chapter 11

Cancer Prevention

- Fiber-Rich Foods Many studies show that as people increase their dietary fiber intakes, their risks for colon cancer decline. -Eat a Balanced and Varied Diet; An estimated 20 percent of all cancers are caused by a combination of excess body weight, physical inactivity, excess alcohol consumption, and poor diet -Whole Foods and Phytochemicals contain a wide variety of nutrients and phytochemicals that may reduce oxidative damage to cell structures, including DNA, the material of genes. In addition, some phytochemicals are thought to act as anticarcinogens, promoting the buildup of the body's arsenal of carcinogen-destroying enzymes. cruciferous vegetables—broccoli, brussels sprouts, cabbage, cauliflower, collard greens, turnips, and the like which contain a variety of potentially protective phytochemicals -Supplements Cannot Provide What Foods Provide- can advance cancer -Use Alcohol Sparingly or Abstain from Use If they choose to drink alcohol, men should drink no more than two drinks a day; women no more than one. Don't combine alcohol use with smoking. -Achieve and Maintain a Healthy Body Weight throughout Life; Limit consumption of energy-dense foods and refrain from drinking beverages with added sugars. Consume "fast foods" sparingly if at all. -Engage in Regular Physical Activity-average of at least 20 minutes of moderate-intensity or 10 minutes of vigorous-intensity physical activity per day and to limit sedentary behaviors Cooking Consumers can take these steps to minimize carcinogen formation during cooking: Marinate meats before cooking, and roast or bake them in the oven. When grilling, line the grill with foil, or wrap the food in foil. Take care not to burn foods. In addition, limit intakes of crispy, browned French fries and chips and other well-browned foods.

carcinogens-Cancer Risk Factors

A Note about Environmental Carcinogens Environmental factors also present risks of cancer. Overexposure to the sun, especially without the use of sunscreen or protective clothing, incurs a risk of skin cancer. Exposure to radiation, as when a nuclear accident occurs, poses a cancer risk fried foods- acrylamide is classified as "a probable human carcinogen. Carcinogens in Red and Processed Meats Population studies spanning the globe for more than 30 years consistently report that diets high in red meat and processed meat increase the risk of colon cancer. Processed meats are listed among human carcinogens by the WHO. They contain additives, nitrites or nitrates, which contribute a pink color and deter bacterial growth in meats. In the digestive tract, nitrites and nitrates form other nitrogen-containing compounds that may be carcinogenic Cooking Methods Cooking meats at high temperatures (frying, broiling) causes amino acids and creatine in the meats to combine and form carcinogens. Grilling meat, fish, or other foods—even vegetables—over a direct flame causes fat and added oils to splash on the fire and then vaporize, creating other carcinogens that rise and stick to the food. Smoking foods has the same effect. Eating these foods, or even well-browned meats cooked to the crispy, well-done stage, introduces carcinogens into the digestive system. A steady diet of foods containing these toxins can overwhelm defenses and increase cancer risk. Fats and Fatty Acids Laboratory studies using animals suggest that high dietary fat intakes correlate with development of cancer. Alcohol with Smoking Alcohol intake by itself raises the risk of cancers of the mouth, throat, esophagus, colon, and breast, and alcoholism often damages the liver in ways that promote liver cancer. When drinkers add smoking to the insults inflicted on the body by alcohol, the rate of cancers of the head and neck rises significantly. Obesity and Estrogen Obesity is clearly a risk factor for cancers, especially those of the colon, endometrium, pancreas, kidney, esophagus, and breast (in postmenopausal women) Chronic Inflammation Inflammation plays a central role in cancer. Chronic inflammation may set in during the development of obesity, heart disease, diabetes, or other diseases, and can then accelerate the development of cancer.

are all called ...... vegetables

Arugula, bok choy, broccoli, broccoli sprouts, Brussels sprouts, cabbages (all sorts), cauliflower, greens (collard, mustard, turnip), kale, kohlrabi, rutabaga, and turnip root are all cruciferous vegetables.

hypertension

Chronic hypertension is one of the most prevalent forms of CVD, afflicting about 85 million U.S. adults, Hypertension is a primary cause of stroke, a leading cause of death in the United States -More than two-thirds of U.S. adults older than 65 have hypertension. -Atherosclerosis and hypertension accelerate each other. -If the blood pressure is even slightly above normal, it increases the risk of heart attack and stroke. Moreover, the relationship is proportional: the higher the blood pressure, the greater the risk. •Blood pressure combination of •Cardiac output from heart contractions •Peripheral resistance from small arteries •Influences; •Nervous system-regulates heart contractions •Hormonal system-fluid retention and vessel constriction •Kidneys- regulate Na+ & fluid balance Chronic high blood pressure-one of most prevalent forms of CVD; 78 million adults in USA •No symptoms you can feel •Systolic pressure: ventricular contraction •Diastolic pressure: ventricular relaxation •Need blood pressure checks at regular intervals

smoking

Cigarette smoking powerfully increases the risk for CVD. The more a person smokes, the higher the risk. Using tobacco in all its forms exposes the heart to damaging toxins, and burdens it by raising the blood pressure. Body tissues starved for oxygen by smoke demand more heartbeats to deliver oxygenated blood, thereby increasing the heart's workload. At the same time, smoking deprives the heart muscle itself of the oxygen it needs to maintain a steady beat. Smoking also damages blood platelets, making clots likely to occur.

Complementary & Alternative Medicine to cancer

Complementary: used with conventional medicine•Alternative: used instead of conventional medicine•Placebo effect: person's belief in treatment can sometimes lead to physical healing•When tested, most prove ineffective or unsafe.•Many herbal medicines contain effective natural drugs•National Center for Complementary and Alternative Medicine (NCCAM): distinguishes potentially useful from useless/harmful therapies•Acupuncture: helps quell nausea from surgery, chemotherapy, and pregnancy, can ease chronic low-back pain, and possibly migraine headaches•Mislabeled herbs: don't contain what they claim when tested; may contain cyanide, lead, mercury, arsenic •Intelligent, clear-minded people can fall for such hoaxes when standard medical therapies fail; loving life and desperate, they fall prey to the worst kind of quackery on the feeblest promise of a cure.

Recommendations for Reducing CVD Risk

Diet to reduce CVD risk: -decreased intakes of saturated fat and trans fat -decreased refined starches and added sugars -increased nutrient-dense fruits, vegetables, nuts, legumes, fish and whole grains -Diet rich in omega-3 fatty acids -->2 fish meals/week •Making lifestyle changes: exercise, eat right, don't smoke, relax, control stress, play, be happy Lifestyle changes to lower the risk of CVD include increasing physical activity, achieving a healthy body weight, reducing exposure to tobacco smoke, and eating a heart-healthy diet, reduce salt intake, look at family history. Dietary measures to lower LDL cholesterol include reducing intakes of saturated fat and trans fat, along with consuming generous quantities of nutrient-dense fruit, vegetables, legumes, nuts, fish, and whole grains.

alcohol intake

Drinking alcoholic beverages alters several risk factors underlying CVD. Wine in moderation, mentioned in Controversy 3, may yield some benefits, but in higher doses any alcoholic beverage damages heart tissues, promotes blood clotting, and raises blood pressure. Alcohol in large amounts, even from wine, also increases inflammation. Hypertension is common among people with alcoholism; so are strokes, even when blood pressure is normal. Alcohol, regularly consumed in excess of two drinks per day for men or one for women, is strongly associated with hypertension and may interfere with drug therapy designed to lower blood pressure.

Chronic diseases arise from a mixture of factors in three areas:

Genetic Inheritance: people cannot control. Current disease states: people may be able to control or modify to some extent (obesity, hypertension). Daily lifestyle choices: people can directly control, and these can often prevent or delay the onset of certain diseases.

chronic diseases

Infectious diseases have a single cause—exposure to a specific pathogen. Today's predominant diseases are chronic diseases—cardiovascular diseases, type 2 diabetes, and cancer. The chronic diseases have many risk factors in common—among them, excessive alcohol intake, lack of physical activity, smoking/tobacco use, and diet.

telltale signs of type 2 diabetes Diabetes Prevention and Management;Achieving and maintaining a healthy body weight. Adopting and maintaining an eating pattern of regularly timed, healthy meals that are moderate in calories, low in saturated fat, and high in vegetables, legumes, fruit, low-fat or fat-free milk products, fish, poultry, and whole grains. Engaging in a program of regular physical activity.

Intense hunger, although there is plenty of glucose in the blood, the cells are starved for energy Frequent urination, because the kidneys are filtering excess sugar out of the blood and having to draw water from the body to excrete it Intense thirst, because the frequent urination brings about dehydration -Know Your Family History -diagnosis can be made using any of several tests, among them the fasting plasma glucose test and a nonfasting A1C test -Lose Weight if Overweight If you are overweight, losing just 5 percent of your body weight, and maintaining that loss, can significantly reduce your risk of diabetes -Be Physically Active Plan to get at least 30 minutes of physical activity on most days of the week physical activity helps the body shed excess fat and strengthens tissue response to insulin. -choose diet for example, DASH, the Healthy Mediterranean- and the Healthy Vegetarian Eating Pattern -Control Carbohydrate Intake -Dietary Fat-People with diabetes are advised to follow the Dietary Guidelines for Americans regarding saturated fat and trans fat intakes. These recommendations include reducing saturated fat intake to less than 10 percent of calories and limiting trans fat as much as possible. As is true for the general population, foods rich in omega-3 fatty acids are recommended for those with diabetes because such foods exert beneficial effects on lipoproteins and the prevention of heart disease. -Protein An ideal protein intake to control blood glucose or to improve CVD risk factors in diabetes has not been determine -Alcohol Intake Alcohol intake, if any, should be moderate.

metabolic syndrome

Metabolic syndrome includes any three or more of the following: High fasting blood glucose. Central obesity. Hypertension. Low blood HDL. High blood triglycerides.

infectious disease

Nutrition cannot directly prevent or cure infectious diseases, but good nutrition can strengthen, and malnutrition can weaken, your body's defenses against them •Many so-called immune-strengthening foods, dietary supplements, and herbs are hoaxes. For healthy, well-fed people, supplements cannot trigger extra immune power to fend off dangerous infections.

Obesity and Physical Inactivity

Obesity, especially abdominal obesity, and physical inactivity significantly increase risk factors for CVD, contributing to high LDL cholesterol, low HDL cholesterol, high triglycerides, hypertension, and diabetes. Conversely, weight loss and physical activity protect against CVD by lowering LDL, raising HDL, lowering triglycerides, improving insulin sensitivity, and lowering blood pressure. Obesity is a major cause of high blood pressure, and the combination of obesity and hypertension greatly increases the risk for CVD. Most people with hypertension—an estimated 70 percent—are overweight or obese. Obesity raises blood pressure in several ways: by altering kidney function, by increasing blood volume, and by promoting blood vessel damage through insulin resistance. Excess fat also has miles of extra capillaries through which blood must be pumped.

Major Risk Factors for Heart Disease

Risk factors that cannot be modified: Increasing age. Male gender. Family history (heredity). Risk factors that can be modified: High blood LDL cholesterol. Low blood HDL cholesterol. High blood triglyceride (VLDL) levels. High blood pressure (hypertension). Diabetes. Obesity (especially central obesity). Physical inactivity. Cigarette smoking. Excessive alcohol consumption. High intake of sodium. An "atherogenic" diet (high in saturated fats and trans fats and low in vegetables, fruit, and whole grains).

cancer

Risk factors: •Smoking: if all Americans quit right now, future total cancers would likely drop by about a third. •Obesity and a lack of physical activity related to colon and breast cancer and probably contribute to pancreatic, esophageal, and renal cancers. •Alcohol contribute to cancer of the mouth, pharynx, larynx, esophagus, breast •Diet influences 30-40% of cancers -Obesity, lack of physical activity, alcohol and tobacco use, and diets high in red and processed meats are associated with cancer development. -Most cancers, lifestyle & environment are major risk factors. A few rare cancers are known to be caused primarily by genetic influences. Others are linked with microbial infections. -Second only to cardiovascular disease as a leading cause of disability and death in the United States is cancer. More than 1.6 million new cancer cases and 600,000 deaths from cancer are expected to occur in the United States in 2017

the dash diet

To lower saturated fat intakes, the DASH diet emphasizes fruit, vegetables, whole grains, and fat-free or low-fat milk and milk products. It also features fish, poultry, and nuts instead of some of the red meat so common in U.S. diets. Compared with the typical American diet, the foods of the DASH diet provide greater intakes of fiber, as well as potassium, calcium, and magnesium, minerals shown to lower blood pressure. -centers on fresh, unprocessed, or lightly processed foods, it delivers less sodium, too. Rich in fruits, vegetables, nuts, whole grains, and low-fat milk products •Increased fiber, potassium, magnesium, and calcium; emphasizes legumes and fish over red meat•Low in total fat and saturated fat. •Limits added sugars and sugar-containing beverages •DASH diet improves vascular function, lowers total cholesterol and LDL cholesterol, and reduces inflammation

immune system and chronic diseases

acute inflammation-normal response to infection/injury: •increase blood flow to area •increaseWhite blood cells -->oxidative products like hydrogen peroxide to kill infection or cancer cells •Chronic inflammation •Harms tissues •Sustained immune response leads to free radials & many other factors worsening chronic diseases

In USA,

chronic disease far outranks infectious disease as leading cause of death.Many deaths have multiple causes, but diet influences the development of several chronic diseases—notably, heart disease, some types of cancer, stroke, and diabetes.

diabetes

more than 29 million people in all have diabetes. Of these, almost 3 million are unaware of it and so go untreated. In addition, well over one-third of U.S. adults, or 86 million more, have prediabetes, exhibiting warning signs of diabetes to come. Prediabetes silently threatens the health of tens of millions of people in the United States. Type 2 diabetes is responsible for 90 to 95 percent of cases in both adults and children•Predominant type closely linked with obesity•Been on the rise among children and adolescents•Insulin resistance: An inadequate response of the body's cells to the hormone insulin Insulin resistance causes glucose and insulin to build up in the bloodstream •The blood glucose concentration rises •The overtaxed cells of the pancreas begin to fail and reduce their insulin output, while blood glucose soars farther out of control Type 2 diabetes is the predominant type of diabetes and is closely linked to obesity. The primary defect in type 2 diabetes is insulin resistance—an inadequate response of the body's cells to insulin. Type 1 diabetes is an autoimmune disorder. A person's own immune cells mistakenly attack and destroy the insulin-producing cells of the pancreas. The rate of pancreatic cell destruction in type 1 diabetes varies. In infants and children, destruction is rapid; in adults, it is slow Type 1 diabetes is an autoimmune disease that attacks the pancreas and abolishes its ability to produce insulin; it necessitates that insulin be provided from an external source.

cardiovascular disease (CVD)-disease of heart and blood vessels

more than 92 million people suffer some form of disease of the heart and blood vessels, Cardiovascular disease claims the lives of more than 800,000 people each year in the United States and has been the leading cause of death in this country for decades. CVD is often called "heart disease," but that is an oversimplification. As the term cardiovascular disease implies, CVD includes diseases of the blood vessels as well as the heart. •Kills 1 million people in U.S.A. annually •Leading cause of death among women •Heart is one of the least regenerative organs -->heals by forming scar tissue which is not contractile -At every age, men have a greater risk of CVD than women do, and men suffer heart attacks more often and earlier in life. Regardless, more than 44 million U.S. women have CVD and the number is increasing, -kills more U.S. women, especially those who are past menopause, than any other cause risk factors; The more you can control, the lower risk of CVD and death. •Nonmodifiable: age, gender, genetic inheritance •LDL -high levels-->greater the risk CVD "atherogenic" •HDL-removes cholesterol --> low levels increase risk •VLDL/triglycerides --> high levels increase risk; associated w/ sedentary, overweight/obesity, DM Atherogenic diet:• increased sat fat •increased trans fats Obesity and metabolic syndrome- cluster of risk factors with obesity and insulin resistance at forefront

Atherosclerosis

the common form of hardening of the arteries, is a major underlying cause of most forms of CVD, including hypertension. Hypertension in turn, worsens atherosclerosis. The two diseases are so interrelated that each is a risk factor for the other. Atherosclerosis begins with damage to the cells lining the arteries, caused by any of several factors: high blood LDL cholesterol, hypertension, diabetes, toxins from cigarette smoking, obesity, and certain viral and bacterial infections. The damage is followed by a series of events that take place over many years: Development of fatty streaks, especially at branch points. Enlargement and hardening of these fat deposits to become plaques. Narrowing and hardening of the arteries Inflammation, which produces abundant free radicals. -Plaques in arteries also promote and aggravate hypertension (high blood pressure). -High blood pressure also worsens atherosclerosis. High pressure damages the artery walls, making fatalities more likely. •Plaques rupture -->body responds to injury with platelets -->blood clots •Thrombus-stationary blood clot •Embolus -traveling clot •Tissues fed by artery robbed of oxygen and nutrients & die rapidly. •Omega-3 fatty acids oppose platelet formation & clotting •Blood pressure rises because harder to push blood through narrow, hard vessel --> causes more damage & plaques •Aneurysm-ballooning of artery wall from pressure

risk factors of type 2 diabetes

three risk factors for type 2 diabetes: Advancing age. Diabetes testing should begin at age 45 for everyone. Family history (heredity). Having a close relative with type 2 diabetes increases the risk. Overweight and obesity. Most, but not all, people with type 2 diabetes are overweight, and obesity can foster insulin resistance. In addition, race and ethnicity affect diabetes risk: African Americans, Latinx populations, certain Asian Americans, Native Americans, and Pacific Islanders all have increased risks for type 2 diabetes. Poor circulation to the eyes impairs vision and can lead to blindness. Diabetes is the leading cause of both kidney failure and blindness in adults in the United States

the immune system

•Among first impaired by vitamin/mineral deficiencies •Spiral of Malnutrition & Weakened Immunity •At-risk groups: very young, very old, hospitalized, poor •MN -->Worsens disease --> Worsens MN cycle •Impaired immunity opens the way for disease; when disease impairs appetite, interferes with digestion and absorption, increases excretion, or alters metabolism, then nutrition status suffers further.