fact or fiction: the power of nutrition nutrition & cancer ... ance/kennedy_nutrition...

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1

Fact or Fiction Nutrition amp Cancer Myths

Stacy Kennedy MPH RDLDN CSOSenior Clinical Nutritionist

Dana-Farber Cancer InstituteBrigham amp Womenrsquos Hospital

Co-Founder Wellness Guides

Adjunct Faculty Simmons College

Fitness Expert Trainer

StacyKennedyRD

The Power of Nutrition

Prevention Treatment Survivorship

Symptom Management

Nausea Fatigue Bowel irregularities Taste amp Appetite

changes

Weight management

Boost energy levels

Support immune system

Overall health and wellness

Stacy Kennedy MPH RD CSO LDN

Stacy Kennedy MPH RD CSO LDN Stacy Kennedy MPH RD CSO LDN


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Cruciferous Vegetables

Broccoli Cauliflower

Cabbage Brussels Sprouts

Radishes Arugula Kale

Collard Greens Mustard

Greens Wasabi

Potent phytochemicals

Sulforaphane Indole-3-

Carbinol 33rsquo-

diindolylmethane (DIM)

Promote natural Liver

Detoxification

Support Immune System



Symptom Management

Nausea

Bowel Concerns (constipation diarrhea gas

bloating pain)

Fatigue

Taste Changes

Swallowing Problems Dry Mouth Mouth Sores


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3




Breast Cancer Data

bull Processed Meats Modest Consumption

= risk

bull Red meat consumption is not

associated with breast cancer

incidence

Red and processed meat consumption and breast cancer UK Biobank cohort

study and meta-analysis

Jana J Anderson a Narisa DM Darwis a Daniel F Mackay a Carlos A Celis-

Morales b Donald M Lyall a Naveed Sattar b Jason MR Gill b Jill P Pell a

European Journal of Cancer 90 (2018) 73e82

Dairy amp Cancer Data

Prostate 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 amp 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)

AICRrsquos Continuous Update Project

Calcium intake and colorectal cancer risk Results from the Nursesrsquo 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) amp Dairy calcium vitamin D and ovarian cancer risk in Africanndash

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

Caini et al Critical Reviews in OncologyHematology (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)

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 RCTs demonstrating causal link

between sugar amp cancer

Indirect link of excess refined sugar and

obesityrsquos contribution to cancer risk

Earlier studies examining relationship of

diets high in fructose or glycemic load

May risk of pancreatic colorectal amp

prostate cancers

Worse overall survival in overweight colon

cancer patients undergoing chemotherapy


Aune D1 Chan DS Vieira AR Navarro Rosenblatt DA Vieira R Greenwood DC Cade JE Burley VJ Norat T Dietary fructose carbohydrates glycemic indices and pancreatic

cancer risk a systematic review and meta-analysis of cohort studies Ann Oncol 2012 Oct23(10)2536-46 Epub 2012 Apr 26

Michaud DS1 Fuchs CS Liu S Willett WC Colditz GA Giovannucci E Dietary glycemic load carbohydrate sugar and colorectal cancer risk in men and women Cancer

Epidemiol Biomarkers Prev 2005 Jan14(1)138-47

Hu J1 La Vecchia C Augustin LS Negri E de Groh M Morrison H Mery L Canadian Cancer Registries Epidemiology Research Group Glycemic index glycemic load and

cancer risk Ann Oncol 2013 Jan24(1)245-51 doi 101093annoncmds235 Epub 2012 Jul 25

Meyerhardt JA1 Sato K Niedzwiecki D Ye C Saltz LB Mayer RJ Mowat RB Whittom R Hantel A Benson A Wigler DS Venook A Fuchs CS Dietary glycemic load and

cancer recurrence and survival in patients with stage III colon cancer findings from CALGB 89803 J Natl Cancer Inst 2012 Nov 21104(22)1702-11 doi

101093jncidjs399 Epub 2012 Nov 7

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4

Recommendations on Sugar

bull Eat balanced meals and snacks

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

meal and snack

bull Stay well hydrated Consider infused waters

bull Include walking and other physical activity regularly

bull Eat plenty of vegetables and other plant-based foods

bull Limit added sugars lt25 gmday women amp lt36gmday

men

bull Plain Greek yogurt + berries amp nuts vs flavored yogurts

bull Choose whole grains and starchy vegetables like

quinoa brown rice or sweet potatoes over refined

grains like white rice breads and potatoes

bull Use fresh or dried herbs and spices like cinnamon to

flavor foods and add nutrients

bull Focus on getting adequate sleep and managing stressStacy Kennedy MPH RD CSO LDN

Is Organic Better Eat Locally

wwwewgorg Stacy Kennedy MPH RD CSO LDN

Organic Label Does Not

Guarantee Itrsquos Healthy


Soy amp Breast Cancer


Safe Insufficient Data

Tofu X

Edamame X

Miso X

Tempeh X

Soy Milk (Unsweetened) X

Soy Oil Lecithin Soy

Sauce

X

Soy Protein Powders

(Isolated Soy Protein)

Common Sources Protein

Powder Bars Veggie

Burgers Breads ldquoHigh

Proteinrdquo Packaged Foods

X


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 hypehellip

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

interesting options for delicious plant-based foods


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5

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


Probiotics amp Cancer

Severity of treatment related diarrhea (CRC)

Duration of diarrhea symptoms during chemo

(CRC)

Diarrhea amp 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



FAKENEWS Alcohol amp Cancer Breast Cancer Risk Specifically

Risk with 3-6 Drinksweek (lt1day) or 10 for every 10 gm

Higher with early or later in life exposure

Daily consumption of alcohol increases the risk

Moderate drinking ndash Low risk for alcohol problems - General

Women ndash lt2 drinks per day

Men ndash lt3 drinks per day

People age ge65 ndash lt2 drinks per day

14 to 15 grams of alcohol (05 to 06 fl ounces) =

12 ounces of beer

5 ounces of wine

15 ounces of 80 proof liquor


Alcohol amp Breast Cancer

bullInsignificant differences between type of alcohol and risk

bullConsuming Folic Acid may help reduce associated riskbullEspecially ER- Breast Cancers bullMultivitamin Recommended bullUS Food Supply Fortification


==

Alkaline Diets

Promote avoidance of processed foods excess meats

amp dairy and abundance of plant-based foods

Biologic Plausibility Can You Change Your Blood pH

Reliability of home testing

Bottom Line


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6

Ketogenic Diet

bullPopular use in weight loss athletic performance may allow body to

burn fat for energy vs carbssugars

bullTherapeutic use in pediatric seizure treatment

bullAcute risks GI Discomfort Nausea Vomiting Fatigue Elevated

blood ketones hypoglycemia trace mineral deficiencies

bullLong 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)963ndash970

Ketogenic Diet amp Cancer

Research bullLack of data for safety of long term use

bullPreliminary research investigating benefits for cancer patients and evaluating safety in preclinical and animal models

bullHuman studies are needed amp underway Currently 21 studies variety of cancer dx

bullData supporting Mediterranean Diet

bullContradicts previous Low-Fat Dietary recommendations for Breast Cancer especially for those with ER-


Todayrsquos Dietitian September 2017 Issue Ask the Expert Ketosis for Weight Loss By Toby Amidor MS RD CDN Vol 19 No 9 P 12

A Nutritional Perspective of Ketogenic Diet in Cancer A Narrative Review Camila L P Oliveira MSc Stephanie Mattingly PhD Ralf Schirrmacher MD Michael B Sawyer MD Eugene J Fine MD Carla M Prado PhD RD J Acad Nutr Diet 2017

BG AllenetalRedoxBiology2(2014)963ndash970

Mediterranean Diet - Effects on Health Outcomes of a Mediterranean Diet With No Restriction on Fat Intake A Systematic Review and Meta-analysis Hanna E Bloomfield MD MPH Eva Koeller BA Nancy Greer PhD Roderick MacDonald MS Robert Kane MD and Timothy J Wilt MD MPH Annals of Internal

Medicine 2016165491-5008WINSWHEL studies J Am Diet Assoc 2009 Apr 109(4) 688ndash696

How to Create a Balanced

Keto-Friendly Diet for

Patients

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 amp Historical Prevalence

12-16 hour window between eating (overnight)

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

2 Daysweek lt500 calories

Focus on Eating PatternTiming

Potential Benefits

Improved insulin sensitivity

Fat metabolism appetite and hunger management

Preliminary research looking at potential benefits during chemotherapy treatment amp in overall survivorship and prevention

Potential Risks

Meeting elevated nutrition needs during treatment

Logistics of scheduling meal prep familycultural eating patterns

Consider options individually with patients


BMC Med 2017 May 2415(1)106 doi 101186s12916-017-0873-x

Adv Nutr 2016 Jul 157(4)690-705 doi 103945an115011767 Print 2016 Jul

Food vs Supplement


XRT Chemo Immuno-therapy

Food Source

Curcumin X X

DriedFresh Turmeric + Black Pepper in cooking

High Dose Vitamin C E carotenes

X X

Colorful veggies fruits nutsseeds

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 amp ASCO suggest all high dose antioxidant supplements be discouraged during radiation and chemotherapy J Natl Cancer Inst 2008 Jun 4100(11)773-83 doi 101093jncidjn148

Epub 2008 May 27

Many patients undergoing clinical trials sp 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 amp Nivolumab)

Popular Supplements amp Treatment Contraindications

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7

Reliable Information for RDs amp

Patients

DFCI Nutrition App Website amp Social Media Insight Blog Podcasts

MSKCC About Herbs App for Supplements

CNC Cancer Nutrition Consortium e-Newsletter amp Print

AND ONC DPG amp Listserv (RD only)

cancergov National Cancer Institute

cancerorg American Cancer Society

aicrorg American Institute for Cancer Research

consumerlabscom Supplement Evaluation

Natural Medicine Database Supplement Research

Up to Date Evidence Based Information


Dana Farber Nutrition Media

Bringing tech to patients caregivers

Patient filters recipes by goal symptom sensitivities

selects recipe amp can build shopping list amp share

Ask the Nutritionist amp Resources

Award-winning App Free iphone amp android

Eating Well During Cancer Series

Social Media Podcasts blogs amp Web Chats Twitter

chats DanaFarber wwwdana-farberorgnutrition


Guide to Evaluate

Supplements

bull Safety First Efficacy Second

bull Communicating to patients that supplements

are not federally regulated for purity safety

or content

bull Natural Medicine Database

bull ConsumerLabscom

bull Memorial Sloan Kettering Cancer Centerrsquos

About Herbs app


Resources for Patients

Local Grocery Store Online

Order amp Delivery

Peapod Roche

National Online Order amp

Delivery

Thrive Market Amazon

Pantry Instacart

Meal Kits

Hello Fresh Blue Apron

Plated Purple Carrots


How to help your patients

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-judgemental

conversations

Address questions concerns internet-nutrition myths

Follow up for feedback to customize the plan



wwwdana-farberorgnutritionStacyKennedyRDgmailcom

StacyKennedyRD

DanaFarber

312018

2




Cruciferous Vegetables

Broccoli Cauliflower

Cabbage Brussels Sprouts

Radishes Arugula Kale

Collard Greens Mustard

Greens Wasabi

Potent phytochemicals

Sulforaphane Indole-3-

Carbinol 33rsquo-

diindolylmethane (DIM)

Promote natural Liver

Detoxification

Support Immune System



Symptom Management

Nausea

Bowel Concerns (constipation diarrhea gas

bloating pain)

Fatigue

Taste Changes

Swallowing Problems Dry Mouth Mouth Sores


312018

3




Breast Cancer Data


= risk



incidence







Prostate Cancer




Colorectal Cancer



Ovarian Cancer


Lung Cancer

No association

Breast Cancer














kefir





Does Sugar Feed









prostate cancers













312018

4




meal and snack





men
















Tofu X

Edamame X

Miso X

Tempeh X



Sauce

X

Soy Protein Powders



Powder Bars Veggie



X




Marketing











312018

5


your everyday diet












(CRC)






looking at risk












12 ounces of beer

5 ounces of wine







==

Alkaline Diets





Bottom Line


312018

6

Ketogenic Diet























Patients















Potential Benefits




Potential Risks





BMC Med 2017 May 2415(1)106 doi 101186s12916-017-0873-x


Food vs Supplement



Food Source

Curcumin X X



X X





Epub 2008 May 27


team




312018

7


Patients






















Guide to Evaluate

Supplements




or content




About Herbs app




Order amp Delivery

Peapod Roche


Delivery


Pantry Instacart

Meal Kits











conversations






StacyKennedyRD

DanaFarber

312018

3




Breast Cancer Data


= risk



incidence







Prostate Cancer




Colorectal Cancer



Ovarian Cancer


Lung Cancer

No association

Breast Cancer














kefir





Does Sugar Feed









prostate cancers













312018

4




meal and snack





men
















Tofu X

Edamame X

Miso X

Tempeh X



Sauce

X

Soy Protein Powders



Powder Bars Veggie



X




Marketing











312018

5


your everyday diet












(CRC)






looking at risk












12 ounces of beer

5 ounces of wine







==

Alkaline Diets





Bottom Line


312018

6

Ketogenic Diet























Patients















Potential Benefits




Potential Risks





BMC Med 2017 May 2415(1)106 doi 101186s12916-017-0873-x


Food vs Supplement



Food Source

Curcumin X X



X X





Epub 2008 May 27


team




312018

7


Patients






















Guide to Evaluate

Supplements




or content




About Herbs app




Order amp Delivery

Peapod Roche


Delivery


Pantry Instacart

Meal Kits











conversations






StacyKennedyRD

DanaFarber

312018

4




meal and snack





men
















Tofu X

Edamame X

Miso X

Tempeh X



Sauce

X

Soy Protein Powders



Powder Bars Veggie



X




Marketing











312018

5


your everyday diet












(CRC)






looking at risk












12 ounces of beer

5 ounces of wine







==

Alkaline Diets





Bottom Line


312018

6

Ketogenic Diet























Patients















Potential Benefits




Potential Risks





BMC Med 2017 May 2415(1)106 doi 101186s12916-017-0873-x


Food vs Supplement



Food Source

Curcumin X X



X X





Epub 2008 May 27


team




312018

7


Patients






















Guide to Evaluate

Supplements




or content




About Herbs app




Order amp Delivery

Peapod Roche


Delivery


Pantry Instacart

Meal Kits











conversations






StacyKennedyRD

DanaFarber

312018

5


your everyday diet












(CRC)






looking at risk












12 ounces of beer

5 ounces of wine







==

Alkaline Diets





Bottom Line


312018

6

Ketogenic Diet























Patients















Potential Benefits




Potential Risks





BMC Med 2017 May 2415(1)106 doi 101186s12916-017-0873-x


Food vs Supplement



Food Source

Curcumin X X



X X





Epub 2008 May 27


team




312018

7


Patients






















Guide to Evaluate

Supplements




or content




About Herbs app




Order amp Delivery

Peapod Roche


Delivery


Pantry Instacart

Meal Kits











conversations






StacyKennedyRD

DanaFarber

312018

6

Ketogenic Diet























Patients















Potential Benefits




Potential Risks





BMC Med 2017 May 2415(1)106 doi 101186s12916-017-0873-x


Food vs Supplement



Food Source

Curcumin X X



X X





Epub 2008 May 27


team




312018

7


Patients






















Guide to Evaluate

Supplements




or content




About Herbs app




Order amp Delivery

Peapod Roche


Delivery


Pantry Instacart

Meal Kits











conversations






StacyKennedyRD

DanaFarber

312018

7


Patients






















Guide to Evaluate

Supplements




or content




About Herbs app




Order amp Delivery

Peapod Roche


Delivery


Pantry Instacart

Meal Kits











conversations






StacyKennedyRD

DanaFarber

fact or fiction: the power of nutrition nutrition & cancer ... ance/kennedy_nutrition...

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