Nutrition and Dietary AdviceNutrition and dietary advice from a professional

The World Cancer Research Fund together with the American Institute for Cancer Research have produced Food, Nutrition and the Prevention of Cancer: A Global Perspective. This document has been the most authoritative source on the topic for 10 years.

One of the main purposes of the report was to explore the extent to which food, nutrition, physical activity, and body composition are responsible for modifying our risk of cancer, and also to find out what relationship the environmental plays in this risk.

Professor Martin Wiseman, author of the report says,

“Cancer is not a fate, it is a matter of risk, and you can adjust those risks by how you behave. It is very important that people feel that they are in control of what they do.”

This is a very extensive, and well written report, with 537 pages in total! If don’t want to read the whole report, here is a little synopsis of the 10 main recommendations:

Please note the recommendations are taken directly from the full report

1) Body fattness

• Ensure that body weight through childhood and adolescent growth projects towards the lower end of the normal BMI range at age 21.
• Maintain body weight within the normal range from age 21.
• Avoid weight gain and increases in waist circumference throughout adulthood.

Evidence

“The evidence that overweight and obesity increase the risk of a number of cancers is now even more impressive than in the mid-1990s…The evidence that greater body fatness is a cause of cancers of the colorectum, oesophagus (adenocarcinoma), endometrium, pancreas, kidney, and breast (postmenopause) is convincing. It is a probable cause of cancer of the gallbladder. Body fatness probably protects against premenopausal breast cancer, but increases the risk of breast cancer overall. This is because postmenopausal breast cancer is more common. The evidence that abdominal (central) fatness is a cause of cancer of the colorectum is convincing; and it is a probable cause of cancers of the pancreas and endometrium, and of postmenopausal breast cancer. Adult weight gain is a probable cause of postmenopausal breast cancer. Greater birth weight is a probable cause of premenopausal breast cancer.”

2) Physical activity

• Be moderately physically active, equivalent to brisk walking, for at least 30 minutes every day.
• As fitness improves, aim for 60 minutes or more of moderate activity every day.
• Or for 30 minutes or more of vigorous, physical activity every day.
• Limit sedentary habits such as watching television.

Evidence

“The evidence that physical activity of all types protects against cancer and also against obesity, and therefore indirectly those cancers whose risk is increased by obesity, has continued to accumulate since the early 1990s. The evidence that physical activity protects against colon cancer is convincing. It probably protects against postmenopausal breast cancer an endometrial cancer.”

3) Foods and drinks that promote weight gain

• Consume energy-dense foods sparingly.
• Avoid sugary drinks.
• Consume fast foods sparingly, if at all.

Evidence

“Evidence shows that foods and diets that are high in energy, particularly those that are highly processed, and sugary drinks, increase the risk of overweight and obesity. Some foods low in energy density probably protect against some cancers. Energy-dense foods and sugary drinks probably promote weight gain, especially when consumed frequently and in large portions. Correspondingly, low energy-dense foods, (often relatively unprocessed) probably protect against weight gain, overweight, and obesity. Specific types of low energydense foods, such as vegetables and fruits and foods containing dietary fibre, probably protect against some cancers.”

4) Plant foods

Eat mostly foods of plant origin:

• Eat at least five portions/servings (at least 400 g or 14 oz) of a variety of non-starchy vegetables and of fruits every day.
• Eat relatively unprocessed cereals (grains) and/or pulses (legumes) with every meal.
• Limit refined starchy foods.
• People who consume starchy roots or tubers as staples also to ensure intake of sufficient non-starchy vegetables, fruits, and pulses (legumes).

Evidence

“The evidence that diets high in vegetables and fruits protect against cancer is overall less compelling than in the mid 1990s. However, vegetables and fruits, and other foods containing dietary fibre, probably protect against a number of cancers. Non-starchy vegetables probably protect against cancers of the mouth, pharynx, larynx, oesophagus, and stomach. Allium vegetables in particular probably protect against cancer of the stomach. Garlic probably protects against cancers of the colon and rectum. Fruits probably protect against cancers of the mouth, pharynx, larynx, oesophagus, lung, and stomach. Foods containing dietary fibre probably protect against cancers of the colorectum. Foods containing folate probably protect against cancer of the pancreas. Foods containing carotenoids probably protect against cancers of the mouth, pharynx, larynx, and lung; foods containing beta-carotene probably protect against oesophageal cancer; and foods containing lycopene probably protect against prostate cancer. Foods containing vitamin C probably protect against oesophageal cancer; and foods containing selenium probably protect against prostate cancer. It is unlikely that foods containing beta-carotene have a substantial effect on the risk of cancers of the prostate or skin (non-melanoma). It cannot be confidently assumed that the effects of these foods can be attributed to the nutrient specified, which may be acting as a marker for other constituents in the foods.”

5) Animal foods

Limit intake of red meat and avoid processed meat:

• People who eat red meat to consume less than 500 g (18 oz) a week.
• Very little if any meat should be processed.

Evidence

“The evidence that red meat, and particularly processed meat, is a cause of colorectal cancer is stronger now than it was in the mid-1990s. The evidence that red meat is a cause of colorectal cancer is convincing. The evidence that processed meat is a cause of colorectal cancer is also convincing. Cantonese-style salted fish is a probable cause of nasopharyngeal cancer: this conclusion does not apply to fish prepared (or salted) by other means. Milk from cows probably protects against colorectal cancer. Diets high in calcium are a probable cause of prostate cancer; this effect is only apparent at high calcium intakes (around 1.5g per day or more).”

6) Alcoholic drinks

• If alcoholic drinks are consumed, limit consumption to no more than two drinks a day for men and one drink a day for women.

Evidence

“The evidence that all types of alcoholic drink are a cause of a number of cancers is now stronger than it was in the mid- 1990s. The evidence that alcoholic drinks are a cause of cancers of the mouth, pharynx, and larynx, oesophagus, and breast (pre and postmenopausal) is convincing. The evidence that alcoholic drinks are a cause of colorectal cancer in men is convincing. Alcoholic drinks are a probable cause of liver cancer, and of colorectal cancer in women. It is unlikely that alcoholic drinks have a substantial adverse effect on the risk of kidney cancer.”

7) Preservation, processing, preparation

Limit consumption of salt:

• Avoid salt-preserved, salted, or salty foods; preserve foods without using salt.
• Limit consumption of processed foods with added salt to ensure an intake of less than 6 g (2.4 g sodium) a day.
• Do not eat mouldy cereals (grains) or pulses (legumes).

Evidence

“Some methods of food preservation, processing, and preparation affect the risk of cancer. The strongest evidence concerns processed meats, preserved by salting, smoking, pickling, addition of chemicals, and other methods; salt from all sources; and salt-preserved foods. Salt and salt-preserved foods are probably a cause of stomach cancer. The Panel judges that refrigeration, while not likely to have any direct effect on the risk of cancer, indirectly protects against some cancers because it affects consumption of foods which themselves influence the risk of cancer. For instance, it may increase the availability and nutrient content of fresh, perishable foods (vegetables and fruits; meat; milk); and decrease the need for processed foods (preserved by salting, smoking, curing, and pickling). Some plant foods, notably cereals (grains) and pulses (legumes), may be contaminated with aflatoxins, produced by moulds (fungi) during storage in hot and humid conditions. The evidence that aflatoxins are a cause of liver cancer is convincing.”

8 ) Dietary supplement

• Dietary supplements are not recommended for cancer prevention.

Evidence

“Randomised controlled trials have produced strong evidence that high-dose supplements of some nutrients modify the risk of some cancers. The evidence that high-dose beta-carotene supplements are a cause of lung cancer in smokers is convincing. Calcium probably protects against cancers of the colorectum. Selenium in high doses probably protects against prostate cancer. It is unlikely that beta-carotene, or foods fortified with this constituent, have a substantial effect on the risk of cancers of the prostate or skin (non-melanoma).”

In addition to this they state, “The evidence shows that high-dose nutrient supplements can be protective or can cause cancer. The studies that demonstrate such effects do not relate to widespread use among the general population…a general recommendation to consume supplements for cancer prevention might have unexpected adverse effects. Increasing the consumption of the relevant nutrients through the usual diet is preferred.”

9) Breastfeeding

• Aim to breastfeed infants exclusively up to six months and continue with complementary feeding thereafter.

Evidence

“The evidence on cancer supports the evidence on well-being, positive health, and prevention of other diseases: at the beginning of life, human milk is best. The evidence that lactation protects the mother against breast cancer at all ages is convincing. There is limited evidence suggesting that lactation protects the mother against cancer of the ovary. Having been breastfed probably protects children against overweight and obesity, and therefore those cancers for which weight gain, overweight, and obesity are a cause. Overweight and obesity in children tend to track into adult life.”

10) Cancer survivors

Follow the recommendations for cancer prevention:

• All cancer survivors to receive nutritional care from an appropriately trained professional.
• If able to do so, and unless otherwise advised, aim to follow the recommendations for diet, healthy weight, and physical activity.

Evidence

“The available evidence on cancer survivors has limitations. It is of variable quality; it is difficult to interpret; and it has not yet produced impressive results. The evidence for this review does not include the active treatment period. The term “cancer survivor” denotes people in a very wide range of circumstances. It is unlikely that specific recommendations based on evidence applying to any one group of people would apply to all cancer survivors. In no case is the evidence specifically on cancer survivors clear enough to make any firm judgements or recommendations that apply to cancer survivors as a whole, or to those who are survivors of any specific cancer.”

In conclusion

Apparently, two-thirds of cancer cases are not thought to be related to lifestyle, and therefore there is little we can do to prevent the disease in these circumstances. However, Professor Wisemen suggests that more than 3 million of the 10 million cases of cancer diagnosed across the world each year could be prevented if the above recommendations were followed.

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