lifestyle medicine & cancer risk
TRANSCRIPT
6/9/2021
1
Lifestyle Medicine& Cancer RiskKara Markin, MD, dipABLMAssistant ProfessorUniversity of Nebraska Medical Center
Disclosures
I have no financial disclosures or conflicts of interest.
1
2
6/9/2021
2
Objectives
1. Define Lifestyle Medicine
2. Recognize the significance of epigenetics in cancer risk
3. List the 10 evidence-based Cancer Prevention Recommendations of the Continuous Update Project of the American Institute for Cancer Research (AICR)
Lifestyle Medicine Defined
Lifestyle Medicine is the use of a whole food, plant-predominant dietary lifestyle, regular physical activity, restorative sleep, stress management, avoidance of risky substances and positive social connection as a primary therapeutic modality for treatment and reversal of chronic disease.
3
4
6/9/2021
3
Field Characteristics
Conventional Use of medications and surgical procedures to treat diseases thought to be caused by pathogens, environmental exposures, genetic predisposition
Lifestyle Use of evidence-based lifestyle recommendations to “treat the cause”
Complementary / Alternative
Uses complementary with conventional medicine or alternative in place of conventional medicine
Integrative Addresses whole person (physical, social, emotional, mental, environmental, spiritual) through combination of conventional, complemental and alternative means.
Functional Focuses on physiologic and biochemical functions of the body and investigates the balances and processes of cellular metabolism, digestive function, detoxification and control of oxidative stress.
Mind-Body Investigates interactions between mind and body – behaviorally, emotionally, mentally, socially and spiritually. Uses modalities like relaxation, hypnosis, visual imagry, meditation, yoga, biofeedback, tai chi
Preventative Includes all aspects of prevention of morbidity and mortality, often on a public health level, including immunizations and screening tests
5
6
6/9/2021
4
Simple, Powerful Therapy
• NUTRITION: Choose predominantly whole, plant-based foods that are fiber-filled, nutrient dense, health-promoting and disease-fighting.
• SLEEP: Lack of, or poor-quality sleep can lead to a strained immune system. Identify and alter environmental habits that may hinder healthy sleep.
• EXERCISE: Regular and consistent physical activity is an essential piece of an optimal health equation.
• SUBSTANCE USE: The well-documented dangers of any addictive substance use can increase risk for many cancers and heart disease.
• STRESS MANAGEMENT: Identify both positive and negative stress responses with coping mechanisms and reduction techniques for improved wellbeing.
• SOCIAL CONNECTION: Being connected to others is essential to emotional resiliency and overall health.
Am J Clin Nutr, Volume 96, Issue 1, July 2012, Pages 150–163, https://doi.org/10.3945/ajcn.111.031674
Adherence to World Cancer Research Fund guidelines and risk of cancer at 13 sites.- 386,355 participants- 11y follow-up
Measured Factors1. Weight2. Physical Activity3. Nutrition4. Alcohol Use5. Breastfeeding
Decreased Risk Increased Risk
7
8
6/9/2021
5
Am J Clin Nutr, Volume 101, Issue 3, March 2015, Pages 558–569, https://doi.org/10.3945/ajcn.114.094854
Adherence to American Cancer Society lifestyle guidelines and risk of cancer at 25 sites.- 476,396 participants- 13.6y follow-up
Measured Factors1. Weight2. Physical Activity3. Nutrition4. Alcohol Use
Decreased Risk Increased Risk
Cancer incidence for selected cancers in Japanese women by generation in Hawaii and Japan, 1968-1977
9
10
6/9/2021
6
Epigenetics is the study of the molecular mechanisms that modify chromatin – usually in a stable or heritable way – that may bring about changes in gene expression without altering the DNA sequence.
Source: https://www.whatisepigenetics.com/fundamentals/
11
12
6/9/2021
7
Dai, Z. Nature Reviews Genetics 21, 737-753
Dai, Z. Nature Reviews Genetics 21, 737-753
13
14
6/9/2021
8
Disease
Lifestyle
Epigenetics
This material has been reproduced from the World Cancer Research Fund/American Institute for Cancer Research. Diet, Nutrition, Physical Activity and Cancer: a Global Perspective. Continuous Update Project Expert Report 2018. Available at dietandcancerreport.org.
15
16
6/9/2021
9
This material has been reproduced from the World Cancer Research Fund/American Institute for Cancer Research. Diet, Nutrition, Physical Activity and Cancer: a Global Perspective. Continuous Update Project Expert Report 2018. Available at dietandcancerreport.org.
This material has been reproduced from the World Cancer Research Fund/American Institute for Cancer Research. Diet, Nutrition, Physical Activity and Cancer: a Global Perspective. Continuous Update Project Expert Report 2018. Available at dietandcancerreport.org.
17
18
6/9/2021
10
This material has been reproduced from the World Cancer Research Fund/American Institute for Cancer Research. Diet, Nutrition, Physical Activity and Cancer: a Global Perspective. Continuous Update Project Expert Report 2018. Available at dietandcancerreport.org.
dietandcancerreport.org
CUP evidence: Increased risk of 12
cancers
IARC*: Increased risk of thyroid cancer, multiple myeloma, meningioma
Overweight and obesity in childhood and early life tend to track into adulthood
Greater body fatness increases the risk of other diseases such
as heart disease
*IARC, International Agency for Research on Cancer
19
20
6/9/2021
11
dietandcancerreport.org
Strong evidence for recommendations
CUP evidence: Reduced risk of
bowel, breast and womb cancers
Indirect: Other cancers via effect on
obesity
Moderately physically active
Follow or exceed national guidelines
Role of sedentary behaviours
Dietary fibre and wholegrains
protective against bowel cancer
Dietary fibre decreases risk of weight gain and
obesity
Non-starchy veg and fruit help
protect against aerodigestive
cancers*
30g fibre per day
“5-a-day” (400g) fruit and veg
Most meals
* ‘Aerodigestive cancers’ include: mouth and throat; nasopharynx; oesophagus; lung; stomach; and bowel.
wcrf.org/dietandcancer/recommendations/be-physically-activewcrf.org/dietandcancer/recommendations/wholegrains-veg-fruit-beans
Be physically activeBe physically active as part of every day life – walk more
and sit less
Eat a diet rich in wholegrains, vegetables, fruit and beans
Make wholegrains, vegetables, fruit and pulses (legumes) such as beans and lentils a major part of your usual diet
This material has been reproduced from the World Cancer Research Fund/American Institute for Cancer Research. Diet, Nutrition, Physical Activity and Cancer: a Global Perspective. Continuous Update Project Expert Report 2018. Available at dietandcancerreport.org.
dietandcancerreport.org
Strong evidence for recommendations
CUP evidence:‘Fast foods’ and a
‘Western type’* diet increase the risk of
weight gain, overweight and
obesity
CUP evidence: Glycaemic load
increases the risk of womb cancer
Relevant for prevention of other
diseases
CUP evidence: Sugar sweetened
drinks increase the risk of weight gain,
overweight and obesity
Provide energy but may not influence
appetite in the same way as food
does so can promote
overconsumption of calories leading to
weight gain
Type 2 diabetes
Dental caries and poor oral health
wcrf.org/dietandcancer/recommendations/limit-fast-foods-fat-sugarwcrf.org/dietandcancer/recommendations/limit-sugar-sweetened-drinks
Limit consumption of ‘fast foods’ and other processed foods high in fat, starches or sugars
Limiting these foods help control calorie intake and maintain a healthy weight
Limit consumption of sugar sweetened drinksDrink mostly water and unsweetened drinks
*A 'Western type’ diet is characterised by high intakes of free sugars, meat, and dietary fat
This material has been reproduced from the World Cancer Research Fund/American Institute for Cancer Research. Diet, Nutrition, Physical Activity and Cancer: a Global Perspective. Continuous Update Project Expert Report 2018. Available at dietandcancerreport.org.
21
22
6/9/2021
12
dietandcancerreport.org
Strong evidence for recommendations
CUP evidence: High-dose beta-carotene
increases risk of lung cancer (current and
former smokers)
For most people, it is possible to obtain
adequate nutrition from a healthy diet
that includes the right foods and drinks
Supplementation may be needed to achieve adequate nutrient intake for
some people
CUP evidence: Red meat and processed meat both increase
the risk of bowel cancer
Three portions per week (350-500g cooked weight)
Balancing the advantages and
disadvantages of eating red meat
CUP evidence: Increased risk of six
cancers
But…decreased risk of kidney cancer
Heavy drinking associated with
increased risk of liver disease, pancreatitis
and CVD*
Effect of moderate drinking on non-
cancer outcomes?
*Cardiovascular disease
wcrf.org/dietandcancer/recommendations/limit-alcohol-consumptionwcrf.org/dietandcancer/recommendations/limit-red-processed-meat
wcrf.org/dietandcancer/recommendations/dont-rely-supplements
Limit alcohol consumptionFor cancer prevention, it’s best not to drink alcohol
Do not use supplements for cancer preventionAim to meet nutritional needs through diet alone
Limit consumption of red and processed meatEat no more than moderate amounts of red meat, such as beef,
pork and lamb. Eat little, if any, processed meat
This material has been reproduced from the World Cancer Research Fund/American Institute for Cancer Research. Diet, Nutrition, Physical Activity and Cancer: a Global Perspective. Continuous Update Project Expert Report 2018. Available at dietandcancerreport.org.
dietandcancerreport.org
Strong evidence for recommendations
CUP evidence:
Mothers: Decreases risk of breast cancer
Children: Having been breastfed
decreases risk of obesity
Aligns with WHO recommendation
for exclusive breastfeeding for six
months
Other benefits of breastfeeding,
including lower risk of infections for the
infant
Nutritional and physical activity
factors can reliably predict outcomes for breast cancer
Quality…?
Likely to help prevent other
diseases and help manage co-existing
disease
After acute stage of treatment, with input from trained
professionals
wcrf.org/dietandcancer/recommendations/breastfeed-your-babywcrf.org/dietandcancer/recommendations/during-after-cancer
For mothers: breastfeed your baby, if you canBreastfeeding is good for both mother and baby
After a cancer diagnosis: follow our Recommendations, if you can
Check with your health professional what is right for you
This material has been reproduced from the World Cancer Research Fund/American Institute for Cancer Research. Diet, Nutrition, Physical Activity and Cancer: a Global Perspective. Continuous Update Project Expert Report 2018. Available at dietandcancerreport.org.
23
24
6/9/2021
13
Objectives
1. Define Lifestyle Medicine
2. Recognize the significance of epigenetics in cancer risk
3. List the 10 evidence-based Cancer Prevention Recommendations of the Continuous Update Project of the American Institute for Cancer Research (AICR)
Lifestyle Medicine Defined
Lifestyle Medicine is the use of a whole food, plant-predominant dietary lifestyle, regular physical activity, restorative sleep, stress management, avoidance of risky substances and positive social connection as a primary therapeutic modality for treatment and reversal of chronic disease.
25
26
6/9/2021
14
Objectives
1. Define Lifestyle Medicine
2. Recognize the significance of epigenetics in cancer risk
3. List the 10 evidence-based Cancer Prevention Recommendations of the Continuous Update Project of the American Institute for Cancer Research (AICR)
Disease
Lifestyle
Epigenetics
27
28
6/9/2021
15
Objectives
1. Define Lifestyle Medicine
2. Recognize the significance of epigenetics in cancer risk
3. List the 10 evidence-based Cancer Prevention Recommendations of the Continuous Update Project of the American Institute for Cancer Research (AICR)
This material has been reproduced from the World Cancer Research Fund/American Institute for Cancer Research. Diet, Nutrition, Physical Activity and Cancer: a Global Perspective. Continuous Update Project Expert Report 2018. Available at dietandcancerreport.org.
29
30
6/9/2021
16
Life happens outside of clinic
References1. Geoffrey C Kabat, Charles E Matthews, Victor Kamensky, Albert R Hollenbeck, Thomas E Rohan, Adherence to cancer
prevention guidelines and cancer incidence, cancer mortality, and total mortality: a prospective cohort study, The American Journal of Clinical Nutrition, Volume 101, Issue 3, March 2015, Pages 558–569
2. Romaguera D, Vergnaud AC, et a. Is concordance with World Cancer Research Fund/American Institute for Cancer Research guidelines for cancer prevention related to subsequent risk of cancer? Results from the EPIC study, The American Journal of Clinical Nutrition, Volume 96, Issue 1, July 2012, Pages 150–163
3. Kolonel LN. Cancer incidence among Filipinos in Hawaii and the Philippines. J Natl Cancer Inst Monogr 69: 93–98.4. Dai, Z., Ramesh, V. & Locasale, J.W. The evolving metabolic landscape of chromatin biology and epigenetics. Nat Rev
Genet 21, 737–753 (2020).5. World Cancer Research Fund/American Institute for Cancer Research. Diet, Nutrition, Physical Activity and Cancer: a
Global Perspective. Continuous Update Project Expert Report 2018. Available at dietandcancerreport.org6. Sapienza C, Issa JP. Diet, nutrition and cancer epigenetics. 2016. Annu. Rev. Nutr. 36:665-681.7. American College of Lifestyle Medicine. https://www.lifestylemedicine.org
31
32