“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.

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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.”

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Twitter: @cathylemanrd

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Easy. Peasy. 

Sources

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