22 November 2016

Nutrition and Bladder Cancer - Part II: Foods for Enjoyment and Health

Part 2 of 4. Jill M. Hamilton-Reeves, PhD, RD, CSO, associate professor, dietitian, and certified oncology nutritionist at the University of Kansas to share her ...

you

on this section of the webinar we'll talk about foods that improve health versus those only for enjoyment there were a lot of questions from all of you about you know what's going to harm me what is going to cause my cancer to come back what can I do to prevent cancer in the first place and so this section really is that broader topic of nutrition and cancer so I'm going to stand on my soapbox a little bit just the first slide to reiterate that a healthy diet is important I'll give you some resources that have quantified the attribution of diet to cancer relationship so generally speaking it's about a 30% diet can answer the collectively contribute to about 30% of cancers and for bladder cancer specifically there's a relatively new review paper by Al's ala Bonnie that suggests that even maybe up to 80% of bladder cancers can be attributed to lifestyle choices you know which would include occupation smoking diet and exercise so it is important but I think what's more important is thinking about what you can do right now from today so as you're listening to the messages think about what changes you may want to

make to improve your health I really don't think that fear and anxiety are a part of this so let that go if you're an anxiety around food should just go away because eating can be enjoyable and easy without harming your health and today I hope to provide you some tools to help you go down that path with learning hat Center keep yourself nourished and enjoy the food that you're eating so one of the critical resources that I'd like to point you to is the American Institute for cancer research they're an authority on diet physical activity and cancer this infographic that I have on here is from them and it essentially just highlights the main messages for diet and cancer so maintain a healthy weight try to move more eat well try to eat a plant-based diet reduced red meat avoid processed meat cut down on alcohol eat less salt after treatment cancer survivors should follow these same cancer prevention guidelines and then it says for cancer prevention don't use supplements we will touch on that topic again in the last section of today's webinar so a healthy diet means different things to different people so just so we can all get on one page

a healthy diet from my perspective includes a variety of vegetables fruits whole grains nuts seeds legumes or beans poultry and fish some foods and drinks may be protective specifically for bladder cancer this is a relatively newer field of study but some studies show that greater consumption and vegetables and fruit decreased the risk of bladder cancer and some studies show that greater consumption of tea decreases the risk of bladder cancer so first we'll talk about tea and bladder cancer so each cup of tea per day has been associated with 6% decreased risk of bladder cancer that's from the Chen study animal studies have seen that polyphenol compounds inhibit bladder tumor growth coffee and tea have been studied in reducing the risk of other cancers green teas with antioxidant Epico gallatin calico galley has shown anti-cancer properties and in regards to bladder cancer prevention really the best type of tea has not yet been determined the black tea verses along or green teas seem to be about equivocal in in most studies the next slide is about vegetables fruit

and bladder cancer total vegetable and fruit consumption has been associated with the 3% decrease in bladder cancer risks per serving and then also citrus fruits such as oranges lemons limes and grapefruit might be protective through their antioxidant action cruciferous vegetables which you would know better as broccoli cauliflower cabbage kale brussel sprouts and asparagus contain a compound called the floor fan and there's some studies suggesting the Batman health inhibits bladder cancer growth so how many such Tibbles and fruits do I need the American Institute of cancer research recommends five servings of non starchy vegetables and fruits every day so a serving size is one of those things that dietitians I think get a little bit finicky and caught up on we're like the accountants of the health system so a certain size is somewhere between a half to a cup of fruit one to two cups of raw vegetables or a half a cup of cooked vegetables and it's important to get a variety of different colors of vegetables including red green white purple yellow and orange and those colors are associated with different nutrients in your foods that

have the properties that help with cancer prevention so that's why we aim to get a lot of different colors of fruits and vegetables there were some questions about juicing and there are some benefits of juicing it can increase the amount of nutrients that you can consume each day and still get it from food it can really benefit those who are having difficulty with chewing or digesting food so I do have some tips though juicing itself when you use a juicer it takes out the fiber and fiber is an important nutrient for gut health for this reason if you're not having feeding difficulties you should really aim for your 5 servings of vegetables and fruit before you juice and then add the juicing vegetables and fruits on after that it would be a good idea to include more vegetables than fruit because they have fewer calories you know less sugar or is keeping the week stable and then drink what you normally would eat and aim for variety some people suggest including some protein with your tooth so that if you are a person that has problems keeping your blood sugar at a normal level the protein will kind of blunt the

sugar response and making you hyperglycemic or have high blood sugars and then just a note of caution not all commercial juicers if you you know buy them off the shelf have the nutrients that you're really looking for so you need to become an avid label reader and look at the added sugar content which is now called out on the food label one other thing about juicing is there's also the option of blending foods so you would get the fiber if you had a high-powered blender like a Vitamix then you through all the fruits and vegetables in there and then blend that up and that's a really great option for those of you that might be going through therapy and having issues with mouth sores or other feeding issues other components of a healthy diet so I had mentioned legumes or or beans so some examples are lentils black beans split peas garbanzo beans soy beans peanuts navy beans also whole grains like oatmeal quinoa barley 100% whole grain products are really a beneficial part of the diet nuts seeds and healthy fats like walnuts chia seeds flax seed pecans almonds cashews olive oil avocados berries such as yogurt milk

cheese and kefir kefir is a fermented milk product so it's kind of like liquid yogurt and then proteins such as fish eggs and poultry you there are some foods that have data behind them suggesting a link with with cancer so red meat has been associated with an increased risk of certain cancers but the data are inconsistent for bladder cancer still the recommendation for cancer prevention includes limiting red meat to 18 ounces per week I live in Kansas City and so that's a tough one to to sell to our patients but it is what it is the other one is actually more relevant to bladder cancer there there are data showing that processed meat so any kind of needs that have been preserved by smoking cheering salting or the addition of of chemicals such as nitrates should be avoided so examples of these foods include bacon sausage hot dogs and luncheon meats and I often get the question if the naturally preserved hotdogs and bacon and things like that are any better or if they come from Turkey instead of red meat is that any better and sadly they still use nitrates

to preserve those food it's usually just a nitrate that is derived from celery but the body doesn't distinguish between that so I think there's we don't really have any solid data saying that those are either better or worse for you and so the recommendation is simply just to limit the amount of processed meats that you consume sugary drinks we talked about that in the missed part of the webinar they do not cause cancer but they really do not add much benefit to our health so we talked about limiting those energy dense foods such as processed foods that are high in added sugar or low in fiber like just fries candies pastries those could contribute to unwanted weight gain and take the place of nutrient rich foods in our diet alcohol is consumed it all should be consumed in moderation two drinks or less for men per day or one drink per day or less for women and then foods processed with salt should be limited and again those are more general diet and cancer kinds of relationships you I did want to take a note to talk about bladder cancer and blood sugar control so there's some work from on that was

just published this year showing that patients that had non muscle invasive bladder cancer and uncontrolled diabetes had a higher rate of progression so I noticed quite a few of you on the call are undergoing BCG treatment and T u RB t and so this might be relevant to you if you have diabetes or you're at risk maybe your your blood sugars run a little bit high and you're pre-diabetic and so keeping tight blood sugar control before and after surgery has been associated with longer progression-free survival and so the the take-home message here is that patients with diabetes should aim to manage their blood sugars with exercise and a carbohydrate controlled diet we actually have a small feasibility study here at university of kansas where we are trying in a low carbohydrate diet in patients on bc cheese so people that ask well okay just you know tell me the good the bad now just tell me what to eat so I love how candid all of your questions where I really just it was just really good to keep me grounded I'm what's important to to all of you so the best diet for bladder cancer prevention is a balanced one

hopefully that message has come through the American Institute for cancer research has several guidelines on how you would build this kind of diet and they call their program the new American plate and this picture here shows you what the new American plate could look like so I think some things to know on this plate is that there's two servings of vegetables here and there's a smaller amount of animal protein and then a kind of carb controlled amount of rice on the plate so the recommendation is to fill two-thirds or more of your plate with vegetables fruits whole grains and beans and limits the animal protein to a third of the plate to fish and lean poultry more often and the new American plate does have several recipes people were asking for some recipes so when you go to your handout again that's the AIC our handout and you can find those resources there so some take-home messages for this section is to make the majority of your diet vegetables fruit whole grains legumes nuts seeds fish and lean poultry and limit processed meats red meats refined starchy foods and sugars to special occasions so again I'm not

demonizing any food I really want that message to come through it nice and clear but you know just to recognize that some foods are really meant just for enjoyment and others have more of a capacity for a nourishment