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Diet and Nutrition Making Healthy Choices After Breast Cancer

Diet and Nutrition Making Healthy Choices After Breast Cancer. Karen Marr MS, RD, LDN, CSO Lead Dietitian-Eastern Regional Medical Center Cancer Treatment Centers of America Philadelphia, PA. Overview. Body Weight Macronutrient Needs Physical Activity Alcohol Bone Health & Vitamin D

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Diet and Nutrition Making Healthy Choices After Breast Cancer

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  1. Diet and NutritionMaking Healthy Choices After Breast Cancer Karen Marr MS, RD, LDN, CSO Lead Dietitian-Eastern Regional Medical Center Cancer Treatment Centers of America Philadelphia, PA

  2. Overview • Body Weight • Macronutrient Needs • Physical Activity • Alcohol • Bone Health & Vitamin D • To Soy or Not to Soy

  3. AICR Report • Weight gain, excess body weight, obesity • Physical activity • Alcohol

  4. AICR Recommendations • Be as lean as possible within the normal range of body weight • Lower end of normal BMI • Avoid weight gain & increases in waist circumference in adulthood • Limit consumption of energy dense foods & avoid sugary drinks • Eat mostly foods of plant origin • Limit intake of red meat & avoid processed meats

  5. How much activity? • 45 to 60 minutes 5 or more days a week

  6. Alcohol & folate • Alcohol increases risk 11% • Risk doubles if inadequate folate intake

  7. Macronutrient Needs • Calories • 25-35 kcal/ kg bw if BMI between 18.5-24.9 • 20-25 kcal/ kg bw if BMI btween 25-29.9 • 15-20 kcal/ kg bw if BMI between 30-35 • 15 kcal/kg bw if BMI >35 • Protein • .8-1.0 gm/ kg bw • 1.0-1.2 gm/ kg bw during treatment • Carbohydrates • 50-65% of daily total calories • Fat • <30% of total calories should come from fat (<10% from saturated fat)

  8. Nutrition During & After Treatment • Prevent weight gain & perhaps start weight loss • Address bone health • Other common questions

  9. Avoid Weight Gain/Encourage Weight Loss • Weight gain may increase risk of recurrence • In a study of 300 postmenopausal survivors on adjuvant AI therapy for an average of 23 months - Weight gain of ≥ 10# since dx. 2x more likely to have hot flashes - Weight gain & hot flash severity

  10. Trials Evaluating Diet Changes • WHEL study - RCT in 3088 women to increase vegetable (carotenoid) & decrease fat intake followed for 7 yrs. - No reduction in recurrence or mortality - High fiber intake decreases VMS - Chemotherapy associated with wt gain - Only 10% returned to pre-diagnosis wt.

  11. Trials Evaluating Diet Changes • WINS - RCT with 2,437 postmenopausal women with early stage breast cancer - Low-fat arm had a 24%↓ in risk for recurrence - Greater reduction in ER- cancer

  12. Strategies for Weight Loss Raise Awareness According to a survey by AICR in 2009: - 94% respondents aware of link w/tobacco - 87% aware of link with sun - 51% aware of link with obesity

  13. Strategies for Weight Loss • WHEL study demonstrated phone counseling effective • NIH endorses incorporating diet, physical activity, & behavior therapy • Knowing and understanding macronutrient needs

  14. Strategies for Weight Loss • RENEW Trial – RCT 641 survivors received phone counseling on diet, exercise, & wt. loss -  QOL - 2.06 kg wt loss vs 0.92 kg over 12 mos.

  15. Vitamin D • Prevents excessive cell proliferation & differentiation • Induces apoptosis • Prevents angiogenesis • Initiates immune response through macrophages • Mediates osteoporosis risk for survivors of breast & prostate cancer through serum calcium/phosphorus balance

  16. Clinical Presentation of Insufficiency • Mild to Moderate Deficiency: asymptomatic or nonspecific musculoskeletal pain • Severe Deficiency: deep bone pain, muscle pain, hip pain, weakness, fractures, falls, difficulty getting out of a chair or walking up stairs

  17. Recommendations for “D” Intake • DRI 2010 600IU ages 19-50 years 600IU ages 51-70 years 800IU ages >70 years • Anywhere from 60-80% of the population, including breast cancer survivors have been shown to have inadequate or deficient levels. Have levels checked.

  18. Sources of Vitamin D

  19. Calcium • 1 cup milk, yogurt, or calcium fortified beverages = 300 mgs • 1 ounce cheese = 200 mgs • ½ cup greens = 75-179 mgs • 5 dried figs = 200 mgs • 1 tbsp flaxseed (10gm) = 25 mgs • 3 oz canned salmon w/bones = 200 mgs • Supplement accordingly to meet DRI

  20. Calcium • DRIs for calcium for females: Age 9 – 18 = 1100 mgs Age 19 – 50 = 800 mgs Age 51+ = 1000 mgs

  21. Flaxseed • Meta-analysis in 2009 found no effect on overall breast cancer risk, but 15% lower risk in postmenopausal women. • 5-40 gms may or may not reduce serum estrone and estradiol • 5-25 gms shows a shift to weaker form of estrogen. • Interactions with other meds

  22. To Soy or Not to Soy? • Factors to consider: • Form & Food Source • Timing of exposure • Equol producer status • Hormone profile

  23. To Soy or Not to Soy? • May be okay in amounts similar to typical Asian diet in the form of tofu, soymilk, etc. • Avoid high dose isoflavone supplements

  24. To Soy or Not to Soy? • Shanghai Breast Cancer Survival Study of 5042 breast cancer survivors: - 32% ↓risk for recurrence in highest quartile - 11 g/d or 40 mg isoflavone/d - No difference in ER+ or ER- cancers

  25. Summary • Strive to achieve & maintain an ideal body weight with integrative approaches • Move and Move often • Have your Vitamin D level checked & corrected if necessary • Consume adequate calcium with diet/supplements • Flax & Soy with caution

  26. Nutrition Resources • www.aicr.org • www.cancercenter.com • www.plwc.org • www.CancerRD.com • www.healthy.net/index.html • www.consumerlabs.com • www.eatright.org • www.cancernutrititioninfo.com • www.nutritionu.com • www.cancer.org • www.herbalgram.org • www.ncbi.nlm.nih.gov/pubmed • www.onhealth.com • www.usda.gov • www.cancerRD.com

  27. References • World Cancer Research Fund/American Institute for Cancer Research. Food, Nutrition, Physical Activity, and the Prevention of Cancer: a Global Perspective. Washington DC: AICR, 2007. pp289-295. • Kushi LH, et al. American Cancer Society Guidelines on Nutrition and Physical Activity for Cancer Prevention: Reducing the Risk of Cancer With Healthy Food Choices and Physical Activity. CA Cancer J Clin2006; 56:254-281. • Doyle C, et al. Nutrition and Physical Activity During and After Cancer Treatment: An American Cancer Society Guide for Informed Choices. CA Cancer J Clin2006; 56:323-353. • Su HI, et al. Weight gain is associated with increased risk of hot flashes in breast cancer survivors on aromatase inhibitors. Breast Cancer Res Treat. 2010 Feb 25 [Epub ahead of print] • Saquib N, et al. Weight Gain and recovery of pre-cancer weight after breast cancer treatments: evidence from the women’s healthy eating and living (WHEL) study. Breast Cancer Res Treat. 2007 Octl105(2):177-86. • Pierce JP, et al. Influence of diet very high in vegetables, fruit, and fiber and low in fat on prognosis following treatment for breast cancer: the Women’s Healthy Eating and Living (WHEL) randomized trial. JAMA 2007 Jul 18;298(3):289-98. • Gold EB, et al. Dietary factors and vasomotor symptoms in breast cancer survivors: the WHEL study. Menopause 2006 May-Jun;13(3):423-33. • Pierce, JP, et al. A randomized trial of the effect of a plant-based dietary pattern on additional breast cancer events and survival: the Women’s Healthy Eating and Living (WHEL) study. Control Clin Trials 2002 Dec;23(6):728-56.

  28. References • Chlebowski RT, Blackburn GL, Elashoff RE, et al. Dietary fat reduction in postmenopausal women with breast cancer: Phase III Women’s Intervention Nutrition Study (WINS) (Abstract). 2005 ASCO Annual Meeting Proceedings. J ClinOncol 2005;23:10. Abstract 10. • Plotnikoff GA, Quigley JM. Prevalence of severe hypovitaminosis D in patients with persistent, nonspecific musculoskeletal pain. Mayo Clin Proc 2003; 78( 12): 1463-70 • Pfeifer M, Begerow B, MinneH W. Vitamin D and muscle function. OsteoporosInt 2002; 13( 3): 187-94 • Zittermann A. Vitamin D in preventive medicine: are we ignoring the evidence? Br J Nutr. 2003;89:552-572. • Whiting SJ, Calvo MS, Dietary recommendations for vitamin D: a critical need for functional end points to establish an estimated average requirement. J Nutr. 2005;2:304-309. • Nagata C. Factors to consider in the association between soy isoflavone intake and breast cancer risk. J Epidemiol 2010(2):83-9. • Messina MJ. Loprinski CL. Soy food for breast cancer survivors: a critical review of the literature. J Nutr 2001 (Suppl):3095S-3108S • Xiao OuShu, et al. Soy Food Intake and Breast Cancer Survival. JAMA 2009;302(22):2437-2443. • Pennington JAT. Bowes & Church’s Food Values of Portions Commonly Used – 17th edition. Philadelphia, PA:Lippincott-Raven;1998.

  29. For more information please visit cancercenter.com or 1-800-333-CTCA

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