Diet and Cancer - What’s New?

The incidence of cancer in Asia has risen over the past few decades with deaths from cancers overtaking previous causes of mortality as we race to catch up with Western countries. Cancers of the bowel, breast and lung are now all too common. But there is some good news. Scientists now believe that most cancers are caused by external factors, many of which we can control. That means that, in theory at least, many cancers are preventable. So how do we reduce our risk of cancer?

In December 2007, the World Cancer Research Fund (WCRF) and the American Institute for Cancer Research (AICR) announced an update of their 1997 recommendations for the prevention of cancer with a healthy diet and exercise. So what has changed since the previous recommendations and just what do the guidelines mean for people on a day-to-day basis?

More emphasis on managing body weight

Interestingly and perhaps not surprisingly, the recommendations are very similar to the previous set of diet and cancer guidelines (WCRF/AICR Report 1997) and consistent with what most health authorities are recommending for a healthy lifestyle and the prevention of diet-related diseases. The main change is that the revised guidelines have a much heavier emphasis on managing body weight. 

Compared to the 1997 recommendations, the changes found in the new guidelines include: 

-          More focus on body weight. The panel found that there was stronger evidence for the link between being overweight or obesity and an increased risk of certain cancers. In fact the first three recommendations of the Report  relate to keeping body weight under control and staying active

-          More focus on physical activity.  The previous report noted a link between colon cancer and physical activity. Further studies in this area have produced convincing evidence that physical activity itself is protective against several types of cancer in addition to playing a key role in the control of body weight.

-          A recommendation to breastfeed for up to 6 months has been included in the 2007 guidelines. Breastfeeding helps control body weight in both mothers and infants and also appears to reduce the risk of breast cancer.

-          A recommendation for cancer survivors (people who are either living with, being treated for or having survived cancer) has been included for the first time. The guideline for this group is to simply follow the recommendations for cancer prevention.

-          A recommendation to get nutrients from a varied diet and not to rely on supplements.

Putting it into practice

Here's what the recommendations actually mean for the average person trying to follow a healthy diet. 

Recommendation 1: Be as lean as possible within the normal range of body weight

 

What it means: Children and adolescents should keep a healthy weight throughout childhood and adults should try to avoid that gradual creeping up of the scales that often goes hand-in-hand with increasing age. The BMI (weight in kg /height in metres squared) for a healthy weight is usually 20 – 25. The WCRF report recommends that people aim for a BMI at the lower end of the normal body weight range, say a BMI of 21-23. 

Recommendation 2: Be physically active as part of everyday life

What it means: Try to be moderately active (this means brisk walking or something similar) for at least 30 minutes a day. Aim to gradually increase the time (up to 60 minutes) or the intensity of exercise and cut back on screen time (TV, computer, and gaming consoles). 

Recommendation 3: Limit consumption of energy-dense foods.

What it means: Energy-dense foods are foods that are high in calories. While any food will cause weight gain if we eat too much of it, these foods offer calories but little in the way of additional nutrients so they should be consumed in moderation. Energy-dense foods include cakes, biscuits, pastries, soft drinks, sweetened drinks, confectionary, fried and fast foods.  

Recommendation 4: Plant foods – fruits, vegetables and grain foods

What it means – Aim for 5 servings of fruits and vegetables every day. The more colourful the better – so aim to include a variety of fruits and vegetables – red, green, purple, yellow, orange.

Choose high fibre cereals and pulses to increase fibre intakes. And avoid grains or nuts that are spoiled or have not been properly stored as they may be infected by toxins from fungus (aflotoxins) which can cause liver cancer. 

Recommendation 5: Animal foods

What it means: The WCRF recommendation is to eat no more than 500g of cooked red meat (beef, lamb, pork or goat) a week and to make sure the meat is lean and trimmed of fat. This translates to about 750g of raw meat and is consistent with the Australian National Dietary Guidelines that recommend 3-4 servings of lean red meat a week. The Report recommends that processed meats (such as ham, bacon, salami, frankfurts) should be avoided or taken only occasionally in small amounts.  

Recommendation 6: Limit alcoholic drinks

What it means: The recommendation is similar to that of most public health authorities – if alcohol is consumed, men should have no more than two standard drinks a day and women should take no more than one drink a day. 

Recommendation 7: Watch your salt intake

What it means: Salt and foods that are preserved using salt (such as pickled vegetables) are thought to be a cause of stomach cancer so it's best to limit the intake of salt and salty foods.  Of particular note for people living in China, the Panel warned against eating Cantonese style salted fish. This fish, which is often given to children, is thought to increase the risk of naso-pharyngeal cancer. 

Recommendation 8: Aim to meet nutritional needs through diet alone

What it means: You don't need supplements if you are taking a healthy diet.  While there are studies suggesting that some supplements may decrease the risk of certain cancers, the evidence is conflicting.  A healthy well-rounded diet is the best remedy for cancer prevention. 

Recommendation 9: Breastfeeding

What it means:  Aim to breastfeed for up to six months. 

Recommendation 10: Cancer survivors

What it means: People who have survived cancer are advised to follow the 9 recommendations given above if possible. The panel noted that there is no evidence to provide any separate recommendations for people who are living with cancer or who have recovered from the condition.  

 

Tips for a Longer Life

Based on the Okinawan experience, it can be safely said that the aging process is influenced by a variety of genetic, environmental and lifestyle factors. While we can't control for all of these, there are a lot of things we can do to increase our chances of living longer. 

Following are some factors that can help contribute to a longer life: 

Stay active – exercise not only helps keep body fat levels down, it also keeps the brain active. A US study of 6,000 women aged 65 yrs and above, found that those who were active tended to retain their cognitive function better than those who were sedentary. Increased cardiovascular fitness appears to be linked to better brain function. 

Watch those calories – while a severe reduction in calories is not advised if you are normal weight or underweight, try to concentrate on wholesome foods like fruit, vegetables and whole grains, and aim to keep off those kilos that come creeping up with age. Watch that serving sizes don't get too big and make sure you offset your calorie intake by being active. If you are overweight, it's a good idea to drop the excess kilos through a healthy diet and exercise plan. 

Load up on fruits and vegetables – the more brightly coloured the better. Fruits and vegetables are rich sources of bioflavenoids and other antioxidants which are known to help neutralise free radicals. They are also low in fat and provide dietary fibre. Aim for a minimum of five servings of fruits and vegetables daily and make sure you get lots of variety. 

Choose the good fats – studies in populations that live longer in both Europe and Japan,  show that their diets tend to be low in saturated fats (the type that raise cholesterol). Instead choose moderate amounts of monounsaturated fats (olive oil, canola oil, fatty fish, nuts, seeds, flax). Choose fish two to three times a week. 

Get enough sleep – a lack of sleep increases the risk of obesity and it can affect metabolism and hormone production. Aim for 7-8 hours a night. 

Moderate alcohol – high alcohol intakes are linked to increased body weight and other health issues including certain cancers. If you drink alcohol, limit it to just one to two drinks daily and aim for 1-2 alcohol-free days a week.  

De-stress – whatever works for you. Meditation, yoga, religion, a simple cup of tea or a walk in a garden.  

Don't smoke – smoking is linked to an increased risk of cancers, heart disease and stroke.

Life Expectancies in Selected Countries, 2005

(Sourced from WHO World Health Statistics 2007)

Country	Life Expectancy for Men	Life Expectancy for Women
Japan	79	86
Australia	79	84
Sweden	79	83
Italy	78	84
Greece	77	82
Selected Asian Countries (Alphabetical Order)
China	71	74
India	62	64
Indonesia	66	69
Malaysia	69	74
Philippines	64	71
Republic of Korea	75	82
Singapore	78	82
Thailand	67	73

Food Facts Asia Issue 32 - The Secrets to a Longer Life

It's a New Year – 2008 and the Chinese Year of the Rat - and many people's thoughts turn to the future. For most of us, that means wishing for a long, healthy and happy life. But what can we do to increase our chances?

In almost every country in the world, the fastest growing population group is the 60 years and over age group. This has been attributed to improved health care, better housing, increased incomes and more nutritious diets. The countries in the world with the greatest life expectances include Japan, Australia, Italy, Greece and Sweden. Japan tops the longevity stakes with a life expectancy of 86 years for women and 79 years for men. The number of people living to be 100 years or more in Japan has increased greatly. In 1963, there were only 153 recorded centenarians in the country while by 2006 the figure had increased to 28,395, of which 85% were women.

While there is a genetic factor influencing life expectancy, scientist's estimate that it accounts for only about 30% of the observed differences in longevity rates. So it makes sense to look at diets and lifestyles and see what other factors play a role.

The International Union of Nutritional Sciences (IUNS) Subcommittee on Nutrition and Aging and the World Health Organization (WHO) attempted to do just that in 1987. The "Food Habits in Later Life" study looked at 818 subjects aged 70 years and over, in Sweden, Greece, Japan and Australia (the study separated the Australian group into Anglo-Celts and Greeks living in Australia). The subjects were followed for seven years. Information was gathered on dietary habits, lifestyles and general health. The study found that those with a better memory and healthier diet (particularly a "Mediterranean" type diet with an emphasis on fruits and vegetables, fish, legumes, cereals and olive oil) tended to live longer than those who didn't follow a healthy lifestyle. Not surprisingly, smoking was found to significantly shorten the life span. Several other studies in European countries have shown similar results – no smoking, moderate alcohol, and a healthy lifestyle including a Mediterranean-style diet and exercise – make for a longer and healthier life.

Why Do We Age?

The aging process is thought to be due to the accumulation of free radicals (substances formed as a result of normal body processes) which damage body tissues and DNA. In younger people, this damage is quickly and easily repaired. However, as we get older the damage accumulates resulting in chronic inflammation and irreversible DNA damage. This in turn increases the incidence of age-related conditions such as cancer and heart disease. But it appears that there are steps we can take to reduce the speed of this aging process and increase our chances of blowing out those 100 candles!

Studies conducted on rats have shown that lowering energy (calorie) intake can extend the lifespan by 30 per cent. It is thought that fewer calories results in a decrease in the production of free radicals and hence an increase in longevity. Researchers have found lower blood sugar levels, reduced insulin levels and a reduction in the production of free radicals in rats fed low calorie diets. Low calorie diets have also been shown to increase the lifespan of worms, mice and flies and an ongoing experiment in monkeys is showing positive results too.

Studies in genetics have also thrown some light on the effects of energy restriction and the aging process. A US study reported that a reduced calorie diet changed the activity of a small number of genes involved in stress response, protein repair and energy production. The activity of these genes usually decreases with age and researchers believe that a reduced calorie diet may delay this reaction and allow the genes to stay intact and active for longer.

The evidence to date in humans is indirect and most of the trials have been short term. A US study in overweight people found that those who reduced their calorie intake by 25% for 6 months had reduced fasting insulin levels and a lower body core temperature, both of which are markers associated with longevity in humans. High levels of insulin are known to increase inflammation and oxidative stress, both linked with cell damage and the aging process. In addition, weight loss is known to reduce blood pressure, blood sugar levels, blood cholesterol, the amount of body fat, heart rates and weight, all factors which in turn are linked with a reduction in the risk of a whole host of lifestyle-related disorders linked with an early demise including certain cancers and heart disease.

But what about people who are not overweight? Can they expect to live longer if they cut their energy intake? Although studies in this area are lacking, scientists have hypothesized that a lowering of insulin levels and body core temperature as well as effects on gene expression from reduced calorie diets are probably linked with an increased life span. However, caution must be exercised with consumption of a very low calorie diet. The varied risks associated with very low calorie diets include problems with nutrient inadequacy; possible loss of muscle mass and bone density; and an increased risk of anaemia, memory loss or depression. Additionally, it's not always easy to follow a calorie restricted diet for long periods of time.

The Case of the Okinawans

One of the most studied elderly populations is a group of people living on the Japanese island of Okinawa. It is believed that Okinawa has the world's largest number of centenarians (people living over 100 yrs) with 50 people per 100,000 aged over 100 yrs. In most developed countries including the USA, the rate is 10-20 per 100,000. So what do the Okinawans do that helps prolong their lives?

They appear to have "better" genes for aging which is thought to account for about one third of their longer life spans. They have a reduced risk of inflammation and autoimmune disease, which is believed to be genetically pre-determined. Yet, when Okinawans moved away from home and migrated and adopted alternative lifestyles, they did not fare as well in the longevity stakes. More recently, lifestyle changes have eroded the average lifespan in Okinawa and this implies that there are probably other factors which contributed to their longevity.

One of these is their low saturated fat diet which is high in seafood, seaweed, fruit and vegetables. The other striking factor is that their diet is low in calories, due to a cultural tradition called "hara hachi bu" meaning "eat until you are only 80% full", which is widely practiced in Okinawa. The Okinawans consume 20% fewer calories than the average Japanese diet which in turn is lower than that consumed in most other countries. In effect this means they consume about 500 cals less than the typical 2,000 plus calorie-diet consumed daily by an adult woman in a Western country.

Alcohol too is consumed in moderation and regular exercise is an important part of their lives, even when they are very old. The Okinawans are also said to have a psycho-spiritual outlook on life and use meditation and other means to reduce stress. This lifestyle seems to be paying off. In addition to their long life spans, the Okinawans have an 80% lower incidence of cancers such as breast and prostrate cancer when compared to the USA. They also have very a low incidence of heart disease and stroke. The average body mass index (BMI) is just 18-22 and they have low levels of body fat.

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