 I'm going to talk about the role of inflammation and cancer sort of preventative during treatment and in terms of survivorship. The reason why I'm talking about inflammation is because it's one of the most well-researched areas of nutrition and cancer and I've cited some studies throughout my presentation. But first I want you to think a little bit, and I know lunch is following this presentation so it's a good timing, about how many plants, and I think of fruits, vegetables, whole grains, how many plant foods you've eaten over the last couple days, just give a thought to that. So today we're going to talk about what is chronic inflammation versus acute inflammation and how does it contribute to cancer cell growth and what can you do to minimize inflammation. And basically this is what we're going to cover is eating a lot of plant foods, maintaining a healthy weight, minimizing alcohol consumption, perhaps increasing foods higher in omega-3 fatty acids and drinking plenty of fluids. Now I realize many of you may have variations in your kidney function and so there might be some particular things that you need to limit like phosphorus, potassium, protein, but in general I'm going to talk about the bigger picture on how food can impact the chronic inflammatory process within the body. First of all I'd like to kind of review that some of the influencers on cancer cell growth and in this slide in the center is a cancer cell and they are not, as we know, not like normal cells and this is from the publication cell done in 2011 and cancer cells are very persnickety. They can evade our body's normal processes to suppress their growth and currently and I say currently because one doesn't know what science will discover but currently this tumor promoting inflammatory process and I guess I could use this, there we go, this tumor promoting inflammatory process is where what we eat comes into play and so that's what we're going to further examine. So what's the difference between short term and chronic inflammation? This is conjunctivitis and this is an acute inflammatory process where might have to have some antibiotic drops or something to help clear it up but it will resolve whereas chronic inflammation is something that occurs within our body that we don't necessarily know that it's going on but it's a continual process and our body can't turn it off but we can mitigate it and slow it down. Inflammation is basically, it's part of the aging process but it also contributes to many chronic diseases, cancer included, rheumatoid arthritis, cardiovascular disease. So by following kind of an anti-inflammatory type diet of which we'll talk about today you're actually going to address many chronic diseases and I think I kind of think about the chronic inflammatory process as one of disorganization like that chaotic picture on the left whereas an anti-inflammatory state is more organized, more functional like a well-functioning city. We know that chronic inflammation can indirectly enhance tumor formation and that it also contributes to about one-third of cancers, some more than others. But in this slide you see that there are some pathways identified, NF, Kappa Beta, STAT-3, COTS-2, these are inflammatory pathways within the body and there's actual impact of food compounds on suppressing these inflammatory pathways, not quite as actively as something like an ibuprofen or an anti-inflammatory medication but nonetheless what you eat does become you and does integrate into your cellular structure. For example, curcumin which is a compound within the root tumeric which is a plant, it's a root, has been very highly studied and probably more so than many compounds within foods and curcumin actually blocks the NF, Kappa Beta pathway and the COTS-2 pathway as does cinnamon and cloves can block this COTS-2 pathway and again there are some anti-cancer medications that also act on these pathways probably with more vigor than foods but nonetheless how you eat does matter and there's studies on whole soy and green tea, the ingredient in whole soy is genstein and what is in green tea are catechins and those compounds have been shown to suppress various inflammatory pathways as well so have these compound formed by the process of photosynthesis within the plant, patients often ask me well what should I eat more of and I just tell them that they need to eat a variety of plants because it's not just blueberries or broccoli or Brussels sprouts or sweet potatoes but it's also white potatoes and cantaloupe and peaches, they all plants have these anti-inflammatory compounds and it's actually more important to eat the plants versus worry about whether they're organic or not, it's more important to get the nutrients and you want to consume the food in more of its whole form, it can be cooked or raw but if you're going to cook it you want to consume the nutrients in the water that you're cooking it in like as in soup or either roast or steam so that a lot of those anti-inflammatory compounds are not lost into the water. So okay what can you do to minimize inflammation? Well eat a plant-focused diet and that doesn't mean that you can't eat some animal products too and I actually encourage people to have some animal protein as well but eating a plant-focused diet really does contribute to reductions in chronic inflammation. So as you kind of looked at or thought about what you eat you should try to consume at least five servings of non-starchy vegetables and fruits a day and you know that's probably why a lot of people choose to juice or eat or drink smoothies because for some people it's really hard to consume that much in the way of fruits and vegetables and juicing is just fine unless you've got issues of diabetes or diarrhea or hyperglycemia for some reason and then juicing might not be such a good idea but I always recommend eating the whole food because the fiber is really important because it feeds your gut bacteria and the gut bacteria is part of your immune system as a matter of fact it's about 70% of our immune system. We have millions of types of bacteria within our gut and eating more plants well because the plants have more fiber that we can't digest that fiber is the food for the bacteria and again that helps support our immune system so that's why I suggest to eat the whole food versus juicing. So you've heard this before and I know you can't read it because it's too small but all colors of fruits and vegetables offer something and they all contribute to reductions in chronic inflammation within the body so trying to eat at least five servings and a serving is like a piece of fruit or a cup of raw vegetables versus a half cup of cooked vegetables so you do have to think about it in order to to get it and I mentioned already that plant foods are higher in fiber so this is another mechanism of how plants can decrease chronic inflammation. A higher fiber diet in general decreases the absorption of carbohydrate from the meal which reduces the amount of insulin that your body puts out in order to get the glucose out of the bloodstream and into the cells and there is a relationship with inflammation and insulin and something called insulin growth factor one and when people I answer this probably four or five times a day people ask well I can't eat sugar right because sugar feeds cancer and I'll say well everything we eat changes into glucose amino acids triglycerides and fatty acids and so we can't really do much about that and we know that cancer cells can utilize glucose for fuel they can utilize amino acids for fuel they can utilize ketones which are byproducts of fat metabolism for fuel and in 2016 we don't have a way to impact that significantly so the role of sugar and and or glucose and cancer cells growth is more related to the amount of insulin required if for example if you eat like an apple versus a couple cookies the carbohydrate content is about the same but within the apple there are nutrients there that decrease chronic inflammation whereas the couple cookies don't have those same nutrients but once you consume them the impact on your glucose level is about the same so it's just a question of getting more for your buck with the with the fruits and vegetables so and the other thing about a higher fiber diet besides decreasing insulin and insulin growth factor one is that it can also decrease like estrogen levels which are more applicable for breast cancer but the fiber is a good thing and plants are very high in antioxidants and in general antioxidants protect cells from damage and that's why we don't typically like people to take a lot of antioxidant supplements during treatment it's a bit of a theoretical argument but there isn't a lot of data saying that it's beneficial to take supplemental antioxidants so we kind of err on the side of caution and say antioxidants from food are absolutely fine but the plants do contain a lot of antioxidants like the carotenoids the flavonoids sulfur compounds from the cruciferous vegetables like you know broccoli cauliflower arugula Brussels sprouts cabbage those are quite well researched and have a lot of benefits in terms of anti-inflammatory activity and the carotenoids are also known to promote cell-to-cell communication and that's essentially also related to this decrease in inflammation is when the cells are communicating with each other at a hundred percent then cells that are irregular such as cancer cells can't get such a good foothold within the body so essentially nutrition is about keeping the healthy organism functioning at a hundred percent either in terms of prevention treatment and as a survivor the goons are also plant of course from plants and they're a great source of plant proteins very high in minerals calcium fiber magnesium we encourage people to eat more non-meat meals non-animal meals a website that you might want to visit is called meatless monday.com and that versus meatless mondays which is a political website i may have had a stake one and i so it's meatless monday.com and they have a lot of recipes for legume based dishes so this diagram here actually shows us how the nutrients in soy which is genstein and in green tea which is the catechins actually block the inflammatory process and slow down the oxidative damage of prostate cancer to develop or like if you have prostatitis or something which is kind of an inflammatory condition you'd have to take antibiotics to get rid of that but long term inflammation plays a role in in prostate cancer and so with more fruits and vegetables you can decrease that inflammatory role and decrease the progression to prostate cancer and i did mention about gut bacteria and how the fiber in the diet can help contribute to the proliferation of gut bacteria that interact in a positive way with our body and it's quite an element of study currently the gut microbiome i've heard several speakers in this very room talking about the gut microbiome and and its impact on our overall health and how it might impact colon cancer specifically intestinal cancers but then overall our general health i did mention that this is a again this is a picture of a turmeric root and a lot of people use powdered turmeric which is fine it's the curcumin within the turmeric that's the active anti-inflammatory compounds there's not so there are curcumin supplements out there but the absorption rate of curcumin isn't very good and so we encourage people to eat food that has turmeric in it because all components within food are enhanced when you eat it with other foods there's a synergistic relationship so if you like indian food turmeric you know this is a very um uh essential component of many indian dishes um i encourage you to eat that if you don't like it don't worry turmeric and curcumin is just one of those anti-inflammatory compounds all plants have those same or similar compounds cinnamon again um is something cloves any other type of herb they also play a part in decreasing these inflammatory pathways within the body maintaining a healthy weight decreases inflammation because your body just functions better again excess body weight is associated with insulin resistance which causes insulin resistance is causes an increased amount of insulin to be produced within the pancreas and that triggers that insulin growth factor one and that is the cancer promoting compound so the leaner you are the less insulin that your body needs to produce in order to get the glucose out of the bloodstream and into the cells where it belongs and also adipose tissue is the main site of estrogen production in postmenopausal women so again a contributor for breast cancer development obesity is is related to many types of cancer kidney cancer included and most likely because of that inflammatory process produce hormones including leptin and increased leptin may promote cell proliferation and blood vessel development while inhibiting the programmed cell death which is what is dysregulated in cancer cell growth i mean normal cells they have a certain lifespan whereas cancer cells are very cagey and figure out ways to live longer than they should and another area here is with increased fat cells there's a reduced amount of a hormone called adiponectin which is protective and it decreases insulin resistance and inflammation and adiponectin promotes programmed cell death so there's a couple of relationships there that increased mostly abdominal fat is something that you want to try to work on so being obese is also associated with a constant state of low-grade chronic inflammation that can promote cancer development and there are clear associations with the obesity with breast pancreas colon and endometrial cancers so the reason why there's a few things but these are the main components of why it's good to be as lean of a version of yourself as you can be and it's because of these compounds and their impact on cancer cell growth the insulin growth factor one leptin abdominal fat and estrogen which isn't applicable for the kidney cancer population but nonetheless it's well known so maintaining a healthy weight and you know you don't have to be extremely thin five to ten pounds of weight loss if if if you have it to lose is helpful and shows improvement in the inflammatory mount in the inflammatory markers so you don't have to go to great extent of weight loss why limit alcohol a lot a lot of it is because it contributes to fat cell formation and for the hormone hormone related cancers like breast cancer or prostate cancer it again it contributes to fat cell production which can drive hormone production as well so not as applicable in kidney cancer but nonetheless it's something that your kidneys would process if you chose to consume it and we know that it's an it's inflammatory to the mucosa of the intestinal tract and so there's a lot of study on you know the the relationship between alcohol and intestinal cancers we hear a lot of about omega-3 fatty acids and they're generally thought to be anti-inflammatory they're found in dark green leafy vegetables and in plant fats primarily and in fatty fish and of course there's fish oil supplements there's flax oil supplements um interestingly there's about as much info there's about as much research promoting omega-3 fatty acids as saying that they really don't show that much benefit so i don't typically recommend additional supplemental fish oil or flax seed oil i recommend that you get it through food but you know there there are there is some body of data that supports an anti-inflammatory mechanism with more omega-3 fatty acids and it's possibly due to the fact that in general are if we're eating a typical american diet which which i'm encouraging you not to do we have a higher amount of omega-6 fatty acids versus omega-3 omega-3 are the more anti-inflammatory ones and the reason why we have more omega-6 is because our agricultural patterns in the united states have developed so that our animals are consuming more corn and soy products which are higher in the omega-6 category and of course that becomes what is in their tissue and we eat it and then it becomes us as well so this is the selling point for the grass fed animal products which are of course higher in cost um but if they're eating alfalfa and uh flax seeds etc they're going to have a higher omega-3 fatty acid composition and should and and will contribute to our own increase in omega-3 fatty acid consumption the other another interesting thing about omega-3 fatty acids is that they can protect against the shortening of the telomeres at the end of our chromosomes which is a process that's been identified as a marker of cell aging and associated with cancer risk so an anti-inflammatory diet is the same as a kind of an anti-aging diet because inflammation is something that increases as we age but we can combat it with how we eat how we live and also i i'm not talking a lot about exercise but exercise is definitely a very important part in managing chronic inflammation so eating foods rich in omega-3 fatty acids um dark green leafies cold water fish nuts seeds um grass fed meats dairy products from grass fed animals omega-3 eggs eat them in moderation uh because they're high in calories even though they're healthy fats the calories are higher than normal you can use this to your advantage if you're trying to maintain your weight and struggling with weight loss um use the right oil for the job uh this is probably why coconut oil is so popular these days it's not a panacea um coconut oil is it doesn't contribute to our body's uh production of cholesterol but it's the real selling point for coconut oil is that it can handle high heat cooking and if you're going to saute or use a wok you want to use an oil that can handle the high heat because some oils that are quite healthy like olive oil they break down with high heat and i'll just wrap up here um some ways to add um anti-inflammatory foods let's say drinking more fluids that's another way to reduce inflammation because it allows our own bodies to detoxify and we don't need any detoxifiers really um our body has its own system that works quite well um through our skin through our lung livers liver kidneys and our intestinal tract and as long as we're well hydrated and our organs are functioning um our body will rid itself of the compounds of food metabolism that we need to get rid of so no need to detoxify we do it quite effectively ourselves um and i'll just kind of summarize here um so an anti-inflammatory diet eat mostly plants maintain a healthy weight it doesn't have to be um if you're overweight now it doesn't have to be a lot of weight loss to show improvement five to ten pounds shows improvement in inflammatory markers minimize alcohol consumption increase omega-3 fatty acids and drink plenty of fluids and i've got maybe time for one or two questions thank you i tried to do a lot of reading about what you were talking about today but i've always been confused about the ratio of omega-6 to omega-3 and do i have the impression that in our typical american diet we get too much omega-6 in a ratio to omega-3 yes so we should strive to increase omega-3 and decrease the omega-6 and you do that by eating more plants okay and it and kind of decreasing the consumption of traditional agricultural raised animal products um it's that simple thank you mm-hmm yes what do you do for protein okay well um red meat in general is um more correlated for uh increased risk of intestinal cancers but three times a week is absolutely fine and so you can eat chicken fish legumes or you can be vegan if you want there's lots of different ways to do it yeah so um the so i think the benefit for an anti-inflammatory diet is to increase the amount of plants that's the takeaway one more oh well if there's only one more i'll give it to her okay but tell us why you don't want visually okay and how about yogurt oh yogurt's fine yes yogurt's fine all right so i'll stick around if you have questions i'm happy to answer them thank you so much