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TAKE THE WHEEL: Healthy lifestyle changes that may reduce the risk of a colorectal cancer recurrence

Part of Fight Colorectal Cancer’s Monthly Patient Webinar Series

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www.FightColorectalCancer.org877-427-2111

Fight Colorectal Cancer

1. Tonight’s speaker: Jessica Iannotta MS, RD, CSO, CDN

2. Archived webinars: FightColorectalCancer.org/Webinars

3. Follow up survey to come via email. Get a free Blue Star of Hope pin when you tell us how we did tonight.

4. Ask a question in the panel on the right side of your screen and look for hyperlinks during throughout the presentation.

5. Or call the Fight Colorectal Cancer Answer Line at 877-427-2111

Fight Colorectal Cancer

www.FightColorectalCancer.org877-427-2111

Jessica Iannotta MS, RD, CSO, CDNMeals to Heal, Chief Operating Officer

Objectives• Symptom Management

– Fatigue– Bowel management– Involuntary weight changes

• Nutritional Recommendations– Weight management– Meat– Alcohol intake

• Physical Activity Recommendations

Colorectal Cancer• The 3rd most common cancer in the US• CRC is the 2nd most common cause of

cancer death in the US • As obesity rates have increased, the

number of cases has increased• Overall, there is evidence that

incidence is decreasing

Fatigue• Fatigue is the most common treatment-

related side effect• Encourage hydration, exercise

– Stretching, yoga, tai-chi, walking

• Keep naps to 20-30 minutes, avoid long naps

• Adequate diet (protein), avoid sugary foods, • Avoid high-dose vitamin/mineral

supplements• Encourage ways to manage stress

Constipation• Caused by

– decreased motility– inadequate fluids/fiber– medications (antidepressants, opioids, sleep

medication)– inactivity– cancer tx– cancer

• Encourage increased fluid/fiber intake, activity, prune juice, probiotics

• Routine habits• Avoid more binding foods

Good Sources of Dietary Fiber

• Fruits• Vegetables• Grains • Beans/legumes• Nuts• Fiber supplements as needed• Be sure to consume adequate fluids

Partial Bowel Obstruction• Focus on a low fiber/low residue diet

– Food choices <2gm fiber/serving– Avoid gas-producing foods - cruciferous

vegs, onions, melons, carbonated drinks

• Adequate fluid intake• Increase activity, if able• Stool softeners/laxatives as

prescribed by medical team

Diarrhea• Talk with physician about your laxatives,

stool softeners• Clears if diarrhea is severe (>7stools/day)• Replace each loose stool with 1 cup of

liquid (Gatorade, broth, diluted juices) • Small, frequent meals, soluble fibers, and

limit dairy products/caffeine• Chronic diarrhea – encourage soluble fiber

foods, probiotics, OTC or prescription medications

Gas and Bloating• Avoid gas producing foods• Avoid carbonated beverages, drinking through a

straw, chewing gum• Daily probiotics (yogurt, kefir, supplement)• OTC meds (Gas-X, Beano) prescribed by medical

team• Other options:

– Peppermint oil– Fennel– Ginger– Parsley– Anise– Caraway seed

Involuntary Weight Changes• For weight loss

– Oral nutrition supplements• Creamy vs clear liquid, CIB, non-fat dry milk

– Small, frequent meals– High calorie snacks– Pleasant, calm surroundings

• For weight gain– Encourage activity– Decrease high calorie choices– Thought that “all cancer patients lose weight”

Risk Factors for CRC• Increased body weight• Inactivity• Diets high in beef, pork, and lamb• Processed meats• Alcohol intake• Age

http://www.aicr.org/learn-more-about-cancer/colorectal-cancer/

http://www.dietandcancerreport.org/expert_report/report_overview.php

Red Meat and Processed Meat• Why red meat and not white meat?

– Heme iron damages the lining of the colon– People who eat a lot of red meat eat less plant-based foods

• Limit red meat to <18 ounces/week• Avoid Processed Meats

– Smoking, curing, salting or the addition of preservatives can create carcinogens

• Heterocyclic amines (HCAs)• Polycyclic aromatic hydrocarbons (PAHs)• Nitrosamines – from nitrates and nitrites

– Calcium and alpha tocopherol may help reduce the effectEgeberg, R. Associations between Red Meat and Risk for Colon and Rectal Cancer Depend on the Type of Red Meat Consumed. J Nutr. 2013:143;464-472.

Be Smart About Meat Consumption• Grilling

– Marinade, cook at lower temperatures

• Include cruciferous vegetables• Replace red meat with fish, shellfish,

chicken, turkey, yogurt, beans, tofu, nuts• Choose lean cuts

– Sirloin, loin, round, and mignon

• Replace processed meats in sandwiches with:– Nut butters, hummus, baked chicken or turkey,

egg, chicken or tuna salad, low-fat cheeseBerjia, F. Burden of diseases estimates associated to different red meat cooking practices. Food and Chem Toxic. 2014;66:237-244.

Weight and CRC • Overall, after not smoking being a healthy

weight is the most important thing you can do• Weight gain in adult life appears to increase

risk for CRC– Specifically abdominal weight gain (apple shape)

• Increases pro-inflammatory components

• Control weight– Portion sizes, increase dietary fiber, decrease

calorie dense foods, increase physical activity

Aleksandrova, K. Adult weight change and risk of CRC in the EPIC and Nutrition. Euro J Cancer. 2013;49:3526-3536.

Dietary Fiber• There is convincing evidence that foods

containing fiber decrease risk• Every 10 grams reduces risk by 10%• Fiber recommendations

– 25g/d women– 38g/d men

• Soluble vs insoluble– Increase transit time, removes harmful substances

• Start slowly

Food, Nutrition, Physical Activity, and the Prevention of Cancer: a Global Perspective and the 2012 CUP Report on

Colorectal Cancer 

Garlic and Cruciferous Vegetables• Garlic may be protective for CRC

– Contain substances that have anti-cancer effects• Quercetin• Allixin• Allicin

• Cruciferous vegetables – High in antioxidants, fiber, folate– Help decrease inflammation– Broccoli, Brussels sprouts, cabbage, etc

Tse, G. Cruciferous vegetables and risk of CRC neoplasms: A systematic review and meta-analysis. Nutr and

Cancer. 2014;66(1):128-139.

Nutritional Recommendations• Focus on the whole picture• We know…

– Keeping a healthy weight – Eating a mostly plant-based diet– Avoiding processed meats, limiting red meat– Avoiding energy dense foods– Avoiding supplements as a protection from

cancer– Limiting alcohol consumption– Increasing daily physical activity decreases

cancer risk

Mostly Plant-Based Diet• Increase fruit and vegetable consumption

– 7 to 9 servings per day– Colorful choices

• Focus on whole grains– At least ½ of grains should be whole grains

• Consume beans, lentils, and legumes– Good alternative to meats

• Meat is the “side dish”• Avoid sugary beverages

– Flavor beverages with fruits/vegetables/herbs

Physical Activity• ACSM recommendations for cancer survivors

– 150mins/wk moderate-vigorous exercise– Strength training 2x per week for each major

muscle group– Stretch major muscle groups when participating

in activity

• Caution with morbidly obese, lower limb lymphedema

• Start with light-intensity, progress slowly, and allow cancer-related symptoms be the guide

http://www.aicr.org/learn-more-about-cancer/colorectal-cancer/#prevention

Resources• YMCA LiveSTRONG program• Referral to RD

– Insurance coverage is limited

• Meals to Heal Nutrition Coaching– Affordable, easy

• New American Plate Challenge– Free, cancer-specific– www.napchallenge.org

• Fight Colorectal Cancer– www.Fightcolorectalcancer.org

References • http://www.aicr.org/learn-more-about-cancer/colorectal-cancer/• http://www.dietandcancerreport.org/expert_report/report_overview.php• http

://www.livestrong.org/What-We-Do/Our-Actions/Programs-Partnerships/LIVESTRONG-at-the-YMCA

• Egeberg, R. Associations between Red Meat and Risk for Colon and Rectal Cancer Depend on the Type of Red Meat Consumed. J Nutr. 2013:143;464-472.

• Helmus, D. Red meat-derived heterocyclic amines increase risk of colon cancer. Nutr and Cancer. 2014;65(8):1141-1150.

• Berjia, F. Burden of diseases estimates associated to different red meat cooking practices. Food and Chem Toxic. 2014;66:237-244.

• Keum, N. Folic acid fortification and CRC risk. Am J Prev Med.2014;46(3S1):S65-S72.

• Tse, G. Cruciferous vegetables and risk of CRC neoplasms: A systematic review and meta-analysis. Nutr and Cancer. 2014;66(1):128-139.

• Aleksandrova, K. Adult weight change and risk of CRC in the EPIC and Nutrition. Euro J Cancer. 2013;49:3526-3536.

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