Download Diet and Nutrition - Living Beyond Breast Cancer

DIET AND NUTRITION
MAKING HEALTHY CHOICES AFTER BREAST CANCER
Karen Marr MS, RD, LDN, CSO
Lead Dietitian-Eastern Regional Medical
Center
Cancer Treatment Centers of America
Philadelphia, PA
OVERVIEW

Body Weight
Macronutrient Needs
 Physical Activity


Alcohol

Bone Health & Vitamin D

To Soy or Not to Soy
AICR REPORT

Weight gain, excess body weight, obesity

Physical activity

Alcohol
AICR RECOMMENDATIONS
Be as lean as possible within the normal range of
body weight
 Lower end of normal BMI
 Avoid weight gain & increases in waist
circumference in adulthood
 Limit consumption of energy dense foods & avoid
sugary drinks
 Eat mostly foods of plant origin
 Limit intake of red meat & avoid processed meats

HOW MUCH ACTIVITY?

45 to 60 minutes 5 or more days a week
ALCOHOL & FOLATE

Alcohol increases risk 11%

Risk doubles if inadequate folate intake
MACRONUTRIENT NEEDS

Calories
25-35 kcal/ kg bw if BMI between 18.5-24.9
 20-25 kcal/ kg bw if BMI btween 25-29.9
 15-20 kcal/ kg bw if BMI between 30-35
 15 kcal/kg bw if BMI >35


Protein



Carbohydrates


.8-1.0 gm/ kg bw
1.0-1.2 gm/ kg bw during treatment
50-65% of daily total calories
Fat

<30% of total calories should come from fat (<10%
from saturated fat)
NUTRITION DURING & AFTER
TREATMENT
Prevent weight gain & perhaps start weight loss
 Address bone health
 Other common questions

AVOID WEIGHT GAIN/ENCOURAGE
WEIGHT LOSS


Weight gain may increase risk of recurrence
In a study of 300 postmenopausal survivors on
adjuvant AI therapy for an average of 23 months
- Weight gain of ≥ 10# since dx. 2x more likely to
have hot flashes
- Weight gain & hot flash severity
TRIALS EVALUATING DIET CHANGES

WHEL study
- RCT in 3088 women to increase vegetable
(carotenoid) & decrease fat intake followed for 7
yrs.
- No reduction in recurrence or mortality
- High fiber intake decreases VMS
- Chemotherapy associated with wt gain
- Only 10% returned to pre-diagnosis wt.
TRIALS EVALUATING DIET CHANGES

WINS
- RCT with 2,437 postmenopausal women with
early stage breast cancer
- Low-fat arm had a 24%↓ in risk for recurrence
- Greater reduction in ER- cancer
STRATEGIES FOR WEIGHT LOSS

Raise Awareness
According to a survey by AICR in 2009:
- 94% respondents aware of link w/tobacco
- 87% aware of link with sun
- 51% aware of link with obesity
STRATEGIES FOR WEIGHT LOSS
WHEL study demonstrated phone counseling
effective
 NIH endorses incorporating diet, physical
activity, & behavior therapy
 Knowing and understanding macronutrient
needs

STRATEGIES FOR WEIGHT LOSS

RENEW Trial – RCT 641 survivors received
phone counseling on diet, exercise, & wt. loss
- QOL
- 2.06 kg wt loss vs 0.92 kg over 12 mos.
VITAMIN D
Prevents excessive cell proliferation &
differentiation
 Induces apoptosis
 Prevents angiogenesis
 Initiates immune response through macrophages
 Mediates osteoporosis risk for survivors of breast
& prostate cancer through serum
calcium/phosphorus balance

CLINICAL PRESENTATION OF
INSUFFICIENCY


Mild to Moderate Deficiency: asymptomatic or
nonspecific musculoskeletal pain
Severe Deficiency: deep bone pain, muscle pain,
hip pain, weakness, fractures, falls, difficulty
getting out of a chair or walking up stairs
RECOMMENDATIONS FOR “D” INTAKE

DRI 2010
years
years
years

600IU
ages 19-50
600IU
ages 51-70
800IU
ages >70
Anywhere from 60-80% of the population,
including breast cancer survivors have been
shown to have inadequate or deficient levels.
Have levels checked.
SOURCES OF VITAMIN D
Source
Serving
Amount of IU’s
Cod Liver Oil
1 tbsp
1,360
Swordfish, cooked
3 oz
566
Salmon, cooked
3 oz
447
Tuna fish, canned in
water
3 oz
154
Orange Juice, fortified
8 oz
137
Milk, vitamin d fortified
8 oz
115-124
Sardines, canned in oil
2 sardines
46
Egg
1 large
41
Fortified cereals
¾- 1 cup
40
CALCIUM






1 cup milk, yogurt, or calcium fortified
beverages = 300 mgs
1 ounce cheese = 200 mgs
½ cup greens = 75-179 mgs
5 dried figs = 200 mgs
1 tbsp flaxseed (10gm) = 25 mgs
3 oz canned salmon w/bones = 200 mgs

Supplement accordingly to meet DRI
CALCIUM

DRIs for calcium for females:
Age 9 – 18 = 1100 mgs
Age 19 – 50 = 800 mgs
Age 51+ = 1000 mgs
FLAXSEED
Meta-analysis in 2009 found no effect on overall
breast cancer risk, but 15% lower risk in
postmenopausal women.
 5-40 gms may or may not reduce serum estrone
and estradiol
 5-25 gms shows a shift to weaker form of
estrogen.
 Interactions with other meds

TO SOY OR NOT TO SOY?

1.
2.
3.
5.
Factors to consider:
Form & Food Source
Timing of exposure
Equol producer status
Hormone profile
TO SOY OR NOT TO SOY?


May be okay in amounts similar to typical Asian
diet in the form of tofu, soymilk, etc.
Avoid high dose isoflavone supplements
TO SOY OR NOT TO SOY?

Shanghai Breast Cancer Survival Study of 5042
breast cancer survivors:
- 32% ↓risk for recurrence in highest quartile
- 11 g/d or 40 mg isoflavone/d
- No difference in ER+ or ER- cancers
SUMMARY
Strive to achieve & maintain an ideal body
weight with integrative approaches
 Move and Move often
 Have your Vitamin D level checked & corrected if
necessary
 Consume adequate calcium with
diet/supplements
 Flax & Soy with caution

NUTRITION RESOURCES
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www.aicr.org
www.cancercenter.com
www.plwc.org
www.CancerRD.com
www.healthy.net/index.html
www.consumerlabs.com
www.eatright.org
www.cancernutrititioninfo.co
m
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www.nutritionu.com
www.cancer.org
www.herbalgram.org
www.ncbi.nlm.nih.gov/pubme
d
www.onhealth.com
www.usda.gov
www.cancerRD.com
REFERENCES
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3.
4.
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6.
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8.
World Cancer Research Fund/American Institute for Cancer Research. Food,
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Washington DC: AICR, 2007. pp289-295.
Kushi LH, et al. American Cancer Society Guidelines on Nutrition and Physical
Activity for Cancer Prevention: Reducing the Risk of Cancer With Healthy Food
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Doyle C, et al. Nutrition and Physical Activity During and After Cancer
Treatment: An American Cancer Society Guide for Informed Choices. CA Cancer
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Su HI, et al. Weight gain is associated with increased risk of hot flashes in breast
cancer survivors on aromatase inhibitors. Breast Cancer Res Treat. 2010 Feb 25
[Epub ahead of print]
Saquib N, et al. Weight Gain and recovery of pre-cancer weight after breast
cancer treatments: evidence from the women’s healthy eating and living (WHEL)
study. Breast Cancer Res Treat. 2007 Octl105(2):177-86.
Pierce JP, et al. Influence of diet very high in vegetables, fruit, and fiber and low
in fat on prognosis following treatment for breast cancer: the Women’s Healthy
Eating and Living (WHEL) randomized trial. JAMA 2007 Jul 18;298(3):289-98.
Gold EB, et al. Dietary factors and vasomotor symptoms in breast cancer
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Pierce, JP, et al. A randomized trial of the effect of a plant-based dietary pattern
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REFERENCES
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15.
Chlebowski RT, Blackburn GL, Elashoff RE, et al. Dietary fat reduction in
postmenopausal women with breast cancer: Phase III Women’s Intervention
Nutrition Study (WINS) (Abstract). 2005 ASCO Annual Meeting Proceedings. J
Clin Oncol 2005;23:10. Abstract 10.
Plotnikoff GA, Quigley JM. Prevalence of severe hypovitaminosis D in patients
with persistent, nonspecific musculoskeletal pain. Mayo Clin Proc 2003; 78( 12):
1463-70
Pfeifer M, Begerow B, MinneH W. Vitamin D and muscle function. Osteoporos Int
2002; 13( 3): 187-94
Zittermann A. Vitamin D in preventive medicine: are we ignoring the evidence?
Br J Nutr. 2003;89:552-572.
Whiting SJ, Calvo MS, Dietary recommendations for vitamin D: a critical need for
functional end points to establish an estimated average requirement. J Nutr.
2005;2:304-309.
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Nagata C. Factors to consider in the association between soy isoflavone intake
and breast cancer risk. J Epidemiol 2010(2):83-9.
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Messina MJ. Loprinski CL. Soy food for breast cancer survivors: a critical review
of the literature. J Nutr 2001 (Suppl):3095S-3108S
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Xiao Ou Shu, et al. Soy Food Intake and Breast Cancer Survival. JAMA
2009;302(22):2437-2443.
Pennington JAT. Bowes & Church’s Food Values of Portions Commonly Used –
17th edition. Philadelphia, PA:Lippincott-Raven;1998.
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