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Cancer Prevention & Management - UNIT 1

UNIT 1
Picture
Do-it-Yourself Cancers
Eat to Beat Cancer
Gene Expression & Telomeres
Article Review
  • Lifestyle and Cancer Risk
  • Lifestyle Medicine & Health Survival
Video on demand Review
  • Fighting Deadly Cancer
  • Cancer and Lifestyle

GOALS
  • Introduce the lifestyle risks in developing cancer
  • Encourage students to understand the role of personal lifestyle and practices that can prevent cancer
  • Appreciate the role of Gene expression and Telomeres in cancer risk

OBJECTIVES
  • To discuss common lifestyle areas connected to cancer development
  • To explain the role of diet in avoiding cancer risk
  • To understand the genetic implication of both cancer development and cancer prevention

LEADING QUESTIONS
  • Are we really bringing cancer to ourselves?
  • How can diet and other lifestyle intervention help in preventing cancer development?
  • Is there any ethnic variation in terms of cancer?
  • Do genes determine our fate in developing cancer?

SOURCES
  • You turn, Hans Diehl, Mechelle Palma, MD
  • 31 day Food Revolution, Ocean Robbins
  • Undo it, Dean Ornish, MD

Do-it-Yourself Cancers

Many cancers are turning out to be do-it-yourself diseases.  We promote them by chronic exposure to certain environmental factors.  What we eat and drink, where we live and work, and what we breathe may well determine whether we become a cancer statistic.
 
ARE YOU SAYING THAT WE BRING CANCER ON OURSELVES?
 
Medical science continues to make strides toward earlier detection and improved treatments for many cancers.  But these efforts are largely after the fact.  The sad truth is that the incidence rates for many adult cancers continue to rise.  Some 7 adults die every hour and 8 children die of cancer daily in the Philippines.  In 2012, about 98,200 people are newly diagnosed with cancer and 59,000 Filipinos are dying from cancer each year. 
 
In 2016, the data released by the Philippine Obstetrical and Gynecological Society have shown that the Philippines topped 197 countries with the most number of cases of breast cancer.  One in every 13 Filipinas is expected to develop breast cancer in her lifetime, according to the Philippine Society of Medical Oncology.  The risk factors includes being overweight, having no children at age of 30, having family history of breast cancer, drinking excessive alcohol, having early menstruation and late menopause, among others.An average of 12 Filipinos die of cervical cancer daily.  The Department of Health has ranked Colon Cancer as the fourth overall in incidence and mortality while lung cancer remains to be the leading cause of cancer-related deaths.
 
In the Philippines, it is estimated that close to 10,000 Filipinos die annually because of lung cancer which is the leading cause of cancer-related deaths among men, and is the third cause of cancer death among women.  About 90 percent of lung cancers are linked to cigarette smoking making it the leading cause of cancer.

This trend, however, could be reversed.  If we would simply take precautions that we already know about, 70 to 80 percent of the cancers that afflict Americans and other ethnicity could be prevented.
 
 
WON’T PEOPLE DO JUST ABOUT ANYTHING TO AVOID SUCH A TERRIFYING DISEASE?
 
Almost anything, it seems, except change their lifestyles.  Take lung cancer (the cancer that is the leading cause of death in men and third in women), for example.  Ever since the United States surgeon general’s report in 1964 we’ve known that lung cancer is directly related to cigarette smoking.  It’s true that millions have quit smoking, yet 28 percent or 17.3 million Filipino adults age 15 years and older are current tobacco smokers!  Some 80 percent of the cancers of the lung, lip, mouth, tongue, throat, and esophagus could be prevented if people simply stopped using tobacco.  It would also prevent almost half of the bladder cancers.  And by not smoking, the life expectancy of a smoker could be extended by almost 10 years.
 
 
ARE SOME CANCERS RELATED TO DIET?
 
In men the second and third most frequently occurring cancers are those of the prostate and colon.  For women it’s cancers of the breast and colon.  Extensive evidence links nearly 50 percent of these cancers to overnutrition - too much fat, too much animal protein, and too much weight.
 

THAT SOUNDS LIKE A LONG SHOT.  WOULDN’T A MORE LIKELY CULPRIT BE THE MANY CHEMICALS THAT FIND THEIR WAY INTO OUR FOOD SUPPLY?
 
Carcinogens (cancer-producing chemicals) are concern- especially with the array of additives, preservatives, flavor enhancers, pesticides, and other chemicals that we use in producing and marketing food.  However, only 2 percent of all cancers can be reliably linked to these substances.

In contrast, evidence of the connection between cancer and such dietary factors as fiber, animal protein, and fat grows stronger every day.  Compared with diets around 1900, the average Filipino now consume more fat, grease, animal protein and less fiber.  In areas of the world in which fat and animal protein intake is low and fiber consumption is high, the incidence of colon, breast, and prostate cancers are negligible.  In countries such as United States, Canada, and New Zealand, where diets are low in fiber and high in fat and animal protein, the rates for these kinds of cancers are much higher.
 
 
COULD ETHNIC VARIATIONS, RATHER THAN DIET, ACCOUNT FOR THESE DIFFERENCES?
 
Researchers asked the same question.  In major study published in 1979 the found, for example, that Japanese living in Japan (and still living on a pre-Western diet) had very few of these cancers.  In Japan, fiber consumption then was high and fat intake was low (15 percent of total calories).  But when these Japanese migrated to Hawaii and adopted Western eating habits and lifestyles, then rates for these cancers increased dramatically and soon equaled those for other Americans.
 
A study on Acculturation and Causes of Death Among Filipinos in California, USA conducted in 2013 showed that cancer was the leading cause of death for Filipinos of both sexes, while in the Philippines, it was fourth after ischemic heart disease, pneumonia and stroke.  It is however remarkable that mortality rates from the major causes of death are much lower among Filipinos in California than in the Philippines, suggesting that Filipinos in California benefit substantially from living in the United States in terms of health outcomes and life expectancy.  Access to a more developed health care infrastructure, effective prevention programs, and better treatment opportunities likely explain the lower mortality rates in the United States.  With the current health care benefit in the country, it is more than necessary for Filipinos to prevent developing cancer by all possible means.
 
 
HOW CAN SUCH THINGS AS FIBER, ANIMAL PROTEIN, AND FAT INFLUENCE CANCER?
 
Not all the answers are in yet, but cancer is associated with carcinogens - chemical irritants that can produce cancerous lesions over time.
 
Bile acids are an example.  The amount of fat in the diet affects the amount of bile the body produces.  In the intestinal tract some of these bile acids can form irritating carcinogenic compounds.  The longer these compounds stay in contact with the lining of the colon, the more irritation results.
This is where fiber comes in.  With a low-fiber diet, digested food moves slowly through the intestines, often taking from three to five days to complete the journey from entry to exit.  Most fibers absorb water like a sponge.  This helps to fill the intestines and stimulates them to increased activity.  With a high fiber diet, food travels through the intestines in 24 to 36 hours.
 
This helps the colon in two ways.  It shortens the exposure to irritating substances, and it dilutes the concentration of the irritants that pass through the colon thanks to fiber’s water-holding ability and insulating effect.
 
Nitrites, as prominently used in meat, are another example.  And for most Filipinos, locally processed meat such as langgonisa, tapa and tocino occupies the table for breakfast.  They can form N-nitroso compounds that are involved in carcinogenesis.
 
 
HOW DOES DIET RELATE TO BREAST AND PROSTATE CANCER?
 
A high fat intake depresses the activity of important cells in the body’s immune system.  This effect has been studied extensively in connection with breast cancer and affect other types of cancer as well.  Dairy products have been implicated in raising the risk of prostate cancer.  Oncogenes that promote prostate cancer and breast cancer do so in part by causing inflammation at every stage in cancer's growth.  Some researchers believe that an inflammatory microenvironment is essential for all cancers.  
 
 
ARE OTHER LIFESTYLE AREAS CONNECTED TO CANCER?
 
Excessive alcohol consumption increases the risk for cancers of the esophagus, breast, liver, colon, and pancreas, and does so dramatically for those who smoke as well.  Excess weight raises the risk of cancers of breast, colon, kidney, endometrium, pancreas, liver, and esophagus.  Then there are such things as exposure to asbestos, sidestream smoke, and toxic chemicals.
 
Just four lifestyle factors - no smoking, no alcohol, a vegetarian diet very low in fat and high in fiber, and normal weight - could prevent close to 80 percent of cancers found in Westernized society today. 
 
 
MIRACLE CURE?
 
Imagine announcing a pill that would make people immune to cancer.  It would be the new story of the decade.  People would flock to their doctors for a prescription, and the inventors would be wealthy beyond belief.  No such pill exists.  But there are a number of things we can do to prevent the majority of adult cancers.  A good place to start is with our diet.  We can begin eating foods considerably lower in fat and cholesterol.  Many studies have shown that such a diet reduces the risk of heart disease, diabetes, stroke, and many cancers.

But making lifestyle changes is not as simple as swallowing a pill.  It involves learning new habits and skills.  For example, cutting the fat and cholesterol in our diet means preparing more meatless dishes.
 
One sensible way to develop these skills is by designating a day or two each week for vegetarian-style meals.  This gives you a chance to experiment with healthful ways of cooking while gradually building up a new repertoire of favorite recipes.
A good cookbook is an investment that will repay you many times over.  There’s no better tool when it comes to changing your eating habits.  It is wise to go back to the original diet that Filipinos used to eat.  Plenty of fruits and indigenous vegetables prepared in the simplest way. 
 

MOVING TOWARD THE OPTIMAL DIET

  • They have the vitamins, mineral, and fiber that products made with refined flour lack.
  • Enjoy a variety of fresh fruit each day.
  • Eat a wide variety of vegetables, dark green leafy vegetables are essential for good health.  (One cup of greens contains more calcium that milk.)  Yellow and orange vegetables are high in vitamin A.
  • Enjoy nuts.  They are high in minerals and vitamins, but use them sparingly, because they are high in fats and calories.
  • Use a wide variety of beans and peas.  They provide protein and fiber and are low in fat.

 
THE RISK OF CANCER
 
TOBACCO
Smoking causes 9 cancer deaths every hour in the Philippines.
RED MEAT
Regular meat eaters have a three times higher risk of developing colon cancer when compared with occasional meat eaters.
JUNK FOOD
Those who fill up on doughnuts, sodas, and potato chips lose out on the cancer-fighting substances found in fruits and vegetables.
INACTIVITY
Those who log at least four hours of exercise a week cut their risk of breast and colon cancer by more than a third.
OVEREATING
Among women, being heavy adds markedly to the danger from breast, colon, and endometrial cancer.  And men are pushing their luck with prostate and colon cancers.
ACLOHOL
Heavy drinking has been clearly linked to cancers of the liver, throat, and esophagus.  In women, even a daily drink or two raises breast cancer risk.
DAIRY
Diets high in calcium and dairy are linked with an increased risk of prostate cancer.


Eat to Beat Cancer

There's one sentence that's probably more feared than any other: "You have cancer."
Despite billons of dollars spent in the war of cancer, despite the pink ribbons and races for cure, cancer now takes the live of more that 8 million people annually.  And the devastating toll keeps rising .

What's causing so many people to get cancer?  is it just we're living longer, and human cells malfunction with age?  Are we prone to a genetic defect that causes cells to go rogue and threaten the organism that brought them into being?  Do we simply lack some as-yet-uninvented drug that will protect or cure us? Or is cancer somehow being caused by the way we're living?

In 2008, researches at the University of Texas MD Anderson Cancer Center set out to understand what was driving the global cancer epidemic.  They connected a meta-analysis of studies in peer-reviewed journals and then published their own summary report in Pharmaceutical Research.  The researchers concluded that only 5 to 10 percent of all cancers have their roots in genetic defects.  The other 90 to 95 percent are caused by combination of diet, lifestyle, and environmental factors.  They found, not surprisingly, that of all cancer deaths, 25 to 30 percent are caused by tobacco consumption.  But there was another factor that the researchers determine was even more significant than smoking.  DIET.  In fact, the researchers reported, diet causes 30 to 35 percent of all cancer cancer worldwide - totaling more than two million deaths per year.  Based on their analysis of all available data, what cancer-prevention diet did these scientists recommend?  "Increase ingestion of fruits and vegetables.... [and' minimal meat consumption."

Global spending on cancer medication exceeds $100 billion annually.  And yet more than two million people worldwide are dying from diet-fueled cancer every year, while fewer than half of all Americans and other people worldwide even realize that a diet high in fruits and vegetables, and low in red meat and processed foods, can help prevent this horrible disease.  Can you imagine what would happen I even a fraction of the tens of billions of dollars now being spent on drugs and surgeries were to be spent on educational campaigns, or on truly healthy food?  Wouldn't we save more lives if we focused on preventing cancer from happening in the first place?  Why don't we?

is it possible that part of the reason is that established interests are profiting from selling foods that are making us sick, and that as long as we're spending hundreds of billions of dollars on drugs and medical care, some folks are earning  a lot of money?  If there was as much money to be made off broccoli as their is for chemo, do you think we'd see more broccoli eaten?

Mother nature gives us a huge pharmacy of natural foods, herb, and spices that are stunningly effective in promoting health.  and the only side effects of feasting in nature's pantry turn out to be good ones.

But natural products, by definition, can't be patented.  A study from the Tufts Center for the Study of Drug Development found that pharmaceutical companies spend an average of $2.6 billion for each new drug they bring to market.  No one's about to spend that much providing that plants are safe and effective as medicines, because they can't be patented.  Whoever financed the millions would be out all that money, with no more ability to profit than your local farmer.  So natural products are at a fundamental disadvantage in the marketplace.  And unfortunately, when it comes to nutrition, sometimes it seems as if the medical establishment is ignoring the basic facts.  

​A typical American diet that is adopted by many countries worldwide is high in animal protein, which increases production of interleukins, blood chemicals that promote chronic inflammation.  in contrast, plant-based proteins are low in inflammatory stimulants and contain literally thousands of protective substances such as phytochemicals, bioflavonoids, retinols, isoflavones, and others that actively decrease rather than increase chronic inflammation - providing a double benefit (protective rather than harmful).

Reducing animal protein intake is known to reduce levels of a growth factor called IGF-1. which promotes chronic inflammation, and lower IGF-1 levels are linked to longer life span and reductions in the risk of cancer and diabetes.  Most fruits and vegetables are anti-inflammatory, especially blueberries, strawberries, tomatoes, nuts, cruciferous vegetables and green leafy vegetables.

Animal protein dramatically increases the risk of premature death independent of fat and carbohydrates.  In a study of over 6,000 people, those ages fifty to sixty five who reported eating diets high in animal protein had a 75 percent increase in overall mortality, a 400 percent increase cancer deaths, and a 500 percent increase in type 2 diabetes during the following eighteen years, whereas plant-based proteins reduced the risk of premature death in all of these categories - again, a double benefit.

Gene Expression

 Another powerful mechanism affected by your lifestyle is the expression of your genes.  Many people believe that they have "bad genes" and there's nothing they can do about it.  In fact, there is a lot we can do about our genes.  We're not merely victims of our genes; we have more control than we may realize.  A research was conducted by Dr. Ornish (best seller author) and his colleagues showing that changing lifestyle actually changes your genes - turning on (upregulating0 genes that facilitate health and turning off (downregulating) genes that cause chronic inflammation, oxidative stress, and other mechanisms causing disease.  For example, the selectin E gene, which promotes inflammation, was downregulated in their study.  Molecular switches (including methylation and proteins such as histones that turn genes off and on) are very responsive to lifestyle changes.  They've found that more than 500 genes were favorably changed in the study participants after only three months on lifestyle medicine program! Hundreds of oncogenes that promote prostate cancer, breast cancer, colon cancer, and other conditions were switched off in only three months.  The research was published with Dr. J. Craig Venter (the first person to sequence a human genome) in the Proceedings of the National Academy of Sciences.

In another study, researchers found out that calorie restriction works to extend life not only because it reduces total calories but, specifically, because it also reduces animal protein, which is more important in longevity.  Again, the type of food is important, not just the amount.  The researchers wrote, "Longevity and health were optimized when [animal] protein was replaced with [complex] carbohydrate.  Calorie restriction achieved by high-protein diets or dietary dilution [eating less] had no beneficial effects on lifespan."  They lived 30 percent longer when replacing animal protein with good carbohydrates.  Why?  These researchers found that limiting animal protein intake reduces levels of protein enzymes called TOR, and lowering TOR extends life.  Another study also found that plant-based diet downregulates TOR, prolonging life.

TOR controls cell growth and metabolism in response to nutrients, growth factors, cellular energy, and stess.  It regulates how quickly your cells grow and proliferate.  When you're young. you're more likely to survive if you grow fast.  That's what TOR does - it regulates your cells, allowing them to grow and reproduce quickly.  One scientist described it as a "speeding car without brakes."

Unfortunately, what's good at one stage of out life can become a problem at another.  As we got older, we want TOR to slow down the rate at which our cells are growing.  Cancer results when there is unrestrained cell growth and proliferation.  For example, TOR levels are upregulated (turned on) in prostate cancer and breast cancer.

During our childhood, TOR is an engine of growth, but in adulthood it can be thought of as an engine of aging.  Therefore, downregulating TOR - putting on the brakes - helps prevent chronic diseases and premature aging.

Until relatively recently, most people died before they were old enough to develop chronic diseases.  For example, just four hundred years ago, half or more of children in London didn't even survive to age fifteen.  So those who grew quickly had an evolutionary advantage, as they were more likely to have children.  In modern times, public health advances such as clean water, better sanitation, and antibiotics extended life spans for most people well beyond what they had been in prior generations.

Now that people are living so much longer, it's important to find ways to downregulate TOR in order to slow down the rate at which you age.  As described earlier, limiting intake of animal protein downregulates TOR.  Plants, especially vegetables such as broccoli and cauliflower and fruits such as berries inhibit TOR.  So do beverages such as green tea and soy milks and spices such as turmeric.  Substances called flavonols, present in vegetables an fruits, posses anitoxidant and anti-inflammatory properties as well as downregulating TOR.  They also enhance autophagy, allowing your body to detoxify itself.

One of the amino acids found in protein, leucine, has an especially powerful impact on upregulating TOR.  Not surprisingly, leucine is found primarily in animal foods, including meat, chicken, fish, and dairy - yet another mechanism to explain why a whole-foods plant-based diet is so beneficial.  Avoiding these foods helps to downregulate TOR.

There is room for fine-tuning based on your genes - for example, some people are less efficient than others at metabolizing dietary sugars and refined carbohydrates.  But since the diet we recommend is low in these anyway, those individual difference are much less important.  In other words, it doesn't matter if you're not very efficient at metabolizing sugar or refined carbohydrates in your diet if you're not eating too much of these in the first place.  As another example of this, prostate cancer often starts when a protective gene, PTEN, shuts down.  But the tumors in men that lose only this gene don't usually spread beyond the prostate and rarely become lethal.  The cancers change, though, if a second gene, called PML, also shuts down.  When this happens, these quiescent cells are more likely to spread and kill.

Investigators were puzzled that prostate cancer didn't spread even when they intentionally turned off both of these genes in mice.  They had a moment of insight at a scientific meeting when they realized that the mice had been fed a low-fat vegetarian diet, which might have protected them.  They wondered if putting these mice on a high-fat meat-based Western diet would cause the cancer to spread.  It did - the Western diet caused them to quickly develop tumors that grew rapidly and spread.

The point is this:  even when there is a known genetic predisposition to developing metastatic (lethal) cancer and other chronic diseases, the lifestyle medicine program may help prevent this from happening.  


The Telomeres

Dr. Dean Ornish and his colleagues also conducted the first controlled study showing that lifestyle modification changes and lengthen telomeres, the ends of our chromosomes that regulate aging.  The conducted this research with Dr. Elizabeth Blackburn, who shared the Nobel Prize in Physiology or Medicine for her pioneering discoveries of telomeres.

Telomeres are like the plastic tips that keep your shoelaces from unraveling.  They are located at the ends of your chromosomes and protect those DNA from damage.  As you get older, your telomeres tend to get shorter and their structural integrity weakens, causing cells to malfunction and die more quickly.  In brief, as your telomeres get shorter, your life tends to get shorter.  Why? Shorter telomeres are associated with an increased risk of premature death from a wide variety of common chronic diseases - again, because these illness share common underlying mechanisms, including shorter telomeres.  These include an increased risk of heart disease, prostate cancer, breast cancer, colon cancer, Alzheimer's disease, type 2 diabetes, and many others.  In Dr. Ornish's program, they measured, for the first time, a 30 percent increase in telomerase, the enzyme that repairs and lengthens telomers.

After five years, average telomere length decreased in the control group by about 3 percent.  This is what usually happens to most people over time.  However for those in the lifestyle medicine group, telomere length actually increased by 10 percent.  The Lancet Oncology editors described this as "reversing aging at a cellular level," the first controlled study documenting that any intervention could lengthen telomeres.

Also, as they have previously found in other measures, those findings gave them the first indication of a dose-response correlation between the degree of adherence to the lifestyle program and the increases in telomere length.  The more people changed their lifestyle, the longer their telomeres grew.  Of course, lengthening and protecting telomeres doesn't mean we'll live forever.  But these studies show that we can usually live healthy, long, and meaningful lives until we die instead of dwindling away with chronic diseases over a span of many years - in other words, to die young as old as possible.

Article Review

Lifestyle and Cancer Risk
Lifestyle Medicine & Health Survival

Video on Demand Review


Unit 1 Task (Reflective Journal)

This unit is very crucial in understanding the culprit of cancer risk and development.  As you finish your readings and video review, create a REFLECTIVE JOURNAL focusing on the role of Lifestyle in both cancer prevention and cancer development.

submit article review & reflective journal here

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