Prostate cancer and diet
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Transcript of Prostate cancer and diet
Foods and Cancer
Neal D. Barnard, MDAdjunct Associate Professor of Medicine George Washington University School of Medicine
President, Physicians Committee for Responsible Medicine Washington, DC
Milk and Prostate Cancer
Ganmaa D, Li X, Wang J, Qin L, Wang P, Sato A. Int J Cancer 2002:98,262-267.
Physicians’ Health Study (Harvard)
≥ 2.5 servings/day of dairy products
20,885 physicians
34% increased risk
of prostate cancer
Relative risk: 1.34 (1.04-1.71)Chan JM. Am J Clin Nutr 2001;74:549-54.
Health Professionals Follow-up Study (Harvard)
83% of milk consumed was skim or lowfat
Giovannucci E. Cancer Res 1998;58:442-7.
> 2 servings/day of milk
47,781 health professionals
60% increased risk
of prostate cancer
Relative risk for advanced cancer: 1.6 (95% CI, 1.2-2.1)
Dairy and Prostate Cancer
• > 20 research reports link milk drinking to PC.
• Association with advanced and fatal PC risk
Qin LQ. Nutr Cancer. 2004;48(1):22-27.Gao X. J Natl Cancer Inst. 2005 Dec 7;97(23):1768-1777.Crowe FL. Cancer Epidemiol Biomarkers Prev. 2009;18(5):1333-40Gonzalez CA.. Eur J Cancer. 2010;46(14):2555-62.Butler LM.. Cancer Res. 2010;70(12):4941-8.
Milk Affects Hormones
Milk
↑ IGF-I
↓ Vitamin D
“Insulin-like” = moves sugar into cells
“Growth factor” = encourages cell proliferation
Insulin-Like Growth Factor IInsulin-Like Growth Factor I
Men and women aged 55 to 85 years
Three 8-oz servings of milk for 12 weeks
Serum IGF-I levels: ↑ 10%
P<.001 Heaney RP. J Am Dietetic Asso 1999;99:1228-33.
Milk Drinking Raises Human IGF-IMilk Drinking Raises Human IGF-I
After 10-year follow-up:
cancer patients healthy controls
(n = 152) (n = 152)
IGF-I 269 ng/ml 249 ng/ml
P=0.03
RR = 2.1 (95% CI = 1.3-3.2) per 100 ng/ml IGF-I increment
Chan JM. Science 1998;279:563-6.
Physicians’ Health Study, HarvardPhysicians’ Health Study, Harvard
Vegetarians have lower IGF-I
• Plant-based diet is associated with lower circulating levels of total IGF- I
• EPIC study: 2019 participants– Animal protein, milk, and cheese ↑ IGF-I
– Vegetables, β-carotene ↓ IGF-I
Allen NE. Cancer Epidemiol Biomarkers Prev. 2002;11(11):1441-1448.Norat T. Eur J Clin Nutr. 2007;61(1):91-98.
Vitamin DVitamin D
skin
Vitamin DVitamin D
skin
liver
Vitamin DVitamin D
skin
liverkidney
Vitamin DVitamin D
skin
liverkidney
intestine
Calcium
Vitamin DVitamin D
skin
liverkidney
prostate
intestine
Calcium
Vitamin DVitamin D
skin
liverkidney
prostate
intestine
Calcium
X X
X
PhIP Structure*
* 2-amino-1-methyl-6-phenylimidazo[4,5-b]pyridine)
Processed meats: Bacon Sausage Ham Hot dogs Deli meats
Lycopene vs Prostate Cancer
Health Professionals Follow-Up Study
47,365 participants
≥ 2 tomato sauce servings per weekProstate cancer risk ↓ 23%
Giovannucci E. A prospective study of tomato products, lycopene, and prostate cancer risk. J Natl Cancer Inst 2002;94:391-8.
Vegan Diet and Prostate Cancer
Preventive Medicine Research Institute
84 men with untreated prostate cancer, 1-year study
Control group:
PSA ↑ 6%
6 of the 43 participants required cancer treatment
Vegan group:
PSA ↓4%
No one required treatmentOrnish D, Weidner G, Fair WR, et al. Intensive lifestyle changes may affect the progression of prostate cancer. J Urol. 2005;174:1065-1069.
Breast Cancer
Association of Dietary Fat & Breast Cancer
USA
SwitzerlandCanada
Denmark
Germany
Norway
New Zealand
FranceUK
SwedenAustralia
ItalyIsrael
Finland
Spain
Poland Hungary
Hong Kong
Yugoslavia
Romania
Japan
0
50
100
150
200
250
600 900 1200 1500
r=0.76
Bre
ast
Can
cer
Inci
den
ce(p
er 1
00,0
00 w
om
en, 4
5-69
yrs
)
Per Capita Fat Availability (kcal)from Prentice, et al. JNCI 1988
Western Diets and Breast Cancer in China
The Shanghai Breast Cancer Study
The “meat-sweet” pattern: meat dessertfish breadcandy milk
30% percent increased breast cancer risk
Cui X. Dietary Patterns and Breast Cancer Risk in the Shanghai Breast Cancer Study. Cancer Epidemiol Biomarkers Prev. 2007;16(7):1443-1448.
Excess body fat
Increasedestrogen activity
Cancer promotion
High-fat / low-fiber dietExcess body fat
Increasedestrogen activity
Cancer promotion
High-fat / low-fiber dietExcess body fat
Increasedestrogen activity
Increased riskof breast cancer
High-fat / low-fiber dietExcess body fat
Increasedestrogen activity
Increased riskof breast cancer
Reduced SHBG
Women’s Health Initiative
48,835 participants, aged 50-79
Diet: 20% fat, ↑ vegetables, fruits, and grains
Fat intake fell from 38% at baseline… to 24% at 1 year, and to 29% at 6 years.
Prentice RI. JAMA. 2006;295:629-642.
Women’s Health Initiative
After 8.1 years:
Overall breast cancer risk ↓9% (not significant).Progesterone-receptor-negative tumor risk ↓24%.
Prentice RI. JAMA. 2006;295:629-642.
Fat Content(Percentage of Calories from Fat)
Leanest beef 29%
Skinless chicken breast 23%
Sea trout 32%
White tuna 16%
Broccoli 8%
Beans 4%
Rice 1–5%
Diet and Breast Cancer Survival
Women’s Intervention Nutrition Study (WINS)
2,437 women with breast cancer
Ages: 48-79, all postmenopausal
Reduced fat (15% of energy) diet vs control
WINSDiet and Cancer Recurrence
All cancers ↓ 24%
Estrogen receptor - ↓ 42%
Estrogen receptor + ↓ 15%
Women’s Healthy Eating and Living Study
3,109 pre- and postmenopausal women previously treated for breast cancer
7 clinical sites, enrollment 1995-2000
Women’s Healthy Eating and Living Study
Comparison diet (“5-a-day”): 5 servings of vegetables and fruits (<30% fat, 20 g fiber)
Intervention diet (“8-a-day”): 5 vegetable servings, 3 fruit servings
16 oz. vegetable juice (15-20% fat, 30 g fiber)
WHEL Study Vegetables-Fruits and Regular Walking
1490 women in comparison group Followed for 5-11 years
Mortality
↑ veg/fruit (7.6 servings) + ↑ activity 4.8%
↓ veg/fruit (3.4 servings) + ↑ activity 10.4%
↑ veg/fruit (7.2 servings) + ↓ activity 10.7%
↓ veg/fruit (3.1 servings) + ↓ activity 11.5%
Pierce JP. J Clin Oncol 2007;25:2345-51.
What about Soy Products?
Source: Wood CE. Biology of Reproduction. 2006;75:477-86.
Soy and Prostate Cancer
Meta-analysis of 15 studies:
Risk for high versus low soy intake:↓26% overall↓48% in Asian populations
Yan L, Spitznagel EL. Soy consumption and prostate cancer risk in men: a revisit of a meta-analysis. Am J Clin Nutr. 2009;89:1155-1163.
Soy and Breast Cancer
Meta-analysis of 8 studies in Asians and Asian Americans:
High soy intake: 29% ↓ risk of breast cancer.
Wu AH. Br J Cancer. 2004;98:9-14.
Soy and Cancer Recurrence or Mortality in WHEL
<0.0
7
0.07
-1.0
1
1.01
-16.
33
>16.
330
1
P for trend = 0.02
Isoflavone Intake (mg/d)
Haz
ard
Rat
io
Caan BJ. Cancer Epidemiology, Biomarkers, & Prevention. 2011;20:854-8.
Soy and Survival
High soy intake:
54% ↓ risk.
16.3 mg isoflavones = ½ cup soymilk or
2 oz. tofu
Soy and Cancer Recurrence or Mortality
<0.0
7
0.07
-1.0
1
1.01
-16.
33
>16.
330
1
P for trend = 0.02
Isoflavone Intake (mg/d)
Haz
ard
Rat
io
Caan BJ. Cancer Epidemiology, Biomarkers, & Prevention. 2011;20:854-8.
Shanghai Breast Cancer Survival Study
Shu XO. JAMA. 2009;302:2437-43
Soy and Cancer Mortality
<20.
01
20.0
1-36
.50
36.5
1-62
.68
>62.
680
1
Isoflavone Intake (mg/d)
Haz
ard
Rat
io
16.3 mg isoflavones = ½ cup soymilk or 2 oz. tofu
Kaiser Permanente Life After Cancer Epidemiology Study
Guha N. Breast Cancer Research & Treatment. 2009;118:395-405.
Daidzein
0
0.10
-7.7
7
7.78
-149
.59
149.
60-1
,453
.00
1,45
3.10
-9,5
96.5
4
>9,5
96.5
40
1
Daidzein Intake (mcg/d)
Haz
ard
Rat
io
Genistein
0
0.10
-6.9
9
7.00
-220
.61
220.
62-2
,184
.8
2,19
9.82
-13,
025.
87
>13,
025.
870
1
Genistein Intake (mcg/d)
Haz
ard
Rat
io
Glycetein
0-3.
61
3.62
-8.1
6
8.17
-14.
99
15.0
0-78
.53
78.5
4-79
5.39
>796
.39
0
1
Glycetin Intake (mcg/d)
Haz
ard
Rat
io
Soy Intake and Breast Cancer Recurrence
Soy and Breast Cancer Recurrence
<4.0
4.0
- 9.9
910
.0
0.0
0.5
1.0
Isoflavone Intake (mg/d)
Haz
ard
Rat
io
Nechuta SJ. Am J Clin Nutr. 2012;96:123-32.
After Breast Cancer Pooling Project
1. Women’s Healthy Eating & Living Study
2. Shanghai Breast Cancer Survival Study
3. Life After Cancer Epidemiology Study
9,514 breast cancer survivors
Nutrition & Breast Cancer Survival Summary
Reduced body fat → ↑ survival
Reduced dietary fat → ↑ survival
Vegetables & fruits + exercise → ↑ survival
Soy (~2 servings/day) → ↑ survival
Nutrition and Cancer: Mechanisms• Low-fat diets reduce body weight
• Fiber increases hormone elimination
• Low-fat, high-fiber diets boost hormone binding to SHBG
• Isoflavones may reduce risk.
• Avoiding meat reduces carcinogen exposure
PCRM 2009 USDA 2011
Complete Nutrition
Protein
Calcium
Vitamin B12
Acceptability
• No artificial calorie limits.
• No portion sizes.
• No carbohydrate-counting.
• Benefits encourage adherence.
Acceptability Acceptability is similar to that of other therapeutic diets.
• Men and women with heart disease (1992) • Young women with dysmenorrhea (2000) • Postmenopausal overweight women (2004)• Men and women with diabetes (2008)
Barnard ND, Scherwitz L, Ornish D. J Cardiopulmonary Rehab 1992;12:423-31.Barnard ND, Scialli AR, Bertron P, et al. J Nutr Educ 2000;32:314-9. Barnard ND, Scialli AR, Turner-McGrievy GM, et al. J Cardiopulm Rehab 2004;24:229-35.Barnard ND, et al. J Am Diet Assoc 2009;109:263-72.
Body Weight
P-value < 0.0001
Am J Health Promotion, In press
Waist Circumference
Am J Health Promotion, In pressP-value < 0.001
Beginning a Healthful Diet
Step 1. Check out the possibilities
Breakfast
Lunch
Dinner
Snack
Foods to Try
Beginning a Healthful Diet
Step 1. Check out the possibilities
Step 2. Do a 3-week test drive
Optional: Use transition foods
PCRM.org
Resourceswww.pcrm.org