1. Foods and Cancer
Neal D. Barnard, MD
Adjunct Associate Professor of Medicine
George Washington University School of Medicine
President, Physicians Committee for Responsible Medicine
Washington, DC
2. Milk and Prostate Cancer
Ganmaa D, Li X, Wang J, Qin L, Wang P, Sato A. Int J Cancer 2002:98,262-267.
3. Physicians’ Health Study (Harvard)
20,885
physicians
≥ 2.5
servings/day of
dairy products
Relative risk: 1.34 (1.04-1.71)
Chan JM. Am J Clin Nutr 2001;74:549-54.
34% increased
risk
of prostate cancer
4. Health Professionals
Follow-up Study (Harvard)
47,781 health
professionals
> 2 servings/day
of milk
83% of milk consumed was skim or lowfat
Relative risk for advanced cancer: 1.6 (95% CI, 1.2-2.1)
Giovannucci E. Cancer Res 1998;58:442-7.
60% increased
risk
of prostate cancer
5. Dairy and Prostate Cancer
• > 20 research reports link milk drinking to PC.
• Association with advanced and fatal PC risk
Qin LQ. Nutr Cancer. 2004;48(1):22-27.
Gao X. J Natl Cancer Inst. 2005 Dec 7;97(23):1768-1777.
Crowe FL. Cancer Epidemiol Biomarkers Prev. 2009;18(5):1333-40
Gonzalez CA.. Eur J Cancer. 2010;46(14):2555-62.
Butler LM.. Cancer Res. 2010;70(12):4941-8.
7. Insulin-Like Growth Factor I
“Insulin-like” = moves sugar into cells
“Growth factor” = encourages cell proliferation
8. Milk Drinking Raises Human IGF-I
Men and women aged 55 to 85 years
Three 8-oz servings of milk for 12 weeks
Serum IGF-I levels: ↑ 10%
P<.001
Heaney RP. J Am Dietetic Asso 1999;99:1228-33.
9. Physicians’ Health Study, Harvard
After 10-year follow-up:
cancer patients
(n = 152)
IGF-I
269 ng/ml
healthy controls
(n = 152)
249 ng/ml
P=0.03
RR = 2.1 (95% CI = 1.3-3.2) per 100 ng/ml IGF-I increment
Chan JM. Science 1998;279:563-6.
10. Vegetarians have lower IGF-I
• Plant-based diet is associated with lower
circulating levels of total IGF- I
• EPIC study: 2019 participants
– Animal protein, milk, and cheese ↑ IGF-I
– Vegetables, β-carotene ↓ IGF-I
Allen NE. Cancer Epidemiol Biomarkers Prev. 2002;11(11):1441-1448.
Norat T. Eur J Clin Nutr. 2007;61(1):91-98.
23. Lycopene vs Prostate Cancer
Health Professionals Follow-Up Study
47,365 participants
≥ 2 tomato sauce servings per week
Prostate cancer risk ↓ 23%
Giovannucci E. A prospective study of tomato products, lycopene,
and prostate cancer risk. J Natl Cancer Inst 2002;94:391-8.
24. Vegan Diet and Prostate Cancer
Preventive Medicine Research Institute
84 men with untreated prostate cancer, 1-year study
Control group:
PSA ↑ 6%
6 of the 43 participants required cancer treatment
Vegan group:
PSA ↓4%
No one required treatment
Ornish D, Weidner G, Fair WR, et al. Intensive lifestyle changes may affect the progression of
prostate cancer. J Urol. 2005;174:1065-1069.
26. (per 100,000 women, 45-69 yrs)
Breast Cancer Incidence
Association of Dietary Fat & Breast Cancer
250
r=0.76
USA
Canada
200
UK
Italy
Israel
150
Australia
Romania
50
0
600
France Germany
Denmark
New Zealand
Sweden
Norway
Finland
Yugoslavia
100
Switzerland
Spain
Hong Kong
Poland
Hungary
Japan
900
1200
Per Capita Fat Availability
(kcal)
from Prentice, et al.
1500
JNCI 1988
27. Western Diets and Breast Cancer in China
The Shanghai Breast Cancer Study
The “meat-sweet” pattern:
meat dessert
fish
bread
candy milk
30% percent increased breast cancer risk
Cui X. Dietary Patterns and Breast Cancer Risk in the Shanghai Breast
Cancer Study. Cancer Epidemiol Biomarkers Prev. 2007;16(7):1443-1448.
34. Women’s Health Initiative
48,835 participants, aged 50-79
Diet: 20% fat, ↑ vegetables, fruits, and grains
Fat intake fell from 38% at baseline…
to 24% at 1 year, and to 29% at 6 years.
Prentice RI. JAMA. 2006;295:629-642.
35. Women’s Health Initiative
After 8.1 years:
Overall breast cancer risk ↓9% (not significant).
Progesterone-receptor-negative tumor risk ↓24%.
Prentice RI. JAMA. 2006;295:629-642.
36. Fat Content
(Percentage of Calories from Fat)
Leanest beef
29%
Skinless chicken breast
23%
Sea trout
32%
White tuna
16%
Broccoli
8%
Beans
4%
Rice
1–5%
38. Women’s Intervention Nutrition Study
(WINS)
2,437 women with breast cancer
Ages: 48-79, all postmenopausal
Reduced fat (15% of energy) diet vs control
39. WINS
Diet and Cancer Recurrence
All cancers
↓ 24%
Estrogen receptor -
↓ 42%
Estrogen receptor +
↓ 15%
40. Women’s Healthy Eating and Living Study
3,109 pre- and postmenopausal women
previously treated for breast cancer
7 clinical sites, enrollment 1995-2000
41. Women’s Healthy Eating and Living Study
Comparison diet (“5-a-day”):
5 servings of vegetables and fruits
(<30% fat, 20 g fiber)
Intervention diet (“8-a-day”):
5 vegetable servings, 3 fruit servings
16 oz. vegetable juice
(15-20% fat, 30 g fiber)
42. WHEL Study
Vegetables-Fruits and Regular Walking
1490 women in comparison group
Followed for 5-11 years
Mortality
↑ veg/fruit (7.6 servings) + ↑ activity
4.8%
↓ veg/fruit (3.4 servings) + ↑ activity
10.4%
↑ veg/fruit (7.2 servings) + ↓ activity
10.7%
↓ veg/fruit (3.1 servings) + ↓ activity
11.5%
Pierce JP. J Clin Oncol 2007;25:2345-51.
43. What about Soy Products?
Source: Wood CE. Biology of Reproduction. 2006;75:477-86.
44. Soy and Prostate Cancer
Meta-analysis of 15 studies:
Risk for high versus low soy intake:
↓26% overall
↓48% in Asian populations
Yan L, Spitznagel EL. Soy consumption and prostate cancer risk in men: a
revisit of a meta-analysis. Am J Clin Nutr. 2009;89:1155-1163.
45. Soy and Breast Cancer
Meta-analysis of 8 studies in Asians and Asian
Americans:
High soy intake: 29% ↓ risk of breast cancer.
Wu AH. Br J Cancer. 2004;98:9-14.
46. Soy and Cancer Recurrence or Mortality in WHEL
1
Hazard Ratio
P for trend = 0.02
.3
3
>1
6
1.
01
-1
6.
33
1
0.
07
-1
.0
<0
.0
7
0
Isoflavone Intake (mg/d)
Caan BJ. Cancer Epidemiology, Biomarkers, & Prevention. 2011;20:854-8.
47. Soy and Survival
Soy and Cancer Recurrence or Mortality
>1
6.
33
1.
01
-1
6.
33
0.
07
-1
.0
1
0
<0
.0
7
16.3 mg isoflavones =
½ cup soymilk or
2 oz. tofu
P for trend = 0.02
Hazard Ratio
High soy intake:
54% ↓ risk.
1
Isoflavone Intake (mg/d)
Caan BJ. Cancer Epidemiology, Biomarkers, & Prevention. 2011;20:854-8.
48. Shanghai Breast Cancer Survival Study
Soy and Cancer Mortality
Hazard Ratio
1
>6
2.
68
36
.5
162
.6
8
20
.0
136
.5
0
<2
0.
01
0
Isoflavone Intake (mg/d)
Shu XO. JAMA. 2009;302:2437-43
16.3 mg isoflavones =
½ cup soymilk or
2 oz. tofu
49. Kaiser Permanente
Life After Cancer Epidemiology Study
Soy Intake and Breast Cancer Recurrence
Daidzein
Genistein
1
Glycetein
1
Hazard Ratio
Hazard Ratio
Hazard Ratio
1
Genistein Intake (mcg/d)
3.
62
-8
.1
6
8.
17
-1
4.
99
15
.0
078
.5
78
3
.5
479
5.
39
>7
96
.3
9
0
03.
61
.7
7.
7
78
-1
14
49
9.
.5
60
9
-1
1,
,4
45
53
3.
.0
10
0
-9
,5
96
.5
4
>9
,5
96
.5
4
0
0.
10
-7
Daidzein Intake (mcg/d)
0
0.
10
-6
.9
7.
9
00
-2
20
22
.6
0.
1
62
2,
-2
19
,1
9.
84
82
.8
-1
3,
02
5.
87
>1
3,
02
5.
87
0
0
Glycetin Intake (mcg/d)
Guha N. Breast Cancer Research & Treatment. 2009;118:395-405.
50. After Breast Cancer Pooling Project
1. Women’s Healthy Eating &
Living Study
0.5
≥1
-9
.9
9
4.
0
9,514 breast cancer survivors
0.
0
0.0
<4
.0
3. Life After Cancer
Epidemiology Study
1.0
Hazard Ratio
2. Shanghai Breast Cancer
Survival Study
Soy and Breast Cancer Recurrence
Isoflavone Intake (mg/d)
Nechuta SJ. Am J Clin Nutr. 2012;96:123-32.
57. Acceptability
Acceptability is similar to that of other therapeutic diets.
•
•
•
•
Men and women with heart disease (1992)
Young women with dysmenorrhea (2000)
Postmenopausal overweight women (2004)
Men and women with diabetes (2008)
Barnard ND, Scherwitz L, Ornish D. J Cardiopulmonary Rehab 1992;12:423-31.
Barnard ND, Scialli AR, Bertron P, et al. J Nutr Educ 2000;32:314-9.
Barnard ND, Scialli AR, Turner-McGrievy GM, et al. J Cardiopulm Rehab
2004;24:229-35.
Barnard ND, et al. J Am Diet Assoc 2009;109:263-72.
{"60":"As you would expect, waist circumference also decreased in the vegan group – about two inches smaller (or X cm).\n","5":"Recent meta-analyses of 12 prospective and 11 case-controlled studies = positive association with both dairy and Ca+ intake on PC risk.\nResearches concluded that non-dairy calcium and protein sources had no significant associations with increased IGF-I levels, suggesting a rise in IGF-I was more likely to occur from the protein in dairy products. BUT some of the main studies observing increased risk stems from Harvard Reseach…..\n","59":"We saw no change in body weight in control group participants, but an average of 11 pound weight loss in participants in the vegan group. \n16 control-group participants began the optional program initiated at their site. These participants attended an average of 46% of meetings and lost a mean of 9 lb. Attendance was significantly correlated with weight loss (r = -0.61, P = 0.01). Of participants who attended >50% of meetings (n = 8), mean weight loss was 13 lbs. \n"}