Nutrition & Breast Cancer

Natalie Ledesma, MS, RD, CSO Ida & Joseph Friend Cancer Resource Center UCSF Helen Diller Family Comprehensive Cancer Center University of California, San Francisco

Good nutrition may reduce the incidence of breast cancer and the risk of breast cancer progression or recurrence. There are many studies in progress to help further understand how diet and cancer are related. We do know, however, that improved nutrition reduces risk of chronic diseases, such as diabetes, obesity, hypertension and heart disease, and also enhances overall quality of life. It is estimated that one third of cancer deaths in the U.S. can be attributed to diet in adulthood [1].

Guidelines for a Healthy Diet
• Plant-based diet o Plenty of fruits and vegetables o High fiber – whole grains and beans/legumes • Low fat diet with emphasis on healthy fats • Limit processed and refined grains/flours/sugars • Drink plenty of fluids • Be physically active to help achieve and maintain a healthy weight

Healthy Plate Diagram
Fill your plate with approximately 50% vegetables, 25% protein, and 25% whole grain.

Plant based diet
A lifelong commitment to a plant based diet may lower a woman’s risk of developing breast cancer and may also reduce the risk of recurrent breast cancer. A plant based diet consists primarily of fruits, vegetables, whole grains, beans/legumes, and other plant protein sources.

* All words noted with an asterisk ( * )

are defined in the glossary on page 44.

•C  ontain vitamins, minerals, fiber, and various cancer-fighting phytonutrients* (for example: carotenoids, lycopene, indoles, isoflavones, flavonols). • Vibrant, intense COLOR is one indicator of phytonutrient* content. •T  here is extensive and consistent evidence that diets high in fruits and vegetables are associated with decreased risks of many cancers, and while results for breast cancer risk are not yet conclusive, they are promising [2-12]. • In a study of about 3000 postmenopausal women, a protective effect for vegetables was observed [2].

oW  omen who consumed 25 or more servings of vegetables weekly had a 37% lower risk of breast cancer compared with women who consumed fewer than 9 vegetable servings weekly.
• An epidemiological study reported a significant protective effect of vegetables against breast cancer when case-control* and cohort* studies were considered together [4]. • A meta-analysis* – looking at the data from 17 studies [13] revealed that high vs. low vegetable consumption was associated with a 25% reduction in breast cancer risk, but these findings were not confirmed by collected data from 8 studies [14]. • A recent case-control* study reported women who consumed more than 3.8 servings of fruits and vegetables daily had a lower risk of breast cancer when compared with women who consumed fewer than 2.3 daily servings [15]. • Japanese women following a prudent dietary pattern (high in fruits and vegetables, low in fat) had a 27% decreased risk of breast cancer [5]. • A Korean case-control study* reported that a high intake of certain fruits and vegetables resulted in a significantly lower risk of breast cancer in premenopausal (tomatoes) and postmenopausal women (grapes and green peppers) [6]. • While no effect was observed for vegetables, increasing total fruit intake significantly lowered the risk of breast cancer when comparing those in the highest to lowest tertile [16].

o This effect was greater for those with estrogen-receptor positive (ER+) tumors.
• Eating a salad vegetable dietary pattern (high consumption of raw vegetables and olive oil) exerted a significant protective effect against HER-2-positive cancers [10]. • A study assessing plasma or blood carotenoids as a marker for fruit and vegetable intake reported that individuals in the top 1/4 had a 43% lower risk of breast cancer recurrence when compared to those in the lowest 1/4 [17]. • However, no association was observed between fruit and vegetable consumption and breast cancer recurrence when women consumed five servings daily vs. eight servings daily [18]. • Breast cancer survivors significantly reduced mortality by following a diet low in fat, high in vegetables, high in fiber, and high in fruit [19]. • The combination of consuming five or more daily servings of vegetables and fruits, and accumulating 540+ metabolic equivalent tasks-min/wk (equivalent to walking 30 minutes 6 d/wk) decreased mortality by nearly 50% [11].

o The effect was stronger in women who had hormone receptor-positive cancers.
• Vegetable intake has been inversely associated with serum insulin-like growth factor-I (IGF-I) levels [20].


• Beta-carotene is one of the 600 carotenoids that can be partially converted into vitamin A in the body. • Carotenoids have a protective role for certain sites of cancer, including breast cancer [7, 21-24]. • Cartenoid intake was significantly associated with reduced mortality in breast cancer survivors [19]. • In various studies, serum beta-carotene levels were lower among breast cancer patients compared to women without cancer [21,25-29]. oO  ne of these studies reported the risk of breast cancer to be 221% greater for women in the lowest quartile of serum beta-carotene compared to women in the highest quartile [29]. • A case-control* study reported that increased plasma levels of beta-carotene, retinol, and total antioxidant* status were associated with about a 50% reduced risk of breast cancer [28]. • In vitro research indicates that carotenoids may inhibit the production of breast cancer cells [30-31]. oB  eta-carotene may inhibit ER+ and estrogen-receptor negative (ER-) breast tumor development [22]. •B  eta-carotene may hinder the development of breast cancer cells by inducing apoptosis*, or programmed cell death [32]. • Research indicates that dietary sources of beta-carotene are likely much more protective than supplemental sources against the risk of cancer [33-35]. o Women who consumed higher amounts of dietary beta-carotene, lycopene, and betacryptoxanthin were associated with a lower risk of breast cancer among Chinese women [23]. o Dietary alpha-carotene, beta-carotene, and lycopene were inversely associated with risk of ER+PR+ breast cancer [24]. o Dietary beta-carotene intake was inversely associated with IGF-I levels in a large case-control study [20].

Cruciferous Vegetables
•S  ome evidence suggests that the cruciferous vegetables, in particular, are associated with a reduced risk of breast cancer [36-40]. • A Swedish study of postmenopausal women reported one to two daily servings of cruciferous vegetables to reduce the risk of breast cancer, possibly by as much as 20-40% [37]. • Women who ate more turnips and Chinese Cabbage, in particular, significantly reduced the risk of postmenopausal breast cancer [40]. • Consumption of cruciferous vegetables, particularly broccoli, was inversely, though not statistically significant, associated with breast cancer risk in women [36]. • The U.S. component of the Polish Women’s Health Study found that women who consumed raw- or short-cooked cabbage and sauerkraut 3 or more times weekly had a significantly reduced risk of breast cancer [39]. o Cabbage that was cooked for a long time had no effect on breast cancer risk. o Researchers suggested that glucosinolates, compounds in cabbage, may affect both the initiation phase of carcinogenesis*, cell mutation*, and inhibit apoptosis*.


• Cruciferous vegetables appear to shift estrogen metabolism in a favorable manner; increasing 2-hydroxyestrone:16-a-hydroxyestrone [41-42]. Fowke and colleagues [42] concluded that consuming more cruciferous vegetables across the population may very well have an impact on the incidence of breast cancer. • Several studies suggest that compounds found in these foods, isothiocyanates (sulforaphane), have inhibitory effects on breast cancer cells in both cell studies and animal studies [38, 43, 44]. o One mechanism appears to be through potent inhibition of phase I and induction of phase II detoxifying enzymes, such as glutathione-s-peroxidase [36,40,43]. o Furthermore, these compounds exhibited reduced cell proliferation and inhibited cyclooxygenase-2 (COX-2) expression in breast cancer cells [45]. o Inhibited cell growth and induced apoptosis has also been observed [46]. • Indole-3-carbinol (I3C) is a compound found in cruciferous vegetables that has anticancer properties and anti-proliferative effects on breast cancer cells [47]. o I3C may inhibit the growth of blood vessels that the tumor needs to grow (anti-angiogenesis) [48]. • I3C and diindolylmethane (DIM) induce apoptosis*, or cell death, in breast cancer cells [41,49] for both ER+ and ER- tumor cells [50]. • Furthermore, I3C and tamoxifen have been shown to act separately and/or cooperatively to inhibit the growth of ER+ breast cancer cells [51]. • Dietary I3C may have effects that bolster immune function [52]. • Calcium-D-glucarate has been shown to inhibit beta-glucuronidase, an enzyme involved in phase II liver detoxification. Elevated beta-glucuronidase activity is associated with an increased risk for various cancers, particularly hormone-dependent cancers such as breast cancer [53]. Nutrient Beta-carotene Cruciferous vegetables Dietary Sources Carrots, sweet potatoes, winter squash, cantaloupe, and mango Recommendation Include these fruits and vegetables daily.

Arugula, broccoli, Brussels sprouts, Include these vegetables daily. cabbage, cauliflower, collard greens, horseradish, kale, kohlrabi, mustard greens, radishes, rutabaga, turnips and turnip greens, and watercress

Organic Produce
• Organic fruits and vegetables have fewer pesticides, lower levels of total pesticides, and less overall pesticide toxicity than fruits and vegetables grown with chemicals. Although more research is needed, recent evidence indicates a significant increase in antioxidants* in organic and sustainably grown foods versus conventionally grown foods [54-58]. o Organic vegetables contained a greater concentration of phytonutrients* (phenolic acids) when compared to conventionally grown vegetables [57,58]. • Consuming organic foods appears to increase salicylic acid, which may contribute to a lower risk of cancer [57].


• Pesticides such as organochlorine compounds (OCC), known as environmental pollutants, have been implicated in the etiology of estrogen-related disorders due to their potential estrogenic and anti-estrogenic properties [59]. • Results of some studies [59-61], but not all [62] suggest that environmental exposure to organochlorine pesticide residues or PCBs may contribute to multifactorial pathogenesis of breast cancer. o In a study of women living on Long Island, New York, breast cancer risk was associated with lifetime residential pesticide use [63]. o Organochlorine pesticide residues, including DDTs and HCHs, may increase women’s risk of breast cancer, particularly in premenopausal women in China [60]. o Exposure to beta-HCH, an organochlorine pesticide residue, both accelerated the appearance and incidence of breast cancer tumors when compared to control mice [61]. • The level of exposure may be integral in determining the effects of these OCC. o One study found that when breast adipose tissue reached levels higher than 2600 ppb, women with postmenopausal ERalpha-positive breast cancer exhibited high proliferation [64]. • Choosing organic produce will help you reduce your levels of pesticide exposure and will most likely increase your phytonutrient* consumption. o Although washing and peeling your non-organic fruits or vegetables may help to reduce pesticide residues, it will not eliminate them. • Listed below are produce with the most and least pesticide contamination, both in terms of number of pesticides used and the level of pesticide concentration on an average sampling. Thus, for the fruits and vegetables shown on the most contaminated list, it is wise to buy organic. Alternatively, if organic choices are not available, you may want to consider substituting with produce that tends to contain the least amount of pesticides. Produce most contaminated by pesticides: Peaches Apples Bell peppers Celery Nectarines Strawberries Cherries Lettuce Grapes–imported Pears Spinach Potatoes Produce least contaminated by pesticides: Onions Avocado Sweet corn Pineapples Mango Sweet peas Asparagus Kiwi Bananas Cabbage Broccoli Eggplant

**Adapted from Environmental Working Group – A Shopper’s Guide to Pesticides in Produce • It is most important, however, to eat fruits and vegetables – organic or conventional. If the availability or cost of organic produce is a barrier, you may wish to avoid those fruits and vegetables that have the highest pesticide residue content.

These include: o Increased fecal bulk and decreased intestinal transit time. vegetables. o Additionally. which allow less opportunity for fecal mutagens to interact with the intestinal epithelium [70]. • Fermented pomegranate juice polyphenols* appear to have twice the anti-proliferative effect as fresh pomegranate juice polyphenols* [67]. • A high fiber diet is also associated with less obesity [72]. which are then later eliminated from the body [69]. slow cell growth.72-75]. a high fiber diet works to reduce hormone levels that may be involved in the progression of breast cancer [70. split peas. SCFA improve the gut environment and may provide immune protection beyond the gut [70. pinto beans). including trace minerals and phenolic compounds. • Various mechanisms have been proposed for the protective effects of dietary fiber against cancer. which are thought to promote cell proliferation [71]. • Furthermore. o Binding to bile acids.71]. producing short-chain fatty acids (SCFA). 6 . • Pomegranate seed oil and fermented juice block the cancer cells’ oxygen supply. legumes (for example: lentils. which have been linked to disease prevention [71]. o Dietary fiber intake increases the amount of estrogen excreted in the stool [76]. a high intake of dietary fiber was significantly associated with low serum levels of estradiol in postmenopausal breast cancer survivors [75]. Thus. • Furthermore. Punicaceae) • Various parts of the pomegranate fruit (for example: seed oil. particularly from cereals and fruit. but not post-menopausal women [77]. low-fat diet intervention found that fiber reduced serum estradiol* (estrogen breaks down into estradiol* in the body) concentration in women diagnosed with breast cancer. one study suggests that pomegranate seed oil may have the greatest preventive activity (87% reduction in lesions) compared to fermented pomegranate juice (42% reduction) [68]. o Similarly. fermented juice and peel extract) have expressed the suppressive effects on human breast cancer cells in laboratory research [65]. was found to significantly reduce the risk of breast cancer in pre-menopausal. FIBER – A PLANT-BASED DIET IS NATURALLY HIGH IN FIBER •A  diet rich in natural fiber obtained from fruits. the majority of whom did not exhibit weight loss. black beans. o This decrease in estrogen levels in the blood thereby may potentially reduce the risk of hormone-related cancers. whole grains are rich in antioxidants*. and whole-grains may reduce cancer risk and/or reduce risk of cancer progression. and promote cell death [66]. o Reduced levels of serum estrone* and estradiol* were observed in premenopausal women with a greater intake of dietary fiber [73]. increased fiber intake was independently related to the reduction in serum estradiol* concentration [74]. o A high-fiber. such as breast cancer. • Fiber binds to toxic compounds and carcinogens.Pomegranate (Punica granatum. juice. • Total dietary fiber intake. o Fermentation in the gut.

6 4.4 1.1 4. another study that reported no significant findings compared women consuming less than 25 grams fiber daily [80]. reporting protective effects [78. This finding is not surprising given that the total grams of fiber consumption was less than 30 grams.8 1.1 7 . Data from prospective studies is mixed. case-control* studies have reported the greater the fiber intake. High-Fiber Sources FRUITS: Food Apple Banana Blackberries Blueberries Cantaloupe Figs (dried) Grapefruit Grapes Guava Kiwi Orange Pear Persimmon Prunes Serving Size 1 medium 1 medium 1/2 cup 1 cup 1/2 cup 1/4 cup 1 medium 1 cup 1 medium 1 medium 1 medium 1 medium 1 medium 1/4 cup Fiber Grams/ Serving 3.7 2.0 6.0 6. when comparing women in the highest quintile of fiber intake compared to the lowest quintile [78]. • Overall.80].85] or no effect observed [79.0 3. the lower the incidence of breast cancer [8. o Similarly. • An earlier prospective cohort* study. • Women who ate beans and lentils at least twice a week had a 24% lower risk of developing breast cancer than women who ate them less than once a month [86].0 3.3 6. however. reported no protective effect of fiber against breast cancer when comparing women who consumed fewer than 26 grams dietary fiber compared to those who consumed even less [79].9 1.9 2.81-84].• A recent cohort* study reported that high fiber intakes were associated with a 42% lower risk of postmenopausal breast cancer.6 3.

6 1.9 2. green Spinach Squash.3 SUGARS AND THE ROLE OF INSULIN* •H  igh sugar foods are usually highly processed and refined. and also low in dietary fiber.4 4.3 4.0 Check labels (5.0 8.5 4.3 2. o Overexpression.9 1.7 Serving Size 1/4 cup dry 1/2 cup cooked 1/2 cup cooked 1/2 cup cooked 1/2 cup cooked 3/4 cup 1/2 cup cooked 1/2 cup cooked 1/2 cup cooked 1/2 cup cooked 1/4 cup 1/4 cup dry 1/2 cup cooked Fiber Grams/ Serving 7. black Beans.5 2. or high amounts.0 2.5 0.7 2.2 5. these foods appear to increase serum insulin* and serum IGF-I levels [87].0 0.4 3.0) 1. In addition.4 2.3 8.GRAINS & OTHER PRODUCTS: Food Amaranth Barley Beans. 8 .0-22.2 3. which appear to stimulate cancer cell growth. garbanzo Bran cereals Brown rice Bulgur Cream of wheat Oatmeal Peanuts Quinoa White rice VEGETABLES: Food Artichokes Beets Broccoli Brussel sprouts Carrots Kale Lima beans Peas. winter-type Sweet potatoes (yams) Serving Size 1 medium 1/2 cup cooked 1/2 cup cooked 1/2 cup cooked 1/2 cup cooked 1/2 cup cooked 1/2 cup cooked 1/2 cup cooked 1/2 cup cooked 1/2 cup cooked 1/2 cup cooked Fiber Grams/ Serving 6. of IGF increases mammary tumors in mice [88].4 2.0 2. low in nutrient value. red kidney Beans.

• Other studies support a stronger link between IGF-I and breast cancer in premenopausal women [91. 9 .96].93]. a large prospective trial reported IGF-I significantly increased risk of breast cancer in premenopausal women under the age of 50. a cohort* study reported that higher insulin* levels significantly increased risk of breast cancer for both pre. a case-control* study in China found that IGF-I significantly increased the risk of breast cancer [95]. no significant relationship was noted for postmenopausal women [97]. • Recent studies indicate that high insulin* levels. and IGF-I were associated with breast cancer risk in heavier subjects (BMI>26 1).o IGF’s may work by stimulating cell cycle progression & prevent cells from premature death [89-92]. • Nonetheless. • Among other factors. which is calculated by body weight (kg)/height2(m2). a diet low in fiber may favor the development of insulin* resistance and hyperinsulinemia [89]. a recent meta-analysis* review of 18 studies reported no overall statistically significant association between circulating IGF-I levels and risk of breast cancer although the levels were greater in breast cancer patients than controls [90].and post-menopausal women [99]. these findings indicate that chronic change of glucose/ sugar metabolism is related to breast cancer development. o In premenopausal women. o However. • Similarly. 1 BMI refers to body mass index. though not statistically significant. women in the highest quartile of serum glucose had a 280% increased risk of breast cancer compared with women in the lowest quartile. the associations of glucose. o Research indicates a synergistic effect between IGF-I and estrogen [94] as well as IGF-I and insulin* resistance [95] in breast cancer. • It has been suggested that decreasing IGF-I levels may be one factor that contributes to tamoxifen’s anti-tumor activity in breast cancer therapy [101]. increased concentration of IGF-I. and greater abdominal fat are associated with increased risk for breast cancer [100]. o A weaker association was found with fasting insulin* levels where premenopausal women in the two highest quartiles had a 70% greater risk for breast cancer. o IGF-I may promote tumor growth via upregulation of ovarian steroid secretion [92. • While not all studies [98] agree. • One study noted a direct association. • Research is inconsistent regarding the association of IGF-I and disease-free survival or overall survival [91]. IGF-I levels did appear to increase breast cancer risk in premenopausal women by almost 40%. • Additionally. insulin*. o In postmenopausal women. between non-fasting serum insulin* levels and 10-year mortality in postmenopausal breast cancer women [102]. • A prospective cohort* study observed a significant 310% increased risk of breast cancer in premenopausal women who had the highest quartile of IGF-I compared to women with the lowest quartile [88]. o Overall.

• This evidence was further supported by a meta-analysis that reported GI to modestly increase the risk of breast cancer [110]. E. obesity and fasting hyperinsulinemia have been associated with a poorer prognosis in women with established breast cancer [104]. One theory posits that excess weight sets off a biochemical cascade that increases insulin and. o Women who consumed the greatest intake of desserts (including biscuits. Both hormones may activate IGF-1 receptors on cells. IGF-1 levels. • Furthermore. puffs and ice-cream) and sugars (including sugar. brioches. honey. • Additionally. Roell/Source: Nature Reviews Cancer. women who consumed a high GI and GL diet had a 57% and 253% increased risk of breast cancer. respectively [108]. This risk was lessened considerably with a higher fiber intake. • Adding credence to the idea that blood sugar levels may affect disease progression. this effect was most pronounced for women with ER. o This effect was most pronounced in premenopausal women and those women at a healthy body weight. • The consumption of sweet foods with a high glycemic index (GI) and glycemic load (GL) have been implicated as a risk factor for breast cancer due to their effects on insulin and IGF-I [107-110]. INSULIN HIGH TIDE. 2004 10 . in turn. marmalade and chocolate) had a 19% increased risk of breast cancer compared with women who consumed the least desserts and sugars [107]. The observed link between obesity and cancer may be explained by the growthpromoting activities of insulin and IGF-1. sucrose (table sugar) imparted the greatest risk [105]. • GI and GL were both associated with an increased risk of breast cancer among postmenopausal overweight women. • A recent case-control* study reported that carbohydrate intake significantly increased risk of breast cancer. an Italian case-control* study found that women who consumed the highest tertile of desserts and sugars had a 19% increased risk of breast cancer compared with women in the lowest tertile [106]. jam.breast cancer [109].• Hyperinsulinemia may contribute to the development of breast cancer in overweight or obese women [103]. which can spur cell growth and inhibit cell death pathways that usually protect against tumor development. cakes.

Further research is needed to determine if in fact these lower levels lead to a reduced risk of breast cancer. • A meta-analysis* observed a 19% increased risk of breast cancer with greater intake of saturated fats [119]. a high intake of saturated fat was reported to increase the risk of breast cancer [116]. However. • Based on a seven-day diary for evaluating saturated fat intake. the European Prospective Investigation into Nutrition and Cancer (EPIC) Study reported that eating a higher fat diet significantly increased the risk of breast cancer. a significant effect was still observed.Sugars & Insulin* – Bottom Line • To help control your insulin* level: o Eat a high-fiber diet with limited refined/processed foods o Follow a low fat diet rich in omega-3 fatty acids o Exercise o Maintain a healthy body weight LOW FAT DIET Several studies have investigated the relationship of fat and the risk of breast cancer. progesterone) [113]. however. Additionally. Saturated Fats • Several studies indicate a positive association between saturated fat intake from meat and dairy products (animal sources) and cancer [114-117]. is inconclusive. 11 . women who had a 35% and 39% fat diet were at a greater risk than those eating a 31% fat diet [112]. Research indicates that the type of fat may be of paramount importance. have not found a significant association between saturated fats and breast cancer [120-122]. The Women’s Intervention Nutrition Study (WINS) found that a reduced fat intake improves relapse-free survival by 24% in postmenopausal women with breast cancer compared with women following a standard diet [111]. with less than 8% of total calories from saturated fat. While neither of these diets would be considered low fat. estrone*. but not premenopausal women [118]. The breast cancer research. particularly in women going through menopause. Aim for close to 20% of your total calories from fat. but the results remain inconsistent. The potential elevated cancer risk may be. high carbohydrate diet may result in a significant reduction in breast density. however. • Total saturated fatty acid intake was significantly associated with breast cancer risk in cohort* studies in postmenopausal women. Later. two recent trials showed some promise in the area. due to the fact that a high fat diet stimulates increased estrogen levels. A study of adolescent females found that modest reductions in fat intake during puberty resulted in significantly lower concentrations of sex hormones (estradiol*. which is associated with breast cancer growth. The risk of recurrence for women with ER. in part. a low fat. • Other studies.breast cancer decreased by 42%.

rich in omega-9 fats. leukotrienes. • These fats may disrupt hormonal systems that regulate healing. 12 . However. thus. prostaglandins). that included three cohort* studies reported total monounsaturated fatty acids and oleic acid. Essential Fatty Acids (EFA) Essential fatty acids are necessary for the formation of healthy cell membranes. an omega-9 fatty acid found in olive oil. to significantly increase breast cancer risk [118]. these chemicals regulate immune and inflammatory responses. o Women in the highest quintile of trans-fatty acid consumption had a 75% increased risk compared with women in the lowest quintile. platelet aggregation. • Oleic acid. the proper development and functioning of the brain and nervous system.127]. Omega-9 Fatty Acids (Monounsaturated Fats) • Most research at this time indicates a neutral relationship [120. • Women who consumed greater amounts of trans-fatty acids significantly increased their risk of breast cancer [126]. inflammation.137]. • Several case-control* studies reported that olive oil consumption. resulted in a 13-34% reduction in breast cancer risk [132-135]. a type of omega-9 fatty acid. Those formed from the omega-3 fatty acids have opposing affects. Current research suggests that the levels of essential fatty acids and the balance between them may play a critical role in the prevention and treatment of cancer. however. • One study reported a 40% increased risk of breast cancer in postmenopausal women who had higher tissue levels of trans-fatty acids [128]. and for the production of hormonelike substances called eicosanoids* (thromboxanes.Trans-Fatty Acids • Preliminary research indicates that these fatty acids may be associated with an increased risk of cancer [123-126]. has been observed to synergistically enhance the efficacy of trastuzumab (Herceptin) [136.126] or a slightly protective effect [122. • A meta-analysis*. o One study found that women who consumed ≥8. more research is needed for conclusive evidence. Among other body functions. some evidence points to a positive association between these fats and breast cancer risk [125. and encourage the development of cancer.129-131] between these fats and risk of breast cancer. Eicosanoids* formed from the omega-6 fatty acids have the potential to increase blood pressure. allergic reactions and cell proliferation. lead to the destruction of defective membranes. • Minimal research exists on the relationship between trans-fatty acids and risk of breast cancer.8 g/day of olive oil had a 73% lower risk of breast cancer [131].

such as flaxseed and others listed in the table below. • Fish and plant-based foods. eicosapentanoic acid (EPA).140. • Mechanisms proposed for their protective effects include: o Suppression of eicosanoid synthesis from arachidonic acid (omega-6 fatty acid). cancer risk was reduced by 61% and 69%.138. •S  tudies show that omega-3 fatty acids inhibit breast cancer tumor growth and metastasis. o Inhibit cell growth and differentiation via effects on gene expression and signal transduction pathways [139. ALA is converted to EPA and DHA. which can be converted to arachidonic acid) promote breast tumor development and metastasis [117. researchers reported that arachidonic acid.120. however. oF  ish contains EPA and DHA. an omega-6 fatty acid almost exclusively 13 .140.142.Omega-3 Fatty Acids •R  esearch is growing supporting a protective relationship between omega-3 fatty acids [alpha linolenic acid (ALA). oF  ish consumption in general has been associated with a protective effect against breast cancer [136. which impedes immune function [139. respectively.145].149].137. oT  he plant-based omega-3 fatty acid sources. 94%. •P  reliminary research indicates that DHA may synergistically enhance taxane cytotoxicity [143]. and total omega-3 fatty acids in their red blood cell membranes from fish had a 73%.138. and docosahexanoic acid (DHA)] against the risk of breast cancer [118. o When comparing women in the highest tertile of ALA and DHA to the lowest tertile.144]. these fats are immune enhancing. two specific fatty acids that have shown promising results in the research literature [135.142]. •A  n inverse relationship was found between omega-3 fatty acids in breast tissue and the risk of breast cancer [137]. contain ALA. In an ideal environment. •A  meta-analysis* of 3 cohort* studies found palmitic acid. Additionally. which reduces estrogen-stimulated cell growth [139.148. a type of omega-6 fatty acid. but these findings would indicate that DHA during taxane administration may improve the effects of chemotherapy for breast cancer patients. Omega-6 Fatty Acids •R  ecent studies indicate that a high intake of omega-6 fatty acids (linoleic acid. however. o Effects on insulin* sensitivity and membrane fluidity [142].142].146]. and 89% lower risk of breast cancer. DHA. •W  omen with the greatest EPA.142]. to be significantly associated with an increased risk of breast cancer [118]. contain different types of omega-3 fatty acids. On the positive side. More research is needed.135-141].147]. this process is inefficient [69. •A  prospective study reported that women who consumed 44 g or more of dietary marine sources of omega-3 fatty acids reduced their risk of breast cancer by 26% when compared with women who consumed 25 g or less [120]. o Alter estrogen metabolism. respectively [140]. • Additionally. the conversion process is enhanced by following a diet that is low in saturated fats and low in omega-6 fatty acids [142.

and avocados Include these healthy fats daily. and fat free” if they contain less cookies than 0. Fat – Bottom Line • Less fat is better.5 mg per serving. COX-2 overexpression was significantly correlated with larger tumor size and advanced clinical stage. crackers. Limit consumption of nuts to no more than ¼ cup with meal or snack to limit total fat and calories. salad dressings and various processed foods includProducts may be labeled “trans ing breads. canola oil. including butter.from meat. and ice cream Recommendation Reduce or eliminate meat and whole milk dairy products. Furthermore. almonds. In this breast cancer study. cereals. • Avoid hydrogenated fats. fried foods. canola oil. and whole milk dairy products. almond oil. omega-6 fat consumption increased risk by 87% in women who consumed 25 g or less of marine omega-3 fatty acids. This was further supported by other studies [137. •A  very interesting finding was reported in a prospective study that found no overall association between omega-6 fatty acids and risk of breast cancer [120]. Fatty Acid Saturated fatty acids Dietary Sources Meats. significantly increased oxidative damage as measured by urinary biomarkers [150]. Extra-virgin olive oil.138. • Increase omega-3 fatty acids. commercial fats. •E  xtra-virgin olive oil. macadamia nut oil or almond oil is preferred for salads and cooking. However. •I t is known that cyclooxygenase is the rate-limiting enzyme that catalyzes the conversion of arachidonic acid to prostaglandins.151. COX-2 is known to be overexpressed in various human cancers.152]. This effect was even greater for advanced breast cancer. • Limit animal fats. poultry skin. cheese. Omega-9 fatty acids 14 . which indicates a poorer prognosis [149]. Trans fatty acids Avoid trans or hydrogenated Margarine. baked goods. the balance between omega-6 and omega-3 fatty acids may be of paramount importance. macadamia nut oil. o Thus. peanut butter.

opt for one that is highest in EPA and DHA concentration. and pumpkin seeds amount of EPA and DHA. and whole milk dairy products Limit consumption of linoleic acid-rich oils. Include these healthy fats daily through diet and/or supplements. respectively in a small Brazilian study [154]. black cod. Linoleic acid Substitute an omega-9 fatty acid-rich oil for your current cooking oil or fat. whole milk. o Frequent consumers of these well-done meats had a 462% greater risk of breast cancer. Meat • In a study of over 35. • Consumption of red and fried meat quadrupled the risk of breast cancer in a case-control study in Brazil [12].000 women. 64%. • Meat consumption increased the risk of breast cancer risk by 56% for each additional 100 g (3. It may be wise to consume herring). trout. meat consumption significantly increased the risk of breast cancer in both premenopausal and postmenopausal women [153]. o Women eating 1. weekly to obtain an adequate hempseeds.75 ounces of processed meat daily increased the risk of breast cancer by 64% in postmenopausal women compared to women who did not eat meat. breastmilk. chia seeds. such as corn oil. and steak had a 54%. If you choose to use a supplement. walnuts. sunflower oil. and cottonseed oil. egg yolks. bacon. sardines. • A large case-control* study found that women who consumed very well-done meat for hamburger. 15 . Common vegetable oils. respectively [155]. and processed foods made with these oils Reduce or eliminate meat and whole milk dairy products. safflower oil.5 oz) daily of meat consumption in a French case-control study [135]. • Regular consumption of fatty red meat and pork fat increased the risk of breast cancer by 348% and 632%. butter. and 221% increased risk for breast cancer.Omega-3 fatty acids: EPA and DHA ALA Cold-water fish (for example: salmon. Omega-6 fatty acids: Arachidonic acid Meats. and DHAcold water fish or fish oil enriched eggs supplements at least twice Flaxseeds.

GENOTOXINS: Heterocyclic Amines (HCAs) & Polycyclic Aromatic Hydrocarbons (PAHs) • Natural components in meat. white pasta) or refined grains. quinoa. and teff. amaranth. and pastries. such as candy. • While human research is forthcoming. Avoid processed. • Carcinogenic activity of HCA’s is affected by various dietary factors [165]: o Factors that enhance carcinogenesis* when combined with HCAs include: • High-fat diet • Caffeine 16 . buckwheat. wild rice. Limit or avoid consumption. HCAs are known to cause cancer in laboratory animals [157.164] have observed a significant association between HCAs and breast cancer. creatine*. cookies. the majority of studies [155. pork. preferably 8-10 total servings daily [156] 5 or more vegetable servings 3 fruit servings Fiber Choose breads with 3 or more grams of fiber per slice. unbleached white flour.158]. brown rice. Dietary sources include beef. cakes. not white flour. spelt. among others. grilled or fried meats.157-162] although not all [163. millet. and polysaccharide precursors. Whole grains include. are converted to HCAs during high-temperature cooking. and lamb. Recommendation At least 5. drinks containing added sugars. and desserts. barley. such as amino acids. white rice. 30-45 grams daily This goal can be achieved by meeting your fruit and vegetable goal plus one serving of legumes or at least two servings of whole grains. Meat Reduce or eliminate meat consumption. bulgur. alcohol. or enriched wheat flour. sodas. First ingredient on the label should be whole or sprouted grain flour.Food Category Fruits and vegetables Summary One serving = ½ cup fruit or vegetable 1 cup raw leafy greens ¼ cup dried fruit or vegetable 6 oz fruit or vegetable juice Eat 1 cup or more vegetables with lunch and dinner. Refined carbohydrates and sugars Dietary sources include products made with refined flours (for example: white bread. oats.

onions.o Factors that inhibit carcinogenesis* when combined with HCAs include: • DHA • Conjugated linoleic acid (CLA) • Isoflavones • Diallyl Sulfides (found in the allium family. the type of protein cooked can also affect the concentration of HCAs. o The heightened risk was more pronounced for women with ER+ and progesterone-receptor positive (PR+) tumor types. o Furthermore. barbecuing) • Charring of food (charcoal-broiled or smoked foods) contribute to PAHs [166]. • Grill vegetables or meat alternatives that do not lead to the formation of HCAs or PAHs. o Small portions require less time on the grill. and shallots) • Green tea catechins* • Indole-3 carbinol • Probiotics • Gamma-tocopherol • The most important variables contributing to the formation of HCAs are: o Cooking temperature (greater than 300°F) o Cooking time (greater than 2 minutes) o Cooking method (frying. for example. o Brief microwave preheating substantially reduces HCA content of cooked meat. o Choose lean. • Additionally. •A  recent study found that as little as a half a glass of wine a day raised a woman’s risk of developing breast cancer by 6% (increased risk by 18% in postmenopausal women) [167]. London broiled steak had more than 600 times the amount of HCAs when compared to salmon. 1-2 drinks a day increased risk by 21% and 2 or more drinks a day increased risk by 37%. leaks. that chicken has more than 100 times the number of HCAs than salmon [165]. o Using marinades significantly reduces the amount of HCAs. o A recent review study reported that data from many well-designed studies consistently shows a small rise in breast cancer risk with increasing consumption of alcohol [172]. • Meat can potentially be made “safer” to eat by being cooked in a way that does not lead to HCA formation. ALCOHOL • Regular consumption of alcohol may increase the risk for breast cancer [167-176]. • Women who drank two or more alcoholic drinks daily in the five years prior to diagnosis had an 17 . oven grilling/broiling. well-trimmed meats to grill. It has been reported. such as garlic.

•A  pooled analysis of six prospective studies suggests that the risk of breast cancer increases linearly by 9% with each 10 g /day (~ 1 drink) alcohol [177]. ER+PR+ (11% ↑ risk) ER+PR. •T  hese differing findings between pre. •F  olate. o Additionally. It has been observed that women with low folate and high alcohol consumption had a 43% greater risk of 18 .tumors was less clearly associated. another meta-analysis* reported that breast cancer risk increased by 32% and 46% in women who consumed 35-44 g alcohol (~3-4 drinks) daily and 45 g or more (~4. o Greatest risk was among heavy drinkers who were also postmenopausal and had a history of benign breast disease or who used hormone replacement therapy (HRT) [168]. may be of even greater significance with alcohol consumption.5% higher risk than women who had one drink per week. Alcohol appears to increase endogenous* estrogen levels [183-187]. •A  large meta-analysis* revealed that one drink daily increased breast cancer risk by 11% [178]. ER-PR. thirties. o For each additional 10 g of alcohol (~1 drink) daily. o Postmenopausal women drinking six or more alcoholic beverages per week had a 2. The risk increased to 41% when comparing women who consumed 30-60 g/day (~2-5 drinks) to nondrinkers.4% higher risk than women who had one drink per week.and postmenopausal women are likely related to the effect of alcohol on estrogen levels. the risk of breast cancer increased [180].5 drinks) daily lowered the risk of breast cancer.5 drinks per week had a 40% greater likelihood of developing breast cancer compared to non drinkers and this was most pronounced in women who were premenopausal at diagnosis [175]. there was no clear association between alcohol and premenopausal risk of breast cancer. but not ER. women who drank about 1. a French study found that drinking 10-12 g wine (~ 1-1. •P  etri and colleagues [171] observed a stronger relationship between alcohol and breast cancer in postmenopausal women compared to premenopausal women. those who consumed approximately 3 drinks or more daily had a 76% increased risk of breast cancer when compared with women who did not consume alcohol [181].5 drinks or more) daily. but consuming 2-5 drinks daily increases the risk of breast cancer by 40% compared to non-drinkers [168].(7% ↑ risk). respectively [170]. but statistical significance was not reached for women in their twenties.82% increased risk of breast cancer compared to non drinkers [173]. •S  imilarly. especially for women with ER+ breast cancers – ER+ (12% ↑ risk). o The association between alcohol and ER.(no effect) [174]. o Premenopausal women drinking more than 27 drinks per week had a 3. but when intake increased above 12 g daily. a recent meta-analysis reported that an increase in 10 g (~1 drink) alcohol daily increased the risk of breast cancer. •A  recent cohort* study of postmenopausal women reported that alcohol consumption was associated with an increased risk of breast cancer in ER+. risk increased by 7%. or forties [169]. • Other studies [168] claim that one glass of alcohol daily does not increase risk. all ER. •A  mong ER+ postmenopausal women. • On a similar note. a B vitamin.(15% ↑ risk). •A  lcohol consumption (1 drink/day) during a woman’s fifties increased risk for postmenopausal breast cancer by 12% in a large cohort* study.tumors [182]. A later meta-analysis* found similar findings [179]. •O  n the contrary. •S  ince then.

26-fold increased risk for breast cancer compared to healthy weight women [198]. • Modest caloric restriction has been shown to decrease oxidative DNA damage. o Maintains blood volume. height and BMI were associated with postmenopausal breast cancer [199]. evidence suggests that a high calorie diet may increase IGF-I levels [192].breast cancer when compared with nondrinkers with adequate folate intake [188]. oI ncreasing BMI was associated with a 40% increased incidence and mortality of breast cancer in postmenopausal women [197]. Alcohol – Bottom Line • It is best to limit or avoid alcohol. o Acts as a lubricant and cushion around joints. o Participates in chemical reactions. CALORIC INTAKE •T  he risk of breast cancer is much higher in industrial countries than in developing countries where women are characterized by lower energy intake and higher energy expenditure. • Drink plenty of water daily to help meet fluid needs. 19 . oO  bese postmenopausal women had 3. o Women with a BMI of ≥25 had a 58% increased risk of breast cancer [5]. • Furthermore. ADEQUATE FLUIDS The functions of water in the body include the following: o Carries nutrients and waste products. o In women with breast cancer. BODY MASS •E  pidemiologic evidence suggests a positive association between body mass and postmenopausal breast cancer [193-196]. • Modest caloric restriction has been shown to inhibit tumor growth in animal models decrease oxidative DNA damage [189]. o Aids in the body’s temperature regulation. o Acts as a shock absorber in the eyes and spinal cord. • Increased fluid intake is needed for a high fiber diet. • The mechanism involved may be related to the decrease in IGF-I observed when caloric intake is restricted [190.191].

o A cohort* study of 1300 women reported that breast cancer recurrence and death increased with body weight in both premenopausal and postmenopausal women [158]. 9 years).210]. Conversely. o Obese postmenopausal women had a 50% increased risk for breast cancer [196]. other research suggests a stronger relationship between body weight and breast cancer in premenopausal women [208. • Overweight or obesity is associated with poorer prognosis in the majority of the studies that have examined body mass and breast cancer [204-210]. • Body weight prior to breast cancer diagnosis significantly increased risk of recurrence and death in nonsmokers [208]. central obesity did not appear to be associated with increased risk [203]. BMI. • Increasing BMI was associated with a 40% increased incidence and mortality of breast cancer in postmenopausal women [197]. o May be related to increased estrogen [196.0) [211]. 20 . women (young and middle-aged) who lose weight may decrease the risk of breast cancer. a larger waist size increased risk of breast cancer among premenopausal women [202].• This effect was most pronounced in women with ER+ tumors. was significantly greater in women with a higher BMI [150]. when adjusted for BMI. and hip circumference were significantly associated with breast cancer risk among HRT nonusers.211. o An earlier study reported similar findings with total weight gain serving as a strong predictor of breast cancer risk. specifically among former and never HRT users [193]. •R  esults from a systematic review showed that. while general obesity was a significant predictor of breast cancer risk. a large trial found that. free estradiol* and free testosterone were two to three times greater in overweight and obese women compared with lighter-weight women. obese women (BMI > 30) had a 31% greater risk compared to women with BMI < 25 [203].212] and elevated insulin* and IGF. significantly increase their risk of breast cancer [200]. Additionally.204]. However. Nonetheless. o However. however. obesity during menstruating years is associated with obesity throughout life and therefore to an eventual increased risk of breast cancer [132]. o Additionally. for postmenopausal women. measured by urinary biomarkers. may not be associated with increased risk of breast cancer. o This study suggests excess body fat increases estrogen levels. o Obese postmenopausal women (BMI >30) had 35% higher concentrations of estrone* and 130% higher concentrations of estradiol* compared with lighter-weight women (BMI < 22. or both [204-210]. which may in turn increase the risk for breast cancer. particularly after age 50. o Obesity among premenopausal women. • A recent case-control* study of 2000 women found that women who gain weight. This study supports the idea that central obesity is of greater concern than general obesity in regards to breast cancer risk. which can stimulate cell proliferation [101. nonsmokers who gained weight after diagnosis had an elevated risk of breast cancer death during follow-up (median. • Various studies report increased BMI or body weight to be a significant risk factor for recurrent disease. • Total body weight. o Recent findings indicated that oxidative damage. survival. compared with women who maintained their weight.

• Survival may be enhanced by physical activity in those women who exercised the year prior to diagnosis. o The effect was stronger in women who had ER+ cancers. diabetes mellitus and breast cancer [214]. such as fruits and vegetables.227].8 MET-h/wk [224]. oS  ome studies indicate that physical activity has a more significant effect in reducing risk of breast cancer in postmenopausal women [222]. • Furthermore. 21 . This decreased risk with physical activity was limited to women without a family history of breast cancer when adjusted for BMI. • A cohort* study reported that postmenopausal women who were most physically active (> 42. •L  ifetime total physical activity has been associated with a decreased risk of breast cancer [219-221].0 MET-h/week) 4 [218]. the combination of consuming five or more daily servings of vegetables and fruits. • A case-control* study reported significantly reduced breast cancer risk among women who maintained. may provide a protective effect from breast cancer for overweight women (BMI>25) [215]. The greatest benefit occurred in women who performed the equivalent of walking 3 to 5 hours per week at an average pace. A similar trend was observed for regular strenuous activity at age 18 and at age 50. PHYSICAL ACTIVITY • Low levels of physical exercise appear to be associated with the risk of breast cancer [172. on average. • As noted earlier.216-218].• Women with a BMI of ≥25 had a 58% increased risk of breast cancer [5]. This difference was greatest for women who did not use HRT at enrollment. These findings were consistent with women who did and did not use HRT. oE  xercise between the years of 14-20 appears to be the most beneficial in reducing risk of breast cancer [219]. 17. • Exercise was associated with improved quality of life among survivors [226. The benefit of physical activity was particularly apparent among women with hormone-responsive tumors. and accumulating 540+ metabolic equivalent tasks-min/wk (equivalent to walking 30 minutes 6 d/wk) decreased mortality by nearly 50% [11].195. • Eating foods high in vitamin C. a prospective observational study reported that physical activity after a breast cancer diagnosis may reduce the risk of death from this disease [216]. especially women who were overweight or obese [225].6 (MET)-hr of activity/week2 from menarche onward [195]. • Increased physical activity following breast cancer diagnosis significantly decreased the risk of dying from breast cancer and improved overall survival when compared with women who exercised <2. • Research suggests a potential link between obesity.0 MET-h/week)3 at baseline had a 29% lower incidence of breast cancer than active women with the least activity (> 0-7. • Women who engaged in regular strenuous physical activity at age 35 had a 14% reduced risk of breast cancer compared with less active women [217].

This is equivalent to a 150lb individual burning about 3000 kcals/week through physical activity. serum IGF-I levels [217.229]. • Promising evidence indicates that selenium may decrease the risk of breast cancer [234-239]. • An increase in lean body mass (often achieved through physical activity) was associated with a favorable change in 2-hydroxyestrone: 16-α-hydroxyestrone. • Greater physical activity in obese women was associated with significantly less mammographic density. • Additionally. • Physical activity may reduce the risk of breast cancer through an influence on ovarian function and a decrease in progesterone and estrogen concentrations via reduced body fat [217]. 2 3 4 This is equivalent to a 150lb individual burning 1257 kcals/week through physical activity.239].232]. exercise reduces serum insulin levels [231]. This is equivalent to a 150lb individual burning 500 kcals/week or less through physical activity. exercise may increase sex hormone-binding globulin* (SHBG) levels and thereby reduce estradiol*. possibly suggesting another mechanism for the protective effect of physical activity [233]. 22 . • Healthy weight control is encouraged with an emphasis on exercise to preserve or increase lean muscle mass. Additional Nutritional and Lifestyle Factors for Breast Cancer Survivors ANTIOXIDANTS* – Found in abundance in fruits and vegetables! • Prevent oxidative damage in body cells. o Research indicates a link between oxidant damage and breast carcinogenesis*. • Examples of antioxidant* nutrients and non-nutrients include vitamins A. o Inhibits cell proliferation and induces apoptosis* [238. Antioxidant* consumption via food sources and a basic multivitamin supplement are very safe. Furthermore. lycopene. C. selenium. Also is essential for the immune system.• Physical activity can help ease cancer-related fatigue during and following cancer treatment [228. • Note that patients may be advised to NOT consume high-dose antioxidant* supplements during chemotherapy or radiation therapy. and improves insulin* sensitivity [217]. • Selenium may interfere and alter estrogen receptors decreasing mammary tumor incidence [236]. a proposed biomarker of breast cancer risk [230]. and E. and beta-carotene. Selenium • Antioxidant* that scavenges free radicals and suppresses damage due to oxidation.

• Dietary vitamin C has been significantly associated with reduced mortality in breast cancer survivors [19]. • Evidence suggests that curcumin may suppress tumor initiation. but the differences did not reach statistical significance [240]. Vitamin E • Vitamin E acts as a cellular antioxidant* and an anti-proliferating agent. T3 concentration was significantly lower in breast cancer patients compared to healthy non-cancer patients. It is known that iodine plays an important role in thyroid function. curcumin promotes detoxification in the liver and possesses anti-inflammatory activity. • Toenail selenium concentrations tended to be lower in postmenopausal breast cancer patients when compared with healthy non-cancer patients. possibly by inhibiting COX-2 activity [248. Thus. • Additionally. o Vitamin C induces apoptotic effects on breast cancer cells [257]. • Furthermore. • Selenium is a precursor to the glutathione* (GSH) antioxidant* system. that exhibits chemopreventive and growth inhibitory activity in several tumor cell lines [243-246]. typical of a Japanese diet. the yellow pigment and active component of turmeric and many curries. Turmeric (Curcumin) • Curcumin. o This may occur through enhanced apoptosis* [243. risk of recurrence and mortality was reduced in women who consumed vitamin C supplements for more than three years [259].256. Research indicates that dietary selenium supplements correct abnormal glutathione* turnover. selenium status may affect both thyroid hormone status and iodine availability. and enhances the effects of chemotherapeutic drugs. It consists of both tocopherols and tocotrienols.245]. • A recent study suggested the combination of selenium and iodine. promotion and metastasis [245.239].247]. has shown no protective relationship between vitamin C and the risk of breast cancer.249]. act synergistically in decreasing breast cancer risk [241]. although not all [7. • Low plasma levels of vitamin C have been associated with a greater risk of breast cancer [258]. GSH is the principal protective mechanism of the cell and is a crucial factor in the development of the immune response by the immune cells [242]. o Interestingly.• Research shows that selenium reduces the incidence of malignant cells in animal models [237]. Vitamin C • Most research [250-255]. this study also found that plasma triiodothyronine (T3) (a thyroid hormone) concentration was positively associated with toenail selenium in breast cancer patients and controls.257]. 23 . is a potent antioxidant*. o Studies suggest the ratio of selenium to glutathione* is at lower levels in breast cancer patients [234].19. such as [235] taxol and adriamycin [235.

o Less tumors and longer tumor latency in a rat study [264].o Some research indicates that tocotrienols are the components of vitamin E responsible for growth inhibition in human breast cancer cells [260]. Resveratrol • Resveratrol is a polyphenol found primarily in red grape skins with known antioxidant and antiinflammatory properties. seafood. and grains. o May inhibit IGF-I mediated cell migration in breast cancer cells [265]. and induced apoptosis in mice [263]. Recommendation 200 mcg selenium daily through diet and/or supplements Two Brazil nuts provide 200 mcg selenium. o Induces apoptosis in breast cancer cells [262. Additionally. and is emerging as a potent chemopreventive and anticancer drug [262]. unlike supplemental sources of vitamin E.263]. Eat liberally. o Decreased levels of vascular endothelial growth factor (VEGF) in breast cancer cells [263]. • Research is inconsistent on the protective effects of vitamin E and breast cancer. these researchers reported a decreased risk of recurrence and mortality associated with long-term use of vitamin E supplements. o Inhibited cell growth and regulates IGF-II in breast cancer cells [266]. • However. 24 . • Recent evidence indicates that resveratrol and glucans have significant synergistic effects on immune function [267]. o Reduced tumor growth. decreased angiogenesis. low plasma levels of vitamin E have been associated with a greater risk of breast cancer [258]. • Note that findings suggest that vitamin E supplements may interfere with the therapeutic effects of tamoxifen [261]. Data from most prospective studies have not revealed a protective relationship between vitamin E and risk of breast cancer [250]. enriched brewer’s yeast. • Supplemental vitamin E does not consistently appear to offer protection against breast cancer [150] although taking vitamin E for more than three years has been associated with a modest protective effect [259]. significantly reduced oxidative damage as measured by urinary biomarkers [150]. Selenium content depends somewhat on the amount of selenium in the soil in which the products are grown. Turmeric (curcumin) A deep orange-yellow spice commonly used in curries and Indian cuisine. Nutrient/Phytonutrient Selenium Summary Dietary sources include Brazil nuts. • Resveratrol has exhibited potential anticarcinogenic activities in several studies. • It was demonstrated recently that dietary vitamin E.

272. This action may act as one of the protective mechanisms of flax for breast cancer. and cranberries.274]. o Lignans* facilitate the removal of estrogens via increased retention within the gut. • Additionally.Vitamin C Dietary sources include various fruits Include these fruits and and vegetables. such as lignans*. and avocados. which are later eliminated in the feces [273. • Flax has been shown in vitro and in human trials to decrease tumor proliferation of breast cancer cells [271]. and increased apoptosis [270]. wheat germ. 25 . strawberries. phytoestrogens found in flax. grape products. cantaloupe. vegetables daily.274]. Vitamin E Resveratrol Dietary sources include grapes.276]. broccoli. o This effect may be partially due to its downregulation of IGF-I [270. and tomatoes. citrus fruits. seeds. including papaya. Dietary sources include vegetable oils. mango. kiwi. a recent pilot study observed lower breast density with a greater intake of dietary lignans* [275]. when mice consumed a 5% flaxseed diet and 10% flaxseed diet compared with those who ate no flaxseed [270]. Eat vitamin E-rich foods regularly. peanuts. Eat resveratrol-rich foods regularly. • Flaxseed is the greatest source of mammalian lignans* [271. respectively. More research is needed to assess whether or not supplements would be beneficial. • Tumor growth was reduced by 26% and 38%. • Consumption of 5 or 10 g flax for 7 weeks significantly decreased blood levels of estrone* and estradiol* [269]. mulberries. Dense breasts are a risk factor for breast cancer. soy. lignans* positively influence estrogen metabolism by improving the ratio of 2:16a hydroxyestrone [273. More research is needed to assess whether or not supplements would be beneficial. inhibit angiogenesis*. and enhance the immune system [268]. • An animal study reported that flaxseed inhibited established human breast cancer growth and reduced incidence of metastasis by 45% [272]. Flax • Flax may also work to block tumor growth. • Flax has been shown to enhance the effects of tamoxifen [270]. which appear to bind with estrogen and lower circulating levels of estrogen. • A recent study indicates that flaxseed (25 g daily) and its metabolites.272]. reduced tumor growth in patients with breast cancer [271]. sweet potatoes. decreased cell proliferation [270]. nuts. bell peppers. • Furthermore.

285]. • EGCG has been shown in human studies to inhibit human breast cancer cell proliferation. o May block the formation of cancer-causing nitrosamines* [278]. o Risk ↓ by 39% for women consuming ≥750 g of dried green tea leaves annually. reduce tumor invasion and metastasis and prevent recurrence of breast cancer in early stage cases (stage I & II) [290-292]. o Moreover.284. • There is a significant amount of in vitro and in vivo evidence suggesting tea polyphenols* have chemopreventive agents against various cancers [280. • A meta-analysis* reported that drinking green tea decreased the risk of breast cancer by 22% when comparing women with the highest vs lowest intake [286]. o Risk ↓ by 13% for women consuming 1-249 g of dried green tea leaves annually. • Research suggests that while green tea did significantly decrease tumor mass. o Studies suggest green tea extract has been successful inhibiting cell proliferation and breast cancer [277]. but more research is needed for conclusive evidence [286-289]. a synergistic effect of green tea and Ganoderma lucidum extracts on the suppression of growth and invasiveness of metastatic breast cancers was observed [295]. o Epigallocatechin gallate (EGCG) alters gene expresssion to lower the risk of breast cancer [283].GREEN TEA • Tea contains phytonutrients* known as polyphenols* (flavonoids) that provide antioxidant* and anticancer properties [277]. the tumor mass decreased even further [294]. green tea increased the inhibitory effect of tamoxifen on the proliferation of ER + breast cancer cells [296]. 26 . Further evidence indicates a possible synergistic relationship between soy and green tea consumption [288]. o Risk ↓ by 41% for women consuming 500-749 g of dried green tea leaves annually. • However. protection was greater with a longer duration of drinking green tea. • Additionally. o Prevents DNA damage [279]. combined studies of 35000 Japanese women found that green tea did not affect risk of breast cancer [293]. • Many studies indicate a lower risk of breast cancer with green tea consumption. o Increase immune response [281]. • A case-control study* found that green tea consumption was associated with a significant reduction in risk of breast cancer [289]. o Green tea and its catechin* components inhibit breast cancer growth and angiogenesis* in both in vitro and in vivo studies. More human data is needed. o Risk ↓ by 32% for women consuming 250-499 g of dried green tea leaves annually. • Furthermore. a greater number of cups consumed and the more new batches prepared daily. when green tea was combined with soy phytonutrients*. • Similarly. o May inhibit tumor growth and induce apoptosis* [280-282]. some evidence suggests that the association of tea catechins* and breast cancer may depend on specific genotypes [284].

possibly protecting from breast cancer. o High soybean intake in Korean women resulted in a significantly lower risk of breast cancer in postmenopausal women [6].SOY • Associated with reduced rates of heart disease [297-299]. and certain types of cancer. o A statistically significant inverse association between plasma genistein and breast cancer was reported among Japanese women [305].306]. Risk was lowest among those who consumed ≥20 mg isoflavones daily [306]. • Recent human research has been more promising. if not protective [6.301]. who consumed tofu. protection against osteoporosis [300. and before puberty onset in animals. o A recent meta-analysis of well-controlled studies that included high-soy-consuming Asians reported a significant trend of decreasing risk with increasing soy food intake. pre. It has been demonstrated that soy processing increases tumor growth in mice for postmenopausal ER+ breast cancer [308]. No statistical significant association was observed between soy intake and breast cancer risk among postmenopausal women. o 40 mg/day soy isoflavones increased menstrual cycle length in Western women [312]. such as increased menstrual cycle length and SHBG* levels and reduced estrogen levels. • An Asian-American study on soy found that women. but more research is needed [309]. Consumption of soy foods or an exposure to a soy isoflavone genistein during childhood and adolescence in women. these studies suggest that WHOLE SOY FOODS appear to not have a negative effect on postmenopausal ER+ breast cancer. a recent trial reported that women in the highest tertile intake of tofu had a 51% decrease risk of premenopausal breast cancer when compared with women in the lowest tertile [303]. o Nonetheless.303]. • While there has been contention regarding soy and breast cancer. including breast cancer [302. 27 . appears to reduce the risk of breast cancer later in life [307]. • It’s becoming more apparent that the timing of soy exposure is critical. o The majority of short-term soy intervention studies conducted in premenopausal women show a reduction in endogenous* estrogen levels in association with soy intake.and postmenopausal. o Research also suggests that soy isoflavones may significantly improve the 2-hydroxyestrone:16-a-hydroxyestrone ratio [313].311]. o The difference in tumor growth observed may be related to isoflavone metabolism and bioavailability. had a 15% reduced risk of breast cancer with each additional serving per week [302]. • The type of soy consumed may provide some insight to the inconsistent findings. • Soy consumption has been suggested to exert potential cancer-preventive effects in premenopausal women. • Moreover. and thus.305. research findings are predominantly neutral [304]. o The conflicting data on the effects of soy isoflavones and breast tumor growth are based on in vitro (test tube) studies. o A recent cohort* study of breast cancer patients found that soy foods had no negative impact on breast cancer survival [310.

differentiation.314. • Furthermore. soy intake increases time spent in the follicular cycles. apoptosis and a wide range of cellular mechanisms central to the development of cancer. [320]. o Research indicates that vitamin D3 (cholecaciferol) is better absorbed than vitamin D2 (ergocalciferol) [322].000 IU per day. and vitamin D intake and the risk of developing and/or surviving cancer [318]. o Risk decreased as women’s levels increased from 30 nM (12 ng/ml) to ≥ 75 nM (30 ng/ml). such as soy. Source Miso (1 tbsp) Soybeans. a factor that may increase the risk of breast cancer. soy intake had no effect on levels of tamoxifen or its metabolites [316]. • It is now believed that the recommended vitamin D dose should be between 800 and 2. edamame (1/2 cup) Soymilk (8 fl oz) Soy nuts (1/4 cup) Tempeh (1/2 cup) Tofu (4 oz) Amount of Soy Protein (gm) 2 11 10 19 19. breast density. vegan protein sources. o Furthermore. was inversely associated with vitamin D intake [319]. • The women in the Nurses’ Health Study observed a 30% reduction in risk of breast cancer comparing the highest with lowest quintiles of 25(OH)-vitamin D levels.human breast cancer cells in a synergistic manner in vitro [317].5 13 Amount of Soy Isoflavones (mg) 7-10* 35* 23* 40-50* 36* 39* * Isoflavone content varies by brand Vitamin D • Epidemiological studies suggest an inverse relationship between sun exposure. o Possible mechanisms that may explain the protective effects of vitamin D may be its role as a nuclear transcription factor that regulates cell growth.o Additionally. • Post-menopausal breast cancer risk was significantly inversely associated with serum 25(OH)vitamin D levels [321].315]. serum levels of 25(OH)-vitamin D. o The combination of tamoxifen and genistein inhibited the growth of ER+/HER2. 28 . appear to decrease circulating IGF-I activity. when proliferation is at its lowest [312]. • Recent literature assessing the effects of soy and tamoxifen have yielded neutral [316] or beneficial findings [317]. which may impede cancer induction [298. o In a study of Asian American breast cancer survivors on tamoxifen.

Opt for ground flax seeds rather than whole flax seeds. with ER+ breast cancer Rich in antioxidants*. nuts. dietary sources Soy supplements or include soybeans. B vitamins. including hot cereals. protein. tempeh. Flax seeds may be ground in a coffee grinder. calcium. iron. isoflavone extracts are not soymilk. flax seed oil. thus. Store flax in the refrigerator or freezer. Dietary sources include cold-water fish. Sprinkle into various foods and beverages. and fortified products. edamame. Some believe the normal level of vitamin D should be 50-60 ng/ml. Food or Beverage Flaxseed Summary Good source of omega-3 fatty acids and fiber. such as milk. o Optimal serum 25-hydroxy vitamin D levels have not been established though research suggests 36-40 ng/ml may be ideal [323]. 400-2000 IU daily Maintain serum 25 (OH)-vitamin D >35 ng/mL. and boron. including Unless soy has been a part of your diet for years. potassium. namely genistein and consumption to 1-3 daily daidzein. Green tea Green tea contains does contain caffeine though much less than coffee or black tea. 1-4 cups daily Vitamin D 29 . opt for those naturally decaffeinated with water as typical caffeine extraction results in a significant loss of phytonutrients.• Due to the likelihood of a biochemical deficiency without clinical symptoms or signs. If opting for decaffeinated green tea. fruit smoothies. or food processor. flax supplements to increase bioavailability. more appropriate dosing of vitamin D supplementation can be made once a serum 25(OH)-vitamin D level has been established. soy milk. fiber. tomato sauces. Soy Contains various nutrients. and soy recommended. contains protein. servings. it is wise to gradually increase consumption. Recommendation 2 Tbsp ground flaxseed daily Flax can have a laxativelike effect. Among others. miso. eggs. A fat-soluble vitamin that we generate through skin synthesis of sunlight (ultraviolet rays). and B postmenopausal individuals vitamins. tofu. blender. a serum 25(OH)-vitamin D level is recommended. known as may be advised to limit soy isoflavones. o While supplementation may be recommended. and cereals. brown rice or other grains. calcium.

thus it is recommended to not use supplemental melatonin 7-10 days prior to surgery. o A recent study found that women with higher urinary melatonin levels had a 30-41% reduced risk of breast cancer [329]. o Melatonin decreases the formation of estrogen from androgens by inhibiting aromatase activity [331]. •I t may be that the length of time working night shifts makes a difference as evidenced by this study where women who reported more than 20 years of rotating night shift work faced an increased risk of breast cancer compared with women who did not report any rotating night shift work [326]. the combination of melatonin and retinoids* [339] as well as the combination of melatonin and vitamin D3 [340] appear to work synergistically to inhibit the growth of breast cancer cells. o Melatonin levels were 42% higher in those who slept 9+ hours vs ≤6 hours daily.333. and sleep patterns. • Furthermore. thus reducing ways that the cancer cell connects to estrogen [336]. • The risk of breast cancer was reduced by 33% in postmenopausal women who slept 9+ hours compared to those who slept ≤6 hours daily [324]. o Decreasing the number and activity of estrogen receptors. endocrine secretions. o Previous studies have reported an increased risk of breast cancer in night-shift workers who are exposed to light at night [325-327].331]. • Some research indicates that individuals with low levels of melatonin are at greater risk for breast cancer. FOOD SAFETY •E  specially important for those with weakened or impaired immune systems and while on chemotherapy 30 . Its primary function involves the regulation of the body’s circadian rhythm. •M  ay improve survival in cancer patients by protecting the immune system from damage caused by chemotherapy [332]. thus acting in an anti-estrogenic manner [331.333].MELATONIN • Melatonin is a hormone produced by the pineal gland.335].337. • Melatonin may act by: o Inhibiting cell proliferation [330. o In vitro and animal research has supported the protective effect of melatonin against breast cancer [328].338]. • Melatonin does have blood thinning properties. • Various studies indicate that melatonin may inhibit breast cancer by interfering with estrogen pathways. o Enhancing the immune system [330. o Reducing IGF-I [334. o Inducing apoptosis* [332].

and raw or undercooked meat. rice. poultry. o Do not eat perishable foods that have been left out of the refrigerator for more than two hours. cutting boards. and more. flaxseed. walnuts. fish. o Use special care in handling raw meats. buffets. such as soup. salad bars. •T  horoughly clean all utensils. • Avoid processed and refined grains/flours/sugars o Keep WHITE off your plate: bread. and eggs. avoid foods that may have bacterial contamination. rice. to shallow containers and place in refrigerator. cream sauces. water or non-caffeinated beverages. o Transfer large volumes of leftovers. unpasteurized beverages or food products. cakes. o Keep all aspects of food preparation meticulously clean. olive oil. soybeans.• The following recommendations have been adapted from guidelines provided by the American Cancer Society. o Wash foods thoroughly before eating. avocados • Eat 2 Tbsp ground flax daily • Limit alcohol consumption • Drink 1 to 4 cups of green tea daily • Maintain serum 25 (OH)-vitamin D levels above 35 ng/mL • Drink plenty of fluids. or casseroles. countertops. • Thaw meats and fish in the refrigerator.HEALTHY BREAST CANCER DIET • Eat 8 to 10 colorful fruit and vegetable servings daily o Two to three pieces of fruit o One cup or more of vegetables with lunch and dinner o 8 fl oz vegetable juice • Consume 30 to 45 grams of fiber daily o You will likely meet your fiber goal if you eat 8 to 10 servings of fruits and vegetables plus one serving of beans/legumes or at least two servings of whole grains daily. including sushi. o Store foods at low temperatures (less than 40oF) to minimize bacterial growth. poultry. pasta. • Limit meats and whole milk dairy products • Include healthy fats like cold-water fish. daily to help meet fluid needs • Engage in daily physical activity to help achieve and maintain a healthy weight 31 . SUMMARY . o When eating in restaurants. This process ensures proper cooling. and sponges that contacted raw meat. and eggs.

32 . family history. phosphorus. • Soy protein and/or soy isoflavones have been proposed to delay bone loss. o On average. o May help to prevent rapid bone loss of menopause years. skiing. and slight curving of upper back. excessive alcohol and tobacco use. age.5% bone mass yearly after 30 years.Bone Health •P  re. lactate. o Good source of minerals (potassium. o Soy contains phytosterols that mimic the actions of estrogen. jogging. stair climbing. humans lose 0. certain medications (diuretics. celiac disease • Many nutrients have bone-building effects. o Enhanced calcium bioavailability of most vegetables. thyroid meds). • Exercise increases bone mass before menopause and slows bone loss after menopause. sedentary lifestyle. such as walking. • Even small amounts of increased bone mass provide great risk reduction for fractures. low testosterone levels in men. • Generally. diet excessive in protein or very low in protein. humans reach peak bone mass around 30 years. o Calcium carbonate is least expensive. • These do not decrease iron absorption like calcium carbonate. including calcium. vitamin K. o Thus. amenorrhea. aerobics. potassium.and postmenopausal survivors of breast cancer are at great risk for development of osteoporosis. o Studies report that soy may ↑ BMD. Asian or white ethnicity. excessive caffeine use. and others. • Recent research indicates diets high in fruits and vegetables have a positive effect on bone health. loss of height. o Symptoms include back pain or tenderness. • Calcium supplements o Take 500 mg or less per meal to maximize absorption. o May help to prevent urinary calcium loss. the goal is to maintain or prevent loss of bone mass. vitamin D. magnesium. o Resistance training exercises are useful to strengthen muscles and bones. and boron (see table below). and wrist. o Include weight-bearing exercise. diet low in calcium. diet low in vitamin D.3 – 0. screening and preventive strategies for osteoporosis are imperative. • Risks for osteoporosis include: female. menopause. • First signs of osteoporosis are seen in spine. o Calcium citrate. diet high in sodium. magnesium) that may have direct effects on bone cells. steroids. but may increase gas and bloating in some individuals. hip. o Counteract acid environment. o Lower urinary calcium loss. or gluconate are recommended if you have iron deficiency. After the age of 30.

o Consider serum vitamin D test. low bone density.343]. or other supplement. • Good posture • Request to have a full body DEXA scan.• What about antacids with calcium? o Trace minerals like zinc or iron may be less well-dissolved and absorbed with a lower stomach acidity. but not ideal. o These measurements are used to diagnose osteoporosis. • Vitamin D o Meet needs from sun. and risk of fracture and to determine rates of bone loss or the effectiveness of treatment over time [342. Bone Health – Bottom Line • Balanced diet – high in fruits and vegetables • Calcium o Aim for 3 rich sources daily. o May interact with thyroid medication. multivitamin. and highly reproducible measurements of bone density to be made [341]. • DEXA (dual-energy X-ray absorptiometry) instruments allow rapid. noninvasive. • Exercise o Weight-bearing exercise for at least 30 minutes on most days. should not present a major problem. 33 . painless. o If you’re only taking enough antacid for the purpose of calcium needs. o Include a supplement if necessary.

peanuts. soybeans. spinach. peanut butter. leafy greens (especially collard greens. Important in calcium uptake and immune function. such as soy milk. fish. legumes. strengthen bones. products. prunes. milk.Bone Building Nutrients Nutrient* Calcium Dietary Sources Dairy products. ↓ effects of vitamin D and magnesium deficiency. prunes. whole grains. avocados. tomatoes. Combines with calcium to 700 mg daily milk. and beans Apples. and garbanzo beans Also produced by intestinal bacteria Phosphorus Meat. and nuts Whole grains. eggs. Important in calcium and spinach. strawberries. nuts. canned fish with soft bones. wheat bran and germ Associated with ↓ urinary calcium and phosphorus excretion. tofu. beans. especially plant sources Vitamin D is essential for calcium absorption. bok choy. fortified products. poultry. 8-15 mg daily Zinc * Vitamin D is listed in the previous table 34 . almonds. blackeyed peas. raisins. and orange juice Dark leafy greens. beans. and vegetables Bananas. meats. cereal. Recommendation 1000-1200 mg daily Vitamin K Associated with ↓ bone turnover and ↓ urinary calcium excretion. liver. and potatoes Seafood. and most fruits potassium uptake. 320 mg daily Function ↑ calcium absorption and bioavailability from foods. pecans. 90 mcg daily Magnesium Potassium 4700 mg daily Boron Improves calcium 2 mg daily absorption. tomatoes. seeds. potatoes. and kale). tofu.

o A previous study reported reduced hot flashes with soy isoflavones by 9 to 40% in some trials. seem to alleviate hot flashes in menopausal women and breast cancer survivors. • Supplemental vitamin E at 400 IU/day [345] and 800 IU/day [346] has shown some limited efficacy in improving hot flashes. • The use of black cohosh appears to be safe in breast cancer patients [352]. • Systematic reviews of randomized controlled trials have observed contradictory results. • Psychoeducational interventions. or call at (415) 885-3693. which can be more severe and long lasting. WORDS OF WISDOM “Let food be your medicine and medicine be your food. o The placebo effect in many of these studies was quite strong [348]. and vitamin E – none have shown much significant clinical value. including relaxation. o More than 90% of young survivors also experience hot flashes.” . The information in this publication is designed for educational purposes only and is not intended to replace the advice of your physician or health care provider. • Approximately 75% of postmenopausal women who had breast cancer report experiencing hot flashes [344]. however. red clover. with iatrogenic ovarian ablation or antiestrogen therapy. o Studies assessing black cohosh and red clover have had inconsistent results. please visit the Ida and Joseph Friend Cancer Resource Center at 1600 Divisadero St. black cohosh. the methodological quality of published research has been considered to be fair or poor [353]. but most trials observed no effect when compared with placebo [349]. • Black cohosh extract had no effect on serum estrogenic markers [351]. o Individual trials report significant reductions in vasomotor symptoms for red clover and soy phytoestrogens. with some trials showing benefit and some no difference compared with placebo [349].Hippocrates For additional information or resources. and meta-analyses* demonstrate no statistically significant reduction of vasomotor symptoms for phytoestrogens [347]. • Various non-hormonal therapies have been studied for improving hot flashes. • Mean hot flash frequency was reduced 17% on black cohosh and 26% on placebo. o In one study. 35 .Hot Flashes • Hot flashes are a major cause of morbidity among postmenopausal women. including soy. as each patient’s circumstances are individual. on the first floor. women receiving black cohosh reported a mean decrease in hot flash score of 20% compared with a 27% decrease for patients on placebo [350]. including many survivors of breast cancer. We encourage you to discuss with your physician any questions and concerns that you may have.

balsamic (1 1/2 tbsp) Roll. whole grain (1 med) Orange (1 med) Vegetable juice (12 oz) Granola bar (1 each) Fruit smoothie Banana (1 med) Berries (1 cup) Flaxseed. cooked (1 cup) Salmon (4 oz) Quinoa.Three Day Menu Plan: 3 Meals + Snack This menu is based on 1600 calories. ground (2 tbsp) Blueberries (1/2 cup) Green tea (2 cups) Day 2 Bagel. whole grain (1 1/2 cups) Tomato sauce (1 cup) Mushrooms (1/2 cup) Olive oil (1/2 tbsp) Broccoli (1 cup) Mixed fruit (1 cup) 36 Green tea (2 cups) Popcorn. cooked (1 cup) Soy milk (1 cup) Flaxseed. air-popped (3 cups) Chicken & vegetable stir-fry Chicken breast (4 oz) Mixed vegetables (2 cups) Walnuts (2 tbsp) OR Olive oil (1/2 tbsp) Brown rice. Day 1 Oatmeal. ground (2 tbsp) Yogurt. calories can be adjusted by altering portion sizes. whole grain (1 med) Hummus (2 tbsp) Tomato (6 slices) Lemon pepper Cantaloupe (1 cup) Green tea (2 cups) Turkey sandwich Whole grain bread (2 slices) Turkey (2 oz) Lettuce (1/2 cup) Tomato (4 slices) Red peppers (1/4 cup) Onions (2 tbsp) Mustard (1 tsp) Carrots (1/2 cup) Snap peas (1/2 cup) Vegetable Bean Soup (2 cups) Corn tortilla (1 med) Green salad (2 cups) Oil/vinegar dressing (1 tbsp) Day 3 Tofu scramble Tofu (4 oz) Onions (1/4 cup) Peppers (1/2 cup) Mushrooms (1/2 cup) Toast. cooked (1 cup) Asparagus (1 cup) Fruit salad (1 cup) . whole grain (1 slice) Jam (1 tbsp) Salad Spinach (3 cups) Broccoli (1/2 cup) Carrots (1/2 cup) Tomato (1/2 cup) Garbanzo beans (1 cup) Barley. cooked (1/2 cup) Avocado (4 slices) Olive oil (1/2 tbsp) Vinegar. The menu has been designed to merely serve as a guide in making healthy food choices. plain nonfat (1/2 cup) Soy milk (1 cup) Fish (3 oz) Pasta. Experiment with substitutions as desired.

Recipes Baked Tofu Ingredients: • 1 pound tofu. RD. Spinach Spread Ingredients: • 1 package (10. Nutrition Information (per serving): Calories: 215 Protein: 10 gm Fat: 4 gm Dietary fiber: 9 gm Recipe developed by Sous Chef Chris at the Occidental Grill. Stir every 15-20 minutes. and serve on a bed of dark green leafy lettuce.4 mg Recipe developed by Natalie Ledesma. firm.C. Washington D. Makes four 4-ounce servings. diced • 3 tbsp balsamic vinegar • 2 tbsp olive oil Prepare vegetables. drained • 3-4 tbsp marinade or sauce (personal favorite: Veri Veri Teriyaki by Soy Vay) Chop drained firm tofu into 1” cubes. Makes 8 servings (1 cup each). Mix all ingredients together. chopped finely • 1 can (11 oz) corn • 1 1/2 cups tomatoes. drained • 1 1/2 cups cooked barley • 6 tbsp cilantro. MS. Place tofu cubes in glass dish for baking. Add salt and pepper to taste. CSO Washington Insider Salad Ingredients: • 1 can (15 oz) kidney beans. stir well. Pour marinade or sauce over tofu. drained • 1 can (15 oz) black eyed peas. Nutrition Information (per 4 oz serving): Calories: 96 Dietary fiber: <1 gm Protein: 8 gm Sodium: 318 mg Fat: 5 gm Calcium: 155 mg Saturated fat: <1 gm Iron: 1. Place tofu in oven at 350 F for 1 hour.5 ounces) silken tofu • 1 tbsp lemon juice 37 .

Stir it into the tofu.• 1/4 tsp garlic powder • 3/4 tsp onion powder • 1/2 tsp dried tarragon • 1/4 tsp salt • 1 box (10 ounce) frozen chopped spinach. Nutrition Information (per serving): Calories: 47 Carbohydrate: 4 gm Protein: 7 gm Dietary fiber: 2 gm Fat: <1 gm Recipe developed by Natalie Ledesma. minced • 3/4 tsp black pepper • Alternative: Use lime/cilantro rather than lemon/basil Blend all ingredients together in a blender or food processor. Serve with crackers. Mix well. Serve over pasta. tarragon.3 ounce) silken tofu • 1/2 cup water • 3/4 cup fresh basil. or other. RD. Nutrition information (per serving): Calories: 39 Fat: 1 gm Saturated fat: 0 gm Protein: 4 gm Sodium: 82 mg Calcium: 51 mg Carbohydrate: 5 gm Dietary Fiber: 2 gm Recipe from the U. vegetables. Scrape into a mixing bowl. Soyfoods Directory. Tofuntastico – Tofu Sauce Ingredients: • 1 package (12. baked potato. Makes 8 servings (1/4 cup each). MS. Makes 6 servings (1/2 cup each). along with the carrots and green onion.S. Squeeze the spinach as dry as possible. and salt just to blend. 1998. thawed • 1 cup coarsely shredded carrots • 1/4 cup chopped green onion Puree the tofu and lemon juice in blender until smooth. chopped • 4 tbsp nutritional yeast • 3 tbsp Bragg’s liquid aminos (or tamari or soy sauce) • 1 tbsp lemon juice • 1 tsp garlic. or vegetables. Whirl in the garlic and onion powders. pita triangles. CSO 38 .

olive oil. finely chopped • 2 tsp parsley. Nutrition Information (per serving): 39 . Nutrition Information (per serving): Calories: 228 Protein: 20 gm Fat: 12 gm Omega-3 fatty acids: 1. Season each salmon fillet with salt and pepper.) • 1 1/2 cup whole wheat pastry flour • 1 tsp baking soda • 1/2 tsp salt • Additional optional ingredients may include 1/2 cup walnuts. and honey in a small bowl. Banana Bread Ingredients: • 3/4 cup ground flax seed • 1 cup mashed banana • 1/4 cup apple juice concentrate • 1/2 cup brown sugar • 1/4 cup applesauce • Egg replacer for 2 eggs or 2 eggs (Ener-G Egg Replacer is made from potato starch & tapioca flour. Serve with lemon wedges. Makes 4 servings (4 oz each). Bake at 350 F for about 40-45 minutes. set aside. walnuts. set aside. Mix together bread crumbs. Brush each fillet with mustard-honey mixture. raisins.Alaska Salmon Bake with Walnut Crunch Coating Ingredients: • 1 pound salmon fillets. or chocolate chips.7 gm Adapted from Alaska Seafood Marketing Institute. thawed if necessary • 2 tbsp Dijon-style mustard • 1-2 tbsp olive oil • 4 tsp honey • 1/4 cup bread crumbs • 1/4 cup walnuts. and parsley in a small bowl. Pour in a coated 8”x4” pan. Makes 10 servings. Pat top of each fillet with bread crumb mixture. Mix all ingredients together. Place on a lightly greased baking sheet or broiling pan. works wonderfully in baked goods. Bake at 450 F for 10 minutes per inch of thickness or until salmon just flakes when tested with a fork. chopped • Salt and pepper to taste • Lemon wedges Mix together mustard.

shallots. Nutrition Information (per serving): Calories: 160 Protein: 17 gm Fat: 4 gm Dietary fiber: 5 gm Adapted from the Women’s Healthy Eating & Living Study (WHEL) at the University of California. Serve salmon mixture over lettuce. mustard. sage 40 . radishes. Prepare the lemon juice. Neat Loaf Ingredients: • 2 cups cooked brown rice • 1 cup walnuts. Developed by Vicky Newman. Makes 6 servings (2 cups each). place in a mixing bowl. MS.4 gm Recipe developed by Natalie Ledesma. thawed • 1/4 cup lemon juice • 1/4 cup fresh dill (or 1-2 tbsp dried dill) • 2 tbsp Dijon-style mustard • 2 shallots. and radishes. RD. finely chopped • 1 onion. RD. Calories: 168 Protein: 5 gm Fat: 4 gm Carbohydrate: 29 gm Dietary fiber: 5 gm Omega-3 fatty acids: 1. San Diego. Mix together gently. finely chopped • 2 medium carrots. and lettuce. shallots. Add to the salmon the peas. drained • 1 package (16 oz) frozen peas. sliced thinly (about 1/2 cup) • 1 bunch radishes (about 11 medium). lemon juice. MS. CSO Dilled Salmon Salad with Peas Ingredients: • 1 can (15 oz) salmon. dill. Add salt and pepper to taste. thinly sliced • 6 cups red leaf lettuce • Salt and pepper to taste Drain salmon. WHEL nutrition coordinator. shredded or finely chopped • 1 cup wheat germ • 1 cup quick-cooking rolled oats • 1/2 tsp each: thyme. and break into pieces. finely chopped • 1/2 medium bell pepper. marjoram.

Quinoa/Sweet Potato Patties Ingredients: • 1 1/2 cups sweet potato. Combine all the ingredients except the barbecue sauce or ketchup. Nutrition Information (per serving): Calories: 64 Carbohydrate: 9 gm Protein: 2 gm Cholesterol: 0 mg Fat: 2 gm Sodium: 275 mg Source anonymous.• 2 tbsp soy sauce • 2 tbsp stone ground or Dijon mustard • Barbecue sauce or ketchup Preheat the oven to 350 F. Mix the vegetables and press with a plate until submerged in liquid for about 1 hour. Makes 8-10 servings. Makes 4 servings. Mix for 2 minutes with a large spoon. dried • 2 tbsp sunflower seeds. toasted With a fork. fresh • 1/2 tsp sea salt 41 . Bake for 60 minutes. mix the miso. maple syrup. peeled and chopped • 1 cup quinoa • 2 tbsp parsley. thinly sliced • 2 tbsp white miso • 2 tbsp brown rice vinegar • 1 tsp maple syrup • 1 tsp dill. Let stand 10 minutes before serving. This will help bind it together. vinegar. Nutrition Information (per serving): Calories: 204 Sodium: 248 mg Protein: 9 gm Cholesterol: 0 mg Fat: 9 gm Carbohydrate: 19 gm Recipe from The Peaceful Palate written by Jennifer Raymond (1996). Fluff the vegetables to serve and garnish with sunflower seeds. Pat into an oil-sprayed 5x9” load pan and top with barbecue sauce or ketchup. quartered and then thinly sliced • 1/4 cup radishes • 1/4 cup red onion. Chinese Cabbage and Radish Salad Ingredients: • 4 cups Chinese cabbage. and dill.

Nutrition Resources Books How to Prevent & Treat Cancer with Natural Medicine – written by Michael Murray (2002) The Color Code – written by James (800) 829-5384 Nutrition Action Health Letter http://www. bring a pot of water to a boil. Form 8 patties and place in a lightly oiled pan over medium-high heat. Drain and mash potatoes. & Mat Edelson (2004) The Peaceful Palate – written by Jennifer Raymond (vegetarian cookbook) (1996) 12 Best Foods Cookbook: Over 200 Recipes Featuring the 12 Healthiest Foods – written by Dana Jacobi (2005) Newsletters/Magazines Cooking Light www. Dry toast the quinoa in a skillet until slightly browned.environmentalnutrition. Nutrition Information (per serving): Calories: 125 Sodium: 165 mg Protein: 4 gm Cholesterol: 0 mg Fat: 2 gm Carbohydrate: 22 gm Recipe adapted from the Vegetarian Resource Group (1997).com Fax: (205) 445-6600 Environmental Nutrition http://www. Cook for about 5 minutes on each side and serve warm. Add the toasted quinoa to the boiling water and cook.written by Kimberly Mathai & Ginny Smith (2004) Fat-Free and Easy: Great Meals in Minutes – written by Jennifer Raymond (vegetarian cookbook) (1997) Lickety-Split Meals – written by Zonya Foco (1998) One Bite at a Time – written by Rebecca (800) 843-8114 42 .aicr. Makes 8 servings. Daniel Nadeau.cookinglight.cspinet.cancer. for ~15 Fax: (202) 265-4954 Websites American Cancer Society http://www. Add the parsley and salt. & Anne Underwood (2002) Ultra Metabolism – written by Mark Hyman (2006) Cookbooks Cancer Lifeline Cookbook . Mix the mashed potatoes and (415) 394-7100 American Institute for Cancer Research http://www. Marsha Tomassi. Drain well.• 2 tsp extra-virgin olive oil Steam or bake sweet potatoes until done. with lid off. Meanwhile. Wash the quinoa well and drain.

informedeating. http://www. Center for Informed Food Choices .consumerlab.Zion WebMD Diana (800) 4-CANCER (800-422-6237) Oncolink – Provides information regarding clinical trials.upenn.caring4cancer.sfvs. RD – Breast cancer survivor & dietitian http://www.Caring4Cancer . Consumer Lab .Offer cooking classes in the Bay Area that emphasize plantbased San Francisco Vegetarian Society – Monthly restaurant outings & pot-luck Ida & Joseph Friend Cancer Resource Center – UCSF Mt.Provides vegetarian nutrition information & vegetarian recipes http://www. psychosocial support. & 43 The Vegetarian Resource Group .Provides up-to-date & comprehensive information on the connection between nutrition & cancer – http://www. http://www. call (415) 885-3693 National Cancer Institute http://www.vrg.ucsf.Evaluates quality of over-the-counter supplements http://www. MS.

thromboxanes. Mutation – Abnormal cell development. that were measured at the start of the study and. They include prostaglandins. etc. Apoptosis – Programmed cell death. carcinogenic in animals. compounds that protects the cells and body chemicals against damage caused by free radicals. Nitrosamines – Derivatives of nitrites that may be formed in the stomach when nitrites combine with amines. and enzyme activation. 44 . Sex hormone-binding globulin (SHBG) – A protein in the blood that acts as a carrier for androgens and estradiol. reactive atoms that contribute to tissue damage in the body. Lignans . specifically. Phytonutrients – Plant compounds that appear to have health-protecting properties. Creatine – An amino acid that is formed in the muscle tissue of vertebrates. appear to offer protection against breast cancer. involved in DNA synthesis and repair. Polyphenols – Phytonutrients that act as an antioxidant. say. supplies energy for muscle contraction.Glossary Angiogenesis – The formation of new blood vessels. inhibits the estradiol-induced proliferation of breast cancer cells. as within the body. alcohol consumption and dietary intake. Retinoids – Chemically related compounds with biological activity similar to that of retinol. which lowers the body’s blood sugar level. blood clotting. prevention of oxidative cell damage. related to vitamin A. Catechin – One of the tannic acids. alcohol consumption. initially disease-free. Meta-analysis – The process of using statistical methods to combine the results of different studies. at later times during the study. sometimes. Endogenous – Originating from within. Insulin . Case-Control Studies – An epidemiological study in which a group of. Cohort Studies – Follow-up study of a (usually large) group of people. and other body functions. and leukotrienes. Differences in disease incidence within the cohort are calculated in relation to different levels of exposure to specific factors. especially the conversion of glucose to glycogen. Carcinogenesis – Beginning of cancer development. Eicosanoids – Biologically active compounds that regulate blood pressure. cancer patients (cases) is compared to a similar but cancer-free population (controls) to help establish whether the past or recent history of a specific exposure such as smoking. diet and exercise.Insulin is a hormone produced by the pancreas in the body that regulates the metabolism of carbohydrates and fats. one of the flavonoids found in green tea. Estrone – A naturally occurring weak estrogen secreted by the mammalian ovary. Antioxidant – A substance that inhibits oxidation or inhibits reactions promoted by oxygen or peroxides. are causally related the risk of disease. metabolism of toxins and carcinogens. protein and prostaglandin synthesis. Glutathione – A polypeptide produced primarily in the liver. amino acid transport. such as smoking.Phytoestrogens that have a similar chemical structure to estradiol and tamoxifen. Estradiol – A naturally occurring powerful estrogen secreted by the mammalian ovary. immune system function. phytonutrient.

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