Cancer by Choice
Senior Consultant Oncology
Batra Hospital, New Delhi
Cancer is a large group of diseases (over 200) characterized by uncontrolled growth and spread of abnormal cells.
1. Cancer cells:
Lose control over growth and multiplication
Do not self-destruct when they become worn out or damaged
Crowd out healthy cells
· C - Change in bowel or bladder habits
· A - A sore throat that does not heal
· U - Unusual bleeding or discharge
· T - Thickening or lump
· I - Indigestion or difficulty swallowing
· O - Obvious change in wart or mole
· N - Nagging cough or hoarseness
· Inherited (<15%)
· . Be as lean as possible without becoming underweight.
· 2. Be physically active for at least 30 minutes every day.
· 3. Avoid sugary drinks. Limit consumption of energy-dense foods. à due to correlation with obesity
· 4. Eat more of a variety of vegetables, fruits, whole grains and legumes such as beans.
· 5. Limit consumption of red meats (such as beef, pork and lamb) and avoid processed meats. à 11 – 18 oz. per week max
· . If consumed at all, limit alcoholic drinks to 2 for men and 1 for women a day. à 12 oz. beer, 5 Oz wine, 1.5 Oz spirits
· 7. Limit consumption of salty foods and foods processed with salt (sodium).à stomach cancer (also moldy foods due to liver cancer in developing countries)
· 8. Don’t use supplements to protect against cancer.
· 9. It is best for mothers to breastfeed exclusively for up to 6 months and then add other liquids and foods. à reduce breast cancer in mom and obesity in child
· 10. After treatment, cancer survivors should follow the recommendations for cancer prevention
West ————— India
· Research shows that fat cells can act as "hormone pumps," secreting hormones and other growth factors into the bloodstream.
· If the body's cells are exposed to very high levels of these substances over an extended period, they tend to reproduce more quickly à ? Increase cancer cell growth.
· Researchers stress that this potentially dangerous condition is reversible!
· New Guidelines
· Minimum 150 min moderate, or 75 min vigorous to reduce risk of chronic disease
· Ideally aim for more – and necessary if weight loss and maintenance of loss is the goal – 300 min of moderate or 150 minutes of vigorous.
Beyond weight control, fruits and vegetables may exert a protective effect:
Phytonutrients: Prevention in a Plant
· Stimulate enzymes that help the body detoxify
· Reduce the genetic damage from cancer causing agents
· May interfere with growth and multiplication of cancer cells
· Decrease inflammation
If It Stains Your Shirt…
If a fruit or vegetable has a strong smell or taste, it’s probablybiomedically active
If it stains your shirt, it’s definitely biomedically active!
Vitamin A, C, E, Selenium, phytonutrients from plants
Help prevent damage to cells from the attack of free radicals
“But I take antioxidant supplements in pill form, so I’m getting all the antioxidant benefits that way, right?”
Food First …….
Phytonutrients work together to provide a synergistic benefit
Sugar and Cancer – It’s not that simple…..
· Sugar does not FEED cancer
· Chronic, excess intake of simple sugar leads to excess production of hormones like insulin, IGF that encourage cellular growth
· Excess insulin can promote tumor cell growth
· Behaviors that increase insulin levels
o Consumption of refined sugar and flour
o Weight gain
o Sedentary lifestyle
o Behaviour that reduces insulin levels
o Physical activity, weight loss, unrefined carbs
o Lower fasting insulin level at time of Breast cancer diagnosis is associated with improved survival.
Mulligan et al. Breast Cancer Res Treat. 2007 Jan 13
Donut vs Orange: It is not necessary to avoid fruit!
· 10 grams sugar
· 0 grams fiber
· 0 phytonutrients
· 62 calories
· 12 grams’ sugar
· 3 grams’ fiber
· 170 phytonutrients
Another reason to mute post-prandial glucose/insulin response!
· Include fat, protein and fiber with carbohydrates
o Process sugar more slowly
o Less insulin released
· Glycaemic Index: number representing insulin response by body to a particular food
· Sugar does “feed” cancer cells – but no differently than it “feeds” the rest of the body’s cells
· Choose healthier carbohydrate foods
o Unprocessed/minimally processed
o Fruits, Vegetables, whole grains
· Combine foods at meals and
o Fat and/or protein with
· AICR Global found no “probable or convincing” connection between cancer and total fat intake (only “limited/suggestive” with post-menopausal breast cancer and lung cancer à weak)
· Concern in primarily with saturated fat, but it’s hard to tease out what’s a dietary fat effect, calorie effect, affect on weight influence, tied to the source of fat (i.e. high intakes of red and processed meats).
§ Bottom Line: Encourage Mono’s and Omega 3’s; limit
§ Saturatedand trans fats; portion control
Healthy Eating Plate
· Aim for ½ plate of plants (preferably vegetables) at lunch and dinner
· ¼ of plate as lean protein
· ¼ of plate of complex carbohydrate
Dietary Supplements That May Help Cancer Survivors
· Vitamin D
· Probiotics and calcium (based on individual circumstances)
24,000 Dietary Supplements marketed to Cancer Survivors!
Vitamin D and Cancer
· Inverse relationship between Vitamin D and several types of cancer
o Possible anti-angiogenesis and helps keep cell replication normal
· Goal of serum 25(OH) vitamin D level is > 40 ng/ml.
· Supplementation is likely necessary.
o 1000 IU/day is safe for most people; many need more.
· Sun Exposure (arms/legs 10-15 min)
· Fortified Multi-vitamin
· Fortified Milk
· 3.5oz salmon (fresh, wild)
· 3.5oz salmon (fresh, farmed)
Amount of Vitamin D
▪ 3000 – 20,000 IU
▪ 400 IU
▪ 100 IU
▪ 600-1000 IU
▪ 100-250 IU
· Link first hypothesized in 1980s
o Rate of colon cancer 3x higher in New York than New Mexico
o Lower exposure to natural light in large cities and areas at higher latitude
o Research has been mostly observational, few clinical trials
o “…Vitamin D levels in the blood vary by race, with the season, and possibly with the activity of genes whose products are involved in vitamin D transport and metabolism. These variations complicate the interpretation of studies that measure the concentration of vitamin D in serum at a single point in time.” - OCCAM
Limit alcohol intake
< 1 drink/day for women
< 2 drinks/day for men
Women who consume 1 drink or more/day have an increased risk of breast cancer (10-40% increased risk)
Adequate folate intake (400mcg/d) may reduce the increased risk of breast cancer Treatment In India associated with alcohol use