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Nutrition for Colorectal Cancer Survivorship Terri Taylor, RD, CSO Virginia G. Piper Cancer Center What is Cancer Survivorship? Cancer survivorship, quite simply, begins when you are told you have cancer and continues for the rest of your life. Family members, friends, and caregivers are also impacted by the survivorship experience and are included in the definition. Stages of Cancer Survivorship • Acute • Extended • Permanent • Chronic Common Goals in Survivorship Stages • Stop cancer cell growth • Manage treatment side effects • Optimize Quality of Life • Control other diseases • Improve overall health Colon Cancer Microenvironment How do cancer cells grow? • Free radicals • Genetic changes • Hormones • Signaling pathways • Growth factors • Angiogenesis • Inflammation • Immune system disruptions Growth Factors with Colon Cancer Growth Factors • mTOR • VEGF • IGF-1 • EGFR • COX-2 Actions • Angiogenesis • Inflammation • Insulin resistance Targeted Therapy for Metastatic Colon Cancer CLASS DRUG TARGET Monoclonal Antibody: Avastin® Erbitux® Vectibix® VEGF EGFR EGFR Small Molecule: Rapamycin mTOR Effects of Lifestyle on Colon Cancer Cells PROCESS INCREASE Inflammation Body fat Red meat Processed fat Alcohol Free radicals, Red meat DNA damage Alcohol DECREASE Plant foods Probiotics Omega-3 fat Exercise Plant foods Effect of Lifestyle on Colon Cancer Cells PROCESS Growth Factors Angiogenesis • IGF-1 • VEGF • mTOR • EGFR • COX-2 INCREASE Body fat Red meat Refined carbohydrate DECREASE Plant foods Probiotics Complex carbohydrate Exercise Lifestyle Guidelines for Colon Cancer Survivorship • Achieve and maintain healthy body weight • Eat more plant foods • Limit intake of red meat and avoid processed meats • Minimize alcohol consumption • Be physically active • Do not smoke Riding the “Roller Coaster”: Living with Cancer • Nutritional needs and concerns fluctuate during survivorship: • Survivorship guidelines as framework • Modifications for treatment symptoms Why eat plant foods? Phytochemicals Fiber Vitamins Folate Minerals Calcium, Selenium “More for Less” High nutrient, low calorie Phytochemicals • • • • • • • • • Found naturally in plant foods Give COLOR to plant foods Regulate hormone production Boost production of cancer-detoxifying enzymes to remove carcinogens and tumors Prevent DNA damage; repair DNA Act as antioxidants to damage free radicals Reduce inflammation Stop blood flow to cancer cells Support immune system Specific Phytochemicals: POLYPHENOLS Apples Beets Berries Cherries Cloves Curcumin Dark chocolate Garlic Green tea Legumes Onions Peppermint Plums Pomegranate Red grapes Sage Targeted Polyphenols: Anthocyanins • mTOR inhibitor • Anti-inflammatory • Antioxidant • Bright red, blue colors • Berries, Cherries, Currants, Acai, Eggplant, Red cabbage, Grape seed extract Targeted Phytochemicals: Flavonoids Cox-2 Inhibitors Targeted Phytochemicals: Glucosinolates • Found in cabbage family vegetables • Broken down into active forms = indoles, sulphoraphanes • Turn off enzymes that promote cell growth and turn on enzymes to stop growth • Steam, do not microwave or boil Anti-angiogenesis, Anti-VEGF Foods Green tea Strawberries Blackberries Raspberries Blueberries Oranges Grapefruit Lemons Apples Pineapple Cherries Red grapes Lavender Red wine Pumpkin Bok choy Sea cucumber Kale Tuna Soy beans Parsley Ginseng Garlic Maitake mushroom Tomato Licorice Olive oil Turmeric Grapeseed oil Nutmeg Dark chocolate Artichokes Pomegranate Source: Angiogenesis Foundation (www.angio.org) Alcohol Linked to Colon Cancer Risk • Enhances carcinogen action to penetrate gut lining • Increases risk of genetic mutations • Forms cancer promoting compound called acetaldehyde • Promotes inflammation • Reduces protective effect of folate • Contributes calories Alcohol Guidelines If choose to drink, limit to: 1 drink serving per day for women 2 drink servings per day for men One serving: 5 ounces 12 ounces 1.5 ounces Eat More Plant Foods for Fiber What is fiber? • Indigestible part of plant foods • Sources: •Fruits •Vegetables •Whole grains •Legumes •Nuts, Seeds Actions of Fiber • Binds toxins and hormones • Speeds food through bowel • Promotes bowel regularity • Converts to butyrate by gut bacteria to stop colon cancer cell growth • Reduces inflammation, COX-2, bile acids • Repairs damaged genes • Controls weight Fiber and Probiotics Probiotics = “Good Bacteria” • May stop colon cancer cells • Found in yogurt, Kefir, Yakult®, fortified drinks • Provide calcium from dairy • Help manage weight Prebiotics = “Food” for Probiotics • High fiber foods • Oats, sauerkraut, beans, garlic, artichoke, inulin Managing Bowel Issues from Therapy Constipation • Insoluble fiber • Wheat bran • Other whole grains • Berries, fresh fruits with peels • Raw vegetables • Extra fluid • Warm teas • Prune juice Diarrhea • Soluble fiber • Oat products • Applesauce • Banana • Peaches • Probiotics • Yogurt, Kefir • Low lactose • Extra fluid, electrolytes Limit Red and Processed Meats • Nitrosamines • Heme iron • HCA (Heterocyclic amines) and PAH (Polycyclic aromatic hydrocarbons) from grilling, pan frying, Processed Meat: smoking and curing “Meat preserved by • Inflammation, free smoking, curing or radicals, damage salting, or addition of chemical preservatives” gut lining Reduce Cancer Risk of Red and Grilled Meats • Eat red meat with broccoli and carrots? • Marinade or dry rub when grilling animal proteins • Not well-done or blackened • Low temperature, slower Best Protein Sources Divide protein servings throughout daily feedings • Skinned poultry • Wild fish • Lean grass-fed red meat • Limit to 18 oz /week • Avoid cured, smoked, processed • Organic fat free dairy, eggs • Legumes, hummus, quinoa • Nut butters • Protein powder (whey, egg) • Soy Obesity and Colon Cancer Survivorship • May result in poorer treatment outcome • Drug resistance to chemotherapy • ↑ risk recurrence • ↑ risk of other chronic diseases • Activates growth hormones • Triggers insulin resistance • Promotes inflammation Benefits of Physical Activity • • • • • • ↑ Energy level, ↓ fatigue during treatment ↓ Depression Preserves muscle mass Improves Quality of Life Helps maintain weight ↓ Risk of recurrence and other chronic diseases Nutrition for Fatigue • • • • Iron foods if anemic Adequate calories “Mini meals” during day Complex, not simple sugar, carbohydrates • Protein + carbohydrate • Adequate fluids • Quick meal preparation Nutritional Strategies for Peripheral Neuropathy • • • • • • L-Glutamine powder Alpha Lipoic Acid B complex vitamin Intravenous Calcium/Magnesium Other supplements as a cause Non-nutritional strategies • Acupuncture • Laser treatment • Prescription medicines Synergy Strength in Numbers: Plant foods work together Eating patterns approach, not single foods What you CAN DO! What you CAN DO! Eat MORE Whole Plant Foods! • One-half plate vegetables and fruits each meal or 2 – 2 ½ cups of variety fruits and vegetables daily • Season with culinary herbs and spices • Whole grains more often than refined grains What you CAN DO! • Eat meatless meal at least 2 times per week • Have poultry and wild fish more often than red meat and processed meats Eat LESS Red Meat • Reduce portions of and AVOID red meat (≤ 18 oz Processed Meats cooked/week) What you CAN DO! • Choose foods with high quality nutrients not “empty calories” • Be mindful Achieve and • Portion foods Maintain a according to HEALTHY WEIGHT calorie needs What you CAN DO! Be Physically ACTIVE! • Get up from desk or chair every hour • Use stairs instead of elevator • Buddy up and walk with a friend or your dog • Participate in supervised exercise program • Do home DVD • Move! What you CAN DO! • “Spritzer” (dilute wine with sparkling water) • Sparkling water with a twist • 100% Fruit juice with club soda • Tomato juice with lemon • “Virgin” version of alcoholic Limit ALCOHOL beverages • Herbal tea • Plain coffee beverage Keep the Momentum! Journal of Cancer Survivorship February 13, 2013 • “Only minority of cancer survivors met American Cancer Society guidelines for physical activity and 5-A-Day intake” • “Majority of cancer survivors do not have better health behaviors than individuals without history of cancer, especially on long-term basis” We CAN help! Support Programs at the Virginia G. Piper Cancer Center • Individual nutritional counseling • 480-882-4703 to schedule appointment • Cooking classes • “Eat Real” Plant-based cooking classes • 480-882-4636 • www.shc.org/events • Exercise and Mind, Body, Spirit • Resource center collection • Community events and screenings
