce the amount of salt added Use spices, herbs or lemon instead of salt – even sea salt 23 11/18/2015 Limit Sodium The expert panel at AICR found that salt and salt‐preserved foods probably increase the chance of developing stomach cancer. Studies have shown that high salt intake can damage the lining of the stomach. This is one way in which it might increase the risk of stomach cancer. Most of the salt in our diets comes from processed foods. Watch out for breakfast cereals, bread, frozen meals, pizza and chips. Also, check the amount of sodium in canned products, such as soups and sauces, and avoid processed meats. Even sweet foods like cookies can contain high levels of salt. SHORT LIST OF DANGEROUS ADDITIVES Artificial Sweeteners (Aspartame, Acesulfame‐K ; Stevia is the choice) Monosodium Glutamate Artificial Food Colorings Sodium Nitrate/Sodium Nitrite (ongoing research) Sulfur Dioxide and bisulphite High Fructose Corn Syrup Trans Fats Butylated hydroxyanisole (BHA) and butylated hydrozyttoluene (BHT) Potassium Bromate … 24 11/18/2015 Increase Fiber Help move potential carcinogens through the intestines faster, lessening the amount of time the intestinal wall is exposed to them Fiber is also thought to help absorb bile acids, thus preventing decaying food from encouraging harmful changes in cells 25 11/18/2015 How fiber affects your health Consuming the National Cancer Institute's recommended 35 grams of fiber per day will help you to: Decrease any inflammatory bowel disease flare‐ups. Normalize your serum cholesterol levels. Stabilize your blood sugar levels. Promote weight loss by creating a feeling of fullness. Speed up elimination and regulate your bowel habits. Decrease your risk of breast, colon, esophagus, mouth, ovarian, pharnyx, rectum, stomach and prostate cancers. Reduce and/or absorb cancer causing toxins. Prevent the binding of estrogen to estrogen‐dependent tumors. High-fiber, cancer-fighting foods Whole grains: whole-wheat pasta, raisin bran, barley, oatmeal, oat bran muffins, popcorn, brown rice, whole-grain or whole-wheat bread Fruit: raspberries, apples, pears, strawberries, bananas, blackberries, blueberries, mango, apricots, citrus fruits, dried fruit, prunes, raisins Legumes: lentils, black beans, split peas, lima beans, baked beans, kidney beans, pinto, chick peas, navy beans, black-eyed peas Vegetables: broccoli, spinach, dark green leafy vegetables, peas, artichokes, corn, carrots, tomatoes, Brussels sprouts 26 11/18/2015 AICR Recommendation Avoid sugary drinks. Limit consumption of energy‐ dense foods. Evidence probable for increased risk of weight gain, overweight and obesity Raises insulin Drink mostly water and up to one glass of fruit juice per day Choose nutrient‐rich foods more often Limit Sugar Does sugar “feed” cancer cells? It’s true that sugar feeds every cell in our body — even cancer cells. So, how much sugar is safe to eat? Women should have no more than six teaspoons per day (25 grams), and men should have no more than nine teaspoons per day (37 grams), says the American Heart Association. This equals to about 100 calories for women and 150 for men. If you’re like most Americans, you actually eat more than double that much sugar in a day — about 22 teaspoons. That’s 260 cups or 130 lbs. of sugar each year! Even worse, all that extra sugar breaks down to about 500 calories per day. That’s hundreds of calories with absolutely no nutritional or cancer‐fighting benefit. 27 11/18/2015 Insulin is the real issue Yes, cancer cells like sugar as “fuel” ◦ Basis of PET scans to detect tumor activity ◦ But tumors can make their own glucose (fat, protein) Large volumes, high GI, fructose? Higher blood sugars Real Concern More Insulin (if IR) Primitive Growth Signal Stimulates growth directly and through IGF1 Increases inflammatory hormones Suppresses immune function Limits normal cell death/apoptosis Diabetes Increased Mortality in Cancer Meta‐analysis: Increased mortality compared to those with normal blood sugar levels Endometrial, Breast, Colorectal, Prostate, Gastric, Liver, Lung, Pancreatic *Cause? DM, hyperglycemia, IR, Inflammation, Diabetes Drugs, Obesity… 28 11/18/2015 WHI: Highest versus lowest fasting insulin 535 women with Breast Cancer Fasting insulin levels Higher stage/grade Highest fasting insulin ◦ Double recurrence ◦ Triple mortality ◦ Metabolic syndrome in Breast Ca recurrence three fold Alcoholic Beverages • Limit consumption if you drink alcoholic beverages • Drink no more than one drink/day for women and two drinks/day for men • A drink is 12 fluid ounces (fl oz) of regular beer, 5 fl oz of wine, or 1.5 fl oz of spirits 29 11/18/2015 Limit Alcohol Evidence for increased risk Convincing for mouth, pharynx, larynx, esophagus, colorectal (men), breast (pre & post) Probable for colorectal (women) and liver Limit alcohol consumption One drink = 12 ounces beer, 5 ounces of wine, or 1.5 ounces of 80 proof spirits Alternate between alcoholic and non‐alcoholic drinks and dilute alcoholic drinks Aim to keep a few nights a week alcohol‐free Water is the recommended beverage of choice Cancers Associated With Alcohol Intake • • • • • • • Oral (mouth) Pharyngeal (throat) Esophageal Laryngeal (voice box) Breast Liver Use NO tobacco at the same time as alcohol increases risk even more 30 11/18/2015 AICR ‐ Breastfeed It’s best for mothers to breastfeed exclusively for up to six months. Protective to moms against breast cancer Evidence for lactation is convincing for decreased risk of breast cancer (pre & post) Decreases the risk of over‐ weight and obesity in children Evidence for weight gain, overweight and obesity is probable Food Components That May Prevent Cancer • Antioxidants: ̶ Vitamins A, C, and E, carotenoids, and selenium ̶ No evidence supports taking antioxidant supplements to prevent cancer 31 11/18/2015 Food Components That May Prevent Cancer (cont’d) • Phytochemicals: ̶ Compounds made by plants that may prevent cancer, such as lycopene in tomatoes ̶ No evidence that phytochemical supplements prevent cancer Lycopene and Prostate Cancer Men in the United States get prostate cancer more than any other type of cancer except skin cancer. It is found mainly in older men. In the United States, about one out of five men will be diagnosed with prostate cancer. Most men diagnosed with prostate cancer do not die of it. 32 11/18/2015 Lycopene and Prostate Cancer Lycopene gives tomatoes and other fruits and vegetables a red color, while serving primarily to protect cells from photosensitization and to aid in photosynthesis. Lycopene is found in high concentrations in tomatoes and tomato products, such as ketchup, tomato paste, and tomato sauce – use low sugar Over 80% of the lycopene in American diets comes from tomato products Lycopene and Prostate Cancer A review of several studies revealed that those who consumed the most tomato‐based foods reduced their total risk of prostate cancer by 35% and their risk of advanced prostate cancer by 50% Lycopene, which is abundant especially in cooked tomatoes is believed to be primarily responsible for this benefit The lycopene in cooked tomatoes is more bioavailable than in raw tomatoes Tomatoes are extremely nutrient‐dense, containing lycopene as well as a variety of other protective phytochemicals, such as flavonoids and antioxidant vitamins. Consumption of carotenoid‐rich yellow and orange vegetables including carrots, pumpkin, sweet potatoes, winter squash and corn was also found to be inversely related to prostate cancer 33 11/18/2015 • Vitamin D: Food Components That May Prevent Cancer (cont’d) ̶ Growing evidence shows that vitamin D may help to prevent colorectal cancer ̶ In some cases, supplements are recommended for good health, but not necessarily for cancer prevention ̶ Accumulating research shows that insufficient vitamin D levels are associated with an increased risk of several cancers, including prostate cancer Vitamin D ̶ ̶ ̶ ̶ While sun exposure is one of the best sources of vitamin D, it is unlikely to get adequate vitamin D from sun exposure throughout life without increasing the risk of skin cancer. Spend some time in the sun (20 minutes) then put on sunscreen A safe way to obtain vitamin D is through supplements. Aim for a vitamin D blood level (25(OH)D) between 30 and 70 ng/ml. 34 11/18/2015 Cruciferous Vegetables The cruciferous vegetables include broccoli, cauliflower, cabbage, Brussels sprouts, bok choy and kale. According to AICR's second expert report, Food, Nutrition, Physical Activity, and the Prevention of Cancer: A Global Perspective, non‐starchy vegetables, like those listed above, probably protect against some types of cancers. This protective effect is strongest for cancers of the mouth, pharynx, larynx, esophagus, and stomach. Cruciferous Vegetables Several laboratory studies have suggested that cruciferous vegetables help regulate a complex system of bodily enzymes that defend against cancer. Components of these vegetables have shown the ability to stop the growth of cancer cells in various cell, tissue and animal models, including tumors of the breast, endometrium, lung, colon, liver, colon and cervix. 35 11/18/2015 Tea Among their many biological activities, the predominant polyphenols in green tea―EGCG, EGC, ECG, and EC―and the theaflavins in black teas have antioxidant activity These chemicals, especially EGCG and ECG, have substantial free radical scavenging activity and may protect cells from DNA damage caused by reactive oxygen species Tea polyphenols have also been shown to inhibit tumor cell proliferation and induce apoptosis (cell death) in laboratory and animal studies Tea In addition, tea polyphenols may protect against damage caused by ultraviolet (UV) B radiation and they may modulate immune system function Green teas have been shown to activate detoxification enzymes, such as glutathione S‐transferase and quinone reductase, that may help protect against tumor development Although many of the potential beneficial effects of tea have been attributed to the strong antioxidant activity of tea polyphenols, the precise mechanism by which tea might help prevent cancer has not been established 36 11/18/2015 Flaxseed • Milled flaxseed has a component called lignans • Lignans may decrease cancer growth • In postmenopausal women, lignans can cause the body to produce less active forms of estrogen. • This is believed to potentially reduce breast cancer risk. • There is evidence that adding ground flaxseeds into the diet decreases cell growth in breast tissue as well. Again, this would be the type of change that would be expected to decrease breast cancer risk. Do These Foods Prevent Cancer? (cont’d) • Garlic: ̶ The health benefits of garlic are widely publicized ̶ Also can help with heart health 37 11/18/2015 Garlic Several population studies show an association between increased intake of garlic and reduced risk of certain cancers, including cancers of the stomach, colon, esophagus, pancreas, and breast. An analysis of data from seven population studies showed that the higher the amount of raw and cooked garlic consumed, the lower the risk of stomach and colorectal cancer Garlic The Iowa Women’s Study is a large study investigating whether diet, distribution of body fat, and other risk factors are related to cancer incidence in older women. Findings from the study showed a strong association between garlic consumption and colon cancer risk. Women who consumed the highest amounts of garlic had a 50% lower risk of cancer of the colon compared with women who had the lowest level of garlic consumption 38 11/18/2015 Garlic •Garlic seems to have an impact on cell cycling (process by which a normal, healthy cell might become cancerous) •Credit for regulating this goes to the component of garlic called allyl sulfide Allyl sulfides are found throughout the onion family •Prevents breast cancer Garlic Several population studies show an association between increased intake of garlic and reduced risk of certain cancers, including cancers of the stomach, colon, esophagus, pancreas, and breast. A study in European Journal of Epidemiology found that increased garlic consumption was associated with a statistically significant reduction in breast cancer risk. After considering total calorie intake and other established risk factors, breast cancer risk was reduced in those consuming greater amounts of fiber, garlic, and onions Protective effects from garlic may arise from its antibacterial properties or from its ability to block the formation of cancer‐ causing substances, halt the activation of cancer‐causing substances, enhance DNA repair, reduce cell proliferation, or induce cell death 39 11/18/2015 Soy Foods • Soy foods: ̶ The phytochemicals that they contain may fight cancer (based on animal studies) ̶ Soy-based foods, such as tofu, may lower the risk of cancers of the breast, prostate, or endometrium Can soy‐based foods reduce cancer risk? As with other beans or legumes, soy and foods derived from soy are an excellent source of protein and a good alternative to meat. Soy contains several phytochemicals, including isoflavones, which have weak estrogen like activity and may help protect against hormone‐dependent cancers. There is growing evidence that eating traditional soy foods such as tofu may lower the risk of cancers of the breast, prostate, or endometrium (lining of the uterus), and there is some evidence it may lower the risk of certain other cancers. Whether this applies to foods that contain soy protein isolates or textured vegetable protein derived from soy is not known. There is little data to support the use of supplements of isolated soy phytochemicals – best not to use 40 11/18/2015 Soybeans But according to the American Cancer Society, when it comes to soy, isoflavones may act like estrogen, but they have anti‐ estrogen properties as well. Some studies even show that people who ate soy were less likely to get breast cancer. “The current research does not support avoiding whole soy foods‐‐even for cancer patients or survivors,” says Clare McKindley, clinical dietitian in MD Anderson’s Cancer Prevention Center. The same appears to be true of prostate cancer; moderate intake is recommended and may provide benefit – more studies are needed Soybeans Like many things, soy seems to be safe in moderation, and there is definitely research showing it's protective effects against a variety of cancers, including breast cancer. 1‐2 servings of whole, unprocessed soy per day Whole, unprocessed soy: tofu, edamame, soymilk, soynuts Soy supplements, a widely used alternative to hormone therapy for menopause‐related hot flashes, should be avoided. 41 11/18/2015 Berries • Blueberries, blackberries, raspberries, and strawberries add color, variety, and flavor • Also power‐packed with vitamins, minerals, and antioxidants • Recent research suggests that blueberries enhance the effect of the often‐prescribed drug tamoxifen in fighting breast cancer cells. Berries Compounds in raspberries slow the growth rate of pre‐malignant cancerous cells, and they stimulate those cells to die, a process called apoptosis. AICR says berries may be among the most beneficial fruits to eat for cancer prevention Research is providing new evidence that berries not only contain strong antioxidants that help to prevent cell damage that precedes cancer: they also appear to affect genes that are associated with inflammation and the growth of cancer. 42 11/18/2015 Turmeric Turmeric is a spice that has been used in cooking for centuries. Substances in turmeric (called curcuminoids) prevent inflammation by inhibiting the molecules that mediate inflammatory reactions Curcuminoids may protect the body by enhancing the activity of an important detoxifying enzyme and also acting as an antioxidant by neutralizing free radicals (which can cause DNA damage). In rats, turmeric prevented the development of kidney damage from toxins. Turmeric Curcumin is thought to have antioxidant properties, which means it may decrease swelling and inflammation. It's being explored as a cancer treatment in part because inflammation appears to play a role in cancer. Laboratory and animal research suggests that curcumin may prevent cancer, slow the spread of cancer, make chemotherapy more effective and protect healthy cells from damage by radiation therapy. Curcumin is being studied for use in many types of cancer. Research is now under way looking at whether turmeric can affect cancer growth. Other spices also being studied for possible anti‐cancer effects include capsaicin (red pepper), cumin, and curry. 43 11/18/2015 Aim to be a healthy weight throughout life Be physically active everyday in any way for 30 minutes or more Eat a variety of healthful foods, with a focus on plant foods Limit consumption of alcoholic beverages Avoid tobacco use and exposure “Eat Food Not too much Mostly plants” Michael Pollan 44