 So in the Lyons-Polling Institute, I am part of the Cancer Prevention and Intervention Group and the mission of this particular group is trying to understand how food components and diet affect cancer processes. A lot of my research is centered around prostate cancer, so I'll talk a little bit about that later on. But I'm going to give a general overview of what we know regarding how diet and food affects a cancer process, especially relative to prevention. So I want to start off with just a little bit of general background. So why do we care about cancer? So there's been huge medical breakthroughs over the last several decades. What this graph is showing is the four major killers in the United States. So heart disease, cerebrovascular disease, which are things like stroke, infections, especially lung infections like pneumonia and influenza, and cancer. And what the bars are showing are a number of people that are succumbing to these diseases over about a 50-year period, so 1950 versus 2000. And here's heart disease, and you can see a huge decrease in the number of people that are succumbing to this disease, more than less than half. Cancer is cerebrovascular disease, so things like stroke. So again, over 50% decrease in number of people that are dying from stroke. When we look at infection equivalent, about a 50% decrease in number of people that are dying from these diseases. When we look at cancer, so here in 1950, let's look at what happens with cancer over the next 50 years. No change in comparison to all the other disorders. So clearly, this is not for lack of trying. We have put billions of dollars into cancer research, cancer therapies. And certainly, there's been some progress. We could spend a long time talking about this graph in terms of maybe there's more people not dying of heart disease, so they're living longer to develop cancer. But regardless, it's very clear that cancer is still a major public health issue in the United States and across the world as well. We really believe that prevention is a real critical piece to this puzzle in terms of combating the number of people who succumb to cancer. In the Lyme's Polling Institute, and my background is in nutrition, our bias is its nutrition factors that are going to play a major role here. So here's another graph that shows the same thing. It's a little bit more recent. It goes to 2010 versus 2011. You can see, again, really remarkable decrease in the number of people who are dying, for example, from heart disease. A lot of this has to do with surgical techniques like angioplasty surgery, early detection methods, being able to detect high risk individuals with hypertension screenings, cholesterol screenings. And here with cancer, we have made some dent, about a 10% decrease over, again, this 50-year span, but still nowhere near the same change that we've seen in the other major diseases that we've seen in the US. So when you look at causes of cancer, this is a difficult thing to understand. When I go and speak to groups, it doesn't matter the walk of life that I ask. If I ask you, if you smoke five packs of cigarettes a day, is that going to increase your risk for cancer? Almost everyone universally understands that, and that very strong link of smoking a lot and cancer is very strong, again, no matter what walk of life that you talk to. If I ask that same question, does diet have a big factor on your cancer development? That connection is not nearly as strong. For a lot of you that are watching this webinar, it may be that strong, so it could be preaching to the choir a little bit here, but in general, the general audience does not have the same link of what you eat and your subsequent risk of cancer, as it is, say, with smoking. However, when you look at the data, diet or perturbations in diet actually contribute to the majority of cancers that we see, especially in the US. And I apologize, I want to mention I have this small font at the bottom of a lot of my slides. These are just references to some of the studies that I'm talking to. So when these slides are posted later on, if you want to refer back to some of this data, but I do know that those references are hard to read, but just take note that those will be available to you later on. And just, again, our references are not extremely critical to what I'm talking about. So again, when you actually look at the data, diet really plays a huge role in the development of cancer, yet that association in the general public is not nearly as strong. I do also want to mention that this isn't really a truly fair comparison. Where smoking is a single exposure, a single type of environmental risk that may cause an increased risk for cancer. And when we talk about diet, it is actually a mixture of things that we're talking about. There are components in our diet that may promote cancer, and I'll talk about those. But it's also talking about imbalances in our diet. So lack of things in our diet that also could promote cancer. So there's a lot of factors that are going to come into play in terms of dietary factors that may kick-start cancer processes or propagate cancer processes. And I'm going to talk about those throughout the rest of this webinar. So cancer is generally considered to be a disease of the DNA, a genetic disease. And certainly when you look around the world, there's a strong family risk of cancer. So if your family members have breast or prostate cancer, for example, the chances of you developing are higher. So there's certainly a genetic factor that comes into play with many of the cancers that we see. However, I do want to point out there's also likely a lifestyle factor. And this is really apparent when you especially look at inter-country data. So when we look in the United States in terms of incidence of cancer, breast cancer and prostate cancer are the most prevalent cancers in the United States. This is not true for a lot of other countries. In particular, Asian countries tend to have a fairly low rate of both breast cancer and prostate cancer, which may suggest potentially a genetic or race-specific risk vector. So here's an example of breast cancer cases. So when we look in Japan, a fairly low incidence of breast cancer and a very high incidence in the US. However, when people from Japan move to the United States, let's look what happens. A huge increase in their risk, which strongly suggests it's not necessarily just their genetics or their race that determines their increased risk or decreased risk for breast cancer. It's something about living in the US that is causing a problem. And we can stand a long time. And so this can be a lot of things in the environment. It can be environmental pollutants. It can be access to health care. But certainly the diet is another major contributor in terms of potentially having this environmental influence on developing cancer. So again, a lot of these migrant studies have been done in some of the major cancers in the United States, like prostate cancer, breast cancer, and colon cancer. And the same trend holds where Asians typically have a low incidence of colon, breast, and prostate. But when they move to the United States, they have a higher risk. One thing also to know in a lot of Asian cities, especially the more populated cities, they're seeing a market increase in their risk as well. And that also coincides with increased availability of Americanized food in those cities as well. So we are very interested in terms of trying to understand some of these dietary links to the development of many of these cancers. Excuse me. This is another example of some inter-country data with prostate cancer. And I know this slide is difficult to read, so I'm going to highlight a few things. So this is incidence of prostate cancer across different countries. So at the very top, in terms of incidence, so we're number one in the US for a lot of things. Unfortunately, we're also number one for prostate cancer, which is not a good thing. When we look at the bottom part of the graph here, all these are Asian countries. So China here on the bottom. So you can see again this really big dichotomy in terms of incidence of prostate cancer across different countries. On the right here, I have a table that shows some of the data in terms of what happens when you migrate to the US. And my background is in basic sciences. All my students, I try to tell them I like to see dose responses. And unfortunately, if you consider living in the US as your toxin, there's literally a dose-dependent increase in your risk of prostate cancer the longer that you've lived in the United States. So here on the top, if you're born in China, your rate is fairly low. If you've moved to the United States, but you've lived here for less than five years, your rate is the same. As you start to live in the US longer, so closer to a decade, you can see this huge jump in terms of your rates of prostate cancer. And then if you're born in the US, you're first born, first generation, born in the US, Chinese, your rate is almost the same as any other Caucasian that's born in the US. So again, longer that you've lived here, more that you've assimilated into the environment, the increased rate. So again, my bias is that nutrition is going to play a big role in here. And we can spend a very long time, past an hour, to talk about what is wrong with the American diet. But I'm going to highlight a few things in particular. So when we look at the dietary guidelines, so these are the 2010 dietary guidelines, they'll very soon going to be updated, but they'll likely be fairly similar. And again, I know this is a fairly busy chart, but what I want you to pay attention to is this line in the middle. So these are our goals and our limits in terms of what we're recommending for a healthy diet for Americans. And the bottom line is on average, Americans are not doing that great. So on the top half of the graph, we have things that we should be eating more of, things like fruits and vegetables, whole grains, healthy oils. And you can see that Americans on average are not doing a fantastic job of meeting these goals, of eating enough five to nine servings of fruits and vegetables. We're also going way over the limit of things that we shouldn't be eating. So we often talk about we need Americans to get off the sofas. That's in a lot of different ways. So sofas here are solid fats and added sugars. So there is also a little bit too much sofa sitting in terms of couch potato-ness, which is also a factor. But in terms of foods, Americans are eating too much of solid fats and added sugars. So these are things like our pastries, our cakes. When we look at refined grains as well, way over the limit in terms of consumption of these things. Salt is also quite high. So again, there's a lot of factors that come into play potentially in terms of things that we may be missing or getting too much of in the American diet. And I'm going to highlight a few examples of things in the diet that may be more important relative to cancer development. So again, when we look at this causes of cancer, we can think about these perturbations in diet that contribute to cancer in a couple ways. One, factors that are in the diet that are going to promote cancer. And then also on the flip side, things in our diet that we may be lacking that also may be a contributor in terms of cancer development. So again, looking at this causes of cancer, smoking again is a very strong factor in terms of associating stuff that's in smoke plays a big role in terms of especially risk of lung cancer. And the reason why smoking and cigarettes are so dangerous is that they contain a whole host of toxic compounds like heterocyclic amines, polycyclic aromatic hydrocarbons, nitrosamines, metals, and other organic compounds that all, when you inhale them, cause immunogenic effects and again can kickstart processes that can lead you down the road for cancer. What you may not realize is a lot of these same compounds are also found in foods. So in particular, processed foods and the way that we cook foods and processed foods can have a huge impact in terms of propagating these dangerous compounds that can lead to cancer. So things like these nitrosamines are found in salt cured and preserved meats. Heterocyclic amines and polycyclic aromatic hydrocarbons can also be found in especially meat products when they're cooked, especially at high heat. And I'll talk about these in a little bit more detail. So you may have seen in the news fairly recently just a couple of weeks ago that the World Health Organization announced that processed meats especially cause cancer. And I want to talk about this a little bit more in more detail. I do want to point out this is not truly new news. We've known about this for a long time. What is new is that the World Health Organization has gotten behind it as well and just gives a larger sounding board in terms of some of the dangers of eating a lot of these types of foods. So does this mean you can never eat bacon? Not necessarily, but I'll talk a little bit of things you can do to decrease your risk. You certainly need to minimize consumption of these foods, but it does not mean if you had a hamburger in your lifetime, you're destined to develop cancer. But again, if you eat that type of food a lot, your risk of cancer is probably going to be elevated. I'm going to tell you why. So the reason why this meat causes cancer is several reasons. So one, again, some of these processed meats have some of these compounds that I highlighted before. But two, cooking and preparation of this food, especially at high heat, are what truly create a lot of these compounds that can ultimately be potentially carcinogenic. So a lot of these meats can become carcinogenic when you cook them at high heat. So when you grill them and smoke these meats, you can develop compounds like these PAHs and like these heterocyclic amines that are the same compounds that are found in cigarette smoke. So whenever you see meats, especially with this charring, that is the compounds that potentially can be carcinogenic. Whenever you have that smoke flavor, you have a presence of some of these compounds. Does this mean that you have to avoid these at all costs? Not necessarily, but you shouldn't consume them at high amounts. So these compounds are all made specifically with meat, especially red meats, because of a very specific reaction that only occurs at high heat with very specific fats and amino acids that are present, especially in these meat products. This is a side note. So this is my husband and I'm the main cook in my household. He loves to grill. If I took away grilling from his life, that would mean I would have to cook 365 days of the year. So I grill food at home. We do it at a minimum. But there are steps you can take to try to minimize the production of these compounds. So again, you don't need to think that eating your grilled meat is going to be a death sentence, but there's things that you can do to minimize your risk. But certainly it's not something you should be doing every day. So why do we cook our meats at high heat if it's going to create all these mutagens? Well, there's also this balance of food safety that you want to. The reason why we cook our foods or preserve our foods is to minimize from food toxins like salmonella and other microbial species. But there are a lot of studies that have shown that the more you cook your meat, the higher risk of cancer. So this is an example of a study that showed that women who consumed meats have almost five times higher risk for breast cancer than those who also consumed those same meats not as well cooked. So again, just the preparation piece is very important in terms of amplifying some of the potential risk of these compounds. So when we look at content of these PAHs and heterocyclic amines, which again are the same chemical toxins that are found in things like cigarette smokes, they're found in things like smoked foods. They're found in charred foods. So again, these grilled foods, broiled foods. So when we look at barbecued meat, for example, it contains about 160 parts per million, per billion of these heterocyclic amines and PAHs. When we look at polluted air, it's about the same order. So again, the level of compound that you can see is not an insignificant amount. So again, if you consume these type of foods on a very regular basis, that potentially is going to increase your risk. This particular reactions, especially these PAHs and heterocyclic amines, are again amplified with temperature. So when you cook at high heat, especially over an open flame, you can produce these compounds in higher amounts. The PAH of function, the concentration of these compounds are also a function of both fat content and also proximity to the heat source. So direct open flame and red meats that have a higher fat content are going to propagate more of these compounds. Because again, it's a very specific chemical reaction that's called the pyrolysis reaction that's between very specific amino acids and fat within these food compounds. So grilling a lower fat food, so for example, if you grill tofu or vegetables, you're not going to create the same chemical reaction because they don't have that same fat and the same amino acids that, say, a steak has as well. But again, never fear. There still are some things that you can do. If you must have grilled meats that, again, if you consume grilled meats, it's not ultimately a dissentance. You need to minimize the amount that you consume. And if you do consume, there are things that you can do to help minimize your risk as well. So again, these compounds are a factor of temperature. So you can cook at lower temperatures for a longer period of time. And that will significantly minimize the production of some of these compounds. You can do things like pre-thaw or pre-microwave your meats as well. What that happens, if you've ever noticed, if you put meats into a microwave to do that pre-thaw, you get that weird liquid that kind of pools at the bottom. That actually removes some of the substrates. So some of those amino acids that are part of this pyrolysis reaction. So that also significantly reduces these things. So if I ask my husband to do these things, he's like, I'm not going to do that. I want to cook hot. I'm not going to add an extra step to my meat preparation. There's this crazy liquid at the bottom. I'm not going to do that. I've tried. But what something that you can do that is fairly feasible, you can marinate your meat. So this is a fairly common practice. And really, so here in the red is a meat function of grilling time. You can see really big increases in the total polycyclic aromatic hydrocarbon, sorry, the PAHs in the food. Again, length of time, longer grilling time. You see this big increase. Contrast when you pre-marinate, and this is not a crazy marinade. It's a simple olive oil, lemon marinade for 30 minutes prior to grilling. You can see a really significant drop in terms of the capacity of these compounds to be made. A lot of this has to do with the fact that the marinade causes a different heat distribution. So the pyrolysis reaction is somewhat blunted with the marinade. So again, there's some simple things that you can do in addition to just limiting your intake to minimize your risk. So what are some other things that we can do? So we already know, we've talked a little bit about how horrible potentially the American diet is. One thing that Americans are not doing a great job about are eating enough fruits and vegetables. So on average in the U.S., a little bit less than 25% of Americans consume 5-9 servings of fruits and vegetables per day. For those of you who are always unsure of what a serving is, so that's usually a good rule of thumb. It's about half a cup. So half a cup of anything is generally what we recommend. So 5-9 half cup servings of either fruits and vegetables. Americans, again, are not doing a great job. For those of you who are in Oregon, when I first moved here to Oregon, I never realized how many different berries there were. Here in Corvallis, we have a fantastic farmer's market. So I, on like that, well, Oregon must do better in terms of these statistics. And unfortunately, we don't. We're still just about at the national average in terms of fruit and vegetable intake. And unfortunately, a lack of these fruits and vegetables can have a potential impact in terms of development of cancers, especially breast, prostate, and colorectal cancer as well. So what is it about fruits and vegetables that are protective? There are a lot of reasons. So fruits and vegetables contain dietary fiber. They also contain a lot of our essential micronutrients. But there's also a lot of non-essential phytochemicals. So chemicals derived from plants that also may come into play in terms of having some protection. So all of the colors that we see in a lot of our fruits and vegetables are a large part of some of these phytochemicals that may have some of the protection. I'm not, in the interest of time, able to talk about all these different compounds. But I'll give you a few examples pulling from some of the research that we've been doing here at the Linus Pauling Institute in Oregon State University. So one paradigm that I've talked about already is that Asians tend to have a lower risk. So in my research, we've done a little bit of both what might be lacking from the American diet that propagates prostate cancer, but also what are some foods that Asians tend to consume a lot more of that may also be protective. So I've done a lot of work with compounds like soy, teas, especially green teas, and vegetables, in particular a grouping of vegetables called cruciferous vegetables. Each of these food products have a very big difference in terms of consumption. In terms of soy, there's up to 50 times more soy consumption within Asian communities and a lot of that exposure is lifelong. In terms of tea consumption, so the typical Asian consumes three to four cups of tea, especially green tea per day. If you're my dad, it's maybe close to 20 cups of tea. I need to put him in one of my studies because he would be a very good prospect. Whereas in America, in the U.S., only 8% of the population even consumes one cup of green tea. Vegetables, especially these cruciferous vegetables, there's again a fairly large difference in terms of these cruciferous vegetables. The cruciferous vegetables are the things like broccoli, kale, watercress, mustard greens. I like to call them that kids will not eat them vegetables. And I'll talk about them in a little bit more detail in a moment. So when we talk about some of these compounds, I'll just briefly talk about teas. And this is a slide that I borrowed from Rod Dashwood who was a former LPI principal investigator. There are a lot of different teas out there. And people may not realize that teas come from the same common plant, but how they're processed potentially changes the way that they both taste and the phytochemicals that are present in them. So black teas are the most processed teas. White teas, fairly minimally processed, and green tea is also fairly minimally processed as well. This processing of the leaf really again changed both the color and the taste of these teas, but also changed the chemical content that affords these teas potentially some health benefits. We've done a lot of work with green teas and white teas, and both these teas appear to be protective, especially in colon cancer, and I'll show you some data with prostate cancer. In contrast, some of the black teas have garnered a lot more interest in terms of their, the different compounds in black teas may have a higher benefit in things like cardiovascular disease rather than cancer. One thing to note with these teas, again, getting back to preparation, is that steeping time and stability of these compounds is also limited. So consuming a freshly brewed cup of tea is very different than the iced tea that you buy pre-bottled in the supermarket, and you're likely not getting the same compounds that you would get from a freshly brewed cup of tea, because again, a lot of these compounds are not stable. What we have found in addition to colon cancers that these compounds have some benefit in prostate cancer, and again, I apologize for the busy slide. So this is an animal model of prostate cancer, and we had them drink tea and also fed them soy. And the bottom line is both supplementation strategies by itself didn't have too much of a benefit, but the combination of consuming both soy and tea in this animal model had a significant effect in terms of decreasing prostate cancer in these animals. So again, not to underestimate consuming multiple foods in terms of a strategy for cancer prevention. We also know that a lot of these compounds from phytochemicals affect a process called initiation. So the classic etiology of cancer is that it starts with off with DNA damage that mutates things and eventually is a kickstarter to these cancer processes. Additionally, we thought that a lot of dietary compounds only helped this piece in terms of helping protect the DNA from damage. What happens later on is as a result of that damage, it causes the cells to not produce factors that the cell needs to be normal and the cells start to grow uncontrollably and eventually lead to the two further steps in the cancer process, promotion and then progression that eventually end up with tumors. We've recently discovered that there, so we've classically thought that development of cancer is all about the DNA and physical damage to the DNA is one of the key things that is critical to cancer development. That is still true, but we now know there's a whole new area called epigenetics, which literally means outside the DNA that also can impact these processes to lead to cancer. So as an analogy, epigenetics, like I said, is outside DNA. So it's not physical changes to the DNA that are occurring here. An analogy is if you think of our DNA as the library of our cell, it contains all the information that tells our cell what to do. So we used to think that DNA, sorry, that cancer was damaged to the book. So something was wrong with the book, a page was turned out, so you couldn't read the information properly and that's what kick starts the process of the cell to become disorganized and cancer starts. So if you go to any very large library, so here at the Oregon State we have the Valley Library and when you need to get your book, you'll notice that you walk to the shelves, that they're these crazy shelves that open and close. So when you need to get the book, you need to press a button on the outside the shelf that opens up the shelf, you're able to go in and get that book. So epigenetics is kind of like that button on the outside of the shelf. So DNA is really, really long and it has to be compacted into a very small space. So for you to access the information, you need to be able to open up the DNA and be able to access the information properly. And what we've discovered is it's not necessarily just something that's wrong with the book when cancer develops. It's sometimes the button that is not working properly that doesn't allow you access to the information that causes this process that leads down to cancer. And the really great news is when the book is damaged that is impossible to fix, very, very difficult to fix. But if there's something wrong with the epigenetic button, that that's actually something that we can reverse and target. And that has caused a whole new paradigm shift in terms of how we think about cancer treatment potentially. So there are several drug companies that have developed epigenetic drugs to modulate dysregulated epigenetics during cancer. And what we have found is there's lots of components from food that also help affect that button to help cancer processes. So this has caused, again, a huge paradigm shift in terms of how we think about a lot of different disease processes, not only cancer. And this is an article quite some time ago, almost five years ago. Now I'm really talking about this epigenetic revolution and why DNA may not be your destiny. And certainly diet is a major factor potentially in helping change that destiny. That just because you have a family history or a genetic mutation that predisposes you to a disease like cancer, we really strongly believe that diet factors are things that can help tip that balance in terms of not having that as your ultimate destiny. So just briefly, categories of these epigenetic alterations fall generally into these three categories, non-coding RNA, methylation of promoter elements, and changes in chromatin. Together all of these things, again, so especially the second two, affect this opening and closing or access of the DNA. But in general, all of these epigenetic alterations all change the way that the DNA is potentially read to give the cell information, but it doesn't physically change the DNA. So mutations physically change the DNA. So things like those PAHs and those toxins I talked about can physically change the DNA that cause these problems. And what I want to talk to you about now is how components of our diet can potentially override some of these things through these epigenetic alterations. So again, I've done a lot of work with cruciferous vegetables. So these cruciferous vegetables are compounds or foods that, again, are in the kids don't like them category usually in terms of class of food. And the reason why your kids don't like them, and to be honest, most a lot of adults don't like them as well, is they tend to have a very bitter taste. So the reason they have that slightly bitter taste is due to a compound called glucosinolates. And these compounds that give the taste, the characteristic taste of these cruciferous vegetables also may have some cancer fighting properties. In particular in broccoli, there is a compound that's derived from broccoli called sulforaphane. So in the broccoli, we have the glucosinolate, which is called glucoraphanin. When you chew the plant, the plant releases an enzyme that cuts the glucose off this molecule and produces this active compound called sulforaphane. So this is a non-essential phytochemical. Broccoli is good for you for a lot of reasons. It's got a lot of B vitamins like folate. It's a high fiber food. It has chlorophylls that are also beneficial. But in particular, I've been very interested in trying to understand sulforaphane as a cancer fighting compound, especially with respect to prostate cancer. So I'm going to show you a little bit of data. I'm going to go fairly quickly through this, but this is an animal model for prostate cancer where we implant a prostate tumor onto the animal. And what we've done is fed them sulforaphane. I want to highlight here, this is tumor growth in the animal. So in the green are animals that are consuming the sulforaphane compound, and you can see that prostate tumor growth is lower. And then more than that, in terms of mechanism, we're able to show that it's affecting some of that epigenetic mechanisms. We've also done this work in a transgenic model. So what transgenic means is it's a genetically altered animal that has a mutation that develops prostate cancer. So these animals always develop prostate cancer with age, so they're highly predisposed to developing prostate cancer. What we did was feed these animals broccoli, and you can see, so on the x-axis is tumor score. Bigger number means worse tumor. And what you can already see in the green are the animals that are consuming broccoli that everything is shifted to the left, which means that the animals that ate broccoli had less severe tumors than the animals that did not consume the broccoli. What suggests, again, these are animals that are genetically predisposed to getting prostate cancer, and consuming the diet helped push them to be less likely to develop the worst types of cancer. So a lot of people ask me, I hate broccoli, what else can I do? Can I consume a supplement instead? And the short answer is yes, you can consume a supplement, but it's not going to do as good a job as the food. So this is bioavailability of sulforaphane from a supplement source versus a broccoli source. You'll notice here I have here a picture of broccoli sprouts. So this compound is produced in the plant right from the very beginning of the seed. So if I go back to some of these animal studies, if I had to scale up how much broccoli a person would have to eat to potentially have some of these effects, I'm not going to lie, it's a big, big, big, big bowl of broccoli. But again, these compounds are produced very early as a plant. So one can consume the tiny broccoli sprout or the big full-ground broccoli. So on a per-weight basis, there is literally 50 times more of this active compound in the broccoli sprout compared to the big broccoli. So I could ask people to consume 50 cups of broccoli or one cup of broccoli sprouts. So we opted for the broccoli sprouts. But again, when we give them a supplement that has the same amount of compounds as the broccoli sprouts, you can see here is the availability of sulforaphane that shows up in the body. And here in the dotted line are the source from the supplement. So you can clearly see that the supplement source isn't getting into the body as well as the food source. And more than that, when we look at the molecular mechanisms as well, there is no change in the epigenetic mechanisms with the supplement and only active with the sprout. So the food source, again, appears to do a little bit of a better job. I get asked a lot as well, what about cooking? So with broccoli, to release that compound, you need active enzyme. So if you really cook your broccoli really, really well, you're also going to kill the enzyme. So it'll be similar to that supplement. Luckily, though, in the plant, the enzyme has really worked well. So you don't need a one-to-one ratio. So as long as you have a few live cells, you'll still be able to release the compound. So if you are going to cook your broccoli, cook it lightly. I usually say steam or boil for five minutes or less. You basically want to still have a little bit of crunch. So if you can still hear the cell walls crunching a little bit, you have enough enzyme to be able to create some of these compounds. So those are just a few examples. I could go literally all day to talk about other food products that have potential effects. The bottom line in terms of what do we need to consume to be in optimal health and prevent cancer is really the same message that we've been getting from the dietary guidelines. What we need to do is get closer to this goal in terms of whole grains, fruits and vegetables, healthy oils, and start to limit refined foods, saturated fats, and that type of thing as well. I wanted to pull in terms of resource. So these are the recommendations for cancer prevention from the World Cancer Research Fund and the American Institute for Cancer Research. They have spent decades compiling data in terms of dietary factors contributing to cancer. Their website is noted here on the bottom. But you'll note the 10 recommendations that they have, and I'll read them in a moment, are really not that far off just from the general guidelines for a healthy diet. So the first recommendation is try to be as lean as possible without being underweight. There's a strong link of obesity to a lot of these different cancers. Try to be physically active for at least 30 minutes per day. So avoid, again, get off the sofa. Try to increase activity. Avoid sugary drinks. So again, limiting the added sugars. Eat more vegetables, fruits, whole grains, and legumes. So again, a mixture of these compounds. Just one food that is the magic bullet. Limit consumption of red meats and avoid processed meats. And again, that comes to some of those compounds that we talked about. And again, I emphasize that cooking processes also make a big impact in terms of the potential danger of these foods. But there are things that you can do to help limit these compounds. Limit alcoholic drinks to two for men, one for women per day if consumed at all. So this number seven is one that is more specific to cancer. So limit the consumption of salty foods and foods processed with salt. So again, this gets to the link of processed foods to especially gastric and colon cancers. They also do not necessarily recommend the use of supplements. Advocating for food rather than supplements to meet your needs and help protect against chronic disease. There are also some specific recommendations in terms of breastfeeding. Bottom line for many reasons, breastfeeding is a good thing. But it also seems to be protective, especially in breast cancer. And then there is a separate recommendation in terms of cancer patients during treatment. And then once you are a survivor to go back to the potential recommendations for cancer prevention. If you are undergoing cancer treatment, please closely work with your doctor and dieticians. There are certainly some of these phytochemicals that can interfere with treatments as well. So advocate just talking with your doctor. So with that, I'm happy to take questions and hopefully look like there are some email questions that have been coming through. Yes. Thank you very much Emily for that talk. There are a few email questions coming through, but I encourage anyone who does have a question to please email it in. Even if we don't get an opportunity to answer it today, we will answer it online later. A lot of questions that we have gotten are about specific foods. The first question I'll read is, I have read that many spices contain anti-cancer properties. Can you comment on this? Yes. So there are a whole host of other phytochemicals found in a lot of different spices that may have some cancer fighting properties. Probably turmeric and curcumin have been the most well studied in terms of their effects to limit processes related to inflammation in particular and have some cancer fighting properties. What is still relatively unknown is what dose may be effective. In general, again, it comes down to timing and dose that are the big unknowns for a lot of these phytochemicals. There's certainly evidence that populations that consume a lot of curry, for example, tend to be protected. But again, it's hard to understand whether or not that's because they've had lifelong exposure to these compounds and that's according to the risk. So there's been limited evidence that a single supplement of curcumin or turmeric has true cancer fighting properties. But it's certainly something that is relatively safe. If you have a high risk, it's unknown if it has cancer fighting properties if you have cancer. So using as treatment is still unknown. But there's certainly evidence that suggests if you consume turmeric on a regular basis that it may be protective in terms of prevention. So the jury is really still out with a lot of these spices. And again, a lot of it comes down to form and dose that's also still unknown. What is the role for moderate consumption of soy products in preventing breast cancer? So soy is certainly a very controversial topic relative to breast cancer. So in soy, there's a phytochemical that are called isoflavones. And these isoflavones have estrogenic activity, which potentially could be a bad thing, especially if you are currently undergoing breast cancer treatment. So there is quite a bit of evidence that suggests that populations, again, that consume soy are protected against breast cancer. What is unclear or what actually is fairly clear is that early exposure to soy. So consumption of soy through early adolescence in particular is very protective for breast cancer later on. Why soy is also, if you are diagnosed with breast cancer, your practitioner often recommends to limit soy intake because of the potential estrogenic, so estrogen could potentially cause breast cancer cells to grow more. So there is a chance potentially that if you consume soy at high amounts that it may promote your breast cancer. So what does that mean for breast cancer patients? Bottom line is if you've already been consuming soy, eating tofu, drinking soy milk on a regular basis and you're diagnosed with breast cancer, you don't need to abort all of that. If you are a breast cancer, if you have been diagnosed with breast cancer and you're not a regular soy consumer, don't add it on and certainly avoid supplements that have high doses of a soy. Soy supplements are a commonly used supplement because of their estrogenic activity to help prevent symptoms of menopause because of their hormonal effects. So certainly you should not consume soy supplements if you're diagnosed with breast cancer, but moderate consumption of soy products, especially if you've already been consuming soy products, is likely not going to be a major factor. We also have some questions about fiber and fermented foods. For example, is the traditional daily morning diet of oatmeal plus yogurt still regarded as a healthy custom when it comes to cancer? So yogurt and oatmeal are certainly good in terms of cancer prevention. The fiber content, probiotics in yogurt are certainly important for gut health and anything that's important for gut health is also very important for helping prevent, especially GI cancers like colon cancer. These fermented foods also produce a lot of the short-chain fatty acids that also may be beneficial. Some of these other fermented foods, so it's hard to consume enough of it to really have a huge protective effect, but certainly consuming whole grains and prebiotic type foods is certainly going to be beneficial, especially for colon cancer. Is there much convincing evidence that a vegan diet can affect the risk for many cancers? So I get asked a lot questions about any specialty diet. In the bottom line, there is not enough evidence that suggests that any specialty diet, including vegan diets, have a strong specific association with cancer prevention. With that said, though, consuming a diet that is largely plant-based with lots of fruits and vegetables and whole grains has certainly been associated with protection against many of these cancers, prostate, breast, and colon, but it doesn't necessarily have to be a vegan diet specifically. There are certainly factors in animal-based products that also are of benefit like B12, Zinc, and a lot of the dairy products as well, and the healthy fats that also are things that we need as well. Somewhat related, but a little different topic is about foods that are high in chlorophyll or chlorophyll supplements. For example, eating spinach or kale or things related to that or isolated chlorophyll by itself. Does those have properties for prevention of cancer? So chlorophyll has the greens that are found in green. So there's been a lot of work suggesting that green, leafy vegetables are a good thing in terms of cancer prevention. Chlorophyll certainly plays a role in that. So chlorophyll, so there's been landmark work done here at the Lawrence Polling Institute by George Bailey that clearly showed that chlorophyll acts to help get rid of a lot of these toxins that we've talked about during this webinar and many other major contributors to cancer like aflatoxin, which is a major mutagen or cancer-causing compound found in especially more grain products that have become moldy. It's a major contributor to liver cancer, especially in Asia. And supplementation with chlorophyll has potentially made a big impact in terms of decreasing exposure or impact of aflatoxin toxicity on liver cancer in Asian countries. So there is certainly a body of evidence that it has an effect. Its effect is fairly specific, though, to areas that we know have high exposure to aflatoxin or these pages in heterocyclic amines. So it doesn't appear to have as much impact in terms of some of the cancers that I've talked about, breast cancer and prostate cancer in particular. And that's true for a lot of these cancer sites that there are different strategies potentially that are more beneficial depending on the cancer that you have as well. Many of us have pets that we love very much and we'd like to provide them with a diet that might help prevent cancer in dogs and cats. Do you have any opinion about dietary prevention of cancer in pets? Yeah, I mean our companion animals have a very similar metabolism to us and as a pet owner who's had a pet that has succumbed to cancer, that there are certainly high prevalence of cancers in especially certain breeds. And dietary interventions can also play a big role potentially in limiting cancer in pets. And in fact, researchers here at the Lyons-Paulings, including myself, are starting to work with the OSU Vet School to answer some of these questions. So the studies that I've been doing in breast and prostate cancer and in people in collaboration with Oregon Health Sciences University, we're going to try to replicate in companion animals as well. So we'll have broccoli eating dogs and cats as well. You talked about the migration studies and migrant studies where people have gone from Japan or China to the United States and saw increased risk of cancer. What about the opposite phenomenon? Have they studied Americans that go over to China or other countries? Do they see a decreased risk, increased risk or does it depend on what kind of cancer we're looking at? I'm not aware of as much opposite work that's been done. As I've mentioned just briefly, there is work that's being done in those countries, especially in the more developed cities in Asia. And they're starting to see a sharp rise in a lot of these cancers that are more American. So again, the thought is that in these bigger cities where there's also almost a bit of a status measurement in terms of being more American, I know I've come from an Asian background, my family's from Hong Kong and Southern China. When I visited there when I was young, I did not see Kentucky Fried Chicken and McDonald's in the places that my family lived. And when I go now, you see them all over the place. And again, what's kind of disconcerting, when I visit there, it's again almost sometimes a place of stature to go to the American restaurants rather than the native foods. But that's an interesting point. I don't know if people have done more work in terms of, again, like you mentioned, the reverse migration in terms of Americans. But certainly there's a lot of work saying that Americans that adhere to the dietary guidelines that have more fruits and vegetables, there's certainly work with more soy consumption, tea consumption, that they seem to be, at least according to epidemiology, more protected. Could you explain the possible connection between salt and cancer risk? So with salts, so when you look historically, around the turn of the century, gastric cancer was extremely high, and it very much coincided to the drop in gastric cancer significantly coincides with the advent of refrigeration. So in the days before we had refrigeration, where we largely relied on salt curing to preserve a lot of our foods, especially our meats, because they wouldn't stay around for very long, that had a huge impact, especially on gastric cancer. Because some of these salts produce a very specific compound called nitrosamine, so it's a sodium nitrate, that through a chemical reaction ultimately becomes something that produces free radicals or causes oxen stress, which can damage the DNA and again kickstart that initiation effects. More recently, the types of salt that we use, we try to purposely limit the amount of nitrates that we use, but you'll still see in a lot of preserved meats, nitrates in there. If you go to the grocery store that you can try to purchase nitrate-free products, but there's still evidence that just high salt content also may be detrimental in terms of cancer risk, some of that may be related to some of the cardiovascular effects. So the things that are impacted in terms of cardiovascular impacts may also affect cancer. So when you think about cancer, one of the big problems why cancer gets bad is because it spreads. And the reason why it spreads is a process called angiogenesis, where blood vessels start to expand. So some of those same processes that are affected with blood vessels relative to heart disease can also be affected in this angiogenesis process and potentially can be bad in terms of propagating cancer. Okay, this is going to be our last question because we're running out of time. A lot of people are concerned about BPA or bisphenol A, especially in canned vegetables or fruits and also other plastics that may come in contact with food. How much of a concern is this? I think there has been a lot of work to be done to try to limit BPA exposure. To be honest, in terms of the data for cancer is much more limited in terms of the impact of these compounds for cancer development. Most of the work has centered around more developmental processes. So early exposure to these compounds, especially during formula feeding or bottle feeding. The other thought is that during a newborn infant or a nursing infant is only getting a food source from potentially these bottles. So their exposure potentially is going to be much, much higher than someone who's eating a mixed diet and eating occasionally from a bottled source. So as an adult, your exposure is probably not going to be as high as during those early days. So there's a couple things that are out still in terms of the jury. There's limited evidence that these compounds have a carcinogenic effect and there's also more limited exposure as an adult. So there isn't as much evidence in terms of BPA effects on cancer processes, but certainly there's still concern with the developmental piece.