Abundant Life Dietetics Services Private Practice & Consultancy Services Nutrition & Dietetics Presents NUTRITION AND CANCER Village Medical Centre Plot 4921 Mosebele Road, Village, Gaborone Kgomotso P. Vasco, Dietitian RD Kings College London University NUTRITION AND CANCER OUTLINE Evidence for an anti-cancer diet Purpose of Nutrition care Drug and nutrient interaction EVIDENCE FOR AN ANTI-CANCER DIET “An estimation of 30-40 percent of cancers can be prevented by lifestyle and dietary measures alone.”(Donaldson,2004) DIETARY FACTORS THAT PROMOTE CANCER RISK Obesity - second leading cause of cancer (fat) Nutrient sparse foods - concerntrated sugar - refined flour products Foods with a high glycaemic load are associated to cancer (Risk with gastric, upper aero digestive tract, endometrial, ovarian and colon or colorectal cancers) Impaired Glucose Metablolism – strong link between diabetes, (High HbA1C, elevated fasting insulin) and colorectal cancer Food contributing to hyperinsulinemia should be avoided DIETARY FACTORS THAT PROMOTE CANCER RISK Low fibre diets Dairy products, eggs, all meats and refined grains There is an inverse correlation of high fibre foods with rectal cancer Fibre is also rich in micro nutrients which have anti cancer properties Red meat Meat and meat products and heterocyclic amines formed in cooking promote colorectal and breast cancers. DIETARY FACTORS THAT PROMOTE CANCER RISK Imbalance of omega 3 and omega 6 fats Omega 3 fats (alpha-linolenic acid, EPA,DHA) - protective of cancer Omega 6 fats (linoleic acid, arachidonic acid) – cancer promoting fats Breast tumour suppressor genes BRCA1 and BRCA2 Flax seed – lignan fraction Good source of dietary fibre and omega 3 fats Lignan in flax seed is digested to enterodiol and enterolactone which have esterogenic activity. Lignan fraction secoisolariciresinol diglycoside (SDG) and the flax seed can reduce metastsis and reduce tumor growth. Fruits and vegetables (Block et al,1992) found that 128 out of 158 studies found fruits and vegetables to be protetive against cancer. They are protective to the stomach, oesophagus, lung, oral cavity and pharynx, endometrium, pancreas and colon. Vegetables especially raw are more protective. - Alllium vegetables ( onions, garlic, leeks, and scallions) - Cruciferous vegetables (cabage,cauliflower, brussel sprouts, brocolli) / sulforophane much richer in brocolli sprouts - Green vegetables - chlorophyll - Carrots - carotenoids There are many nutrients and phytochemicals that are found in fruits and vegetables such that the protective effect can not be due to one nutrient or phytochemical. Selenium A mineral with anti cancer properties Selenium Functions - Present in active site of many enzymes, including thioredoxin reductase which catalysis oxidation-reduction reaction.These reactions may encouage cancer cells to under apoptosis. - Component of anti oxidant enzyme glutathione peroxidase - Causes formation of natural killer cells - P450 enzymes in the liver may be induced by selenium, leading to detoxification of some carcinogenic molecules. - Inhibits prostaglandins that cause inflamation - Improves the immune systems‘ ability to respond to infection - Can decrease rate of tumour growth Dietary sources - whole grains, legumes, brazil nuts, sunflower, yeast o Chloropphyll Green colour in plants, the light collecting molecule. - Chlorophyl and its derivatives are very effective at binding polycyclic aromatic hydrocarcarbons (carcinogens largely from incomplete combustion of fuels), heterocyclic amines (generated whe grilling food), aflotaxins (toxin from molds in foods which causes liver cancer), and other hydrophobic molecules. - The chlorophyl-carcinogen complex is difficult for the body to absorb, therefore most of it is swept out with the stool. Vitamin B-12 Evidence of anti cancer effect havs been seen in experimental studies. Not yet proven. Cohort studies need to be carried out. Folic Acid - Dark green leafy vegetable vitamin. - Follic acid works with B6 and B12. If Folic acid is insufficient, uracil is substituted for thymidine in DNA, which leads to strand breakage. This then promotes DNA methylation. - Folate reverses DNA methylation. - Alcohol is an antagonist to folate - Folate may be important for the rapidly dividing tissue like the colonic mucosa. Alpha and Beta Carotene and other Carotenoids Alpha caroteinoids (carrots, pumpkin, winter squash) are more protective from cancer than Beta cartenoids. Lycopene – more abundant in tomato. More bioavailable in cooked tomato than the raw. Protect against prostrate cancer. Vitamin C More effective given intraveneously. Oral dose of Vit C do not give adequate serum concerntration as when injected. 1.25g orally - 135umol 1.25 intraveneously - 885umol Other Antioxidants Grape seed extract – proanthocyanidin (anti carcinogenic) Green tea- flavanol, epigallocatechin-3-gallate (EGCG) Probiotics Still being studied. To increase pro biotics you have to eat a lot of prebiotics (Fibre). Oral Enzymes Most cancer patients will have impaired digestion or intestinal tract disoder. Therefore lessen the digestive side effects Proteases - if they reach the circualory system they have anti tumour effect. Enzyme suplementation reduces side effects of cancer therapy Need more evidence – more studies to be carried out to confirm findings. Conclusion The American Institute for Cancer Research have the following cancer prevention guifdelines - Eat a plant based diet. Eat atleast 5 servings of fruit and vegetables daily. Include beans in the diet and eat grain products (such as cereals, breads, and pasta) - Choose foods low in fat - Choose foods low in salt - Get to and stay at a healthy weight - Be at least moderately active for 30 minutes on most days of the week - Limit alcohol drinks - Prepare and store food safely - Do not use tobacco in any form FOOD PYRAMID Purpose of Nutrition care To restore or conserve nutitional status, body composition, and functional status prior, during and after cancer treatment. To minimise food related discomforts associated with cancer and its treatment To improve strength and well being and quality of life. Effects of treatment of cancer on nutritional status Sugery - (dumping syndrome, fat malabsorption, steatorrhea,and deficiencies in iron, calcium, fat solublevitamins and vitamin B12) Chemotherapy - (anorexia, nausea, vomiting, diarrhea, stomatitis, constipation, taste changes) Radiation therapy - (nausea, vomiting, diarrhea, stomatitis,dry mouth, swallowing problems, oesophageal reflux, fistular, oesophageal fibrosis or stricture, dysphagia, tiredness) Nutrition Therapy Diet modification - High Calorie High Protein - texture modification - restricted fibre - High fibre Nutrition Supplement drinks Enteral Nutrition Parenteral Nutriton Advaned Cancer Palliative care - Less solid food and clear liquids better tolerated. - Terminally ill will feel less hungry and eat less. - View food as a source of enjoyment - Dietary restriction not ussually neccessary unless if the diet may cause complications such as bowel blockage. DRUG NUTRIENT INTERACTION - grapefruit may increase a drug‘s effects Methotrexate - Alcohol may cause liver damage Plicamycin - Supplements of calcium and vit D may decrease the drug‘s effect Procarbazine - Alcohol may cause a reaction that includes flushing of the skin, breathing difficulty, nausea, and low blood pressure. Caffeine may raise blood presure. Temozolomide - Food may slow or decrease the drugs effect. Bexarotene Good nutrition, Adequate Exercise and rest will add more good years to your life. Try it! THANK YOU!