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Slide 1 - Nutrition & Prostate Health:Are they related? Presented by Natalie Ledesma, MS, RD UCSF Comprehensive Cancer Center
Slide 2 - Nutrition & Prostate Cancer “Scientific evidence suggests that differences in diet & lifestyle may account in large part for the variability of prostate cancer rates in different countries” (Heber et al., 1998).
Slide 3 - Guidelines for a Healthy Diet Plant-based diet Fruits, vegetables, whole grains, beans/legumes, & other plant protein sources Low fat diet with emphasis on healthy fats Limit simple & refined sugars Adequate fluids Stop smoking if you smoke Limit alcohol consumption Be physically active
Slide 4 - Insulin & Cancer A Western lifestyle -- characterized by low physical activity, & high dietary intake, animal protein, saturated fats, trans fats, & rapidly digestible carbohydrates -- is associated with  risks of many cancers. May be mediated by alterations in the metabolism of insulin and insulin-like growth factors (IGFs).  serum insulin & IGF-I levels and insulin resistance  development & promotion of cancer. (Hsing et al., 2001; Barnard et al., 2003; Ngo et al., 2002; Moyad, 2003; Yu & Berkel, 1999; Giovannucci, 2003; Aksoy et al., 2004; Li et al., 2003; Cardillo et al., 2003; Kaaks, 2001)
Slide 5 - Insulin & Cancer (cont.) Elevated serum insulin & IGF-1 levels (Hsing et al., 2001; Barnard et al., 2003; Ngoet al., 2002; Moyad, 2003; Yu & Berkel, 1999; Giovannucci, 2003; Aksoy et al., 2004; Li et al., 2003; Cardillo et al., 2003; Kaaks, 2001) as well as insulin resistance (Hsing et al., 2003) appear to lead to both the development & promotion of cancer. Additionally, hyperinsulinemia is associated with increased risk of heart disease, type 2 diabetes, and weight gain (obesity).
Slide 6 - Limit Simple Carbohydrates Sources: candy, cookies, pastries, alcohol, drinks/juices, & WHITE refined breads, pastas, crackers, etc. High sugar foods are usually highly processed & refined, low in nutrient value, & low in fiber.  serum insulin & serum IGF-I levels & contribute to insulin resistance (Hsing et al., 2003; Snyder et al.,1989; Reiser et al., 1981; Manolio et al., 1991).
Slide 7 - High-Fiber Diet A diet rich in natural fiber obtained from fruits, vegetables, legumes, & whole grains may reduce cancer risk &/or prevent prostate cancer progression. While the results regarding fruit & vegetable consumption & prostate cancer risk are not conclusive, they are promising (Hodge et al., 2004; Cohen et al., 2000; Jain et al., 1999; Deneo-Pellegrini et al., 1999). Fiber binds to toxic compounds & carcinogens, which are then later eliminated by the body (Harris et al., 1993). Additionally, fiber  circulating hormone levels (Tariq et al., 2000; Tymchuk et al., 2001; Slavin, 2000).
Slide 8 - Low Fat Diet  fat   testosterone   cancer A comprehensive review reported that 20 of 30 studies found positive, although not all statistically significant, associations between dietary fat intake and prostate cancer risk (Fleshner et al., 2004). Recommendation: 20% of total calories from fat, with <8% of total calories from saturated fat.
Slide 9 - Types of Free Fatty Acids Saturated Fatty acids are saturated with hydrogen molecules Semi-solid or solid at room temperature Monounsaturated (omega-9) Fatty acid contains one double bond Liquid at room temperature Polyunsaturated (omega-6 & omega-3) Fatty acid contains 2 or more double bonds Liquid at room temperature Hydrogenated Industrial hardening of edible oils to make products hard at room temperature
Slide 10 - Saturated Fats Many studies indicate a positive association between saturated fat intake from meat & dairy products & prostate cancer. Intakes of red meat (Giovannucci et al., 1993; Michaud et al., 2001; Ramon et al., 2000; Bairati et al., 1998) and dairy products (Michaud et al.; Ramon et al.; Bosetti et al.; Bairati et al.) appear to also be related to increased risk of metastatic prostate cancer. Recommendation: Limit use of meats, dairy, products, butter, mayonnaise, & baked goods due to high saturated fat & total fat content.
Slide 11 - Essential Fatty Acids (EFA) Balance of omega-6 to omega-3 oils is critical to proper prostaglandin metabolism. Most American diets contain excessive omega-6 fats. Consuming a diet rich in omega-3 acids can restore the balance between the two fatty acids & can possibly reverse these disease processes.
Slide 12 - EFA Dietary Sources Omega-6 Dietary Sources: Include meats (especially grain-fed), butter, whole milk, egg yolks, sunflower oil, safflower oil, cottonseed oil, corn oil, & processed foods made with these oils. Omega-3 Sources: Include cold-water fish (i.e., salmon, trout, sardines, herring), flaxseed, walnuts, pumpkin seeds, canola oil, & soybeans.
Slide 13 - Omega-3 Fatty Acids Studies show omega-3 fatty acids reduce risk of prostate cancer. Men who consumed cold-water fish 3-4x/week had a reduced risk of prostate cancer. Researchers in New Zealand reported that men with high levels of EPA & DHA had a 40% lower risk of prostate cancer than those with low blood levels.
Slide 14 - Omega-9 Fatty Acids Offer cardio-protective benefits, may offer cancer protection. Results suggest a neutral relationship between these fats & prostate cancer (Hodge et al., 2004; Norrish et al., 2000; Veierod et al., 1997; Hughes-Fulford et al., 2001). Good sources: olives, extra-virgin olive oil, canola oil, avocadoes, & almonds. Remember, however, to use oils only in moderation.
Slide 15 - Healthy Fat Recommendations Keep saturated fats to 8% total kcals from fat. Limit fatty meats, whole milk dairy products, cheese, mayonnaise, butter, & baked goods. Avoid hydrogenated oils. Aim for 1:1 to 4:1 omega-6:omega-3. Limit processed foods Inquire about type of oil used at restaurants Use olive, almond, or canola oil for cooking/salads. Increase sources of omega-3’s daily Fish, flaxseed, walnuts, pumpkin seeds EPA/DHA supplement if appropriate
Slide 16 - Body Weight & Physical Activity Higher body mass & physical inactivity may contribute to prostate cancer risk. A large prospective study observed a significant positive association between BMI& prostate cancer risk. A cohort study reported obese men to have a 20% increased risk of dying from prostate cancer & those men who were severely obese had a 34% elevated risk. This research was further supported by recent evidence that obesity is a risk factor for aggressive prostate cancer.
Slide 17 - What Can A Healthy Diet Do For Me? May help to inhibit cancer growth Reduce risk of chronic diseases Enhance immune system Increase energy levels Facilitate recovery –  toxicities of treatment
Slide 18 - Healthy Prostate Cancer Diet 8-10 colorful fruit & vegetable servings daily 25-35 grams of fiber daily Limit processed & refined grains/flours/sugars Limit meats & dairy Healthy fats  cold-water fish (i.e., salmon, trout, herring, sardines), flaxseed, walnuts, soybeans, olive oil, avocadoes, almonds Selenium (200 mcg)  Brazil nuts, supplement Lycopene (30 mg)  ¾ C tomato sauce, 12 fl oz tomato juice Vitamin E (200 IU) natural form with -tocopherol Green Tea  1-4 cups daily Vitamin D Pomegranate  1 oz concentrate, 8 oz juice
Slide 19 - Resources Books The ABC’s of Nutrition & Supplements and Prostate Cancer – written by Mark Moyad, 2000 The Color Code – written by James Joseph, PhD, Daniel Nadeau, MD, & Anne Underwood 2002 Natural Health, Natural Medicine : The Complete Guide to Wellness and Self-Care for Optimum Health – written by Andrew Weil, MD 2004 How to Prevent & Treat Cancer with Natural Medicine – written by Michael Murray, 2002
Slide 20 - Resources (cont.) Cookbooks Cancer Lifeline Cookbook – written by Kimberly Mathai, 2004 One Bite at a Time – written by Rebecca Katz, 2004 Websites http://www.aicr.org http://www.cancernutritioninfo.com http://cancer.ucsf.edu/crc http://www.cancerproject.org