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An Integrative Approach to Breast Cancer

An Integrative Approach to Breast Cancer. Dr Lily Tomas McGrath Foundation 2009. Aetiology of Breast Cancer. Multifactorial Genetics and Environment = Epigenetics Genetics and Nutrition = Nutrigenomics Mind/ Body/ Spirit Connection = Psychoneuroimmunology Psychoneuroendocrinology.

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An Integrative Approach to Breast Cancer

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  1. An Integrative Approach to Breast Cancer Dr Lily Tomas McGrath Foundation 2009

  2. Aetiology of Breast Cancer • Multifactorial • Genetics and Environment = Epigenetics • Genetics and Nutrition = Nutrigenomics • Mind/ Body/ Spirit Connection = Psychoneuroimmunology Psychoneuroendocrinology

  3. Breast Cancer and the Immune System • Where in the spectrum are you??? • Past History Breast Cancer • Current Diagnosis Breast Cancer • Family History of Breast Cancer

  4. Breast Cancer and the Immune System • Where in the spectrum are you??? • Disease Wellness • Breast Cancer

  5. Integrative Medical Model

  6. Integrative Management of Breast Cancer

  7. Breast Cancer and CAM • A recent Australian survey of women with breast cancer indicates that 87.5% women had used complementary therapies in order to improve their physical health (86.3%), emotional well-being (83.2%) and to boost their immune system (68.8%) Support groups and meditation were also commonly used therapies. • Use of CAM by Australian women with breast cancer. Kremser T, Evans A, Moore A et al. s.l. : Breast 2008;17(4):387-94.

  8. Lifestyle factors and Immunity • Important endogenous and steroid hormones can combine with various lifestyle factors (low exercise, excess weight, poor diet, poor sleep etc) to heighten the risk of many diseases, including cancer. • Obesity is associated with increased mortality from all cancers and there is an accumulating body of evidence as to the mechanisms by which obesity can contribute to the carcinogenesis process. • Benson S, Arck PC, Tan S et al.Effects of obesity on neuroendocrine, CV and immune cell responses to acute psychological stress in premenopausal women. s.l. : Psychoneuroendocrinology 2009;34(2):181-9. • Fair AM, Montgomery K.Energy balance, physical activity and cancer risk. s.l. : Methods Mol Biol 2009;472:57-88.

  9. Stress and Immunity • There is a wealth of evidence demonstrating that psychological stress can adversely affect the development and progression of almost every known disease. Both acute and chronic stressful states produce documentable changes in our innate and adaptive immune responses, which are predominantly mediated via neuroendocrine mediators from the HPA (hypothalamic-pituitary-adrenal) axis and the sympathetic-adrenal axis. • MR, Irwen.Human PNI: 20 years of discovery. s.l. : Brain BehavImmun 2008;22(2):129-39. • 14. Ziemssen T, Kern S.PNI-cross-talk between the immune and nervous systems. s.l. : J Neurol 2007;254 Suppl 2:II8-11.

  10. Stress and Cancer • Chronic stress has been associated with increased susceptibility of individuals to infectious diseases and cancer. • Severe stressful events can increase the risk of cancer by almost 12x and severely threatening life events, by 15x. • Reiche EM, Nunes SO, Morimoto HK.Stress, depression, the immune system and cancer. s.l. : Lancet Oncol 2004;5(10):617-25. • Reiche EM, Morimoto HK, Nunes SM.Stress and depression-induced immune dysfunction : implications of the devt and progression of cancer. s.l. : Int Rev Psychiatry 2005;17(6):515-27. • B, Leonard.Stress, depression and the activation of the immune system. s.l. : World J Biol Psychiatry 2000;1(1):17-25. • Chen C, David A, Nunnerly H, al. e. Adverse Life Events and Breast Cancer: Case Control Study. BMJ 1995;311(7019):1527-30.

  11. Stress and Cancer • Chronic stress has also been linked with worse outcomes in many immune-related disorders, including cancer, inflammatory and infectious diseases, indicating that the effects of our mental state on our immune system are directly and clinically relevant to disease expression. • Mawdsley JE, Rampton DS.Psychological stress in IBD: new insights into pathogenic and therapeutic implications. s.l. : Gut 2005;54(10):1481-91. • Maunder RG, Levelstein S.The role of stress in the devt and clinical course of IBD: epidemiological evidence. s.l. : Curr Mol Med 2008;8(4):247-52. • Raison CL, Miller AH.The neuroimmunology of stress and depression. s.l. : SeminClin Neuropsychiatry 2001;6(4):277-94.

  12. Mind-Body Medicine and Cancer • Various behavioural strategies, psychological and psychopharmacotherapeutic interventions that enhance effective coping and reduce affective distress show beneficial effects in many disease, including cancer. • ReicheEM, Morimoto HK, Nunes SM.Stress and depression-induced immune dysfunction : implications of the devt and progression of cancer. s.l. : Int Rev Psychiatry 2005;17(6):515-27. • Psych intervention and health outcomes among women treated for breast cancer : a review of stress pathways and biological mediatore. NcGregor BA, Antoni MH.s.l. : Brain BehavImmun 2009;23(2):159-66.

  13. Mindfulness-based Stress Reduction • There have been many recent studies, including a systematic review, which demonstrate the efficacious potential of MBSR in the management of cancer, particularly breast and prostate . • Those with breast and prostate cancer not only showed improvements in mood but also improved cytokine parameters with a reduction in levels of pro-inflammatory cytokines. • Patients with advanced cancer were shown to have a 10% chance of regression of growth and a 50% chance of greatly improved quality of life.

  14. Mindfulness-based Stress Reduction • MBSR as supportive therapy in cancer care : a SR. Smith JE, Richardson J, Hoffman C et al.s.l. : J Adv Nurs 2005;52(3):315-27. • Effect of MBSR on immune function, QOL and coping in women newly-diagnosed with early stage breast cancer. Witek-Janusek L, Albuquerque K, Chroniak KR et al.s.l. : Brain BehavImmun 2008;22(6):969-81. • 1 year pre-post intervention follow-up of psychological, immune, endocrine and BP outcomes of MBSR in breast and prostate Ca outpatients. Carlson LE, Speca M, Faris P et al.s.l. : Brain BehavImmun 2007;21(8):1038-49. • MBSR in relation to QOL, mood, symptoms of stress and levels of cortisol, DHEA and melatonin in breast and prostate cancer outpots. Carlson LE, Speca M, Patel KD et al.s.l. : Psychoneuroendocrinology 2004;29(4):448-74. • MBSR in relation to QOL, mood, symptoms of stress and immune parameters in breast and prostate cancer outpts. Carlson LE, Speca M, Patel KD et al.s.l. : Psychosom Med 2003'65(4):571-81. • Mindfulness meditation for oncology pts : a discussion and critical review. Ott MJ, Norris RL, Bauer-Wu SM.s.l. : Integr Cancer Ther 2006'5(2):98-108. • Meares A. What can the cancer patient expect from intensive meditation? Australian Family Physician 1980;9(5):322-5.

  15. Hypnosis, Relaxation and Guided Imagery • In those with breast cancer, significant effects have been found with respect to NK cell activity, mixed lymphocyte responsiveness and the number of peripheral blood lymphocytes when compared with controls. • Thus, there appears to be a role for hypnotic guided imagery as an adjuvant therapy to breast cancer. • A review of the impact of hypnosis, relaxation, guided imagery and individual differences on aspects of immunity and health. JH, Gruzelier.s.l. : Stress 2002;5(2):147-63. • Immunological responses of breast cancer pts to behavioual interventions. Gruber BL, Hersh SP, Hall NR et al.s.l. : Biofeedback Self Regul 1993;18(1):1-22. • Immune reponses to guided imagery during breast cancer treatment. Lengacher CA, Bennett MP, Gonzalez L et al.s.l. : Biol Res Nurs 2008;9(3):205-14. • The effect of hypnotic guided imagery on psychological well-being and immune function in patients with prior breast cancer. Bakke AC, Purtzer MZ, Newton P.s.l. : J Psychosom Res 2002;53(6):1131-7.

  16. Cognitive Behavioural Therapy • Group CBT training and psychotherapy for women with breast cancer have also resulted in improved immune parameters. • Attending group therapy may double survival time and a self-perception of being strong can also improve survival time. • A pilot RCT assessing the effects of autogenic training in early stage cancer pts in relation to psychological status and immune system responses. Hidderley M, Holt M.s.l. : Eur J OncolNurs 2004;8(1):61-5. • An exploratory study into the effects of group psychotherapy on CV and immunoreactivity to acute stress in breast ca pts. vadderPompe G, Antoni MH, Duivenvoorden HJ et al.s.l. : PsychtherPsychosom 2001;70(6):307-18. • Spiegel D, Bloom J, Kraemer H, Gottheil E. Effect of psychosocial treatment on survival of patients with metastatic breast cancer. Lancet 1989;2:888-891. • 28. Hawks S, Hull M, Thalman R, Richins P. Review of spiritual health: definition, role, and intervention strategies in health promotion. American Journal of Health Promotion 1995;95:371-8.

  17. Group Therapy • Group support activities can also address components of spiritual health such as meaning and purpose in life, self-awareness and connectedness with self, others and a larger reality. • Combinations of diet, meditation, prayer and group support are available at specialised centres • Ian Gawler (www.gawler.org) • Petrea King (www.quest forlife.com.au)

  18. Sleep • Good sleep is essential for physical and mental health. There is strong evidence demonstrating that inadequate sleep is associated with a multitude of health problems, including cognitive impairment, mood disorders, parasitical infections, cardiovascular diseases and compromised immunitysuch as cancer. • Imeri L, Opp MR.How (and why) the immune system makes us sleep. s.l. : Nat Rev Neurosci 2009;10(3):199-210. • CA, Smyth.Evaluating sleep quality in older adults : the Pittsburgh Sleep Quality Index can be used to detect sleep disturbances or deficits. s.l. : Am J Nurs 2008;108(5):42-50. • Meerlo P, Sgoifo A, Suchecki D.Restricted and disrupted sleep : effects on ANS function, neuroendocrine stress systems and stress responsitivity. s.l. : Sleep Med Rev 2008;12(3):197-210. • Novati A, Roman V, Cetin T et al.Chronically restricted sleep leads to depression-like changes in NT receptor sensitivity and neuroendocrine stress reactivity in rats. s.l. : Sleep 2008;31(11):1579-85. • Preston BT, Capellini I, McNamara P et al.Parasit resistance and the adaptive significance of sleep. s.l. : BMC EvolBiol 2009;9:7.

  19. Sleep • Melatonin is our natural sleep hormone and it is known to decrease with increasing age. Recent studies have shown that melatonin has an immune-modulating effect. • It stimulates the production of NK cells and CD4+ cells and inhibiting CD8+ cells. It also stimulates the production of granulocytes and macrophages, as well as the release of various cytokines from NK cells and T-helper lymphocytes. • Cardinali DP, Esquifino AI, Srinivasan V et al.Melatonin and the immune system in aging. s.l. : Neuroimmunomodulation 2008;15(4-6):272-8.

  20. Sleep • Atypical time schedules such as shift-work has also been associated with breast cancer, due to a circadian disruption and to a nocturnal suppression in melatonin production. • In-vitro studies show that melatonin can reduce the invasiveness of breast cancer cells. • Thus, enhancement of the production of melatonin, or melatonin itself, has the potential therapeutic value to enhance immune function. • MC, Spaggiari.Sleep medicine in occupational health. s.l. : G Ital Med LavErgon 2008;30(3):276-9. • Sanchez-Barcelo E. Melatonin modulates aromatase activity in MCF-7 human breast cancer cells. Int J Cancer 2006:274-278.

  21. Exercise • There is a wealth of evidence supporting the beneficial effects of exercise upon the immune system. • NK cells have been found to be the most responsive immune cell to acute exercise. Their sensitivity to physiological stress combined with their important role in innate immune defences indicate that these cells are one link between regular physical activity and general health status. • Woods JA, Vieira VJ, Keylock KT.Exercise, inflammation and innate immunity. s.l. : Immunol Allergy Clin North Am 2009;29(2):381-93. • Schedlowski M, Schmidt RE.Stress and the immune system. s.l. : Naturwissenschaften 1996;83(5):214-20. • Kizaki T, Takemasa T, Sakurai T et al.Adaptation of macrophages to exercise training improves innate immunity. s.l. : BiochemBiophys Res Commun 2008;372(1):152-6. • Timmons BW, Cieslak T.Human NK cell subsets and acute exercise : a brief review. s.l. : ExercImmunol Rev 2008;14:8-23. • de Lima C, Alves LE, Iagher F et al.Anaerobic exercise reduces tumour growth, cancer cachexia and increases macrophage and lymphocyte response in Walker 256 tumour-bearing rats. s.l. : Eur J ApplPhysiol 2008;104(6):957-64.

  22. Exercise • Anerobic exercise in animal studies has been shown to increase both innate and adaptive immune function, decreasing tumour growth and cancer cachexia. • It is important to note, however, that exercise needs to be performed in moderation. Multiple effects of over-training resulting in impaired immune response have been documented in the literature. • de Lima C, Alves LE, Iagher F et al.Anaerobic exercise reduces tumour growth, cancer cachexia and increases macrophage and lymphocyte response in Walker 256 tumour-bearing rats. s.l. : Eur J ApplPhysiol 2008;104(6):957-64. • Bishop NC, Gleeson M.Acute and chronic effects of exercise on markers of mucosal immunity. s.l. : Front Biosci 2009;14:4444-56. • West NP, Pyne DB, Kyd JM et al.The effect of exercise on innate mucosal immunity. s.l. : Br J Sports Med 2008 May 22 [Epub ahead of print]. • Nieman DC, Henson DA, McMahon M et al.Beta-glucan, immune function and URTI in athletes. s.l. : Med Sci Sports Exerc 2008;40(8):1463-71. • Close P, Thielen V, Bury T.Mucosal immunity in elite athletes. s.l. : Rev Med Liege 2003;58(9):548-53.

  23. Physical therapies- Yoga • There have been some studies on the efficacy of yoga practice on the immune system. Most have been focused on the breathing disciplines within yoga, namely Pranayama and SudarshanKriya, that are both rhythmic breathing processes traditionally used to reduce stress and improve the immune system. • Cancer patients who were either undergoing or had completed their conventional therapy also showed a significant increase in NK cells at 12 and 24 weeks after practicing the above yogic breathing techniques compared with controls. • Wellness through a comprehensive yogic breathing program- a controlled pilot trial. Kjellgren A, Bood SA, Axelsson K et al.s.l. : BMC Comp Altern Med 2007;7;43. • Effect of rhythmic breathing (SK and P) on immune functions and tobacco addiction. Kochupillai V, Kumar P, Singh D et al.s.l. : Ann N Y AcadSci 2005;1056:242-52. • Effects of yoga on NK cell counts in early breast cancer pts undergoing conventional treatment. Rao RM, Tellas S, Nagendra HR et al.s.l. : Med SciMonit 2008;14(2):LE3-4.

  24. Physical therapies- Massage • There are mixed results as to the benefits of massage for immune enhancement. Two studies have noted increases in dopamine, serotonin, NK cells and lymphocytes in women with breast cancer after thrice weekly massage for 5 weeks. Depression, anxiety and anger were also significantly reduced. • NK cells and lymphocytes increase in women with BC following massage therapy. Hernandez-Reif M, Field T, Ironson G et al.s.l. : Int J Neurosci 2005;115(4):495-510. • BC pts have improved immune and neuroendocrine functions following massage therapy. Hernandez-Reif M, Ironson G, Field T et al.s.l. : J Psychosom Res 2004;57(1):45-52.

  25. Physical therapies- Acupuncture • Acupuncture has been used for centuries to prevent and treat various conditions and to simply maintain good health. In addition to its known effects on the nervous system, emerging evidence suggests that it may also effectively modulate the innate immune system which plays important roles in inflammation, pain, metabolism, cell proliferation and apoptosis. • Acupuncture and immune modulation. Cabioglu MT, Cetin BE.s.l. : Am J Chin Med 2008;36(1):25-36. • Acupuncture and innate immunity. G, Peng.s.l. : Zhen Ci Yan Jiu 2008;33(1):49-52. • The messengers from PNS to CNS: involvement of neurotrophins and cytokines in the mechanisms of A. J, Du.s.l. : Zhen Ci Yan Jiu 2008;33(1):37-40.

  26. Environmental Influences • Today’s society is filled with novel environmental toxins which may play a significant role in the development and progression of many chronic diseases, including breast cancer: • Xeno-oestrogens • Pesticides/chemicals • Heavy metals • Electromagnetic radiation • Sick building syndrome • Recent advances in research on RF fields and health : 2001-2203. Krewski D, Glickman BW, Habash RW et al.s.l. : J Toxicol Environ Health B Crit Rev 2007;10(4):287-318. • Worgroup report : base stations and wireless networks RF exposures and health consequences. Valberg PA, van Deventer TE, Repacholi MH.s.l. : Environ Health Perspect 2007;115(3):416-24. • EMF and health outcomes. B, Knave.s.l. : Ann Acad Med Singapore 2001;30(5):489-93.

  27. Dietary Modulation • There is strong evidence regarding the pro-inflammatory effects of fast-“foods” that contain high amounts of saturated fatty and trans-fatty acids, refined carbohydrates with an high glycaemic index. • “Junk food” – Either junk or food

  28. Foods to Avoid or Minimise • Sugar • Cancers require sugar for survival, consuming 3-5 x glucose compared with healthy cells. This, in turn, wastes energy reserves. • High GI diets have been linked with increased breast cancer rate in post-menopausal women. • Read labels – corn syrup, hydrogenated starch, sorbitol, sorghum, dextrin, lactose, fructose, galactose….. • Limit all fruit juices Navarro Silvera S, et al. Dietary carbohydrates and breast cancer risk. International Journal of Cancer 2004;114(4):653-658.

  29. Foods to Avoid or Minimise • Animal fats • Fat tissue is a major source of oestrogen production in post-menopausal women. • High fat diets may reduce the amount of oestrogen excreted in the faeces, thereby increasing circulating oestrogens. • High fat intake is linked to obesity, insulin resistance and lower levels of SHBG, which potentiates oestrogenic effects. • Reducing fat intake may lower the risk of relapse in women with early-stage breast cancer. Chlebowski R, Blackburn G, al e. Dietary fat reduction and breast cancer outcome: interim efficacy results from the Women's Intervention Nutrition Study. J Natl Cancer Inst 2006;98(24):1767-76.

  30. Foods to Avoid or Minimise • Processed foods, Preservatives, Colourings, Nitrites, Nitrates, Plastics, Agrichemicals • Significantly higher levels (50-60%) of pesticides and PCBs have been found in malignant breast tissue compared with benign breast disease. • The Breast Cancer Prevention Group. Breast Cancer: Environmental Factors. The Lancet 1992;340:904. • Willett WC, et al. Dietary Fat and Fiber in Relation to Risk of Breast Cancer: An Eight Year Follow-up". JAMA 1992;268(15):2037-2044.

  31. Foods to Avoid or Minimise • Several foods either contain naturally-occurring hormones (animal products) or have natural oestrogenic properties (soy) that may stimulate oestrogen production in the body. • Added synthetic hormones (commercially packed meat, poultry, dairy products) may also have oestrogenic effects. • Women who ate BBQ meat > 2x month had an increased risk of developing breast cancer. • Xeno-oestrogens (plastics) which are thought to leach large amounts of polymers into food/drink contents with possible carcinogenic effects. • Charcoal or Flame Broiled Meat Linked To Breast Cancer Risk. Annual Meeting of the American Association for Cancer Research; 2000 April 3,2000.

  32. Foods to Maximise • Regular intake of colourful vegetables has been shown to decrease the incidence of cancer by 40%. • In particular, cruciferous vegies(broccoli, brussel sprouts, bokchoy, kale, turnips, cauliflower) contain I3C, which pushes the breakdown of oestrogen into a cancer preventing rather than promoting pathway. • Rock C, al. e. J ClinOncol 2005;23(27):6631-8. • Doyle C, et al. Nutrition and Physical Activity During and After Cancer Treatment. CA Cancer J Clin 2006;56:323-353. • Rahman K, Li Y, Sarkar F. Inactivation of akt and NF-kappaB play important roles during indole-3-carbinol-induced apoptosis in breast cancer cells. Nutrition and Cancer 2004;48(1):84-94.

  33. Foods to Maximise • 100g fresh vegetable sprouts daily for just 2 weeks has clearly been shown to protect against DNA damage in human blood cells. • Fish high in omega-3 EFAs (sardines, mackeral, herring, salmon, tuna),whey, eggs, nuts (brazil) may also confer protective benefits. • Flaxseed has the potential to reduce tumour growth in patients with breast cancer. • Gill C. The Effect of Cruciferous and Leguminous Sprouts on Genotoxicity, In vitro and In vivo. Cancer Epidemiol. Biomarkers Prev 2004;13:1199-1205. • Thompson L, Chen J, Li T. Dietary flaxseed alters tumor biological markers in postmenopausal breast cancer. Clin Cancer Res 2005;11(10):3828-35.

  34. Foods to Maximise • Onions and garlic can provide some protection from a variety of cancers, including breast. • Maitake, Shiitake and Reishi mushrooms can increase NK cells and improve antibody responses. • Coriolusversicolor (PSK) • Galeone C, et al. Onion and garlic use and human cancer. American Journal of Clinical Nutrition 2006;84(5):1027-1032. • Diamond W, al e. An alternative medicine definitive guide to cancer. Tiburon, California: Future Medicine Publishing, Inc., 1997.

  35. Foods to Maximise • Curcumin (turmeric) also has chemopreventative effects and can inhibit the growth of cancer cells and the formation of breast cancer metastases in animal models. • Curcumin has also been shown to reduce cell sensitivity to radiation-induced DNA damage without affecting DNA repair. • Curcumin inhibits proliferation, invasion, angiogenesis and metastasis of different cancers through interaction with multiple cell signalling proteins. Kunnumakkara AB, Anand O, Aggarwal BB.s.l. : Cancer Lett 2008;269(2):199-225. • Curcumindownregulates the inflammatory cytokines CXCL1 and 2 in breast cancer cells via NFkappaB. . Bachmeier BE, Mohrenz IV, Mirisola V et al.s.l. : Carcinogenesis 2008;29(4):779-89. • Extended treatment with physiologic concentrations of dietary phytochemicals results in altered gene expression, reduced growth and apoptosis of cancer cells. Moiseeva EP, Almeida GM, Jones GD et al.s.l. : Mol Cancer Ther 2007;6(11):3071-9.

  36. Foods to Maximise • GLA (Gamma-linolenic acid), Omega-6 EFA, can inhibit the action of the cancer gene Her-2/neu which is responsible for almost 30% all breast cancers. • Found in evening primrose oil, blackcurrent seed and borage oil. • Digestive enzymes :chymotrypsin (animal sources), papain (papaya), bromelain (pineapple) have anti-inflammatory and possibly anti-tumour effects. • Javier A, Menendez, al e. Effect of -Linolenic Acid on the Transcriptional Activity of the Her-2/neu (erbB-2) Oncogene. Journal of the National Cancer Institute 2005;97(21):1611-1615. Cichoke A. The effect of systemic enzyme therapy on cancer cells and the immune system. Townsend Letter for Doctors and Patients 1995(ov):30-32.

  37. Foods to Maximise • Various dietary anti-oxidants have shown considerable promise as effective agents for cancer prevention by reducing oxidative stress which has been implicated in the development of many diseases, including cancer. (1) • A low intake of carotenoids, through poor diet and/or lack of vitamin supplementation, has been associated with an increased risk of breast cancer. (3) (4) (5) (6) (7) • Lutein is a carotenoid found particularly in dark green leafy vegetables and in egg yolks. (8) • Thus far, it appears that these benefits are more pronounced in postmenopausal women, particularly with oestrogen receptor positive tumours. (10)

  38. Foods to Maximise • Cancer chemoprevention through dietary anti-oxidants : progree and promise. Khan N, Afaq F, Mukhtar H. s.l. : Antiox Redox Signal 2008;10(3):475-510. • Dietary carotenoids and risk of breast cancer in Chinese women. Huang JP, Zhang M, Holman CD et al. s.l. : Asia Pac J clin Nutr 2007;16 Suppl !:437-42. • Serum carotenoids and breast cancer. Toniolo P, Van Kappel AL, Akhmedkhanov A et al. s.l. : Am J Epidemiol. 2001;153912):1142-7. • Prospective study of carotenoids, tocopherols and retinoid concentrations and the risk of breast cancer. Sato r, Helzlsouer KJ, Alberg AJ et al. s.l. : Cancer epidemiol Biomarkers Prev. 2002;11(5):451-7. • Breast cancer, serum antioxidant vitamins and p53 protein overexpression. Kim MK, Park YG, Gong G et al. s.l. : Nutr Cancer. 200243(2):159-66. • Nutrition and Cancer: a review of the evidence for an anti-cancer diet. MS, Donaldson. s.l. : Nutr J. 2004;3:19. • Diet and cancer. Divisi D, Di Tommaso S, Salvemeni S et al. s.l. : Acta Biomed 2006;77(2):118-23. • Lutein and zeaanthin and their potential roles indisease prevention. Ribaya-Mercado JD, Blumbaerg JB . s.l. : J Am Coll Nutr 2004;23(6 Suppl):567S-587S. • Puced oxidative stress in women previously treated for breast cancer.lasma and dietary carotenoids are associated with re. Thomson CA, Stendell-Hollis NR, Rock CL et al. s.l. : cancer Epidemiol Biomarkers Prev. 2007;16(10):2008-15. • Fruits, vegetables and micronutrients in relation to breast cancer modified by menopause and hormone receptor status. Gaudet MM, Britton JA, Kabat GC et al. s.l. : Cancer Epidemiol Biomarkers Prev. 2004;13(9):1485-94.

  39. Specific Dietary Programmes • Gerson Diet • Use of specific foods, juices, supplements and coffee enemas • Gawler Foundation Diet • Raw, vegetarian food • Macrobiotic Diet • low fat, high fibre, mainly vegetarian diet emphasising whole grains and vegetables and rich in phyto-oestogens from soy. • And so on………

  40. Dietary Modulation • It is important to realise that any food, however, may be pro-inflammatory for an individual who is intolerant to that food. • Adverse reactions to foods can have a significant impact on the immune system and general well-being of an individual’s life.

  41. Dietary Modulation • The simplest test to determine which foods contribute to gastrointestinal or other symptoms is to perform a food elimination diet (FED), with initial avoidance then separate re-introduction of individual foods. Some of the most common dietary intolerances are due to wheat, dairy and soy. • Food intolerances can be associated with gastrointestinal and , indeed, whole-body inflammation. This is extremely important as the gut (GALT) houses the largest number of immune cells in the body (70%). • Overview of Gut immunology. Mason KL, Huffnagle GB, Noverr MC et al.s.l. : Adv Exp Med Biol 2008;635:1-14.

  42. Dietary Beverages to Maximise • EPG (Epigallocatechin-3-gallate), present in green tea, is well-known for it’s ability to reduce the risk of a variety of immunodeficiency disorders. Green tea possesses anti-oxidant, anti-inflammatory, anti-carcinogenic (breast) and immune enhancing properties. • Lime flower, peppermint and verbena teas may also decrease cancer risk. • Immunostimulating activity of a crude polysaccharide derived from green tea extract. Monobe M, Ema K, Kato F et al.s.l. : J Agric Food Chem 2008;56(4):1423-7. • Zhang M, Holman C, al e. Green tea and the prevention of breast cancer: a case-control study in southeast China. Carcinogenesis 2006(Dec 20). • Hirvonen T, Mennen L, al e. Consumption of antioxidant-rich beverages and risk for breast cancer in French women. Ann Epidemiol 2006;16(7):503-8.

  43. Dietary Beverages to Maximise • Fresh juices, especially vegetable juice, are loaded with cancer-fighting phytochemicals, enzymes, anti-oxidants and vitamins, in a state that is easily absorbed by the body. • Wheatgrass, spirulina and other nutrients may be added to the juices for extra benefit.

  44. Dietary Beverages • Alcohol in light-moderate amounts (10g for women, 20g for men) has been shown to be particularly beneficial for the immune system when compared with both non and heavy drinkers. • In particular, Resveratrol, a polyphenol from red wine, is able to stimulate both innate and adaptive immune responses. • Influence of alcohol consumption on immumological status : a review. Diaz LE, Montero A, Gonzalez-Gross M et al.s.l. : Eur J ClinNutr 2002;56 Suppl 3 :S50-3. • Polyphenols from red wine modulate immune responsiveness : biological and clinical significance. Magrone T, Candore G, Caruso C et al.s.l. : CurrPharm Des 2008;14(26):2733-48. • Resveratrol induces the heat-shock response and protects human cells from severe heat stress. Putics A, Vegh EM, Csermely P et al.s.l. : AntioxRedox Signal 2008;10(1):65-75. • Effects of resveratrol on human immune cell function. Falchetti R, Fuggetta MP, Lanzilli G et al.s.l. : Life Sci 2001;70(1):81-96.

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