Stacy Kennedy, MPH, RD/LDN, CSO Senior Clinical ......ketones, hypoglycemia, trace mineral...

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

The Power of Nutrition Prevention, Treatment, Survivorship

Symptom management

Weight management

Boost energy levels

Support immune system

Overall health and wellness

Stacy Kennedy MPH RD CSO LDN

GUIDELINES

The NCI currently recognizes 13 cancer types associated with overweight and obesity

dietandcancerreport.org

• Diet, nutrition, physical activity and cancer survival – all-cause mortality

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 SystemStacy Kennedy, MPH, RD, CSO, LDN

SYMPTOM MANAGEMENT

Taste Changes

Include Tart, Sour Flavors

Avoid Metal Hydrate with natural flavors

Season meals with herbs

Consider cooler temperatures Link with smell & taste


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

• 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 & feeding your microbiome


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).


MYTHS, FADS & “INTERNET NUTRITION”


*Red and processed meat consumption and breast cancer: UK Biobank cohort study and meta-analysisJana J. Anderson a, Narisa D.M. Darwis a, Daniel F. Mackay a, Carlos A. Celis-Morales b, Donald M. Lyall a, Naveed Sattar b, Jason M.R. Gill b, Jill P. Pell aEuropean Journal of Cancer 90 (2018) 73e82

Dairy & Cancer DataProstate Cancer:• Excessive intakes of whole milk appear to raise risk of mortality from prostate cancer.*The evidence that a higher consumption of dairy products increases the risk of prostate cancer is limited**The evidence that diets high in calcium increase the risk of prostate cancer is limited**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-fatFermented 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 Fuel Cancer?

Source: “Sugar and Cancer Risk.” American Institute for Cancer Research, www.aicr.org/reduce-your-cancer-risk/diet/sugar-and-cancer-risk.html.

Sugar Increased Cancer risk

High-sugar

foods in the diet

Excess calories

Weight gain and body fat

Increased Cancer

risk

Recent Research

Makarem, Nour, et al. “Consumption of Sugars, Sugary Foods, and Sugary Beverages in Relation to Adiposity-Related Cancer Risk in the Framingham Offspring Cohort (1991–2013).” Cancer Prevention Research, vol. 11, no. 6, 2018, pp. 347–358., doi:10.1158/1940-6207.capr-17-0218.

• Background: Cohort study investigates the association between sugary foods and breast, prostate and colorectal cancer

• Methods: Dietary data collected on adults, 26-84 years old using an FFQ

• Results: Higher sugar-sweetened beverage intake was associated with increased cancer risk among participants with central adiposity

How to Reduce Added Sugars

Check nutrition facts labels

Choose simple foods over packaged and heavily processed

Drink unsweetened coffee and tea

Infuse water with fresh berries and lemon

Choose sparkling water over soda

Snack on nuts, seeds or fresh fruit

“Cut Out Added Sugars Infographic.” About Heart Attacks, www.heart.org/en/healthy-living/healthy-eating/eat-smart/sugar/cut-out-added-sugars-infographic.“Sugar and Cancer Risk.” American Institute for Cancer Research, www.aicr.org/reduce-your-cancer-risk/diet/sugar-and-cancer-risk.html.

Understanding Food Marketing• “Natural”

• USDA has not established a formal definition • “Processed”

• Food that has undergone a “change of character”• Raw nuts vs. roasted nuts

• “Local”• Food grown or produced close to your community

• “Whole”• General term that suggests no processing, refinement or additives

• “Organic”• Legal definition and standards set by the USDA

Source:“USDA.” USDA, www.usda.gov/.

Organic Label Does Not Guarantee It’s Healthy


Latest Research on Organic • Background: Cohort study investigates the association

between high consumption of organic food and cancer risk

• Methods: Frequency of organic-labeled food was collected voluntarily from French adults, which determined an organic food score (0-32)

• Results: High organic food scores were inversely correlated with decreased risk of Non-Hodgkin’s Lymphoma, and postmenopausal breast cancer

• Conclusions: Is an absolute risk reduction of 0.6% a significant impact on cancer risk?

Baudry, Julia, et al. “Association of Frequency of Organic Food Consumption With Cancer Risk.” JAMA Internal Medicine, vol. 178, no. 12, 2018, p. 1597., doi:10.1001/jamainternmed.2018.4357.Hemler, Elena C., et al. “Organic Foods for Cancer Prevention—Worth the Investment?” JAMA Internal Medicine, vol. 178, no. 12, 2018, p. 1606., doi:10.1001/jamainternmed.2018.4363.JAMA Network. “JAMA Internal Medicine : Association of Organic Food Consumption With Cancer Risk.” JAMA Network, 22 Oct. 2018, player.fm/series/jama-network/jama-internal-medicine-association-of-organic-food-consumption-with-cancer-risk.

Stamp of Approval?• Recent Study

• “Organic Diet intervention significantly reduces urinary pesticide levels in U.S. children and adults”

• Findings• Pesticide intake was reduced by 60% in one week

• Red Flags• 16 participants • Short time frame• Researchers provide a diet that is known to be lower in

conventional pesticides

Food for Thought

• Organic foods have the same macro- and micronutrients as conventional foods

• Limited research to suggest pesticides used for organic farming are safer than those for conventional farming

• 100% organic diet may be unrealistic or unaffordable for some

• Environmental Working Group• Dirty Dozen• Clean 15

Miracle Diets• Hundreds of “fad” or “miracle” diets

exist..why? • Magazine sales• Food companies sponsor research

to promote specific products• Improve supplement sales

• Truth• Our diets consist of a variety of

foods• Limited research to support that

one food or diet can cure disease Source: Inoue-Choi, Maki, et al. “Reality Check: There Is No Such Thing as a Miracle Food.” Nutrition and Cancer, vol. 65, no. 2, 2013, pp. 165–168., doi:10.1080/01635581.2013.748921.

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


Legal Consequences • Bestselling author of pH Miracle books to pay

$105 million to a cancer patient • Diet based on the idea that acidity in the body

causes disease and an alkaline diet will cure disease

• Patient was advised to skip traditional cancer treatment and opt for alkaline-based remedies

• As a result, the patient has Stage 4 cancer

Spot the Warning Signs Be aware of any diet plan, supplement or product that:

• Guarantees rapid weight loss

• Eliminates food groups

• Promotes unlimited quantities of particular

foods

• Requires a strict eating plan

• Discourages exercise

“Staying Away from Fad Diets.” Eat Right. Academy of Nutrition and Dietetics., www.eatright.org/health/weight-loss/fad-diets/staying-away-from-fad-diets.

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/

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

Probiotics & Cancer• Severity of treatment related diarrhea (CRC)

• Duration of diarrhea symptoms during chemo (CRC)

• Diarrhea & boost QOL in long term symptom management for patients with IBS

• Lack of sufficient evidence linked to cancer prevention or promotion of survivorship

• Preliminary In Vitro, animal model studies looking at risk


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 for individual patient, duration you would suggest.


Intermittent Fasting

• Common Practices

• Cultural & Historical Prevalence

• 12-16 hour window between eating (overnight)

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

• 2 Days/week <500 calories

• Focus on Eating Pattern/Timing

• 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 treatment & 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 with patients


*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

https://www.ncbi.nlm.nih.gov/pubmed/27422504

RESOURCES

Reliable Information

• DFCI Nutrition Website & Social Media, Insight Blog, Podcasts• MSKCC About Herbs App for Supplements • CNC Cancer Nutrition Consortium e-Newsletter & Print • AND ONC DPG & Listserv (RD only) • NCCN National Comprehensive Cancer Network • cancer.gov National Cancer Institute • cancer.org American Cancer Society• aicr.org American Institute for Cancer Research• consumerlabs.com Supplement Evaluation • Natural Medicine Database Supplement Research • Up to Date Evidence Based Information


Guide to EvaluateSupplements

• Safety First, Efficacy Second • Communicating to patients that

supplements are not federally regulated for purity, safety or content

• Natural Medicine Database• ConsumerLabs.com• Memorial Sloan Kettering Cancer

Center’s About Herbs app


Resources for Patients

• 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


• The Continuous Update Project (CUP)

How to build a healthy eating plan

Well Balanced, Plant based diet

Schedule timing of meals and snacks

Consider taste changes, preferences

Factor in ease of preparation

Motivational Interviewing, open-minded, non-judgmental conversations

Address questions, concerns, internet-nutrition myths

Follow up for feedback to customize the plan


Stacy Kennedy, MPH, RD, CSO, LDNwww.dana-farber.org/nutrition

[email protected]

@StacyKennedyRD

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

Stacy Kennedy, MPH, RD/LDN, CSO Senior Clinical ......ketones, hypoglycemia, trace mineral...

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