Cancer and Diabetes: Two Epidemics or One?

1

• Cancer and Diabetes Two Epidemics or One?
• Andrea Reser, RD/LD
• Diabetes Program Coordinator/Clinical Dietitian

2
Overview

• Diabetes Epidemic
• Cancer Statistics
• Relationship of Diabetes and Cancer
• Importance of Blood Sugar Control
• Treatment Challenges
• Cancer Fighting Diabetic Diet
• Prevention
• Conclusions

3

• Cancer Diabetes The Connection

4
US Mortality

1. Heart disease 652,091
2. Cancer 559,312
3. Stroke (cerebrovascular diseases) 143,579
4. Chronic lower respiratory diseases 130,933
5. Accidents (unintentional injuries) 117,809
6. Diabetes 75,119
7. Alzheimer's disease 71,599
8. Influenza/Pneumonia 63,001
9. Nephritis, nephrotic syndrome, and nephrosis
   43,901
10. Septicemia 34,136

Source Centers for Disease Control, 2008,
www.cdc.gov
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Diabetes Overview

• Diabetes
• Disease in which the body does not produce or
  properly use insulin

Source American Diabetes Association, 2008
www.diabetes.org Picture http//www.medicinenet.
com/islet_cell_transplantation/article.htm
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Major Types of Diabetes

• Type 1 Diabetes
• Results from bodys failure to produce insulin
• 5 to 10 of Americans
• Type 2 Diabetes
• Results from insulin resistance (body fails to
  properly use insulin), combined with relative
  insulin deficiency
• Most Americans
• Gestational Diabetes
• Immediately after pregnancy 5-10 have Type 2
  diabetes
• Pre-diabetes
• Blood glucose levels higher than normal but not
  enough for diagnosis in Type 2 diabetes

Source American Diabetes Association, 2008,
www.diabetes.org
7
Diabetes Epidemic

• 23.6 million children and adults in United States
  (8)
• 17.9 million have been diagnosed
• 5.7 million are unaware
• 57 million prediabetes
• CDC Last 15 years numbers have more than doubled

Sources American Diabetes Association, 2008,
www.diabetes.org Centers for Disease Control,
2008, www.cdc.gov
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Mortality Change
Rate Per 100,000
1950 2004
HeartDiseases
CerebrovascularDiseases
Pneumonia/Influenza
Cancer
Sources 1950 Mortality Data - CDC/NCHS, NVSS,
Mortality Revised. 2004 Mortality Data US
Mortality Public Use Data Tape, 2004, NCHS,
Centers for Disease Control and Prevention, 2006
9
2008 Estimated US Cancer Deaths
Men294,120
Women271,530

• 26 Lung bronchus
• 15 Breast
• 9 Colon rectum
• 6 Pancreas
• 6 Ovary
• 3 Non-Hodgkin lymphoma
• 3 Leukemia
• 3 Uterine corpus
• 2 Liver bile duct
• 2 Brain/ONS
• 25 All other sites

Lung bronchus 31 Prostate 10 Colon rectum
8 Pancreas 6 Liver intrahepatic 4bile
duct Leukemia 4 Esophagus 4 Urinary bladder 3
Non-Hodgkin 3 lymphoma
Kidney renal pelvis 3 All other sites
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Source American Cancer Society, 2008,
www.cancer.org
10
Lifetime Probability Men
Site
Risk
All sites 1 in 2 Prostate 1 in 6 Lung
and bronchus 1 in 12 Colon and rectum 1 in
17 Urinary bladder 1 in 28 Non-Hodgkin
lymphoma 1 in 47 Melanoma 1 in 49 Kidney 1
in 61 Leukemia 1 in 67 Oral Cavity 1 in
72 Stomach 1 in 89
Source American Cancer Society, 2008,
www.cancer.org
11
Lifetime Probability Women
Site
Risk
All sites 1 in 3 Breast 1 in 8 Lung
bronchus 1 in 16 Colon rectum 1 in
19 Uterine corpus 1 in 40 Non-Hodgkin
lymphoma 1 in 55 Ovary 1 in 69 Melanoma
1 in 73 Pancreas 1 in 79 Urinary
bladder 1 in 87 Uterine cervix 1 in 138
Source American Cancer Society, 2008,
www.cancer.org
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Overview

• Diabetes Epidemic
• Most undiagnosed
• Lifetime Risk
• Male 1 in 2
• Female 1 in 3
• 8-18 of cancer patients also have diabetes

Source American Cancer Society, 2008,
www.cancer.org
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Diabetes and Cancer

• Type 1
• Cervical Cancer
• Stomach Cancer
• Type 2
• Breast Cancer
• Endometrial Cancer
• Pancreatic Cancer
• Liver Cancer
• Kidney Cancer
• Colon Cancer

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Obesity Trends
1992
1995
1998
2005
Source Centers for Disease Control, 2008,
www.cdc.gov
15
The Relationship

• Hyperglycemia (high blood sugar)
• Elevated insulin concentrations
• Growth promoting effects of IFG-1

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Blood Sugar Control

• 80-110 mg/dl
• Increased length of stay and cost
• Higher infection rate
• Shorter remission periods
• High morbidity and mortality rates
• Decreased Immune Function
• Decreased Quality of Life

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Treatment Challenges

• Treatment induced diabetes
• Parenteral and enteral nutrition
• Reduced/omission of dose
• Delays in treatment
• Co-morbidities
• Aftercare and quality of life
• No National Standards

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• Cancer Fighting Diabetic Diet

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Nutrition Goals

• Diabetes
• Achieve and maintain
• Blood glucose
• Lipid profile (cholesterol, LDL, HDL, TG)
• Blood pressure
• Prevent/Slow chronic complications
• Address individual nutritional needs
• Maintain pleasure with eating

• Cancer
• Achieve and maintain
• Energy stores
• Lean body mass
• Maximize the Immune System
• WBC, RBC, platelets
• Prevent/Slow treatment side effects
• Address individual nutritional needs
• Maintain pleasure with eating

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Carbohydrates (CHO)

• Largest effect on blood sugar
• Encouraged to include
• Low CHO (lt130g/day) not recommended
• Monitor CHO intake
• Exchange List
• Carbohydrate counting
• Plate Method

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Carbohydrates
White Refined Products
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Sweeteners

• Artificial sweeteners
• Aspartame, saccharin, sucralose, acesulfame-K
• No calories
• Sugar Alcohols
• Xylitol, mannitol, sorbitol
• Calories, GI discomfort
• Natural sweeteners
• Stevia, fructose, honey, molasses

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Carbohydrates (CHO)

• Choose More Often
• Whole Fruits
• Whole Vegetables
• Whole Grains
• Beans/Legumes
• Natural Sugars

• Choose Less Often
• White, refined products
• Simple sugars
• Cakes, candy
• Sugar free products

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Protein Overview

• Building block of our bodies
• Regulates blood sugar
• Builds
• Immune system
• WBC, RBC
• Muscles
• Hormones
• Enzymes
• Specific amount established by Dietitian

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Protein

• 2/3 of Protein in Diet
• Beans/Legumes
• Nuts/Seeds
• Nut Butters
• Whole Grains
• Soy
• Powders
• Rice
• Vegetable
• Soy

• 1/3 of Protein in Diet
• Animal Meats
• Red meat lt18 oz week
• Dairy
• Eggs
• Powders
• Whey (Dairy)
• Goat

Builds and Supports Immune System
Source American Institute for Cancer Research,
2008, www.aicr.org
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Fat Overview

• Essential in diet
• Regulates blood sugar
• Fat and Cholesterol
• Increase risk for heart disease
• Increase cancer risk

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Fats

• Saturated Fats
• Solid at room temperature
• Animal Sources
• Linked to cancer
• Limited quantity
• Unsaturated Fats
• Liquid at room temperature
• Plant sources
• Trans Fats
• Hydrogenated Fats
• Self stable and frozen products

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Fats (cont)

• Monounsaturated Fats (MUFA)
• Polyunsaturated Fats (PUFA)
• Omega-3
• Fish (from ocean)
• Walnuts
• Canola Oil
• Fortified Foods
• Flaxseed
• Omega-6
• Fried Foods
• Animal Meats
• Grains

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Overview Fats
Limit
Encouraged
AVOID
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Alcohol

• Alcohol
• Increase risk of low blood sugar
• Consume with food
• Empty calories
• Increase cancer risk
• Dehydrates body
• Female one drink
• Male two drinks

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• Cancer and Diabetes Prevention

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Prevention

• Lifestyle modifications
• Maintain a healthy weight
• Moderate wt loss (7 of body wt)
• Regular physical activity
• At least 30 minutes daily, 5 days week
• Three strategies for weight loss
• Eat a greater proportion of plant based foods
• Watch the size of your portions
• Keep physically active

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Play with Your Food
Size of fist one serving of carbohydrates
Size of thumb joint one to two servings of fat
Eat with your Hands!
Size of palm one serving of meat, poultry, or
fish
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Body Mass Index (BMI)
BMI Weight Status
Below 18.5 Underweight
18.5-24.9 Normal
25.0-29.9 Overweight
30.0 and above Obese
BMI Weight in Pounds
x 703 (Height in
inches) x (Height in inches)
Example 150
pounds x 703 26.5
(63 inches) x (63 inches)
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Prevention Diet

• Eat plenty of vegetables and fruits
• Five to Nine a Day
• Standard serving ½ cup
• Prevent at least 20 of all cancers
• Fiber
• Juice
• Vitamins, Minerals, Phytochemicals
• Antioxidants

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Vegetable and Fruit Servings
Source American Cancer Society, 2008,
www.cancer.org
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Prevention Diet

• Select foods low fat and in salt
• Limit processed foods
• Linked to most cancers

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Cancer Alcohol

• Drink alcohol only in moderation, if at all
• Can cause cancer
• Mouth, esophageal, laryngeal, pharyngeal, breast,
  and liver cancers
• 75-80 of oral cancers frequently used alcohol
• Men 2 drinks a day Females 1 drink per day
• More alcohol Higher risk
• Higher risk if use tobacco
• Empty calories
• Increase appetite

Source American Cancer Society, 2008,
www.cancer.org
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New American Plate
1/3 (or less) animal protein
2/3 (or more) vegetables, fruits, whole grains,
and beans
Protein
Vegetables
Carbohydrate/Fruit
Fats
Source American Institute for Cancer Research,
2008, www.aicr.org
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Stage 1 Old American Plate
Stage 2 Transitional Plate
Stage 3 The New American Plate
Source American Institute for Cancer Research,
2008, www.aicr.org
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Overview

• Maintain a healthy weight and be physically
  active
• Choose a diet rich in a variety of plant based
  foods
• Eat plenty of vegetables and fruits
• Drink alcohol only in moderation, if at all
• Select foods low in fat and salt

Eat with Your Hands!
Source American Institute for Cancer Research,
2007
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Conclusions

• Diabetes epidemic continues
• Strong correlations with diabetes and cancer
• Control blood sugar more cancer fighting
• Future of Cancer and Diabetes
• Education gap
• National standards

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• Thank You!

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Resources

• American Cancer Society
• www.cancer.org
• American Diabetes Association
• www.diabetes.org
• American Institute for Cancer Research
• www.aicr.org
• Cancer Treatment Centers of America
• www.cancercenter.com

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Resources (cont)

• AICR ScienceNOW. Summer 2008
• American Cancer Society. Cancer Facts and Figures
  2008. Available at http//www.cancer.org/download
  s/STT/2008CAFFfinalsecured.pdf
• American Diabetes Assocation. Nutrition
  Recommendations and Interventions for Diabetes A
  Position Statement of the American Diabetes
  Association. Diabetes Care. 2007 30 Suppl 1
  S48-S65.
• Basaria S, Muller DC, Carducci MA, Egan J, Dobs
  AS. Hyperglycemia and Insulin Resistance in Men
  with Prostate Carcinoma who Receive
  Androgen-deprivation therapy. Cancer. 2006
  106(3) 581-588
• Bunker K. A Diet-Cancer Connection. Diabetes
  Forecast. June 2008.
• Eyre HJ, Kahn R, Robertson RM. Preventiong
  Cancer, Cardiovascular Disease, and Diabetes A
  common Agenda for the American Cancer Society,
  the American Diabetes Association, and the
  American Heart Association. CA Cancer J Clin.
  2004 54(4) 190-207.
• Garg R, Bhutani H, Alyea E, Pendergrass M.
  Hyperglycemia and Length of Stay in Patients
  Hospitalized for Bone Marrow Transplantation.
  Diabetes Care. 2007 30 (4) 993-994
• Grant B and Evert A. Managing Patients Diagnosed
  with Cancer and Diabetes. Todays Dietitian,
  August 2008
• Richardson LC, Pollack LA. Therapy Insight
  Influence of Type 2 Diabetes on the Development,
  Treatment, and Outcomes of Cancer. Nat Clin Pract
  Oncol. 2005 (2)1 48-53.