Nutrition, Exercise & Cancer

Nutrition, Exercise & Cancer IWMF 2018

Stacy Kennedy, MPH, RD/LDN, CSO Senior Clinical Nutritionist,

Dana-Farber Cancer Institute/Brigham & Women’s Hospital

Adjunct Faculty, Simmons College

Co-Founder, Wellness Guides

Fitness Expert, Trainer

@StacyKennedyRD

The Power of Nutrition & Exercise

Prevention, Treatment, Survivorship

Symptom Management

Nausea, Fatigue, Bowel irregularities, Taste & Appetite changes

Weight management

Boost energy levels

Support immune system

Overall health and wellness

Stacy Kennedy, MPH, RD, CSO, LDN

Cruciferous Vegetables

Broccoli, Cauliflower,

Cabbage, Brussels Sprouts,

Radishes, Arugula, Kale,

Collard Greens, Mustard

Greens, Wasabi

Potent phytochemicals:

Sulforaphane, Indole-3-

Carbinol, 3,3’-

diindolylmethane (DIM)

Promote natural Liver

Detoxification

Support Immune System


Symptom Management

Nausea

Bowel Concerns (constipation, diarrhea, gas, bloating, pain)

Fatigue

Taste Changes

Mouth Sores

Peripheral Neuropathy


Nausea Management

• Lemon & Ginger

• Small, frequent meals =

• Avoid the “empty stomach” trigger

• Salt is your friend

• Easy to digest foods – potatoes are not ”bad”

• Address constipation, reflux


Bowel Concerns

• Constipation

• Role in reflux

• Hydration

• Senna Tea

• Proper fiber balance

• Walking & activity

• Small, frequent meals

• Protein Power

• Probiotics & Feeding your microbiome


Bowel Concerns

Diarrhea = >4 bowel movements per day,

may be loose, float, light/grey in color

Malabsorption and electrolyte depletion are

concerns

Small, frequent meals

Avoid concentrated sweets, lactose, extreme

food temperatures, spicy foods, excess

caffeine

Right balance of dietary fiber in foods

Hydrate with electrolytes

Bland, carb rich foods with sodium can help

Probiotics


Taste Changes

Include Tart, Sour Flavors

Avoid Metal

Hydrate with natural flavors

Season meals with herbs

Consider cooler temperatures

Link with smell & taste


Fatigue

Sleep hygiene

Small, frequent patterns

Hydration

Movement

Nourishment

Medication timing


Peripheral Neuropathy

Lack of consistent evidence showing benefit of

supplements or special diet for prevention or treatment

Always check with MD & RD before introducing vitamins,

minerals, supplements or exercise regimen

Avoid cold temperatures on oxaliplain

Consider adding:

Physical Activity

Well, balanced, plant-based, anti-inflammatory diet with

omega-3 fats (walnuts, walnut oil, salmon, sardines,

chia/flax).


Dairy & Cancer Data

Prostate Cancer:

Excessive intakes of whole milk appear to raise risk of mortality from prostate cancer.*

Colorectal Cancer:

Consumption of dairy & calcium supplements is protective against incidence***

Gastric cancer, no association or modest risk reduction****

Ovarian Cancer:

Potentially reducing exposure and choosing low-fat or lactose free may be associated with reduced risk of developing certain types of ovarian cancer*****

Lung Cancer:

No association******

Breast Cancer:

Highest intake vs. Lowest = statistically significant lower risk of developing breast cancer


*Dairy products intake and cancer mortality risk: a meta-analysis of 11 population-based cohort studies [Lu et al. Nutrition Journal (2016)

**AICR’s Continuous Update Project

*** Calcium intake and colorectal cancer risk: Results from the Nurses’ Health Study and Health Professionals Follow-up Study [Zhang et al. International Journal of Cancer (2016)]

****Dairy Consumption and Gastric Cancer Risk: A Meta-Analysis of Epidemiological Studies [Guo et al. Nutrition and Cancer (2015

*****Milk, Yogurt, and Lactose Intake and Ovarian Cancer Risk: A Meta-Analysis [Liu et al. Nutrition and Cancer (2015) & Dairy, calcium, vitamin D and ovarian cancer risk in African–

American women [Qin et al. British Journal of Cancer (2016)]

******Caini et al. Critical Reviews in Oncology/Hematology (2016)

*******The Association between Dairy Intake and Breast Cancer in Western and Asian Populations: A Systematic Review and Meta-Analysis [Zang et al. Journal of Breast Cancer (2015)

http://wcrf.org/sites/default/files/Prostate-Cancer-2014-Report.pdf

Recommendations on Dairy

If consuming dairy, choose low-fat

Fermented dairy products such as yogurt and

kefir

Plant-based sources of calcium

Ex: spinach, kale, swiss chard, dried

beans, legumes, soymilk, and tofu


Does Sugar Feed

Cancer?

Human body requires glucose

Lack of well designed, human

studies demonstrating causal link

between sugar & cancer

Indirect link of excess refined

sugar and obesity’s contribution to

cancer risk


Recommendations on Sugar

• Eat balanced meals and snacks.

• Include a protein-rich and fiber-rich food with each

meal and snack.

• Stay well hydrated. Consider infused waters.

• Include walking and other physical activity regularly.

• Eat plenty of vegetables and other plant-based foods.

• Limit added sugars: <25 gm/day women & <36gm/day

men

• Plain Greek yogurt + berries & nuts vs. flavored yogurts

• Choose whole grains and starchy vegetables like

quinoa, brown rice or sweet potatoes over refined

grains like white rice, breads and potatoes.

• Use fresh or dried herbs and spices, like cinnamon, to

flavor foods and add nutrients.

• Focus on getting adequate sleep and managing stress. Stacy Kennedy, MPH, RD, CSO, LDN

Organic Label Does Not

Guarantee It’s Healthy


Is Organic Better? Eat Locally!

www.ewg.org Stacy Kennedy, MPH, RD, CSO, LDN

Superfoods: Nutrition

Superstars or Brilliant

Marketing?

Synonymous with ultra-healthy, nutrient-packed, plant-based

foods and supplements.

Advertised as having exceptional powers for fighting or

preventing common health conditions, like cancer.

Preliminary or complete lack of data: In Vitro, animal studies.

Lack of evidence in humans.

While superfoods may not always live up to their hype…

Enjoy as part of a well-balanced diet to offer new and

interesting options for delicious plant-based foods


How to include superfoods in

your everyday diet:

Drink Chaga mushroom or green tea once or twice a day

Add goji, acai, sea buckthorn, currant or other berries to oatmeal, cereal, salads, baking or smoothies.

Add chia, hemp or ground flax seeds to salads, smoothies, baked goods, hot or cold cereals.

Include seaweed in soups or as a snack paired with avocado.

Drink Kefir or Kombucha for a fun treat.

Add cacao powder to smoothies, waffle or pancake mix, oats, muffins, breads, desserts or other baking for chocolate flavor without added sugars.

Swap brown rice with teff in stir-fry, bowls or side dishes

Dana-Farber Podcast: http://blog.dana-farber.org/insight/2018/03/superfoods-can-fight-cancer/


http://www.dana-farber.org/health-library/recipes/berry-walnut-oatmeal/

http://www.dana-farber.org/health-library/recipes/blueberry-smoothie/

http://www.dana-farber.org/health-library/recipes/mango-coconut-overnight-oats/

http://www.dana-farber.org/health-library/recipes/super-food-sushi/

http://www.dana-farber.org/health-library/recipes/chocolate-yogurt-mousse/




Alcohol Cancer Risk •Insignificant differences between type of alcohol and risk

•Consuming Folic Acid may help reduce associated risk

•Especially ER- Breast Cancers •Multivitamin Recommended •US Food Supply Fortification


= =

Alkaline Diets

Promote avoidance of processed foods, excess meats

& dairy and abundance of plant-based foods

Biologic Plausibility: Can You Change Your Blood pH?

Reliability of home testing

Bottom Line


Ketogenic Diet

•Popular use in weight loss, athletic performance, may allow body to

burn fat for energy vs. carbs/sugars

•Therapeutic use in pediatric seizure treatment

•Acute risks: GI Discomfort, Nausea, Vomiting, Fatigue, Elevated

blood ketones, hypoglycemia, trace mineral deficiencies

•Long term risks: Increased LDL, Bone mineral loss, kidney stones,

decreased IGF-1, renal damage

Stacy Kennedy, MPH, RD, CSO, LDN Allen, B, et al. Ketogenic diets as an adjuvant cancer therapy: History and potential mechanism. RedoxBiology2(2014)963–970.

How to Create a Balanced

Keto-Friendly Diet

Higher in healthy fat, moderate in lean proteins,

lower in carbohydrates without compromising

phytonutrient intake. Adjust macro %s as

appropriate individually.

Focus on increasing fiber and reducing added sugars

Consider logistics for adherence, safety, duration


Intermittent Fasting Common Practices

Focus on Eating Pattern/Timing

12-16 hour window between eating (overnight)

Circadian regimens (100% total daily calories 8a-2p)

2 Days/week <500 calories

Potential Benefits

Improved insulin sensitivity

Decreased blood glucose, growth factor signaling, inflammation & angiogenesis.

Fat metabolism, appetite and hunger management

Preliminary research looking at potential benefits during chemotherapy, radiation treatments & in overall survivorship* and prevention**.

Potential Risks

Meeting elevated nutrition needs during treatment

Logistics of scheduling, meal prep, family/cultural eating patterns

Consider options individually


*BMC Med. 2017 May 24;15(1):106. doi: 10.1186/s12916-017-0873-x.

**Adv Nutr. 2016 Jul 15;7(4):690-705. doi: 10.3945/an.115.011767. Print 2016 Jul.

https://www.ncbi.nlm.nih.gov/pubmed/28539118



XRT Chemo Immuno- therapy

****

Food Source

Curcumin X X *,***

? Dried/Fresh Turmeric + Black Pepper in cooking

High Dose Vitamin C, E, carotenes

X X *,***

? Colorful veggies, fruits, nuts/seeds

Vitamin D OK OK OK Dairy, Fortified Non-Dairy, Mushrooms, Sardines

Probiotics OK OK OK Plain Greek Yogurt, Kefir, Kombucha, Fermented Foods

*May be drug-specific, however until more research is conducted, NCI, ACS & ASCO suggest all high dose antioxidant supplements be discouraged during radiation and chemotherapy. J Natl Cancer Inst. 2008 Jun 4;100(11):773-83. doi: 10.1093/jnci/djn148.

Epub 2008 May 27.

**Many patients undergoing clinical trials, s/p recent BMT, dx GVHD, pancytopenia, severe neutropenia may have additional contraindications. Check with

team.

***Potential Contributions of Antioxidants to Cancer Therapy. Immunomodulation and Radiosensitization Anita Thyagarajan-Sahu PhD, Ravi P. Sahu, PhD, Integrative Cancer Therapies, First Published March 20, 2017 Review Article

****No specific data for examples Keytruda (Pembrolizumab & Nivolumab)

Popular Supplements & Treatment Contraindications

https://www.cancer.gov/about-cancer/treatment/research/dietary-supplements

https://www.cancer.org/treatment/survivorship-during-and-after-treatment/staying-active/nutrition/nutrition-and-physical-activity-during-and-after-cancer-treatment.html

http://www.ascopost.com/issues/july-25-2014/avoiding-antioxidant-drug-interactions-during-cancer-treatment/


http://journals.sagepub.com/author/Thyagarajan-Sahu,+Anita



http://journals.sagepub.com/author/Sahu,+Ravi+P

Optimal Meal Planning

Well Balanced, Plant based diet

Schedule timing of meals and snacks

Consider taste changes, preferences

Factor in ease of preparation

Address questions, concerns, internet-

nutrition myths

Follow up with your nutritionist &

share feedback to customize your plan


Fitness Benefits During

Treatment

Fight fatigue, anxiety

Reduce nausea, reflux, constipation, neuropathy

Elevate mood, improve sleep, boost energy levels

Support immune system, reduce risk for recurrence

Social connection


Meal Planning Resources

Local Grocery Store Online

Order & Delivery

Peapod, Roche

National Online Order &

Delivery

Thrive Market, Amazon

Pantry, Instacart

Meal Kits

Hello Fresh, Blue Apron,

Plated, Purple Carrots


Reliable Information

DFCI Nutrition App, Website & Social Media, Insight Blog,

Podcasts

MSKCC About Herbs App for Supplements

CNC Cancer Nutrition Consortium e-Newsletter & Print

cancer.gov National Cancer Institute

cancer.org American Cancer Society

aicr.org American Institute for Cancer Research

consumerlabs.com Supplement Evaluation


Dana Farber Nutrition Media

Bringing tech to patients, caregivers

Patient filters recipes by goal, symptom, sensitivities,

selects recipe & can build shopping list & share

Ask the Nutritionist & Resources

Award-winning App: Free, iphone & android

Eating Well During Cancer Series

Social Media, Podcasts, blogs & Web Chats, Twitter

chats @DanaFarber www.dana-farber.org/nutrition



www.dana-farber.org/nutrition

[email protected]

@StacyKennedyRD

@DanaFarber

http://www.dana-farber.org/nutrition



Nutrition, Exercise & Cancer

Documents

Transcript of Nutrition, Exercise & Cancer