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Cancer and Diabetes: Two Epidemics or One? Andrea Reser, RD/LD

Cancer and Diabetes: Two Epidemics or One? Andrea Reser, RD/LD Diabetes Program Coordinator/Clinical Dietitian. Overview. Diabetes Epidemic Cancer Statistics Relationship of Diabetes and Cancer Importance of Blood Sugar Control Treatment Challenges Cancer Fighting Diabetic Diet

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Cancer and Diabetes: Two Epidemics or One? Andrea Reser, RD/LD

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  1. Cancer and Diabetes: Two Epidemics or One? Andrea Reser, RD/LD Diabetes Program Coordinator/Clinical Dietitian

  2. Overview • Diabetes Epidemic • Cancer Statistics • Relationship of Diabetes and Cancer • Importance of Blood Sugar Control • Treatment Challenges • Cancer Fighting Diabetic Diet • Prevention • Conclusions

  3. Cancer & Diabetes: The Connection

  4. US Mortality • Heart disease: 652,091 • Cancer: 559,312 • Stroke (cerebrovascular diseases): 143,579 • Chronic lower respiratory diseases:130,933 • Accidents (unintentional injuries): 117,809 • Diabetes: 75,119 • Alzheimer's disease: 71,599 • Influenza/Pneumonia: 63,001 • Nephritis, nephrotic syndrome, and nephrosis: 43,901 • Septicemia: 34,136 Source: Centers for Disease Control, 2008, www.cdc.gov

  5. Diabetes Overview • Diabetes • Disease in which the body does not produce or properly use insulin Source: American Diabetes Association, 2008 www.diabetes.org Picture: http://www.medicinenet.com/islet_cell_transplantation/article.htm

  6. Major Types of Diabetes • Type 1 Diabetes • Results from body’s failure to produce insulin • 5 to 10% of Americans • Type 2 Diabetes • Results from insulin resistance (body fails to properly use insulin), combined with relative insulin deficiency • Most Americans • Gestational Diabetes • Immediately after pregnancy 5-10% have Type 2 diabetes • Pre-diabetes • Blood glucose levels higher than normal but not enough for diagnosis in Type 2 diabetes Source: American Diabetes Association, 2008, www.diabetes.org

  7. Diabetes Epidemic • 23.6 million children and adults in United States (8%) • 17.9 million have been diagnosed • 5.7 million are unaware • 57 million prediabetes • CDC: Last 15 years numbers have more than doubled Sources: American Diabetes Association, 2008, www.diabetes.org; Centers for Disease Control, 2008, www.cdc.gov

  8. Mortality Change Rate Per 100,000 1950 2004 HeartDiseases CerebrovascularDiseases Pneumonia/Influenza Cancer Sources: 1950 Mortality Data - CDC/NCHS, NVSS, Mortality Revised. 2004 Mortality Data: US Mortality Public Use Data Tape, 2004, NCHS, Centers for Disease Control and Prevention, 2006

  9. 2008 Estimated US Cancer Deaths Men294,120 Women271,530 Lung & bronchus 31% Prostate 10% Colon & rectum 8% Pancreas 6% Liver & intrahepatic 4%bile duct Leukemia 4% Esophagus 4% Urinary bladder 3% Non-Hodgkin 3% lymphoma Kidney & renal pelvis 3% All other sites 24% • 26% Lung & bronchus • 15% Breast • 9% Colon & rectum • 6% Pancreas • 6% Ovary • 3% Non-Hodgkin lymphoma • 3% Leukemia • 3% Uterine corpus • 2% Liver & bile duct • 2% Brain/ONS • 25% All other sites Source: American Cancer Society, 2008, www.cancer.org

  10. Lifetime Probability: Men Site Risk All sites† 1 in 2 Prostate 1 in 6 Lung and bronchus 1 in 12 Colon and rectum 1 in 17 Urinary bladder‡ 1 in 28 Non-Hodgkin lymphoma 1 in 47 Melanoma 1 in 49 Kidney 1 in 61 Leukemia 1 in 67 Oral Cavity 1 in 72 Stomach 1 in 89 Source: American Cancer Society, 2008, www.cancer.org

  11. Lifetime Probability: Women Site Risk All sites† 1 in 3 Breast 1 in 8 Lung & bronchus 1 in 16 Colon & rectum 1 in 19 Uterine corpus 1 in 40 Non-Hodgkin lymphoma 1 in 55 Ovary 1 in 69 Melanoma 1 in 73 Pancreas 1 in 79 Urinary bladder‡ 1 in 87 Uterine cervix 1 in 138 Source: American Cancer Society, 2008, www.cancer.org

  12. Overview • Diabetes Epidemic • Most undiagnosed • Lifetime Risk: • Male: 1 in 2 • Female: 1 in 3 8-18% of cancer patients also have diabetes Source: American Cancer Society, 2008, www.cancer.org

  13. Diabetes and Cancer • Type 1: • Cervical Cancer • Stomach Cancer • Type 2: • Breast Cancer • Endometrial Cancer • Pancreatic Cancer • Liver Cancer • Kidney Cancer • Colon Cancer

  14. Obesity Trends Less than 50% 50 to 55% More than 55% State did not participate in survey 1992 1995 1998 2005 Source: Centers for Disease Control, 2008, www.cdc.gov

  15. The Relationship • Hyperglycemia (high blood sugar) • Elevated insulin concentrations • Growth promoting effects of IFG-1

  16. Blood Sugar Control • 80-110 mg/dl • Increased length of stay and cost • Higher infection rate • Shorter remission periods • High morbidity and mortality rates • Decreased Immune Function • Decreased Quality of Life

  17. Treatment Challenges • Treatment induced diabetes • Parenteral and enteral nutrition • Reduced/omission of dose • Delays in treatment • Co-morbidities • Aftercare and quality of life • No National Standards

  18. Cancer Fighting Diabetic Diet

  19. Diabetes Achieve and maintain: Blood glucose Lipid profile (cholesterol, LDL, HDL, TG) Blood pressure Prevent/Slow chronic complications Address individual nutritional needs Maintain pleasure with eating Cancer Achieve and maintain: Energy stores Lean body mass Maximize the Immune System: WBC, RBC, platelets Prevent/Slow treatment side effects Address individual nutritional needs Maintain pleasure with eating Nutrition Goals

  20. Carbohydrates (CHO) • Largest effect on blood sugar • Encouraged to include • Low CHO (<130g/day) not recommended • Monitor CHO intake • Exchange List • Carbohydrate counting • Plate Method

  21. Carbohydrates White Refined Products

  22. Sweeteners • Artificial sweeteners • Aspartame, saccharin, sucralose, acesulfame-K • No calories • Sugar Alcohols • Xylitol, mannitol, sorbitol • Calories, GI discomfort • Natural sweeteners • Stevia, fructose, honey, molasses

  23. Choose More Often: Whole Fruits Whole Vegetables Whole Grains Beans/Legumes Natural Sugars Choose Less Often: White, refined products Simple sugars Cakes, candy Sugar free products Carbohydrates (CHO)

  24. Protein Overview • Building block of our bodies • Regulates blood sugar • Builds: • Immune system • WBC, RBC • Muscles • Hormones • Enzymes • Specific amount established by Dietitian

  25. 2/3 of Protein in Diet: Beans/Legumes Nuts/Seeds Nut Butters Whole Grains Soy Powders: Rice Vegetable Soy 1/3 of Protein in Diet: Animal Meats Red meat <18 oz week Dairy Eggs Powders: Whey (Dairy) Goat Protein Builds and Supports Immune System Source: American Institute for Cancer Research, 2008, www.aicr.org

  26. Fat Overview • Essential in diet • Regulates blood sugar • Fat and Cholesterol • Increase risk for heart disease • Increase cancer risk

  27. Fats • Saturated Fats • Solid at room temperature • Animal Sources • Linked to cancer • Limited quantity • Unsaturated Fats • Liquid at room temperature • Plant sources • Trans Fats • “Hydrogenated Fats” • Self stable and frozen products

  28. Fats (con’t) • Monounsaturated Fats (MUFA) • Polyunsaturated Fats (PUFA) • Omega-3 • Fish (from ocean) • Walnuts • Canola Oil • Fortified Foods • Flaxseed • Omega-6 • Fried Foods • Animal Meats • Grains

  29. Overview: Fats Limit Encouraged AVOID

  30. Alcohol • Alcohol • Increase risk of low blood sugar • Consume with food • Empty calories • Increase cancer risk • Dehydrates body • Female: one drink • Male: two drinks

  31. Cancer and Diabetes Prevention

  32. Prevention • Lifestyle modifications • Maintain a healthy weight • Moderate wt loss (7% of body wt) • Regular physical activity • At least 30 minutes daily, 5 days week • Three strategies for weight loss • Eat a greater proportion of plant based foods • Watch the size of your portions • Keep physically active

  33. Play with Your Food Size of fist = one serving of carbohydrates Size of thumb joint = one to two servings of fat Eat with your Hands! Size of palm = one serving of meat, poultry, or fish

  34. Body Mass Index (BMI) BMI = [ Weight in Pounds ] x 703 (Height in inches) x (Height in inches) Example: [ 150 pounds ] x 703 = 26.5 (63 inches) x (63 inches)

  35. Prevention & Diet • Eat plenty of vegetables and fruits • Five to Nine a Day • Standard serving ½ cup • Prevent at least 20% of all cancers • Fiber • Juice • Vitamins, Minerals, Phytochemicals • Antioxidants

  36. Vegetable and Fruit Servings Source: American Cancer Society, 2008, www.cancer.org

  37. Prevention & Diet • Select foods low fat and in salt • Limit processed foods • Linked to most cancers

  38. Cancer & Alcohol • Drink alcohol only in moderation, if at all • Can cause cancer • Mouth, esophageal, laryngeal, pharyngeal, breast, and liver cancers • 75-80% of oral cancers frequently used alcohol • Men: 2 drinks a day; Females: 1 drink per day • More alcohol = Higher risk • Higher risk if use tobacco • Empty calories • Increase appetite Source: American Cancer Society, 2008, www.cancer.org

  39. New American Plate 1/3 (or less) animal protein 2/3 (or more) vegetables, fruits, whole grains, and beans Protein Vegetables Carbohydrate/Fruit Fats Source: American Institute for Cancer Research, 2008, www.aicr.org

  40. Stage 1: Old American Plate Stage 2: Transitional Plate Stage 3: The New American Plate Source: American Institute for Cancer Research, 2008, www.aicr.org

  41. Overview • Maintain a healthy weight and be physically active • Choose a diet rich in a variety of plant based foods • Eat plenty of vegetables and fruits • Drink alcohol only in moderation, if at all • Select foods low in fat and salt Eat with Your Hands! Source: American Institute for Cancer Research, 2007

  42. Conclusions • Diabetes epidemic continues • Strong correlations with diabetes and cancer • Control blood sugar = more cancer fighting • Future of Cancer and Diabetes • Education gap • National standards

  43. Thank You!

  44. Resources American Cancer Society: www.cancer.org American Diabetes Association: www.diabetes.org American Institute for Cancer Research: www.aicr.org Cancer Treatment Centers of America: www.cancercenter.com

  45. Resources (con’t) • AICR ScienceNOW. Summer 2008 • American Cancer Society. Cancer Facts and Figures 2008. Available at: http://www.cancer.org/downloads/STT/2008CAFFfinalsecured.pdf • American Diabetes Assocation. Nutrition Recommendations and Interventions for Diabetes: A Position Statement of the American Diabetes Association. Diabetes Care. 2007; 30 Suppl 1: S48-S65. • Basaria S, Muller DC, Carducci MA, Egan J, Dobs AS. Hyperglycemia and Insulin Resistance in Men with Prostate Carcinoma who Receive Androgen-deprivation therapy. Cancer. 2006; 106(3): 581-588 • Bunker K. A Diet-Cancer Connection. Diabetes Forecast. June 2008. • Eyre HJ, Kahn R, Robertson RM. Preventiong Cancer, Cardiovascular Disease, and Diabetes: A common Agenda for the American Cancer Society, the American Diabetes Association, and the American Heart Association. CA Cancer J Clin. 2004; 54(4): 190-207. • Garg R, Bhutani H, Alyea E, Pendergrass M. Hyperglycemia and Length of Stay in Patients Hospitalized for Bone Marrow Transplantation. Diabetes Care. 2007; 30 (4): 993-994 • Grant B and Evert A. Managing Patients Diagnosed with Cancer and Diabetes. Today’s Dietitian, August 2008 • Richardson LC, Pollack LA. Therapy Insight: Influence of Type 2 Diabetes on the Development, Treatment, and Outcomes of Cancer. Nat Clin Pract Oncol. 2005; (2)1: 48-53.

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