Dr. Bhaskar K.S. & Dr. Shweta M.
Cancer is a major health problem, being the second leading cause of death in United States. Recently there has been surge of interest in relationships between Cancer and Diet. Concerns fall in two categories:-
1. Relationship between nutrition and etiology of Cancer.
2.Relationship between diet and progression of Cancer in the host. (1)
In comparison to the number of people who might never develop Cancer if a few changes are made in lifestyle and dietary habits. Diet and environmental factors might be related to 80% of all Cancers. (2,3)
The most common fatal Cancers, Lung, Large intestine and Breast are directly related to either Cigarette smoke or diet. Smoking is the cause of more cancers than any other known substances. A high fat, low fiber diet is linked to Cancer of Bowel and Breast.(4,5)
Additionally, the health of immune system-the body’s defense against infection and disease might be important in protecting the body from the development and growth of abnormal cells. (6)
Nutritional deficiencies, as well as dietary excesses, exert an influence on Cancer growth. It is estimated that diet accounts for up to 70% of all Cancers and is the most influential environmental cause of Cancer in addition to smoking. (7)
The National Academy of Sciences states that “Cancer of most major sites is influenced by dietary patterns”. (8)
Nutrition and Carcinogenesis
Of all the forms of Cancer known, a handful have been associated with diet and nutrition. This is not to say that diet causes Cancer but that under some circumstances diet may influence development of Cancer.
Dietary fat in relation with Breast and other hormone dependent Cancers
Total fat intake has been called an indicator of the risk of Breast Cancer in post-menopausal woman. (9,10)
A mechanism that has been suggested to explain relationship between high fat intake and breast is an altered hormonal environment in which ratio of Prolactin to Estrogen is increased. (10,11)
Woman with Ovarian Cancer consume more fat from whole milk butter and other animal sources and less non-fat milk, margarine and fish than healthy woman.(12,13)
A change in the body’s hormonal state as a result of diet may also be involved in development of other endocrine dependent Cancers, including Cancers of the Prostate and Endometrium, although the relationship is not clear cut. (9,14,15)
Ideal body weight
People who maintain an ideal body weight live longer and are less likely to develop Cancer. (16,17)
Low calorie diets also might reduce the incidence of tumour formation, although this might be caused more by the reduction in total calories. People who are 20% or more above their ideal body weight are more likely to develop Cancers such as of Uterus (16,18), gall bladder, kidney, prostate, cervix, stomach, colon and breast.
Dietary fat
All forms of dietary fat are linked to Cancers. The saturated fats found in foods from animal sources and unsaturated polyunsaturated fats in foods from plant sources and vegetable oils both increase the risk of developing Cancer. (19)
Vegetable oils cannot replace butter in diet, so that the total fat intake should be reduced.
When people consume a diet high in fatty meat and low in fruits and vegetables the risk of cancer increases 8 fold as compared to people who eat a low fat, high fiber diet. (20)
The poly unsaturated fats in vegetables oils are as likely to cause Cancer as saturated fats. Dietary polyunsaturated fats are incorporated into cell membranes in the body. The fats are susceptible to damage, called Oxidation, by highly reactive compounds called free radicals. Free radicals are formed from air pollution, radiation and natural metabolism of proteins. This in-turn can trigger a chain reaction that cause damage to fat and destroys cells and tissues. This process might cause Cancer. (21)
Another type of fat that is linked to Cancer is trans fatty acid found in margarine and shartenig. These fats are found sparingly in nature, but levels can be high in hydrogenated vegetable oils. (22)
Trans fatty acids might impair cell function and they could be involved in development of Cancer. (23,24)
Smokers, a group at high risk for lung cancer might increase this risk by consuming a diet high in Cholesterol .(25)
Colon Cancer
Compounds that act as tumor promoters might be produced when dietary fats turn rancid. The consumption of vegetable oils and other dietary fats that contain same rancid fats can expose the intestine to Cancer causing substances.(26)
Since Cancer patients have altered metabolism, the benefit of nutrition is not as much as in non-Cancer patients. Factors other than poor nutrition are responsible for their low serum albumin; total parenteral nutrition may not increase the serum albumin.(27)
For these reasons, routine intravenous feeding is discouraged. (28)
Experienced clinicians prefer oral feeding or peripheral vein nutrition and resort to central parenteral nutrition only when if absolutely essential.
Incidences of Colon Cancer appears to rise with increasing fat intake of populations; however, the correlation of colon cancer with calories from animal foods is slightly higher than that for fat.(29)
High fat diets increase the release of bile acids from gal bladder. It has been suggested, though not supported by research, that bile acids that have been modified by bacteria within the intestine may contribute to CARCINOGENESIS.
Colon cancer rates are lower in members of certain religious groups who consume a low fat, high fibre vegetable diet than American population.(19)
Meat
Nitrosamines, food additives that are found in processed meat are initiative of Cancer(21).
Meat intake may be related to incidence of Colon cancer for reasons other than its fat content. Frying or broiling meat can result in the formation of PYROGENS, which are mutagenic substances(30).
It is unknown whether methods of cooking meat have a significant effect on colon cancer rates.
Alcohol
It is clear that incidence of specific types of Cancer (Cancer of oral cavity, pharynx, larynx, colon and oesophagus ) is greatly increased in person who both drink alcoholic beverages and use tobacco. Risk of pancreatic cancer may be increased by heavy use of alcoholic beverages, particularly beer (31).
Certain types of alcoholic beverages may increase the risk of specific Cancers because they contain other compounds ,Congeners which increase cancer risk (32).
Evidence is lacking that high alcohol intake contributes to the development of Liver Cancer (33).
One substance known to convert substances in body to Carcinogens is CYTOCHROME P-450,found in the liver. Alcohol increases the level of Cytochrome P-450 and is believed to be linked in to the risk of certain cancers in alcoholics (34).
Beer consumption, but not alcohol consumption, is directly correlated with colon cancer ; the greater the intake of beer the greater the likelihood of colon cancer (35,36).
Alcohol abuse is also associated with a suppression of the immune system, a factor that may make person susceptible to Cancer (35,37).
Alcoholics are known for their poor food intake and poor nutritional status. Alcohol interferes with the absorption of some nutrients and raises requirement for other nutrients. Alcoholics often have low levels of Vitamin-A and Vitamin-C, Folic acid, many B-Vitamins, Zinc and Selenium (38).
Deficiencies of these vitamins and minerals are associated with an increased risk of Cancer.
OTHER SUBSTANCES
Food additives
The general public trends to feel comfortable using food additives which they are familiar such as Salt, Herbs, Spices and Vitamins. Some purpose of food additives are to improve the appearance , texture, storage life of convenience food.
Nitrites and Nitrates
Nitrites and Nitrates are food additives used to preserve and color processed meat. These compounds also occur in nature, especially in beats, celery, lettuce, spinach, radishes and rhubarb. Nitrates can be converted to Nitrites by bacteria in saliva. Nitrites then combine with other substances found in stomach and form cancer causing substances called Nitrosamines. In the areas of World where exposure to these substances is great, there is an increased incidence of cancers of the stomach and oesophagus (8,40).
Cigarettes are high in nitrosamines and the use of nitrogen fertilizers has increased the amount of nitrosamines in water supply. A diet high in Vitamin-C and Vitamin-E can reduce the formation in the stomach of nitrosamines from nitrites (37).
Sugar
A diet high in Sugar is linked to increased risk for developing cancer of breast and bowel. Although these diets also are associated with reduced fibre intake, increased fat consumption and excess Calorie intake, the sugar might exert an independent effect on the incidence of Cancer. (40,41)
Artificial Sweeteners
Many people turn to artificial sweeteners to satisfy their sweet tooth while reducing their calories. Experimental studies on animals show that SACHHARIN, given at high dosages, produce Urinary tract tumors.(37)
This sweetener promotes the action of other carcinogens in the bladder. Saccharine use has increased since Cyclamates were banned in 1970, after studies showed that an increase in bladder tumors. (8)
Saccharine might increase a person’s risk for bladder cancer and as saccharine use increase so does the risk of cancer. The concern over the safety of saccharine has led to an increase in the use of aspartame. It does not appear to have negative effects on human health. (8,37)
Other food additives
More than 3000 chemicals are intentionally added to foods during processing. Another 12000 additives are added unintentionally to foods. These additives such as Vinyl chloride, migrate into foods during the growing , harvesting, packaging or storage of food.
Butylated hydroxyl toluene(BHT) and Butylated hydroxyl anisole(BHA) are preservatives used to prolong the shelf-life of foods.BHT might promote the formation of tumors (37).
No cancer promoting action has been found for BHA.
Natural Carcinogens-
Aflatoxin- A naturally occurring carcinogen is aflatoxin. Aflatoxin is a mold that forms on Corn, Cotton seed, Peanut and Peanut butter when these foods are not well preserved (42).
This substance is believed to be a potent carcinogen that increase risk of liver cancer.
Coffee-The statement that coffee or its caffeine content are linked to cancer has not been supported by research. Excess coffee consumption might be linked to a slight increase in bladder cancer incidence, but these results are not substantiated by studies (37).
The link between coffee consumption and pancreatic cancer also is weak and inconclusive (43,44).
Carcinogens formed during cooking-While a food might not be carcinogenic, the method used to prepare it might cause changes in the food that might make carcinogenic. Frying, Barbecuing or broiling meat or fish at high temperatures can produce cancer promoting substances from the fat and proteins in these foods. Smoked foods, such as ham, sausage, fish or oysters absorb the tars that are produced from the incomplete combustion of fuel. These tars contain several cancer causing substances that are similar to the carcinogenic tars in tobacco smoke. The liquid smoke sold commercially is less hazardous.
Cancer causing substance also have been found in other foods that are browned such as toast and fried potatoes. Dark roasted coffee contains some potential carcinogens (8).
Potentially protective effects of food components
Dietary fibers-The combination of a high fat diet with a low intake of fiber is linked to cancer of the colon (45).
Coffee-The statement that coffee or its caffeine content are linked to cancer has not been supported by research. Excess coffee consumption might be linked to a slight increase in bladder cancer incidence, but these results are not substantiated by studies (37).
The link between coffee consumption and pancreatic cancer also is weak and inconclusive (43,44).
Carcinogens formed during cooking-While a food might not be carcinogenic, the method used to prepare it might cause changes in the food that might make carcinogenic. Frying, Barbecuing or broiling meat or fish at high temperatures can produce cancer promoting substances from the fat and proteins in these foods. Smoked foods, such as ham, sausage, fish or oysters absorb the tars that are produced from the incomplete combustion of fuel. These tars contain several cancer causing substances that are similar to the carcinogenic tars in tobacco smoke. The liquid smoke sold commercially is less hazardous.
Cancer causing substance also have been found in other foods that are browned such as toast and fried potatoes. Dark roasted coffee contains some potential carcinogens (8).
Potentially protective effects of food components
Dietary fibers-The combination of a high fat diet with a low intake of fiber is linked to cancer of the colon (45).
It has been suggested that fiber can provide protection against development of the colon cancer by
1) Decreasing length of time that feces.
2) Diluting the intestinal contents.
3) Absorbing and /or affecting the metabolism of pro-carcinogens or cancer promoting substances, thus retarding the formation of carcinogens. (1)
Fiber also might affect the incidence of breast cancer. Woman who are vegetarians and consume a fiber-rich diet, 28 grams daily, excrete more estrogen than woman who consume the typical American diet containing 12 gram fiber daily. The increased removal of Oestrogen suggests that less Estrogen is reabsorbed (46).
Vegetarian woman also have lower blood levels of other hormones (47).
Vegetarian woman consume a diet containing 30% of fat and thus have a low incidence of breast cancer, compared to woman who eat meat and consume 40% of their calories as fat.
There are many types of fiber and different fibers are found .Hemicelluloses found in whole grain cereals. Gums such as Guar gum, are found in beans, oats, fruits and vegetables. The insoluble fibers, such as cellulose or wheat bran, appear to be the best protectors against cancer. Cellulose and other insoluble fibers might alter the type and activity of bacteria in the intestine and reduce their ability to produce cancer causing compounds. Finally, some cancer causing compounds are formed from bile. Fiber binds to bile and discourages its conversion to harmful substances (48).
Other types of cancer prevention have been attributed to fiber. Pectin decreases the production of certain fatty acids that are known to accelerate the growth of cancer cells in the bowel (49).
Lignin, a fiber in some vegetables has antioxidant properties. Lignin might protect a cell from damage by free radicals and might protect against some forms of cancer. (3, 50)
Vitamin-A—A diet that contains ample amounts of Vitamin-A and its form found in plant sources, Beta carotene, is associated with a reduced risk for developing some cancer including cancer of mouth, larynx, oesophagus, breast, cervix , bladder and lungs (51,52).
Diets that are low in Vitamin-A or Beta carotene increase a person’s risk for cancer (52).
The 2 step process in the development of cancer includes an initiation and a promotion phase. Vitamin-A and Beta carotene play an inhibiting role in both of these phases. Vitamin-A or Beta carotene might—
a)inhibit the growth of abnormal cells so that cancer tissue is unable to form
b)alter immune function and improve the body’s defense against abnormal cell growth
c)strengthen cell membranes and make them less vulnerable to attack or damage
d)or alter cell production so that abnormal cells are less likely to form (52).
Beta carotene might reduce the risk of developing lung cancer. Lung cancer rates are lower in smokers who consume a diet high in fruits and vegetables. When the intake of Beta carotene is low, the incidence of lung cancer in smokers increases (53).
The RDA for Vitamin-A might not be adequate to reduce a person’s risk of cancer (54).
The adult RDA of 4000IU-5000IU is designed to protect against the development of night blindness, which is the classic Vitamin-A deficiency disease. Large dosage for this fat soluble vitamin between 10,000 IU and 25,000 IU, have been suggested to decrease the risk of cancer (54).Because Vit-A can be toxic, large dosage on a routine basis are discouraged.
Vitamin-C-Use of high dosage of Vitamin-C has been promoted for prevention and treatment of Cancer (55,56,57). But these recommendation are based on very shaky evidence (58.59).
1) Decreasing length of time that feces.
2) Diluting the intestinal contents.
3) Absorbing and /or affecting the metabolism of pro-carcinogens or cancer promoting substances, thus retarding the formation of carcinogens. (1)
Fiber also might affect the incidence of breast cancer. Woman who are vegetarians and consume a fiber-rich diet, 28 grams daily, excrete more estrogen than woman who consume the typical American diet containing 12 gram fiber daily. The increased removal of Oestrogen suggests that less Estrogen is reabsorbed (46).
Vegetarian woman also have lower blood levels of other hormones (47).
Vegetarian woman consume a diet containing 30% of fat and thus have a low incidence of breast cancer, compared to woman who eat meat and consume 40% of their calories as fat.
There are many types of fiber and different fibers are found .Hemicelluloses found in whole grain cereals. Gums such as Guar gum, are found in beans, oats, fruits and vegetables. The insoluble fibers, such as cellulose or wheat bran, appear to be the best protectors against cancer. Cellulose and other insoluble fibers might alter the type and activity of bacteria in the intestine and reduce their ability to produce cancer causing compounds. Finally, some cancer causing compounds are formed from bile. Fiber binds to bile and discourages its conversion to harmful substances (48).
Other types of cancer prevention have been attributed to fiber. Pectin decreases the production of certain fatty acids that are known to accelerate the growth of cancer cells in the bowel (49).
Lignin, a fiber in some vegetables has antioxidant properties. Lignin might protect a cell from damage by free radicals and might protect against some forms of cancer. (3, 50)
Vitamin-A—A diet that contains ample amounts of Vitamin-A and its form found in plant sources, Beta carotene, is associated with a reduced risk for developing some cancer including cancer of mouth, larynx, oesophagus, breast, cervix , bladder and lungs (51,52).
Diets that are low in Vitamin-A or Beta carotene increase a person’s risk for cancer (52).
The 2 step process in the development of cancer includes an initiation and a promotion phase. Vitamin-A and Beta carotene play an inhibiting role in both of these phases. Vitamin-A or Beta carotene might—
a)inhibit the growth of abnormal cells so that cancer tissue is unable to form
b)alter immune function and improve the body’s defense against abnormal cell growth
c)strengthen cell membranes and make them less vulnerable to attack or damage
d)or alter cell production so that abnormal cells are less likely to form (52).
Beta carotene might reduce the risk of developing lung cancer. Lung cancer rates are lower in smokers who consume a diet high in fruits and vegetables. When the intake of Beta carotene is low, the incidence of lung cancer in smokers increases (53).
The RDA for Vitamin-A might not be adequate to reduce a person’s risk of cancer (54).
The adult RDA of 4000IU-5000IU is designed to protect against the development of night blindness, which is the classic Vitamin-A deficiency disease. Large dosage for this fat soluble vitamin between 10,000 IU and 25,000 IU, have been suggested to decrease the risk of cancer (54).Because Vit-A can be toxic, large dosage on a routine basis are discouraged.
Vitamin-C-Use of high dosage of Vitamin-C has been promoted for prevention and treatment of Cancer (55,56,57). But these recommendation are based on very shaky evidence (58.59).
It does appear that Vitamin-C may serve to reduce the risk of cancer of Stomach and Oesophagus (59,60,61).
If a source of ascorbic acid is taken with a meal that includes a source of nitrites (e.g. Pickled fish) the production of nitrosamines in stomach is reduced (62).
This is advantageous because nitrosamines are known to be potent mutagens and animal carcinogens.
Vitamin-E- Vit-E’s function as an antioxidant is its primary link in the prevention of cancer. Vit-E might inhibit the the growth of cancer(63).
This fat soluble vitamin reduces the formation of Nitrosamine from dietary nitrites and might reduce the risk for development of stomach cancer (64).
Vit-E also might assist selenium, a mineral that inhibits the development of cancer, when it is present in the diets(65).
The vit-E content of vegetable oils also declines when they are refined and bleached(66).
Folic acid- A folic acid deficiency causes damage to cells that resembles the initial stage of cancer(67).
Preliminary evidence shows that folic acid might prevent the conversion of abnormal cells to cancer cells and might convert damaged cells back to normal ones(68).
Vitamin-B6-Helps strengthen the immune system.The body might have more resistance to cancer when Vit-B6 is present in ample amount(69).
Vit-B6 also might protect against the initiation of cancer(70).
Iron-An iron deficiency might increase a person’s risk for cancer.Adequate iron intake is necessary for the proper function of the immune system, which might explain the link between this mineral and cancer. Iron deficiency also might increase the risk for stomach cancer(64).
Selenium-It’s a trace mineral that might be important in prevention of cancer. People who live in areas where the selenium content of the soil is poor have higher rates for cancer of digestive tract, lung, breast, lymph system than people who live in areas where the soil is selenium rich(71).
Blood levels of selenium are low in people with cancer and people with very low selenium levels have twice the risk for cancer as those with high selenium levels(72,73).
Selenium might protect against cancer in several ways, it is an antioxidant nutrient and apparently prevents cancer by protecting cell membranes from damage by free radicals(73-74).
In addition to its effectiveness as an antioxidant, selenium also might stimulate the immune system and strengthen the body’s defence against disease(75).
This is advantageous because nitrosamines are known to be potent mutagens and animal carcinogens.
Vitamin-E- Vit-E’s function as an antioxidant is its primary link in the prevention of cancer. Vit-E might inhibit the the growth of cancer(63).
This fat soluble vitamin reduces the formation of Nitrosamine from dietary nitrites and might reduce the risk for development of stomach cancer (64).
Vit-E also might assist selenium, a mineral that inhibits the development of cancer, when it is present in the diets(65).
The vit-E content of vegetable oils also declines when they are refined and bleached(66).
Folic acid- A folic acid deficiency causes damage to cells that resembles the initial stage of cancer(67).
Preliminary evidence shows that folic acid might prevent the conversion of abnormal cells to cancer cells and might convert damaged cells back to normal ones(68).
Vitamin-B6-Helps strengthen the immune system.The body might have more resistance to cancer when Vit-B6 is present in ample amount(69).
Vit-B6 also might protect against the initiation of cancer(70).
Iron-An iron deficiency might increase a person’s risk for cancer.Adequate iron intake is necessary for the proper function of the immune system, which might explain the link between this mineral and cancer. Iron deficiency also might increase the risk for stomach cancer(64).
Selenium-It’s a trace mineral that might be important in prevention of cancer. People who live in areas where the selenium content of the soil is poor have higher rates for cancer of digestive tract, lung, breast, lymph system than people who live in areas where the soil is selenium rich(71).
Blood levels of selenium are low in people with cancer and people with very low selenium levels have twice the risk for cancer as those with high selenium levels(72,73).
Selenium might protect against cancer in several ways, it is an antioxidant nutrient and apparently prevents cancer by protecting cell membranes from damage by free radicals(73-74).
In addition to its effectiveness as an antioxidant, selenium also might stimulate the immune system and strengthen the body’s defence against disease(75).
Selenium detoxifies Cadmium and mercury, two minerals known to cause cancer(8).
Selenium is available in supplements as the organic forms, such as Selenanethionine or Selenocysteine and the the inorganic form, which is sodium selenite.The organic form of selenium might be toxic and might promote cancer when taken in large doses (76-77).
Zinc-is required
1) for normal formation and regulation of genetic code within each cell.
2)maintenance of healthy immune system.
3) healing of tissues (78).
Whereas adequate intake of Zinc might be important in the prevention of cancer, large doses of zinc might inhibit the immune system and increase the risk for infection and disease(79).
Best dietary source of zinc are whole grain bread and cereals, low fat milk.
NUTRITIONAL CARE & GUIDELINES FOR PREVENTION OF CANCER
Good news about cancer is there is something each person can do to prevent it. Cancer may have several adverse effects on nutritional status for a variety of reasons. Helping the patient to comfortably maintain adequate nutrient intake may help him retain a sense of wellbeing and ability to carry-out activities of daily living. Impaired nutritional status can contribute to impaired function and feelings of depression (80)
CHANGED NUTRIENT REQUIREMENT:
Changes in nutrient, requirements resulting from cancer are unpredictable. Increase in metabolism that may be caused by tumor might be offset by decreased physical activity. If a person’s defense mechanism are impaired and he develops an infection, accompanying fever significantly increases resting metabolic requirement. Considerable variation is seen in resting caloric expenditure of people with cancer, with higher values found in those who are progressively losing weight. No definitive studies of changed micronutrient requirements have been reported for cancer.
It is clear that quality care of person with cancer requires careful assessment of their food intake, eating problems and special emotional and physical needs. Treatment of cancer can have profound effect on a patients nutritional and emotional status. Patient benefits from regular monitoring of changes and continuing support from healthcare providers and family.
DELETERIOUS NUTRITIONAL EFFECTS OF ANTICANCER THERAPY:
Antineoplastic (anticancer) therapy includes radiation therapy, chemotherapy and surgery. All of these lead to malnutrition (82).
Selenium is available in supplements as the organic forms, such as Selenanethionine or Selenocysteine and the the inorganic form, which is sodium selenite.The organic form of selenium might be toxic and might promote cancer when taken in large doses (76-77).
Zinc-is required
1) for normal formation and regulation of genetic code within each cell.
2)maintenance of healthy immune system.
3) healing of tissues (78).
Whereas adequate intake of Zinc might be important in the prevention of cancer, large doses of zinc might inhibit the immune system and increase the risk for infection and disease(79).
Best dietary source of zinc are whole grain bread and cereals, low fat milk.
NUTRITIONAL CARE & GUIDELINES FOR PREVENTION OF CANCER
Good news about cancer is there is something each person can do to prevent it. Cancer may have several adverse effects on nutritional status for a variety of reasons. Helping the patient to comfortably maintain adequate nutrient intake may help him retain a sense of wellbeing and ability to carry-out activities of daily living. Impaired nutritional status can contribute to impaired function and feelings of depression (80)
CHANGED NUTRIENT REQUIREMENT:
Changes in nutrient, requirements resulting from cancer are unpredictable. Increase in metabolism that may be caused by tumor might be offset by decreased physical activity. If a person’s defense mechanism are impaired and he develops an infection, accompanying fever significantly increases resting metabolic requirement. Considerable variation is seen in resting caloric expenditure of people with cancer, with higher values found in those who are progressively losing weight. No definitive studies of changed micronutrient requirements have been reported for cancer.
It is clear that quality care of person with cancer requires careful assessment of their food intake, eating problems and special emotional and physical needs. Treatment of cancer can have profound effect on a patients nutritional and emotional status. Patient benefits from regular monitoring of changes and continuing support from healthcare providers and family.
DELETERIOUS NUTRITIONAL EFFECTS OF ANTICANCER THERAPY:
Antineoplastic (anticancer) therapy includes radiation therapy, chemotherapy and surgery. All of these lead to malnutrition (82).
Since cancer has come to be viewed as a systematic disease, even when it appears to be localized (83) attempts to cure it are now likely to include treatment with drugs that act systematically as a form of adjunctive therapy.
VALUE OF ADEQUATE NUTRITIONAL STATUS:
Because antineoplastic therapy has many side effects that may interfere with adequate food intake or utilization, a person who is malnourished at the start of therapy is susceptible to developing serious nutritional problems as a result of treatment. Some studies show that person who have lost 6% or more of their usual body weight prior to treatment have significantly reduced response to chemotherapy and decreased survival (83).
It is not known whether weight gain prior to antineoplastic therapy improves a person’s response to treatment. It is hoped that maintaining satisfactory nutritional status during therapy improves a person’s response to treatment and will reduce symptoms of fatigue, weakness and depression that are associated with under nutrition. Thus, intensive nutritional support can be an important aspect of care.
DIETARY PATTERN THAT REDUCE RISK FOR DEVELOPING CANCER:
a)Maintaining ideal body weight:
The best method of weight control, besides exercise is to eat less fat and fatty food. A person can eat more food and lose weight if low fat foods are included in diet to replace the fatty foods. Maintenance of normal body weight is associated with a reduced risk for developing cancer (8).
b)Reducing dietary fat:
Fat consumption must not be more than 30% of total calorie intake if risk for developing cancer and other disease is to be reduced (8, 9).
i)Two third to three quarter of the food in the diet should come from foods from the plant sources such as fresh fruits & vegetables, whole grain breads & cereals, and dried beans & peas. These foods are high in fiber and low in fat & sugar.
Fruit and vegetable are good dietary source of Vit. A and Vit. C. A rule of thumb is three out of every four food or three quarter food on the plate should be foods from the plant sources.
ii) Low- fat and non- fat dairy foods should be emphasized rather than fatty dairy food to reduce the intake of saturated fat & cholesterol. The change from whole milk dairy food to low-fat or non-fat should be gradual
iii)Vegetable oil, butter. And other fats should be used sparingly. In cooking bake, steam or broil the foods.
c)Increasing the dietary fiber:
Recommendation for reducing fat in the diet will increase fiber intake. Not all the grains in the diet have to be whole grain, however at least half of the grain in the diet should be from the whole grain variety to guarantee adequate fiber intake.
Fresh fruits and green vegetables to be consumed adequately. Excessive consumption of fiber might reduce the absorption of some mineral and irritate the intestinal tract. The estimated safe and adequate amount of fiber that can be consumed daily is between 35-45 gm (84).
Example:
*6 serving of whole grain bread/roti, cereals & pasta.
1 serving=1 slice of bread, ½ cup cooked cereal or pasta, 1 cup whole grain cereal= 13 gm fiber.
*4 serving of fresh fruits and vegetables.
1 serving=1 piece of fruit or vegetable, 1 cup raw or ½ cup cooked = 15-23gm fiber.
*1 serving dried beans or peas.
1 serving =1/2 cup cooked =9 gm fiber
TOTAL == 37-45gm Fiber
d)Increasing intake of food high in Vit A & Vit C.
Vit A comes in two major form :
Retinol- animal source / origin.
Carotene- (B- Carotene) found in fruits and vegetables.
The Vit C content of food is easily destroyed. To protect this, store food at temperature below 40 degree, cook in a minimal amount of water, use cooking water to make gravies or soup, do not leave food out in air or under heat lamps.
VALUE OF ADEQUATE NUTRITIONAL STATUS:
Because antineoplastic therapy has many side effects that may interfere with adequate food intake or utilization, a person who is malnourished at the start of therapy is susceptible to developing serious nutritional problems as a result of treatment. Some studies show that person who have lost 6% or more of their usual body weight prior to treatment have significantly reduced response to chemotherapy and decreased survival (83).
It is not known whether weight gain prior to antineoplastic therapy improves a person’s response to treatment. It is hoped that maintaining satisfactory nutritional status during therapy improves a person’s response to treatment and will reduce symptoms of fatigue, weakness and depression that are associated with under nutrition. Thus, intensive nutritional support can be an important aspect of care.
DIETARY PATTERN THAT REDUCE RISK FOR DEVELOPING CANCER:
a)Maintaining ideal body weight:
The best method of weight control, besides exercise is to eat less fat and fatty food. A person can eat more food and lose weight if low fat foods are included in diet to replace the fatty foods. Maintenance of normal body weight is associated with a reduced risk for developing cancer (8).
b)Reducing dietary fat:
Fat consumption must not be more than 30% of total calorie intake if risk for developing cancer and other disease is to be reduced (8, 9).
i)Two third to three quarter of the food in the diet should come from foods from the plant sources such as fresh fruits & vegetables, whole grain breads & cereals, and dried beans & peas. These foods are high in fiber and low in fat & sugar.
Fruit and vegetable are good dietary source of Vit. A and Vit. C. A rule of thumb is three out of every four food or three quarter food on the plate should be foods from the plant sources.
ii) Low- fat and non- fat dairy foods should be emphasized rather than fatty dairy food to reduce the intake of saturated fat & cholesterol. The change from whole milk dairy food to low-fat or non-fat should be gradual
iii)Vegetable oil, butter. And other fats should be used sparingly. In cooking bake, steam or broil the foods.
c)Increasing the dietary fiber:
Recommendation for reducing fat in the diet will increase fiber intake. Not all the grains in the diet have to be whole grain, however at least half of the grain in the diet should be from the whole grain variety to guarantee adequate fiber intake.
Fresh fruits and green vegetables to be consumed adequately. Excessive consumption of fiber might reduce the absorption of some mineral and irritate the intestinal tract. The estimated safe and adequate amount of fiber that can be consumed daily is between 35-45 gm (84).
Example:
*6 serving of whole grain bread/roti, cereals & pasta.
1 serving=1 slice of bread, ½ cup cooked cereal or pasta, 1 cup whole grain cereal= 13 gm fiber.
*4 serving of fresh fruits and vegetables.
1 serving=1 piece of fruit or vegetable, 1 cup raw or ½ cup cooked = 15-23gm fiber.
*1 serving dried beans or peas.
1 serving =1/2 cup cooked =9 gm fiber
TOTAL == 37-45gm Fiber
d)Increasing intake of food high in Vit A & Vit C.
Vit A comes in two major form :
Retinol- animal source / origin.
Carotene- (B- Carotene) found in fruits and vegetables.
The Vit C content of food is easily destroyed. To protect this, store food at temperature below 40 degree, cook in a minimal amount of water, use cooking water to make gravies or soup, do not leave food out in air or under heat lamps.
1)Add a salad to daily menu.
2)Drink fruit and vegetable juices.
3)Select snacks of raw vegetable and fruit.
4)Serve fruit for dessert.
5)Include atleast one dark green leafy vegetable in the daily menu.
e)Increased intake of cruciferous vegetables.
The cruciferous vegetables including cabbage, broccoli, cauliflower contain more than just fiber, VitA, Vit C. Cruciferous vegetables contain cancer fighting substance called Indoles.
Therefore include several servings of these vegetables in the weekly menu.
f)Avoid salt-cured and smoked foods & foods that might cause cancer.
No diet is completely free of cancer –promoting substances.It is possible , however to minimize these substances while increasing the nutrients that protect against cancer, such as fiber, Vit A , Vit C.
Avoid cooking methods that promote the formation of cancer causing substance.
Examine nuts in their shell for freshness before eating; old peanuts &other nuts might contain aflatoxin, a potent carcinogen. Some non nutritive sweetener such as saccharine might increase the risk for developing cancer. These should be avoided.
THE ANTI-CANCER DIET:
* A high fiber low fat diet will provide ample amount of nutrients that fight cancer, such as Vit A & Vit C, as well other nutrients such as Vit D, Vit E, folic acid, VitB6, iron,selenium, zinc.
* This diet has only minimal amount of dietary component that encourage cancer.
* A reduction in fat is good way to reduce unnecessary calories and maintain a healthy weight.
REFERENCES:
2)Drink fruit and vegetable juices.
3)Select snacks of raw vegetable and fruit.
4)Serve fruit for dessert.
5)Include atleast one dark green leafy vegetable in the daily menu.
e)Increased intake of cruciferous vegetables.
The cruciferous vegetables including cabbage, broccoli, cauliflower contain more than just fiber, VitA, Vit C. Cruciferous vegetables contain cancer fighting substance called Indoles.
Therefore include several servings of these vegetables in the weekly menu.
f)Avoid salt-cured and smoked foods & foods that might cause cancer.
No diet is completely free of cancer –promoting substances.It is possible , however to minimize these substances while increasing the nutrients that protect against cancer, such as fiber, Vit A , Vit C.
Avoid cooking methods that promote the formation of cancer causing substance.
Examine nuts in their shell for freshness before eating; old peanuts &other nuts might contain aflatoxin, a potent carcinogen. Some non nutritive sweetener such as saccharine might increase the risk for developing cancer. These should be avoided.
THE ANTI-CANCER DIET:
* A high fiber low fat diet will provide ample amount of nutrients that fight cancer, such as Vit A & Vit C, as well other nutrients such as Vit D, Vit E, folic acid, VitB6, iron,selenium, zinc.
* This diet has only minimal amount of dietary component that encourage cancer.
* A reduction in fat is good way to reduce unnecessary calories and maintain a healthy weight.
REFERENCES:
- Cancer, Nutrition-Principles and application in health promotion, Carol Jean West Suitor and Merrily Forbes Crowley, J.B Lippincott company, Philadelphia, 2nd edition, page no.517, 519.
- Wynder E, Gori G- Contribution of the environment to cancer incidence. An epidemiological exercise Natl Canc Inst1997; 58; 825-832.
- Reddy B, Cohenl, Mc coy Getal, Nutrition and its relationship to cancer. Adv cancer Res 1980; 32; 237- 345.
- Healthy people: The Surgeon Generals report on Health Promotion and disease prevention. Washington DC,U.S. Department of health, Education and welfare / public health services 1979, Pbl. No-79-55071 ,pp-60-67.
- Garrison R, Somer E, The Nutrition Desk Reference, New Cannan, Conn, Keats publishing co, 1985, pp 127-137.
- Walford R, The immunologic theory of ageing current status. Fed proc. 1974,3320-20.
- Doll R, Petor.The causes of cancer-quantitative estimates of avoidable risk of cancer in the united states today.J.Natl cancer Inst. 1981, 66, 1192.
- National Research Council: Diet, Nutrition, and cancer.2101 Constitution Ave, NW Washington DC 20418, National academy press, 1982.
- Symposium: Hypertension, and antihypertensive drugs. Fed proc 40:2250, 1981.
- Batterson B: Hypertension, Part 1. Detection and evalution.Cardiovasc Nurs 11:38, 1975.
- Borhani No: Epidemiology of Hypertension as a guide to treatment and control. Heart lung 10:245, 1981.
- Cramer D, Welen W, Hutchinson G, etal: dietary animal fat in relation to ovarian cancer risk.Obstet Gyn 1984; 63:833, 838.
- Snowden D: diet and ovarian cancer.JAMA 1985; 254:356.
- Hypertension detection and follow-up program co-operative group five year findings of the hypertension detection and follow up program. I .Reduction in mortality of persons with high blood pressure, including mild hypertension. Jama 242:2562,1979.
- Hypertension detection and follow up program co-operative group five year findings of the hypertension detection and follow-up program II. Mortality by race, sex, age. Jama 242:2572, 1979.
- Willet W, MacMahon B:diet and cancer-an overview.N Eng JMed 1984; 310:697-703.
- Snowdon D, Phillips R, Warren C:Diet,Obesity and risk of fatal prostate Cancer,American Journal of Epidem 1984;120:244-250
- Hirayana T:Diet and Cancer, Nutrition & Cancer 1979;1;67-81
- Garrison R.Somer E; The Nutrition Desk reference,New Canoun, Conn,Keats publishing Co.1985,P..130.
- Manousos U, Day N,Trichopoulos D, et al:Diet and Colorectal Cancer;A case control study in Greece,Intl J Cancer 1983;32;1
- Cancer and Nutrition. David Herber, Elizabeth Somer, 1994 CBS Publishers and distributors. Ist edition 4.
- Garrison R,Somer E;The Nutrition Desk Reference,New Canoun,Conn,Keats publishing Co.,1985,P-168-169
- Mc Gill H, Geer J,Strong J:The Natural History of Atherosclerosis,in kummerow F(ed),Metabolism of lipids as related to Atherosclerosis,Springfield,IL,Charles C Thomas,1965,P.36
- Hsu C,Kummerow F,Influence of elaidate and erucate on Heart mitochondria,Lipids 1977;12;486
- Hinds M,Kilonel L,Hankin J et al, Dietary Cholesterol and lung cancer risk in a multi-ethnic population in Hawaii,Int J Cancer 1983;32:727-732
- Ames B: Dietary Carcinogenes and anti carcinogenes Science,1983;221:1256-1262
- Gray GE, Meguid MM. Can total potential nutrition reverse hypoalbuminemia in oncology patients?Nutrition 1990;6:225-8.
- MC Geer AJ, Detsky AS, O’Kourkek. Parenteral nutrition in cancer patients undergoing chemotherapy:a meta-analysis. Nutrition 1990;6:233-40.
- Luft FC, Wein berger MH, Grim CE:Sodium sensitivity and resistance in normotensive humans.Amj Med 72:726, 1982.
- Mc carron DA: Low serum concentrations of ionized calcium in peatients with hypertension. N Engl Jmed 307:226, 1982.
- WHO / ISH Mild hypertension Liaison committee:trials of the treatment of mild hypertension: an interim analysis Lancett 1:149, 1982.
- Hypertension detection and follow-up programe coo-operative group. 5-year findings of the hypertension detection and follow up program.III. Reduction in stroke incidence among persons with high blood presure JAMA 247:633, 1982.
- Symposium: Hypertension and antihypertensive drugs. Fed proc 40:2250, 1981.
- Alexander L,Goff H:Chemicals,Cancer and Cytochrome,P-450,J Chem Ed 1982;59:179
- National Research Council:Diet,Nutrition and Cancer,2101,Constitution Ave,New Washington D.C. 20418,National Academy Press,1982
- Newell G,Ellision N (eds):Nutrition and Cancer: Etiology and treatment, New York, Raven Press,1981.P-93-110
- Czajka-N farins D,Cheney C,Aker S;Nutrition, Diet and Cancer in Krause M,Mahan L(eds):Food,Nutrition and Diet therapy,7th Ed,Philadelphia,WB Saunders,1984,P-735-743
- Garrison R,Somer E:The Nutrition Desk reference,New Canoun,Conn,Keats publishing Co,1985,P-210
- Weishburger J, Wynder E,Horn C:Nutrition and Cancer-A review of relevant mechanism,Cancer Bulletin 1982;34:128-136
- Bristol J,Emmett P,Heaton K et al ,Sugar, Fat and risk of Colorectal Cancer,Br Med J,1985,291:1467-1470
- Sugary foods may promote Breast Cancer,New Scientist,March 10,1983,P-648
- Ames B:Dietary Carcinogens and anti carcinogens, Science,1983,221:1256-1262
- Lin R,Kessler I: A multifactor model for Pancreatic Cancer in Man:Epedemiological evidence,JAMA 1981;245:147
- Jacobsen B,Bjelke E;Coffee consumption and Cancer: A prospective study. Presented at the 13th International cancer congress, Seattle,1982.
- Medeloff A: Dietary fiber and health in Nutrition in Disease-fiber.Columbus, ohio, Ross laboratories, 1978,PP5-15.
- Goldin B, Adler creutz H, Gorbach S, etal: Estrogen excretion patterns and plasma levels in vegetarian and omnivorous women.Neng J Med 1982; 307:1542-1547.
- Armstrong B, Brown J, Clarke H, ETAL:Diet and reproductive hormones: Astudy of vegetarian and no vegetarian postmenopausal women. JNCI 1981; 67:761-767.
- Eastwood M, Kay R: An hypothesis for the action of dietary fiber along the gastrointestinal tract. AMJ Clinical nutrition 1979; 32:364-367.
- Thomsen L, Roberton A, Wong J, Etal: Intracaecal short chain fatty acids are altered by dietary pectin in the rat. Digestion1984;29:129-137.
- Hirayama T: Diet and cancer.Nutrition cancer 1979;1:67-81.
- Bjelke E:Dietary vit A and human lung cancer.Int. J Cancer 1975;15:561.
- Garrison R, Somer E: The nutrition desk reference. New Canoan, Conn,Keats Publishing co, 1985,pp139-140.
- Shekelle R, Lius, RagnorW, etal:Dietary vitA and risk of cancer in the western electric study. Lancet 1981;2:1185-1189.
- Kummet T, Meysskens f:Vit A:Apotential inhibitor of the human cancer, Seminars in oncology 1983;10:281.
- Berkley GE:Cancer, How to prevent it and how to help your doctor fight it. Englewood cliffs, prentice-Hall,1978.
- Passwater RA:Cancer and its Nutritional Therapies New Canan,CJ, Keats, 1978.
- Cameron E, Pauling L:Supplementalascorbate in the supportive treatment of cancer:Prolongation of survival times in terminal human cancer. Proc Natl Acad Sci USAA73:3685,1976.
- CreagonET, Moertel CG,O’FallonJR etal:failure of high dose vit C(ascorbic acid) therap to benefit patients with advanced cancer.N Engl J Med 301:687,1979.
- Ellison NM, Londer H. Vitamins E&C and theit relationship to cancer.I n Newell GR, Ellison NM (eds):Nutrition and cancer.Etiology and treatment.Newyork, Rave Press, 1981.
- Kolonel LN:Cancerpattern of four ethnic group in Hawaii INCI 65:1127,1980.
- Committee on diet, nutrition and cancer:Washington,National Academy Press, 1982.
- Mirvish SS:Inhibition of the formation of carcinogenic N-nitroso compoundss by ascorbic acid and other compounds.In Burchenal JH, Dettgen HF(eds): Cancer, Achievements, challenges and prospects for the 1980’s, vol 1.P557.Newyork, Grune and Stratton,1981.
- Prasad D, Edwards-Prasad J:Effects of tocopheral (VitE) Acid succinct or morphological alterations and growth inhibition in melanoma cells in culture.Canc Res 1983;42:550-555.
- Czajka-N farin D, Cheneyc, Akers:Nutrition, diet and cancer, in krauseM, Mahan L(eds):food , nutrition and diet therapy 7 ed.Philadelphia, WB saunders, 1984,PP 735-743.
- Horvath P,Clement L:Synergistic effect of vit E and selenium in the chemoprevention of the mammary carcinogenesis in rats.Canc Res 1983; 43:5335-5541.
- Garrison R, Somer E: The Nutrition Desk Reference.New CANAN,Conn, Keats Publishing Co, 1985,PP40-42.
- Yunis J, Soreng A: Constitutive fragile sites in cancer. Sience 1984; 226:1199-1204.
- Butter worth C: Folate-induced regression of cervical intraepithelial neoplasm in users of oral contraceptive agents.AMJ clinical nutrition 1980;32:926.
- Hendler S: The complete guide to anti ageing nutrients.Newyork, SIMON AND Schuster, 1985,PP 99-100.
- Proir F: Theoretical involvement of vitB6 in tumor initiation Medical Hypothesis 1985;16:421,428.
- Snemberger R, Tytko S, Willis C:Antioxidants and cancer: V1 Selenium adjusted human cancer mortality.Arch Environ health 1976; 31:23.
- Hamberger R, Rukovenaa E Longfield A, etal: antioxidant and cancer: I Selenium in blood of normals and cancer patients. JNCI 1973;50:863.
- Willett W,Polk B, Harris j, etal: prediagnostic serum selenium and risk of cancer. Lancet 1983;2:130-134.
- Griffin A:Role of selenium in the chemoprevention of cancer.Adv canc Res 1979; 29:419-442.
- Spalnoz J:Selenium: what role in immunity and immune cytotoxicity, in SpalholJ, Martin J, Ganther H(eds):selenium in biology and medicine.Westport, Conn, AVI Publishing,1981,PP103-117.
- Hellzlsover K: Selenium and cancer prevention.Seminars in oncology 1983;10:308.
- Noda M, Takano T, Sakurai H: Effects of selenium on chemical carcinogens.Nutrition Res 1979:66:175.
- Garrison R, Somer E: The nutrition desk reference.New Canoan, Conn, Keats Publishing Co. 1985, PP 77-78.
- Chandra R: Excessive intake of zinc impairs immune responses.JAMA 1984;252:1443-1446.
- Goldberg RJ:Management of depression in the patient with advanced cancer.JAMA 246:3733,1981.
- Horoyde CP,Gabuzda TG Putnam R6 etal, Altered glucose metabolism in metastatic carcinoma.cancerRes 35:3710,1975.
- Hoffmann-Guetz L, Blackburn GL: Relationship of nutrition to immunology and cancer.In Newell GR, Ellison NM:Nutrition and cancer: Etiology and treatment Newyork, Raven Press 1981.
- Martin DS: The scientific Basis for adjuvant chemotherapy. Cancer treatment Rev 8:169,1981.
- Sell BF valdivieso M, Zaren HA etal:Protection against chemotherapy toxicity by I.V. hyper alimentation.Cancer Treat Rep 62:1139,1978.
No comments:
Post a Comment