The Impact of Diet: Understanding Today’s Nutritional and Healthy Living

Guidelines

The Impact of Diet: Understanding Today’s Nutritional and Healthy Living

Guidelines

Presented by: Suzanne Dixon, MPH, MS, RDThe Health Geek, LLC

Presented by: Suzanne Dixon, MPH, MS, RDThe Health Geek, LLC

OverviewOverview

Obesity: Why It Happens, Why It Matters

Paradigm Shift: Nutrition vs. Physical Activity

New Paradigm: Great News for Breast Cancer Survivors

New Ideas for an Old Problem: Interoception

Health Guidelines, Survivorship, & Myth

Obesity: Why It Happens, Why It Matters

Paradigm Shift: Nutrition vs. Physical Activity

New Paradigm: Great News for Breast Cancer Survivors

New Ideas for an Old Problem: Interoception

Health Guidelines, Survivorship, & Myth

Reality for General Public & Cancer Survivors Alike

Reality for General Public & Cancer Survivors Alike

Our (Often Unrealistic) Response & GoalsOur (Often Unrealistic) Response & Goals

Energy Imbalance: The Myth We Perpetuate

Energy Imbalance: The Myth We Perpetuate

An energy deficit of approximately 500 kcal per day leads to steady rate of weight loss of 1 pound per week, however…

This static weight-loss rule of thumb does not account for physiological adaptation to decreased bodyweight

Widespread use of this estimate leads to drastically overestimated expectations for weight loss

An energy deficit of approximately 500 kcal per day leads to steady rate of weight loss of 1 pound per week, however…

This static weight-loss rule of thumb does not account for physiological adaptation to decreased bodyweight

Widespread use of this estimate leads to drastically overestimated expectations for weight loss

Hall KD, et al. Lancet. 2011;378(9793):826-37.

Energy Imbalance: By the NumbersEnergy Imbalance: By the Numbers

What is driving obesity epidemic? Population-averaged model, energy-balance dynamics demonstrate:

+30 kJ per day average daily energy imbalance gap underlies the observed average weight gain, however…

The larger we become, the more calories we burn

Average energy intake increase to sustain increased weight, called the maintenance energy gap, is approximately 0.9 MJ per day

What is driving obesity epidemic? Population-averaged model, energy-balance dynamics demonstrate:

+30 kJ per day average daily energy imbalance gap underlies the observed average weight gain, however…

The larger we become, the more calories we burn

Average energy intake increase to sustain increased weight, called the maintenance energy gap, is approximately 0.9 MJ per day

Hall KD, et al. Lancet. 2011;378(9793):826-37.

Energy Imbalance: By the NumbersEnergy Imbalance: By the Numbers

What does +30 kJ per day look like?

Hint: 7.16 kcal

What does 0.9 MJ per day look like?

Hint: 214 kcal

What does +30 kJ per day look like?

Hint: 7.16 kcal

What does 0.9 MJ per day look like?

Hint: 214 kcal

Weight Mgmt: Nutrition vs. Physical ActivityWeight Mgmt: Nutrition vs. Physical Activity

Large behavior changes are required to produce and maintain reductions in body weight

Small behavior changes may be sufficient to prevent excessive weight gain

“Dieting” effective for weight loss, but very ineffective (alone) for weight maintenance

Physical activity to match intake is likely the most effective way to achieve weight maintenance

Large behavior changes are required to produce and maintain reductions in body weight

Small behavior changes may be sufficient to prevent excessive weight gain

“Dieting” effective for weight loss, but very ineffective (alone) for weight maintenance

Physical activity to match intake is likely the most effective way to achieve weight maintenance

Hill, JO, et al. Circulation. 2012;126(1):126-32.

Cannot Afford to Ignore (+) Energy BalanceCannot Afford to Ignore (+) Energy Balance

Breast cancer: > 50% gain weight during/after treatment

>10% weight gain post-dx = 2.7 HR (all-cause mortality) >5% gain (2 years post-dx) = 5.9 HR (all-cause

mortality)

Survivors of other tumor types experience gain as well: Adult lymphoma: 9% experience gain > 20% Childhood ALL: Overweight: 21%, 45%, 35% at diagnosis,

end-therapy, and 7 yrs post-treatment, respectively Prostate cancer: 2001-2007 survey suggests 42% gain wt

Breast cancer: > 50% gain weight during/after treatment

>10% weight gain post-dx = 2.7 HR (all-cause mortality) >5% gain (2 years post-dx) = 5.9 HR (all-cause

mortality)

Survivors of other tumor types experience gain as well: Adult lymphoma: 9% experience gain > 20% Childhood ALL: Overweight: 21%, 45%, 35% at diagnosis,

end-therapy, and 7 yrs post-treatment, respectively Prostate cancer: 2001-2007 survey suggests 42% gain wt

Vance V, et al. Obes Rev. 2011;12(4):282-94.Bradshaw PT, et al. Epidemiology. 2012;23(2):320-7.Lynce F, et al. Leuk Lymphoma. 2012;53(4):569-74. Love E, et al. Pediatr Blood Cancer. 2011;57(7):1204-09.Whitley BM, et el. Prostate Cancer Prostatic Dis. 2011;14(4):361-6.

For Cancer Survivors, Be Kind to YourselfFor Cancer Survivors, Be Kind to Yourself

Normalize your experience but don’t create expectation of gain

Needs are unique: fear and anxiety can drive behavior

Nutrition and food go far beyond meeting basic needs for most people – who eats for fuel?

Cannot ignore physical activity

Normalize your experience but don’t create expectation of gain

Needs are unique: fear and anxiety can drive behavior

Nutrition and food go far beyond meeting basic needs for most people – who eats for fuel?

Cannot ignore physical activity

Benedetti F, et al. Neuroscience. 2007;147(2):260-71.

Mo

rtal

ity

(%)

Diet and Exercise CategoriesFrom data presented in Pierce JP et al. J Clin Oncol. 2007;25(17):2345-51.

Greater Br Ca Survival in Physically Active Women with High FV Intake Regardless of

Obesity

Greater Br Ca Survival in Physically Active Women with High FV Intake Regardless of

Obesity

Survivorship: More Promising Research

Low Fat Diet for Breast Cancer Survivors (WINS)

2,437 women with early stage breast cancerAssigned low-fat or regular dietFollowed 5 years

Low fat diet group significantly lower risk of recurrence 24% non-significant lower risk of recurrence in

group overall 42% lower risk of recurrence in ER- breast cancer

groupChlebowski RT, et al. J Natl Cancer Inst. 2006 98:1767-76.

Energy Balance: Nutrition vs. Physical Activity

Energy Balance: Nutrition vs. Physical Activity

New ParadigmNew ParadigmInstead of…

Strive to achieve…

Mo

rtal

ity

(%)

Diet and Exercise CategoriesFrom data presented in Pierce JP et al. J Clin Oncol. 2007;25(17):2345-51.

Greater Br Ca Survival in Physically Active Women with High FV Intake Regardless of

Obesity

Greater Br Ca Survival in Physically Active Women with High FV Intake Regardless of

Obesity

Getting from Here to There…Getting from Here to There…

A Quick Exercise For YouA Quick Exercise For You

For one minute, count your heartbeats just by feeling your heart’s rhythm (estimated heartbeat)

Write down this number

Now take your pulse the usual way - wrist or neck Take pulse again; average these two numbers

Calculate difference between estimate and average:

1- [(estimated - average)/average]

For one minute, count your heartbeats just by feeling your heart’s rhythm (estimated heartbeat)

Write down this number

Now take your pulse the usual way - wrist or neck Take pulse again; average these two numbers

Calculate difference between estimate and average:

1- [(estimated - average)/average]

Adapted from Sci Am Mind; http://www.scientificamerican.com/article.cfm?id=inside-the-wrong-body

How is Your Interoception?How is Your Interoception?

Interpretation of interoception test:1- [(estimated - average)/average] = ?

Score:> 0.80 very good interoceptive ability0.60 to 0.79 moderately good interoception< 0.59 poor interoception

Good interoceptive awareness, as measured by heartbeat perception test, correlates strongly with sensitivity for gastric functions

Interpretation of interoception test:1- [(estimated - average)/average] = ?

Score:> 0.80 very good interoceptive ability0.60 to 0.79 moderately good interoception< 0.59 poor interoception

Good interoceptive awareness, as measured by heartbeat perception test, correlates strongly with sensitivity for gastric functions

Herbert BM, et al. PLoS ONE. 2012;7(5): e36646.Adapted from Sci Am Mind; http://www.scientificamerican.com/article.cfm?id=inside-the-wrong-body

Improving InteroceptionImproving Interoception

What Improves Interoception? Yoga, Meditation Looking at your face in the mirror Cognitive Behavior Therapy Regular, enjoyable physical activity Journaling; Keeping Food/Mood Records

What Hinders Interoception? Anxiety/Mislabeling emotional/mental cues Ignoring body function/sensory cues Eating in front of TV, in the car, when distracted,

off your kids’ plates, etc

What Improves Interoception? Yoga, Meditation Looking at your face in the mirror Cognitive Behavior Therapy Regular, enjoyable physical activity Journaling; Keeping Food/Mood Records

What Hinders Interoception? Anxiety/Mislabeling emotional/mental cues Ignoring body function/sensory cues Eating in front of TV, in the car, when distracted,

off your kids’ plates, etc

Ainley V, et al. Poster Presentation at ASSC 16. 2012; (179).Pollatos O, et al. Hum Brain Map. 2007;28(1):9-18.McDonald K. J Fam Pract. 2007;6(11):www.jfponline.com/Pages.asp?AID=5462.

Health Guidelines, Survivorship, & Myth

Myth: Dairy Causes CancerMyth: Dairy Causes Cancer

Discovery Education

Things to Consider About DairyThings to Consider About Dairy

Dairy is highly politicized in North America

Pro-Dairy states you must have dairy for good health

Anti-Dairy states you can’t have dairy for good health

The truth? Somewhere in the middle

Example: Smoking & Risk of Lung Cancer

Decreased Risk Increased Risk

RR = 1.0 (null value)

Example: Exercise & Risk of Heart Disease

Decreased Risk Increased Risk

RR = 1.0 (null value)

Example: Dairy & Risk of Breast Cancer

Decreased Risk Increased Risk

RR = 1.0 (null value)

Myth: Soy Feeds ER+ Breast TumorsMyth: Soy Feeds ER+ Breast Tumors

SoyBase.org

Soy: Beyond HormonesSoy: Beyond Hormones

Soy nutrients have dozens of anti-cancer properties completely unrelated to so-called “estrogenic” effects

Anti-angiogenesis through actions on VEGF & EGF pathways

Induce G2/M cell cycle phase arrest (expression of P21) Inhibit tyrosine kinases Antioxidant activity Inhibit enzymes in our own estrogen-producing

pathways Upregulate natural killer cell function Turn up production of sex hormone binding globulin Inhibit metastasis through multiple pathwaysHan H, et al. Nutr Cancer. 2010;62:641-47.

Yu X, et al. Med Oncol. Dec 2010; published online before print.Barnes S. Lymphat Res Biol. 2010;8:89-98.

Soy: Safe/Possibly Beneficial to Survivors

Represent different groups (2 US, 1 China) varying levels soy intakeAll 3 - no adverse effect of soy food consumptionAll 3 - soy may be protective against recurrence

*16.3 mg of isoflavones = 3+ servings soy food per day**Daidzein = one of two main soy isoflavones***Reduced risk postmenopausal women; no association with recurrence risk in premenopausal women

Cancer Epidemiol Biomarkers Prev. 2011;20:854-58.Breast Cancer Res Treat. 2009;118:395-405.CMAJ. 2010;182:1857-62.

Soy - More Reassurance

96 women in randomized, cross-over diet study; soy intervention provided 50 mg isoflavones per day

Did not affect nipple aspirate volume Did not affect nipple aspirate estrogen levels

Meta-analysis (14 studies on incidence; 4 on recurrence)

24% reduced risk of breast cancer in women consuming the most soy; significant among Asian populations, non-significant in western populations

16% reduced risk of recurrence among all populations combined for breast cancer survivors consuming the most soy

Soy is food and should be treated like foodEnjoy soy if you like it, avoid if you don’t: The choice is

yours!

Maskarinec G, et al. Cancer Epidemiol Biomarkers Prev. 2011;20:1815-21.Maskarinec G, et al. J Nutr. 2011;141:626-30.Dong JY & Qin LQ. Breast Cancer Res Treat. 2011;125:315-23.Magee PJ & Rowland I. Curr Opin Clin Nutr Metab Care. 2012;15(6):586-91.

Where to Go for Good Information?Where to Go for Good Information?

Other Useful Resources/CommunitiesOther Useful Resources/Communities

American Institute for Cancer Research (AICR) The only large cancer organization focused

principally on connection between nutrition & cancer

http://www.aicr.org

Health at Every Size (HAES) Developed by Dr. Linda Bacon, Nutrition

Professor, City College of San Francisco “We’ve lost the war on obesity. Fighting fat has

n ’t made the fat go away.” http://www.haescommunity.org/

American Institute for Cancer Research (AICR) The only large cancer organization focused

principally on connection between nutrition & cancer

http://www.aicr.org

Health at Every Size (HAES) Developed by Dr. Linda Bacon, Nutrition

Professor, City College of San Francisco “We’ve lost the war on obesity. Fighting fat has

n ’t made the fat go away.” http://www.haescommunity.org/

Health After CancerHealth After Cancer

New and Existing Resources Fit What We Know

New and Existing Resources Fit What We Know

The Big Picture: What Should I Eat?

Plants, plants, and more plants

2/3 to 3/4 of plate should be covered by vegetables, legumes, fruit – in that order of volume/amount – heavy emphasis on cruciferous and dark purple/red fruit

Remaining 1/4 to 1/3 of plate should be split between whole grains and small amount of lean protein

Michael Pollan said it best: “Eat Food. Not too much. Mostly Plants.”

In Summary

• We must:– Place focus on health, not weight– Become educated and take care of ourselves– Foster neutral energy balance and total health

• Stop dwelling on nutritional “minutia” and instead focus on whole foods

• Stop reading labels; we know what healthy eating looks like and it doesn’t involve a label!