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Michelle Bratton RD CSO

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Presentación del tema: "Michelle Bratton RD CSO"— Transcripción de la presentación:

1 Michelle Bratton RD CSO
Serie Educativa Para Promover Buena Salud Beneficios de Una Dieta Basada en Verduras Para Reducir el Riesgo de Enfermedades Crónicas Michelle Bratton RD CSO 27 de septiembre de 2013 Centro de Cáncer de la Universidad de Arizona Plant based is very similar to Mediterranean and an anti-inflammatory diet. Explain the term plant based. Bring up the PCRM.

2 Objetivos Educativos Identificar el riesgo para cáncer y para otras enfermedades crónicas Describir recomendaciones para la dieta y el estilo de vida para reducir el riesgo de enfermedades crónicas Hacer lista de las características de una dieta basada en verduras

3 Quien toma medicinas y descuida la dieta, desperdicia la habilidad del médico.
- Proverbio chino

4 Review 3 functions of an oncology nutritionist.
Proverbial google search: 116 million. Talk about the confusion that most patients experience and lead into next picture…

5 This is how our patients often feel and quite honestly I get frustrated (and look like this woman) when I read studies that seem to pose more questions than answers. Top leading causes of death: heart dz and stroke, cancer, and diabetes. All of these have a strong nutrition component. Enter the AICR and the World Cancer Research Fund. They estimate that 1/3 of all cancers can be attributed to diet and lifestyle factors, NOT including smoking.

6 Resumen: Alimentos, Nutrición, Acitividades Físicas
y Prevención del Cáncer: Perspectiva Global The Second Expert Report was released in November Publication of the World Cancer Research Fund and the American Institute of Cancer Research. First edition was released in the mid-1990’s. Ten recommendations. Summary available online at We are going to use these recommendations as a basis for our discussion today and incorporate similar suggestions from the AHA and the ADA. In general, there is more consistency than differences in these guidelines. Included were over 7,000 studies reviewed by a group of over 200 scientists from around the world. They looked at 17 different cancer diagnoses. The expert panel rated the likelihood that a particular factor, such as diet, causes or protects against cancer. Results were defined as convincing/probable, or limited. The recommendations included in the report are based only on convincing or probable evidence. And further study is encouraged in areas where there was only limited evidence.

7 Se lo más esbelto posible sin aumentar peso.
Factor importante para reducir el cáncer Evidence linking overweight, obesity, and cancer is even stronger now than it was 10 years ago. Increases risk of cancers of the colon, esophagus, pancreas, kidney, endometrium, ovary, prostate, and breast in postmenopausal women. Decreasing weight and keeping it off can reduce risk of heart disease. If you’re overweight, losing 10% of body weight is linked to many health benefits, including lowering blood pressure, blood cholesterol, blood sugar, and reducing risk of heart disease.

8 La Obesidad Como Riesgo
La cardiopatía La apoplejía La diabetes tipo dos El cáncer Del pecho posmenopáusico, renal, esófago, colorrectal,, pancreático, vesícula biliar, endometrio, mieloma And yet rates of obesity and overweight are high with more that 1/3 of children and 65% of adults being classified as overweight or obese.

9 ¿Cual es mi riesgo? Indice de masa del cuerpo
Menos que 18.5 – bajo de peso – saludable – sobrepeso 30 o más – obeso La obesidad abdominal puede ser una “bomba hormonal” Explain BMI. Weight in pounds divided by ht in inches squared x Google BMI calculator. Fat cells release hormones such as estrogen. Fat, particularly if it is stored around the waist, encourages the body to produce substances known as ‘growth hormones.’ Obesity is also considered to be an inflammatory state. Waist circumference – women < 35; men < 40. Increased WC associated with Type 2 DM, increased blood pressure, high cholesterol, and heart dz.

10 Cómo Hacerlo Escoger alimentos de bajas calorías
Mantener lista de alimentos que se consumen Participar en actividades físicas y hacer ejercicio Desayunar a diario Cocinar en casa Evitar alimentos que no sean saludables y que contengan mucha azúcar Planificar comidas Buscar ayuda sobre alimentación saludable Estar consciente del tamaño de las porciones de los alimentos For weight management, it’s best to choose lower energy-dense food, which contain few calories but are filling because they contain plenty of water and fiber. A couple of examples: non-starchy vegetables, fruit and beans. Notice these are plant-based foods. Be physically active. Example of a goal: Walk for a minimum of 20 minutes, three times a week – with no excuses. And plan for how you are going to do it. Avoid fast food and sugary drinks – fat and sugar are two of the most nutrient dense components of the diet. Portion size – we have all heard of portion distortion. Options: measure, equivalents, plate. Food diary Eat breakfast – very important for weight control. Cooking – you control fat, sugar and calories. Get Help – weight watchers, RD, online resources like or, accountability partner. Refer to an RD. Argument: people don’t want to pay to see a dietitian and yet many physicians will now refer to a personal trainer. RD - $200 for the first month/1.5 months. Bi-weekly f/u at 35 per visit and then maybe $35 every 1-2 months. Personal trainers per session (can be as high as 100). Tucson market: $22/1/2 hour 2-3 x per week. $45-60/hour with recommendation for 5x/week for weight loss.

11 Haga ejercicio por lo menos 30 minutos al día.
Most of us know that regular physical activity can help keep our hearts healthy – and the good news is that it can also reduce our risk of cancer. As well as helping us avoid weight gain, research shows that activity itself can help to prevent cancer. Recommendation is for 30 minutes of moderate physical activity every day. In other words you don’t have to run a marathon. May need to work up to 30 minutes per day. Moderate activity is brisk walking, swimming, dancing, cycling.

12 ¿Ejercicio? ¡Sí! Regula el nivel hormonal Regula el sistema inmune
Mantiene el peso estable Hormones – estrogen, growth hormones. In spite of this, statistics show that only 39-47% of cancer survivors meet physical activity recommendations. And this decreases to 25% for older cancer survivors. RENEW trial just published in JAMA subjects, overweight, years old Patient were assigned to an intervention of a counseling geared toward promoting exercise, improved diet quality and modest weight loss. The control group did not receive the counseling until after the trial ended. After 12 months, physical activity, dietary behaviors and overall QOL increased. Less of a decline seen in functional status. This is very important since maintaining functional independence is an integral part of QOL and functional decline is more prevalent in cancer survivors.

13 Evitar bebidas con azúcar exesiva y el consumo de alimentos con altas calorías.
Limit consumption of energy dense foods particularly processed foods high in added sugar, or low in fiber, or high in fat. Avoiding energy dense foods plays an important role in avoiding weight gain and obesity. Energy dense foods provide more calories on an ounce for ounce basis.

14 Compare 100 gramos de… Sandía 23 calorías Avena 71 calorías
Plátanos 85 calorías Pescado 105 calorías Pollo 165 calorías Pan de trigo 266 calorías Chocolate 535 calorías Nueces 597 calorías Now I would consider all of these relatively healthy foods but it illustrates the principle of caloric density. Dark chocolate is part of the anti-inflammatory diet. It provides polypheniols with anti-oxidant activity. Choose dark chocolate with at least 70% pure cocoa and have an ounce several times a week (or daily if you can afford the calories). Approximately 140 calories.

15 No Beber las Calorías Evitar refrescos Limitar jugo de frutas
Limitar bebidas alcohólicas Beber agua, té, o café sin azúcar. 100% fruit juice counts as one of our recommended 5 or more daily portions of vegetables and fruits, but it does contain a lot of sugar and it does not fill you up. It’s best not to drink more than one glass a day. I often encourage patients who are having a tough time maintaining or gaining weight to replace water in their diet with juice as a added source of calories. That should tell you something. Be careful of the juice bars that have become very popular. Many of their drinks are high in calories. My daughter’s favorite is Razzmatazz and it has 337 calories in a 16 ounce serving (the smallest). Role of sweetened or high calorie beverages study in AJCN looked at relationship between beverage consumption and weight. Weight loss was positively associated with a decrease in liquid calories consumed and liquid calorie consumption had a stronger impact on weight than solid calorie intake. Of all classes of beverages consumed only sugar sweetened beverages (i.e. regular soda, fruit drinks, sports drinks) had a significant effect on weight. Inverse relationship seen with diet soda and alcohol but not significant. Other beverages studied: milk, 100% juice, coffee and tea with sugar, coffee and tea without sugar, EtOH.

16 Comer variedad de verduras, frutas, granos integrales y legumbres como los frijoles.
Research shows that vegetables and fruits probably protect against a range of cancers, including head and neck cancers, esophageal, stomach, lung and breast to name a few.

17 ¿ Cuál es la relación…? Vitaminas Minerales Fibra Fitoquímicos
5 cada día Aproximadamente de 7 a 9 cada día Vitamins and minerals can help strengthen our immune system. Fiber is linked to a reduced risk of cancer. Phytochemicals are plant compounds that often impart a characteristic color or smell. Think of the billiant red color of raspberries and strawberries, the very characteristic smell of garlic, or the astringent sensation when we sip tea. These phytochemical compounds help defend the plant against infection and damage. But their action may not stop there. A large number of them can interfere with the sequence of events that trigger the birth of a tumor. These compounds are being studied for their anti-cancer properties. Plant foods can also help us to maintain a healthy weight because many of them are lower in energy density. SURVIVORSHIP: study in JAMA looked at 1,000 colon cancer survivors. Followed for 5 years and looked at Western diet vs. prudent diet. Western diet was high in refined grains, processed and red meat, high fat dairy. Prudent diet was high in f/v, fish, leaner meats. Those individuals following the western diet had 3x the rate of recurrence. WHEL study – looked at 3000 early breast cancer survivors. Eating 7-9 servings f/v coupled with 150 minutes per week of exercise had a 40% lower risk of recurrence of their breast cancer 7 years out. Plant foods can also help us

18 Cómo Hacerlo Desayuno Almuerzo Merienda Cena
Bayas (fresas, moras, frambuesas, etc.) en los cereales o en el jugo Almuerzo Sopa de verduras o pedazos de zanahoria Merienda Manzana Cena Ensalada o verduras cocidas Salad – different greens, peppers, mushrooms, tomatoes, beets, etc. To increase to 7-9, do both berries and juice at breakfast, add V-8 or tomato juice, mid-morning fruit, increase serving size of vegetables at dinner. It takes some planning to hit the mark.

19 El nuevo platillo en los E.U.
The New American Plate is a public awareness campaign by AICR. 2/3 to ¾ of your plate should be filled with plant based foods, specifically fruits, vegetables, whole grains and beans. Cookbook to go along with. Sign up at This plate model has now replaced the Food Pyramid. HALLELUJAH! People eat plates of food, not pyramids.

20 Alimentos de fécula y de granos integrales
Escoger granos naturales Pan de trigo Arroz integral, arroz blanco Cereales de granos integrales Pasta de granos integrales Quínoa, couscous, trigo, cebada Less processed grains or carbohydrate foods are less energy dense b/c they contain more water and fiber. Release their energy slowly and help us feel full.

21 Limite el consumo de carne de res y evite la carne procesada
Red meat includes beef, pork and lamb. To reduce your cancer risk, eat no more than 18 oz. per week of red meats, like beef, pork and lamb and avoid processed meat such as ham, bacon, salami, hot dogs and som sausages. Processed meat refers to meats preserved by smoking, curing or salting, or by the addition of preservatives.

22 Evidencia más convincente para el cáncer colorrectal
La dieta con más carne de res equivale a menos consumo de verduras La diferencia entre “limitar” y “evitar” Evidence is stronger now than it was in the mid-1990’s. In other words, consistent or convincing evidence. Those people who regularly eat higher amounts of red meat have a 28% higher risk of CRC. Several mechanisms involved but one of the most pertinent here is that in general those people that eat a lot of red meat typically eat less plant-based food, so they benefit less from their cancer-protective properties. Notice the difference: Limit red meat/ Avoid processed meats. The Expert Report takes a harder line on processed meats. The research shows there is a safe amount of red meat you can eat before cancer risk increases. Not so with processed meat. Save processed meats for special occasions. My family knows that if we are having hot dogs it must be either Memorial Day of 4th of July 

23 Porciones de 3 onzas seis veces a la semana
Porciones de 6 a 8 onzas dos o tres veces a la semana Which brings us to the recommendation to LIMIT red meat. The evidence suggests setting the limit at 18 ounces of cooked red meat a week. In other workds, if you serve yourself the recommended 3 ounce serving, you can include red meat in 6 meals out of your weekly 21 and stay within the limit. If you usually eat the more common size of 6 or 8 oz. cooked, two or three meals with red meat will bring you up to the limit. You don’t have to be a vegetarian to have a healthy diet. If you do eat red meat, choose leanest meat available.

24 En lugar de carne de res…
Pescado Pollo Pavo Frijoles Idea of one day a week that is meatless. Meatless mondays.

25 Si consume bebidas alcohólicas, limite la cantidad a 2 (para hombres) y 1 (para mujeres), cada día
Read this slide and then go to next slide. As a rough guide, a drink contains about 1/3 to ½ ounce of pure alcohol, so one drink is the same as: 12 ounces of beer or 5 ounces of wine or 1.5 ounces of spirits such as vodka or whiskey. The evidence that alcohol is a cause of a number of cancers is now stronger than it was in the mid-1990’s. There is convincing evidence that alcohol increases the risk of CRC, cancers of the head and neck region (not brain tumors) and breast cancer. In fact, 1 drink a day for a woman will lead to an increased risk of breast cancer. So, for cancer prevention, AICR recommends not to drink alcoholic drinks. But, some evidence suggests that small amount of alcohol may be protective against heart dz. So that is why the recommendation is written as it is. Heart dz is still the number one killer in the US. Men over 40 and postmenopausal women are at higher risk of heart dz. And remember the risk of some alcohol-related cancers is even greater if you smoke.

26 Consejos para reducir el consumo de alcohol
Servirse raciones pequeñas Alternar entre bebidas alcohólicas y bebidas sin alcohol Diluir bebidas alcohólicas Evitar bebidas alcohólicas varias veces a la semana Avoid double measures of spirits, which are often encouraged as a better value. NO SUPER SIZING. Dilute – Try for a white wine spritzer rather than a full glass of wine. Light beer??? For heart health…choose red wine.

27 Limite el consumo de alimentos con mucha sal, ya sea naturales o procesados
The expert panel found that salt and salt-preserved foods are probably a cause of stomach cancer.

28 5 pasos para reducir el consumo de sal
Comer más verduras Elegir comidas caseras Gradualmente, reducir la sal Usar especias, hierbas, ajo y limón Leer etiquetas de alimentos envasados o de caja More vegetables and fruits in place of salty, processed foods. Most of the salt in our diets comes from processed foods. Home cooking vs. restaurant eating. Idea that cooking has become a spectator sport. Gradually reduce the salt you add in cooking and at the table. It may take a couple weeks for your taste buds to adjust allowing you to enjoy the true taste of food and notice more subtle flavors.

29 No use suplementos vitamínicos para protegerse del cáncer
To reduce your risk of cancer, choose a balanced diet with a variety of foods rather than taking supplements. Nutrient –rich whole foods contain substances that are necessary for good health – like fiber, vitamins and mineral. Although some of these substances are available as supplements, scientists cannot be sure that we get the same benefit if we consume nutrients in this form. Research also shows that taking high doses of some supplements could be harmful to our health. La Vitamina Flinstone Original

30 Balanza delicada Comparados con los alimentos, los suplementos vitamínicos producen niveles más altos de nutrientes SELECT Trial Some studies have shown that supplements can upset the balance of nutrients in the body. More research needs to be done, but this is one way that they might affect our risk of cancer. Vitamin A, folic acid and selenium are a few of the nutrients that may pose a problem at higher intakes. A recent example of this is the SELECT trial. SELECT is a large study looking at over 35,000 men at 400 sites. U of A participated. Designed to see if selenium and/or Vitamin E supplements could help prevent prostate cancer. The supplements failed to prevent prostate cancer. And in September 2008 men were told to stop taking their supplements. Two worrisome trends seen: increased prostate cancer in men taking Vitamin E alone and increased rate of DM in those taking selenium alone. Researchers have said the trends were not statistically significant and they may be due to chance. Most recent analysis: 17% increase in prostate cancer risk. Decided to study Vitamin E after ATBC study (alpha-tocopherol beta carotene) which was done in the 90’s. Smokers were randomized to Vitamin E or beta carotene. Saw increased risk of lung cancer and secondary analysis showed decreased risk of prostate cancer which was part of the impetus for SELECT. October 10 Archives of Internal Medicine: Examined data from more than 38,000 women over a 19 year period of time. Women who took supplements had a 2.4 %increased risk of dying over the course of the study. Controlled for age and calorie intake. Problems with multivits, Vitamin B-6, folic acid, iron, mg, zinc and copper. Calcium supplements did see to lower the womens death risk slightly. Earlier study showed that men who took multivitamins more than 7x/week (they were classified as excessive vitamin users) had a significantly higher risk of advanced and fatal prostate cancer compared with men who did not take multivitamins at all. DON’T READ: Selenium is found in wheat, rice, seafood, meat, Brazil nuts. Vitamin E -

31 Suplementos Utiles Acido fólico durante el comienzo del embarazo
Vitamina D y hierro para mujeres embarazadas y madres lactantes Calcio para la salud de los huesos ¿Niños? Dieta de bajas calorías Vitamina D Folic acid for preconception through week 12. Calcium for bone health if dietary calcium is not adequate. Children – some pediatric practitioners recommend drops containing Vitamins A, C and D although children with a good appetite who eat a wide variety of foods may not need them. Frail older people who have low calorie needs may benefit from a low-dose, balanced multi-vitamin. Vitamin D – older people, limited sun exposure, limited intake of milk and fish. Whole new and exciting area of Vitamin D and its role in dz prevention including cancer.

32 Después del tratamiento, los sobrevivientes de cáncer deben seguir las recomendaciones para prevenir que el cáncer se repita For cancer survivors who want to reduce their risk of recurrence of the disease, or a new primary diagnosis of cancer, the best advice is to follow the recommendations of the Second Expert Report. AICR is trying to fund more studies in this area, looking specifically at cancer survivors. This is a very important point for Primary Care Physicians. Statistics for cancer survivors: approximately 12 million cancer survivors living in the US. These patients will be returning to their PCP for health care.

33 Prevención para que el cáncer no se repita
There is growing evidence that physical activity and other measures that help us to maintain a healthy weight, such as a balanced diet with lots of fruits and vegetables, may help to prevent cancer recurrence. This is particularly true for breast cancer and colon cancer. However, the evidence is not yet clear enough to be able to make any specific recommendations for cancer survivors in general, or for those who are survivors of any specific form of cancer. The recommendations can also reduce the risk of other chronic diseases, such as heart dz and diabetes.

34 Recursos Confiables American Cancer Society
La Clínica Mayo American Institute for Cancer Research (AICR) El archivo de datos para las medicinas naturales, Nutrition Action Health Letter What to Eat por Marion Nestle

35 Nada sería más fatigante que tener que comer y beber si Dios no los hubiera creado como placer y como necesidad. -VOLTAIRE


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