“How Targeted Nutrition May One Day Eliminate Your Breast Cancer Risk”

Purchased this in 2007! #aheadofmytime

“Essentially, “nutrigenomics” is the study of the effects of foods and food constituents on gene expression. Identifying the effects of individual nutrients or an entire nutritional plan based on an individual’s genotype allows for a customized nutritional “prescription” targeting unique and specific health needs. | What I love about nutrigenomics is the focus on wellness and prevention rather than the treatment of disease. While nutrigenomics is not yet mainstream, consumer awareness and demand combined with robust scientific evidence (the ability to replicate studies) is moving us toward the day when a prescription for a targeted eating plan will be as common as a prescription for penicillin.”  – Cathy Leman, MA, RD, LD

Nutrigenomics [nutri-gen-O-mics] is a term that may be new to you, and why wouldn’t it be?

Unless you’re steeped in the world of nutrition (and genetics) and prevention, nutrigenomics wouldn’t necessarily be on your radar, yet it’s a fascinating area of nutrition and I’m excited to give you a quick introduction here.

My first experience with nutrigenomics was somewhere in the early 2000’s when I attended a workshop on functional nutrition. I’ll never forget how Ruth DeBusk, PhD, RD (a nutrigenomics guru, btw) shared the concept of using nutrition to “switch” certain genes off and on. I was captivated by what that could mean for the future of nutrition and disease management and prevention, and my work continues to be influenced by that idea today.

Consider this. A simple DNA cheek swab reveals breast cancer genes that could be modified with targeted dietary advice. What if that advice was simply to eat an apple every day, because nutritional constituents identified in that apple were known to reduce or eliminate that particular individual’s risk of developing breast cancer. For someone else, the same cheek swab reveals apples INCREASE the risk of developing breast cancer. Advice to skip the apple and eat the fruit(s) identified to decrease risk would be life-changing.

Can you imagine?

Essentially, nutrigenomics is the study of the effects of foods and food constituents on gene expression. Identifying the effects of individual nutrients or an entire nutritional plan based on an individual’s genotype allows for a customized nutritional “prescription” targeting unique and specific health needs.

What I love about nutrigenomics is the focus on wellness and prevention rather than the treatment of disease. While nutrigenomics is not yet mainstream, consumer awareness and demand combined with robust scientific evidence (the ability to replicate studies) is moving us toward the day when a prescription for a targeted eating plan will be as common as a prescription for penicillin.  

At the recent Academy of Nutrition and Dietetics conference, I attended “Nutrigenomics: Is It Ready for Prime Time?”, presented by Ahmed El-Sohemy, PhD, adjunct professor in the Department of Nutritional Sciences at the University of Toronto, and the Canada Research Chair in Nutrigenomics, who outlined a solid argument for why we should even “bother” to consider nutrition and genetics/genomics.

Quite simply, one nutritional protocol does not fit all.

Take caffeine, one example highlighted during the talk. Depending on an individual’s genotype (the underlying genetic information encoded in a chromosome), caffeine can have an increased, decreased, or zero effect on health outcomes. If you’re someone who experiences elevated blood pressure or heart rate when you eat or drink anything with caffeine – wouldn’t you want to know more about how to manage that?

For now, we use broad nutrition recommendations supported by research that, while effective,  aren’t always as targeted as we’d like. The idea of applying nutritional recommendations that match each person’s health needs is absolute nirvana to me. I simply can’t wait until that’s the norm in how we practice dietetics.

Until then, stay tuned for more on the topic of nutrigenomics. The implications for each of us in taking control of our health is monumental.

FYI, a couple of recommendations for further reading on this topic, both penned by Dr. DeBusk, RD:

“Genetics The Nutrition Connection”   |  “It’s Not Just Your Genes”

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“What We Can Learn About Breast Cancer & Diet From the Women’s Health Initiative”

* Photos originally accompanying the initial publishing of this post have been removed to honor the request of the presenters of this session. *

You would be forgiven if you think the Women’s Health Initiative (WHI) is a vehicle for women to initiate action and take good care of themselves. You would also be forgiven if you’ve never even heard of the Women’s Health Initiative.

Sitting down with a friend over a steaming cup of coffee to discuss the outcomes and nuances of WHI is not an everyday occurrence for the lay public, but it’s exactly the lay public, specifically the FEMALE portion, that the WHI works to impact.

The Women’s Health Initiative is a multi-million dollar, 20+ year national health study focusing on the prevention of heart disease, breast and colorectal cancer, and osteoporotic fractures in postmenopausal women. In older women, regardless of race and socioeconomic background, these chronic diseases are the major causes of death, disability and frailty. (1)

This robust study was one of the most definitive, far-reaching clinical trials of postmenopausal women’s health ever undertaken in the U.S., and will continue into the future to provide practical information to inform women and their physicians.

The Observational Study portion continues to examine the relationship between lifestyle, health and risk factors and specific disease outcomes, and involves tracking the medical history and health habits of 93,676 women. 

Every aspect of the study yields fascinating outcomes for improving health, yet as you may have guessed, I’m most interested in the Dietary Modification component, an evaluation of the effect of diet, specifically a low-fat, high fruit, vegetable and grain diet, on the prevention of breast and colorectal cancers and coronary heart disease.

I recently attended the Academy of Nutrition and Dietetics annual Food & Nutrition Conference (FNCE) where three dietitians knee-deep in the WHI research presented on this topic; Dr. Marian Neuhouser and Dr. Lesley Tinker from Fred Hutchinson Cancer Cancer Research Center in Seattle, WA (the WHI Clinical Coordinating Center for data collection, management, and analysis), and Dr. Linda Van Horn from Northwestern University Feinberg School of Medicine in Chicago, IL.

Because this research continues to evolve and yield new findings, it was no small undertaking to distill volumes of information into an insightful overview and actionable directives we can use NOW , but these esteemed speakers did not disappoint. Below, I share the main take-home messages:

Insight Into Why Specific Diet Protocols Don’t Yet Exist

 

Cancer cells are wily; able to successfully evade our immune system’s efforts to destroy them, replicate themselves many times over, invade and metastasize to other areas of the body, build new blood supply’s, and resist cell death. Determining the EXACT way that food, dietary patterns and nutrition can outsmart and confer protection against a cancer cell’s innate arsenal remains elusive – yet researchers are making progress.

Nutrition, Diet and Its Impact on Cancer Initiation

 

We aren’t there yet – true prevention, that is. While I dream of a world where prevention rules, until that time comes I use the term “risk reduction.” Still, findings exist that link diet and nutrition to a positive impact on the cancer disease process at several points, specifically: DNA repair, cellular proliferation, differentiation, the cell cycle and apoptosis (cell death). How does diet do that, you ask?

Per Dr. Neuhouser, who graciously responded to my email request for answers to that question (my notes were sketchy!), “These mechanisms are influenced by nutrients – primarily micronutrients – that act as co-factors of enzymes that up-regulate or down-regulate these pathways. Energy intake also plays a role, because macronutrient intake leads to insulin secretion, and hyper insulin secretion up-regulates the cell proliferation pathways.”

Here’s a translation:

Micronutrients are nutrients in food that the body needs in small amounts; vitamins and minerals, whereas macronutrients are foods required in large amounts; carbohydrate, protein, fat (and water and fiber.) Micronutrients (i.e. vitamins E, C, D, A and minerals like calcium, potassium and phosphorus) act like “helpers” (co-factors) to make other processes happen in the body, and macronutrients supply calories (making up our “energy intake”) to fuel the body. It’s the action of these micro and macronutrients – too much or too little micronutrients and/or calorie intake – in “regulating” certain pathways that help tame or spur on cancer cells in their proliferation or differentiation, support cells in their repair efforts, or encourage cell death.

Having the ability to one day share with patients/clients specific foods that turn cancer cells on or off, knowing how much to eat for targeted results, providing meal timing guidelines, and micro and macronutrient distribution for each individual’s specific breast cancer would be a game changer. Personalized nutrition protocols such as this would make a significant difference in healing, treatment outcomes, risk reduction, and dare I say, even PREVENTION!

What We DO Know

  • Being overweight or obese is linked to nearly every common cancer in both men AND women.
  • Lifestyle factors, exercise AND diet are responsible for ~30% of all cancers.
  • A better diet is associated with lower risk of cancer deaths, which held true for all women in this study EXCEPT for those who started with a body mass index (BMI)  >30.
  • There appears to be an interrelationship between pre-diabetes and diabetes as risk factors for breast cancer, with obesity a contender as the link.
  • We may see some differences in outcomes between the different types of breast cancer (there are many) and diet.
  • Women who ate a high-fat diet at the start of the study (which was reduced during the study through intervention) showed greater reduction in breast cancer risk (possibly connected to weight loss.)
  • Over the long term, postmenopausal women who followed a diet consistent with the American Cancer Society guidelines on nutrition and other healthy diet indicators (i.e. American Institute for Cancer Research) had significantly lower breast cancer risk and mortality.
  • Breast cancer takes years to develop; a healthy diet should be maintained long-term for the maximum health benefit.

_________________________________

Putting It Into PRACTICE

As I see it, the challenge for most women in effectively and consistently using the ACS nutrition guidelines lies in only being told WHAT to do, but not HOW to do it. Below are the “whats”, and I’ve added a few “how-tos” to help make this work for you:

6 American Cancer Society Guidelines on Nutrition

  • Eat a healthy diet, with an emphasis on plant foods. 
      • ⅔ of plate filled with vegetables.
      • Eat a vegetable and/or fruit with each meal/snack.
  • Choose foods and drinks in amounts that help you get to and maintain a healthy weight.
      • Serve meals at home on 9 inch plates; have seconds if you’re still hungry (are you REALLY?), yet refill plate only 50%.
      • Take ⅔ of restaurant meals home as leftovers.
      • Order smallest size available for beverages containing calories.
  • Limit how much processed meat and red meat you eat.
      • ≤ 18 ounces/week.
  • Eat at least 2 1/2 cups of vegetables and fruits each day.
      • Not sure how much that is? Use measuring cups to train your eye, or visualize 2 ½ fists full.
  • Choose whole grains instead of refined grain products.
      • Whole wheat pasta and flour.
      • Brown rice.
      • Quinoa, amaranth, whole grain (vs. pearled) barley, millet.
  • If you drink alcohol, limit your intake.
    • No more than 1 standard drink (defined below) per day for women or 2 per day for men:
      • 12 ounces of regular beer
      • 5 ounces of wine
      • 1.5 ounces of distilled spirits
    • A standard drink contains 14 grams of PURE alcohol (the true culprit behind the cancer connection, which has nothing to do with the VOLUME in your glass.) (2)
    • For breast cancer, there is NO safe limit for alcohol.

If you want more nutrition and breast cancer information and updates on programs and services, shoot me an email at cathy@cathyleman.com.

I’ll subscribe you to my weekly newsletter, and as a thank you, send along my “25 Ways To Strike Back At Breast Cancer.”

You can follow me here. . .

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Sources

  1.  “The Women’s Health Initiative” 
  2. “The National Institutes of Health | The National Institute on Alcohol Abuse and Alcoholism”

 

“Food & Nutrition Conference (FNCE) 2017 Snappy & Quick Recap”

100th anniversary for the academy; 20th anniversary for me!

When you celebrate a milestone anniversary, throw a bash, and 13,000 people show up?

It could end up messy, chaotic, and jumbled, or, as was the case for the Academy of Nutrition and Dietetics 100th anniversary celebration, a rousing success.

Sure, there was some grumbling – you simply can’t shuttle bus 13,000 people between McCormick Place and beyond for 3.5 days straight without long lines and extended wait times – and that was only for the women’s bathroom (a hazard of belonging to a predominantly female profession!)

But then again, some people are NEVER happy. I wasn’t one of them.

I’ve just returned from my profession’s annual food and nutrition conference and exhibition (FNCE) held October 21-24. My brain is stuffed full of new information, and my heart overflows with gratitude and love for not only what I do, but the amazing people I get to do it with; my colleagues.

I got to hang out with a group of the most dedicated healthcare professionals and caring friends I know – from literally every corner of the United States and beyond. Regardless of our individual areas of practice – sports, women’s health, pediatric or oncology nutrition – soaking up the latest nutrition science from cutting edge researchers, physicians and other professionals while sitting shoulder to shoulder with our nutrition besties literally had all of us a little giddy.

Except those complainers ;).

Below are a few highlights of the event, and in the coming weeks share blog posts that dig deeper into the four hottest presentations I attended:

  1. The Women’s Health Initiative: Two Decades of Knowledge Ready for Dissemination
  2. The Evidence: Intermittent Fasting Effects on Cardiometabolic Disease and Cancer
  3. Cancer Survivorship Lifestyle Guidelines: Time for Action
  4. Nutrigenomics: Is It Ready for Prime Time?

EXHIBIT FLOOR FINDS

While I didn’t get to spend a lot of time at the exhibits, here’s what I saw trending: 

  • Foods you can eat on the run – everything seemed to be packaged to take with you.
Power Bar w/a Savory Item
  • Foods that are already prepared; just heat and eat, rip open and eat, or squeeze and eat.
Bagged and plastic bowl’d ready-to-eat salads were plentiful.

  • Bars are going NOWHERE. Whether meal replacement, snack, protein or granola – packaged food bars show no signs of slowing down.
If I have to eat a bar that I didn’t make in my kitchen – this is one of my favs!
Have to send a shout-out to this bar, created by local Glen Ellyn guys who (very) recently sold the company to Kellogg – for enough $$ to buy 10 lifetimes of bars. Company still headquartered in Chicago!
  •  An obvious focus on what’s NOT in your food vs what is, and a reminder that this product really is REAL food. Ok.

  • Superfoods, superfruits, etc. were just – everywhere.

And finally, what would a nutrition and food conference be without an actual cranberry bog. Yes, this really happened. Don the waders and boots and climb in to slosh through the bog. . .I didn’t.

 

“How To Outsmart Your Kitchen’s Counter-Culture”

“Out of sight, out of mind”: The idea that something is easily forgotten or dismissed as unimportant if it is not in our direct view.

If you were to stop reading this right now, snap a photo of your kitchen countertops and text it to me, what would I see?

That may sound like a crazy idea, but it’s exactly what Cornell University researchers did in two fascinating studies. In the first, researchers asked 500 random household occupants nationwide to inventory their kitchen and provide their height and weight. In the second, the kitchens of 210 households were photographed and inventoried, and the occupants’ height and weight measured.

Knowing that we control the food in our kitchen, and environment strongly influences health, the researchers were curious to learn whether the visibility of certain foods sitting out on a person’s counter impacted their weight. While this study showed correlation only, they learned that the presence of fruit on the counter was associated with lower weight in both studies, and the presence of foods like candy, cereal, soda and dried fruit were associated with higher weights.

Hanging out in my own kitchen last weekend, I thought about how certain items on our counters influence not only weight, but health in general (this wasn’t a stretch for me, I’d just been to the grocery store while at the same time contemplating topics for this week’s blog!).

Grapes for nibbling. These were in the path from kitchen to garage where my husband was working. He grabbed one every time he walked by. . .he’s the grazer in the family.
Fruit for snacks/dessert and a visual reminder to cook the potatoes (vs forget while they rot in the pantry!).

I’m all about the HABITS that determine our health, and a simple habit is to carefully curate what hangs out on your countertop!

I’ve counseled many clients who say they can’t avoid eating certain foods when they’re kept in plain sight, regardless of hunger. If this sounds familiar, let’s make that tendency work FOR rather than against you; put the “healthier” stuff in plain sight, and the “treat” foods. . .well, read below to find out.

Hey there grapes – it’s time for your close up.
  • Avoid bringing into the house snacks that call to you from the kitchen. Instead, eat them when dining out (i.e. ice cream, cookies) to help manage serving sizes.
  • Store cereal, crackers, chips and granola bars in your pantry or cabinets. These tend to be “grazing” foods that don’t satisfy hunger, do raise insulin, and keep you coming back for just-one-more-handful.
  • Store bakery treats in the freezer, behind the frozen fruit. Portion out a single slice of coffee cake or muffin for the day, and stash it in the back of the refrigerator.
  • Individually portion nuts into 1-ounce packages; leave 1 packet/day on the counter next to the fruit bowl.
  • If you’re a soda drinker (even diet), store it in the refrigerator, behind the pitcher of water.
  • Candy? An open bowl is too tempting for too many people. Rather than completely avoiding it – deprivation never works – keep it “out of sight, out of mind.”
  • What’s your tidiness score? A kitchen counter covered in books, papers, bills and your kids’ school projects doesn’t whisper invitingly “Come cook with me” – it screams “Call for takeout!”

 

“Three Reasons Why Strawberries Actually DON’T Cure Breast Cancer”

I get a little cranky when I see headlines like this: “Eating Strawberries Daily Can Help Prevent and Even Cure Breast Cancer”

I know I shouldn’t get cranky. This sort of headline primarily serves to increase readership and subscriptions, for heaven’s sake. I mean, why would an editor ever consider that these words could be a dagger to the heart for some of their readers?

Editors don’t think about those of us who’ve been through the ravages of REAL breast cancer (vs. in the laboratory FAKE breast cancer), feeling all vulnerable and open to trying most ANYTHING if it will cure the REAL breast cancer or keep the REAL breast cancer away or prevent it from returning forever, amen.

Not to mention, headlines like this confuse the heck out of breast cancer folks – they’re already unsure about what to eat or not – rickety science headlines do nothing to help.

In order to assuage my crankiness, let’s take this apart; first looking at this headline for what it is, and then seeing if we can find something good in it, shall we?

  1. FREQUENCY

Let’s start with a question. What food (or foods), do you actually eat daily – 365 days/year?

I’d say, not many, probably.

For me personally, the ONLY thing I eat or drink every, single day, is coffee. Even my own anti-cancer, risk-reduction diet that I cling to like a life-raft can deviate (slightly) from day to day.

Without question, there are standard items that I aim to eat daily, but sometimes my food choices depend on whether I’m traveling, if I’ve been to the grocery store, or if my husband polished off the remaining (fill in food here) that I’d planned to eat.

So if, as the headline screams, the prevention and cure hinges on the frequency of strawberry eating, and you can’t (or won’t) sustain daily strawberry eating? You’re already doomed.

2. FORM and VARIETY

Next question. When was the last time you ate strawberry extract?

And not just any old strawberry extract. Extract from the “Alba” strawberry.

Right. Never.

In this study, the researchers used polyphenol-rich strawberry extract (PRSE) obtained from the “Alba” variety.

As it turns out, the “Alba” strawberry is an early ripening variety from Italy. A quick online search reveals that this particular variety is very difficult to get your hands on in the United States.

Believe me when I say, there is little I would like better than to be in Italy 365 days/year, eating early ripening strawberries, be they juiced, dried, whole, macerated, even extracted.

But that’s highly unlikely, so if I were looking for this strawberry cure or prevention RIGHT NOW? Vorrei, ma non posso.

If the prevention and cure hinges on the FORM (extract – read “concentrated”) and VARIETY (“Alba”, courtesy of beautiful Italy), once again, doomed.

3. SUBJECT(s)

This research was performed using “cell lines” of both mouse and human origin.

Cell lines are cell cultures developed from a single cell. In cancer research they’re used as fundamental models to study the biology of cancer and to test the beneficial effectiveness of anticancer agents, but cell lines have limitations, and aren’t perfect representations of actual human or cancer cells.

Also of note, this study looked at the effects of the PRSE on one particular cell line; the highly aggressive and invasive basal-like breast cancer cell line A17.

If I’ve learned anything since my own breast cancer diagnosis, it’s that there are many different types of breast cancer, so a beneficial treatment, even in food form, may perhaps not have the same outcome for everyone. Which begs the question; what impact, if any, would this strawberry extract variety have on different types of cancer cells?

We don’t know. And that can feel discouraging. Bleh.

THE GOOD NEWS

But hey, let’s not write strawberries off yet! Here’s where we unearth the goodies from this story, and I get less cranky.

Berries (of ALL types) have a group of phytochemicals (anti-cancer compounds) called “polyphenols.” Two particularly active types of polyphenols that work together are anthocyanins, a class of flavonoids that gives berries their color, and ellagitannins, the source of ellagic acid, which may inhibit tumor cell production.

Berries also contain simple, yet powerful phenols such as quercetin and ferulic acid, and they’re loaded with vitamin C, manganese (a mineral) and fiber.

Strawberries in particular have high levels of antioxidants and phytochemicals, as well as a host of other bioactive compounds. Yet, as the researchers do point out (yay researchers!):

“The role of strawberry bioactive compounds on cancer prevention seems to involve different mechanisms, which have not yet been fully elucidated; therefore, further investigations are needed to clarify the roles of the different strawberries phytochemicals against cancer cells. Several studies on extracts of strawberries, raspberries, and other fruits and berries, did not find any correlations between the content of some phytochemicals and inhibition of cancer cell proliferation. Different studies indeed have shown that the complex mixtures of phytochemicals present in fruits and vegetables are more effective than their individual constituents in preventing cancer, through both additive and synergistic effects.”

So, here’s what you can do.

Eat the whole, entire, real fruit. Skip the berry extract supplements and powders and drinks. Buy yourself a pint of strawberries, and if you’re so inclined (and don’t have diabetes where you need to watch carb portions), eat the entire thing in one sitting. The calories are low(ish), fat non-existent, and the benefit completely outweighs eating an entire bag of potato chips (duh) – which people are inclined to do with nary a thought.

Each week, add 4-5, 1/2 cup servings of berries to smoothies, oatmeal and other cereal, salads and snacks, keeping in mind that there may be merit to eating a variety of berries (black, blue, straw, rasp).

They each bring something different to the anti-cancer party!

Source: Polyphenol-rich strawberry extract (PRSE) shows in vitro and in vivo biological activity against invasive breast cancer cells