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Vicky Newman, MS, RD Associate Clinical Professor UCSD School of Medicine

HEALING FOODS PHYTOCHEMICALS Foods for Cancer Prevention Focus on Vegetables & Fruits with “BIG Color & BIG Flavor”. Vicky Newman, MS, RD Associate Clinical Professor UCSD School of Medicine. Diet and Cancer Current Associations. Breast Prostate Colon Pancreas Lung Bladder Ovary/cervix

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Vicky Newman, MS, RD Associate Clinical Professor UCSD School of Medicine

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  1. HEALING FOODSPHYTOCHEMICALSFoods for Cancer PreventionFocus on Vegetables & Fruits with“BIG Color & BIG Flavor” Vicky Newman, MS, RD Associate Clinical Professor UCSD School of Medicine

  2. Diet and CancerCurrent Associations • Breast • Prostate • Colon • Pancreas • Lung • Bladder • Ovary/cervix • Gastric • Oral/esophagus

  3. POSSIBLE WAYSDIETARY CONSTITUENTSPROTECT AGAINST CANCER • Antioxidant effects • Effects on cell differentiation • Increased activity of enzymes that detoxify carcinogens • Blocked formation of nitrosamines • Altered estrogen metabolism

  4. POSSIBLE WAYSDIETARY CONSTITUENTSPROTECT AGAINST CANCER • Altered colonic milieu (including bacterial flora, bile acid composition, pH, fecal bulk) • Preserved integrity of intracellular matrixes • Maintenance of normal DNA repair • Increased destruction of cancer cells (apoptosis) • Decreased cell proliferation

  5. PHYTOCHEMICALS(Plant Protectors) • Substances produced by plants to protect them from damage from environment (predators, pathogens, solar radiation). • Antioxidants. • Include toxins produced by plant to fight off predators. When eaten by humans, these up-regulate detoxifying enzymes that help protect from harmful substances, including carcinogens. • Considered non-nutritive, because they do not provide energy, vitamins, or minerals. • Most are heat stable and not significantly lost in cooking water.

  6. Increase Proportion WhoCONSUME > 3 DAILY SERVINGS VEGETABLES • Healthy People 2010 Target 75% • All age groups* 49% • Female 20-39 years* 43% • Female 40-59 years* 49% • Female 60+ years* 43% • Male 20-39 years* 68% • Male 40-59 years* 64% • Male 60+ years* 56% *CSFII (2-day average), 1994-96.

  7. Increase Proportion WhoCONSUME > 1 DAILY SERVINGDARK GREEN/DEEP YELLOW VEGETABLES • Healthy People 2010 Target 75% • All age groups* 8% • Female 20-39 years* 9% • Female 40-59 years* 11% • Female 60+ years* 13% • Male 20-39 years* 4% • Male 40-59 years* 9% • Male 60+ years* 11% * CSFII (2-day average), 1994-96.

  8. Increase Proportion WhoCONSUME > 2 DAILY SERVINGS FRUIT • Healthy People 2010 Target 75% • All age groups* 28% • Female 20-39 years* 20% • Female 40-59 years* 26% • Female 60+ years* 35% • Male 20-39 years* 23% • Male 40-59 years* 28% • Male 60+ years* 40% * CSFII (2-day average), 1994-96.

  9. Nine are Divine

  10. Go for the BOLDBIG COLOR • Pigments give color to food and thus enhance eating enjoyment. • Almost 2,000 known plant pigments in our food, including over: - 800 flavonoids (yellow) - 450 carotenoids (orange, red) - 150 anthocyanins (blue, purple). • These pigments help protect us from disease.

  11. CAROTENOIDS • Powerful antioxidants • Some metabolized to vitamin A (retinol): - stimulate immune function; - role in differentiation of normal epithelial cells; - may further inhibit cell proliferation; - may induce increased cell- to-cell communication.

  12. DARK-GREEN LEAFY VEGETABLES • Contain carotenoid lutein: - no vitamin A activity, but antioxidant activity; - protective against macular degeneration. • Rich in folic acid: - deficiency may lead to chromosomal damage (cells less resistant to viral damage; also necessary for DNA repair).

  13. LYCOPENE • Responsible for the red color of tomatoes, also found in tomato juice, sauce, pink grapefruit, salsa • The predominant carotenoid in plasma; age and BMI inversely assoc with lycopene concentrations • Inverse relationship with prostate cancer (RR 0.65, CI =0.42-0.99) & cancers of GI tract • Evidence in breast cancer less substantial with RR of approx. 0.8-1.02. Giovanucci E. JNCI , 2002; Giovanucci E. JNCI, 1995; La Vecchia C. PSEBM, 1998; Ching, J Nutr 2002.

  14. TOMOTOES vs LYCOPENE • Study supports “whole is greater than sum of its parts”…or food more effective than an isolated food component. • Tomato powder but not lycopene supplement inhibited prostate cancer in rats. Boileau TW-M, JNCI 2003;95:1578-86; Gann PH, JNCI 2003;95:1563-65).

  15. BERRIES, RED GRAPES, RED CABBAGE Contain significant levels of phenolic flavonoids (like ellagic acid, ferulic acid): • Act as antioxidants; • Protect against LDL oxidation; • Inhibit platelet aggregation.

  16. ANTHOCYANINS(red & blue pigments) • Antioxidant flavonoids. • Anti-inflammatory. • Relax blood vessels. • Inhibit cholesterol production. • Inhibit activity of enzyme that speeds cell division (potentially decreasing cancer risk). • May protect against memory loss (aging).

  17. Go for theBOLDBIG Flavor

  18. CITRUS FRUIT(coumarins, D-limonene, glucarates) • Contain coumarins & D-limonene, a terpenoid shown to increase activity of detoxification enzyme (glutathione transferase). • Citrus pulp & white inner peel rich in glucarates (potential to prevent breast cancer & lower PMS symptoms).

  19. CITRUS FRUIT(Rich in Vitamin C) • Fights infection. • Antihistamine effects. • Antioxidant (protects cell membranes & DNA from oxidative damage). • Decreases conversion of nitrate to nitrite (reducing formation of nitrosamines). • Necessary for synthesis of collagen (deficiency could affect integrity of inter- cellular matrixes allowing tumor growth or hindering tumor encapsulation).

  20. CITRUS FRUIT(Rich in Flavonoids) • Extend activity of vitamin C. • Antioxidants. • Protect LDL cholesterol from oxidation to unsafe cholesterol oxides. • Inhibit platelet aggregation (decreasing blood clotting) • Anti-inflammatory & anti-tumor action. • Bioflavonoids in plants thought to act as insect attractants, repellants, & anti-fungal agents.

  21. CRUCERIFEROUS VEGETABLES • Arugula, Watercress • Broccoli • Brussels Sprouts • Cabbage • Cauliflower • Greens (Collard, Mustard) • Kohlrabi • Kale • Radishes • Rutabaga • Turnips

  22. CRUCIFEROUS VEGETABLES • Rich in sulfur compounds (sulphorophane & other isothiocyanates) that increase activity of enzymes involved in detoxification of carcinogens. • Contain indole-3-carbinol: - increases inactivation & removal of estrogen; - favors production of estrogen that is essentially inactive biologically.

  23. The Anticarcinogenic Mechanisms of Isothiocyanates (ITCs) Procarcinogens Inhibit carcinogen-activating enzymes e.g., P450s Ultimate Carcinogens Induce carcinogen-detoxifying enzymes e.g., GST ITCs DNA Damage Induce apoptosis & cell cycle arrest Inhibit inflammation Cancer

  24. ALLIUM VEGETABLESOnions, garlic, scallions, leeks, chives Contain protective sulfur compounds (allyl sulfides): • Enhance enzymatic detoxification systems; • Antibacterial activity may serve to inhibit bacterial conversion of nitrate to nitrite in stomach (reducing formation of nitrosamines).

  25. Allium Vegetables, Derivatives & Breast Cancer • Inhibition in growth of ER+ and ER- breast cancer cell lines • Epidemiological evidence: reduced incidence of breast cancer assoc. with allium vegetable consumption, but not garlic supplement (Dorant et al., Brst Ca Res and Treatment, 1995).

  26. AROMATIC HERBS • Basil, marjoram, mint, oregano, rosemary, sage, savory, & thyme contain potent antioxidants (some possess anti-tumor activity. • Terpenoids, compounds responsible for flavors of many common herbs & seasonings, also useful in cancer chemoprevention.

  27. PLANT PHENOLICSCancer Prevention Agents • Found in fruits, vegetables, grains. • Average consumption 1-2 g/day. • Functions in plants: - Antioxidant - Antiviral agents - Color - Structural (used to produce lignins)

  28. ANTI-CARCINOGENIC PROPERTIES • Antioxidants • Inhibit production of cancer-causing nitrosamines • Inhibit chemical mutagens (protect DNA) • Modulate inflammatory response (arachidonic metabolism)--decreases growth/spread of cancer cells

  29. Broccoli (highest) Spinach Onion (yellow) Pepper (red) Carrot Cabbage Potato Lettuce Celery Cucumber (lowest) HIGHEST IN PHENOLICS10 Commonly Consumed Vegetables(Chu YF. J Agric Food Chem 2002 (Nov 6);50(23):6910-6).

  30. Pepper (red) (highest) Broccoli Carrot Spinach Cabbage Onion (yellow) Celery Potato Lettuce Cucumber (lowest) HIGHEST TOTAL ANTIOXIDANT ACTIVITY10 Commonly Consumed Vegetables (Chu YF. J Agric Food Chem 2002 (Nov 6);50(23):6910-6).

  31. HIGHEST INHIBITORY EFFECT ON CANCER CELLS(Chu YF. J Agric Food Chem 2002 (Nov 6);50(23):6910-6). • Spinach • Cabbage • Pepper (red) • Onion (yellow) • Broccoli

  32. ANTIOXIDANT - RICH FRUITSRanked by ORAC Units/1/2 cup serving(adapted from Nutr & MD, 8/99) • Prunes, dried • Blueberries, fresh • Blackberries, fresh • Strawberries, fresh • Raisins, dried • Oranges, fresh • Plums, fresh • Raspberries, fresh • Grapes, red, fresh • Cherries, fresh

  33. ANTIOXIDANT- RICH VEGETABLESRanked by ORAC Units/1/2 cup serving (adapted from Nutr & MD, 8/99) • Kale, cooked, fresh • Brussels sprouts, cooked, fresh • Beets, cooked, fresh • Peppers, red bell, raw • Onions, cooked • Broccoli florets, cooked, fresh • Spinach, raw • Corn, cooked, frozen, kernels • Alfalfa sprouts, raw • Eggplant, cooked, fresh

  34. Strawberries Bell peppers (green & red) Spinach Cherries (US) Peaches Cucumbers Cantaloupe (Mexican) Celery Apples Apricots Green beans Grapes (Chilean) Pesticide RiskHANDLE WITH CARE(Environmental Working Group - www.ewg.org)

  35. Avocados Corn Onions Cauliflower Sweet potatoes Brussels sprouts Cabbage Broccoli Green peas Carrots Bananas Grapes (US) Kiwifruit Plums Pesticide RiskSAFE BETS(Environmental Working Group - www.ewg.org)

  36. FIBER-RICH FOODS(Vegetables, Fruits, Whole Grains, Beans) • Rich sources of protective nutrients & phytochemicals. • Feel full with fewer calories (lowers risk obesity & hormone-related cancers). • Fiber speeds transit through GI tract (reducing exposure of GI mucosa to cancer-causing chemicals). • Fiber enhances excretion of carcinogens & excess hormones. • Bound phenolics released in colon to provide antioxidant protection.

  37. PHYTIC ACIDin Cancer Prevention • Phytic acid found in whole grain, beans, nuts, & seeds. • Also known as inositol hexaphosphate or IP6. • In laboratory studies: - Ability to halt abnormal cell proliferation & shrink tumors; - Reduce angiogenesis (creation of new blood vessels that promote tumor growth).

  38. WHOLE GRAINS(Adom KK. J Agric Food Chem 2002;50(21):6182-7). • Antioxidant phytochemicals (phenolic compounds, especially ferulic acid) • Vitamin E (especially gamma tocopherol) • Folate • Fiber

  39. INCREASE PROPORTION WHOCONSUME > 3 DAILY SERVINGSWHOLE GRAIN PRODUCTS • Healthy People 2010 Target 50% • All age groups* 7% • Female 20-39 years* 5% • Female 40-59 years* 5% • Female 60+ years* 6% • Male 20-39 years* 11% • Male 40-59 years* 10% • Male 60+ years* 12% * CSFII (2-day average), 1994-96.

  40. BEANS • Protease inhibitors may increase accuracy of DNA repair, decrease rate of tumor cell division, or decrease destruction of surrounding tissue. • Saponins may exert a preventive effect against colon cancer by binding bile acids & cholesterol in colon. • Rich in fiber (hastens movement of potentially irritating substances through intestines).

  41. BEANS • Significant inverse relationship between frequency of legume intake & colon cancer incidence: - Individuals consuming legumes >2 times/week were 47% less likely to develop colon cancer than individuals who consumed legumes <once/week. • Inverse relationship between non-soy legume consumption & prostate cancer. • Data from 41 countries revealed that countries with greatest consumption of had lowest death rates due to breast, prostate, & colon cancer. • One mechanism may be regulation of blood glucose and insulin (insulin-like growth factor).

  42. SOYBEANS(Isoflavones) • Weak phytoestrogens (compete with more potent estrogens for binding sites). • Genistein inhibits activity of enzyme involved in growth of transformed cells. • Genistein & biochanin A increase destruction of tumor cells.

  43. Best Sources ofPHYTOESTROGENS

  44. FLAXSEEDS • Rich in alpha-linolenic (omega-3 fatty acid)-- anti-inflammatory. • Flaxseed meal rich in lignans (content is 75-800 times that of 66 other plant foods). • Lignans act as estrogen antagonists (may decrease risk of hormone-related cancers).

  45. LESS IS MORECorrelated with Less Fat in Diet • More vegetables • More fruit • More fiber • More carotenoids • More folate • More vitamins • More lowfat milk Subar AM. Am J Pub Health 1994;84:359-66.

  46. Tea and Breast Cancer • Breast cell line growth inhibition; apoptosis • Reduced tumor size and multiplicity in mouse model of mammary tumor • Consumption assoc. w/ reduced axillary lymph node metastases in post-menopausal women (Fujiki H, J Ca Res Clin Oncol, 1999). • Case-control study (Asian women in Los Angeles) found risk of breast cancer not related to black tea consumption, but 47% reduction in risk with 3 cups green tea/day (Wu AH. Int J Cancer 2003;106(4):574-9.

  47. Dietary Recommendations • Choose predominantly a plant-based diet. • Maintain a healthy weight & avoid weight gain in adulthood (<11 pounds) • Maintain physical activity (1hr/day moderate activity & 1hr/wk vigorous activity) • Increase vegetables (3-5 svg/day) • Increase fruits (2-4 svg/day) • Increase whole grains & legumes (3+/day) • Limit red meat (< 3 oz/day) • Limit dietary fat (15-30% energy) • Limit alcoholic beverages (<1/day for women) • Limit charcoaled or smoked foods

  48. UCSDHEALTHY EATING PROGRAM Sponsored by The American Cancer Society 619-682-7431

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