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Whole grain consumption v. refined grain consumption and disease free survival in stage III colon cancer

SandiaBuddy's picture
SandiaBuddy
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https://academic.oup.com/jncics/article/2/2/pky017/5025854

[A] higher consumption of refined grains was associated with an increased risk of cancer recurrence and mortality, and the substitution of refined grains with whole grains was associated with a decreased risk of cancer recurrence and mortality. . . higher intake of whole grains was associated with a reduced risk of cancer recurrence and mortality (P = .05) (Figure 3). The multivariable-adjusted hazard ratio for DFS was 0.89 (95% CI = 0.66 to 1.20) for those consuming three or more servings per day of whole grains compared with those consuming less than one serving per day (Ptrend = .54) . . . The consumption of refined grains was negatively correlated with the consumption of whole grains (r = –.19, P < .001). We therefore sought to estimate the influence of substituting one daily serving of refined grain with one daily serving of whole grain. In substitution analysis, the multivariable-adjusted hazard ratio for DFS by substituting one daily serving of refined grain with one daily serving of whole grain was 0.87 (95% CI = 0. 79 to 0.96, P = .007). Results were similar for RFS (HR = 0.86, 95% CI = 0.77 to 0.96, P = .006) and OS (HR = 0.87, 95% CI = 0.78 to 0.97, P = .01).

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Mikenh
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Thanks. I'm going to read that on the treadmill today. I already read a few paragraphs and it looks statistically significant. But I wish that they'd translate hazard ratio to recurrence odds.

I went to look up hazard ratio and Wikipedia indicated that it was related to hazard rates. So I had a look at hazard rates and it requires a little calculus (derivatives) and linked to survival analysis which requires integration and power series. So it looks like this stuff might be in a stats course. It would probably be easier to learn this stuff from a textbook as the wikipedia pages are on the sparse side.

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SandiaBuddy
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Mike, the statistics always make my head spin, and unfortunately they do not use consistent reporting techniques.  On simple things like whole grains instead of refined grains, where switching is simple and seems risk free, I do not really bother to suss out the specific gain (I think they said something like 13%).  To me, it is a more logical risk/benefit analysis.  There is no real risk to eating better, so even a non-statistically significant benefit would make it wothwhile from my perspective.  With that said, I more or less avoid all grains and stick to vegetables and fruits.  If something more compelling comes along, maybe I will change that approach, but when I eat gain I put on too much weight.

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peterz54
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this is consistent with the general priciple of keeping refined carbs and sugars out of our diet to lower the growth signaling pathways which influence tumor growth.  It puzzles me why more attention isnt paid to monitoring HbA1c and insulin in cancer patients.  These should be on the low end of the reference range and if elevated swift action should be taken to bring them down.  

Short article in Harvard Gazette linking insulin and colon cancer

https://news.harvard.edu/gazette/story/2012/11/insulin-and-colon-cancer-linked/

You're right, no risk to eating better.  Actually, quite a lot to gain...

 

 

 

 

SandiaBuddy's picture
SandiaBuddy
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Interesting article about the glucose/glyemic index issue.  I keep a pretty clean diet, so I have not gotten too deeply into it, but I would imagine there are countless people who could benefit from the knowledge.  It seems like the available strategies are limited only by the time to research them.  Sometimes the hard part is deciding where to focus.  But the "free" ones (sunshine, exercise, coffee, tree nuts, vitamin d, whole grains, etc) are the easiest to adopt, from my perspective.

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peterz54
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I really think a tiny part of the ACS one billion dollar budget should go to this kind of thing - combing the literature for simple things that, while not proven beyond a shadow of doubt, are healthy and shown to likely have positive effects (maybe profound effects) on outcome, and summarizing in layman's terms. 

Would be great if ACS could organize this site to to provide lifestyle information based on actual data (with pointers to the studies) rather than standard boiler plate (in my view watered down and generic) recommendations.    Posting news alerts about these things in the individual forums could have cumulative major effects over time as many people will lend a lot more weight to a posting from ACS than from forum member. 

And the basics ("free" ones as you say) need constant reinforcement and encouragment.

   

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SandiaBuddy
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It would be nice if there were a single resource for natural or easy strategies to optimize the odds of cancer avoidance, but as of yet I have not found an easily accessible, up-to-date resource.  I think for the time being it is up to us to educate ourselves about what is available and to share that information.  That's why I post things I think are useful that I come accross monitoring pubmed.

peterz54's picture
peterz54
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we really have no other option but to educate ourselves.  It's dangerous to be a passive consumer of information.  PubMed is also my primary resource for finding out new things and validating what I read or hear elsewhere.

 

 

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BRHMichigan
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I cut out all simple carbs for about 3 months, and felt extremely weak. I added whole grains and feel much better. My integrative Onc endorses a Mediterranean diet with some whole grains for all his cancer patients. It's good to see reinforcement like the article you shared!  Thanks 

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peterz54
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John McDougall, a plant based MD, is an advocate for a high starch diet (potatoes, corn, whole rice) in complex form and makes the point about about starches providing needed energy and that most preindustrial societies ran on high levels of starches.    This seems valid for the last ten thousand years or so, but not sure that this holds when you take the long view, what our species evolved to eat over the last million years or so   

In any case, whole rice is a complex carb and in modest amounts may not drive up glucose and insulin. And if it makes you feel better and be more active that's good. I also eat a small amount of brown rice or red potatoe and can feel the difference, in a positive way. It seems that you're beneifiting from your relationship with a good Int Oncologist.  Too bad most patients don't go beyond their conventional oncologist for guidance.       

 

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Mikenh
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I think that this works for societies where there is a lot of physical labor involved in day-to-day livng but most of us aren't living that kind of life. I've noticed that potatoes and corn have a thickening effect on illeostomy output and that's often a good thing (it's a lot easier to manage than watery output).

I've walked or run 17,000 steps or more per day for the past six days and it means that I sleep better and probably consume more calories. It's fewer calories than my running days (running burns lots more calories than walking) but it's the best that I can manage for now. I would guess that exercise, even walking a lot, helps numbers - actually there's probably research that shows that. My list is exercise, tree nuts, vitamin D3, whole grains and low carb now.

SandiaBuddy's picture
SandiaBuddy
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From my research, it seems exercise is the number one or number two (vitamin d is the other alternative) strategy to optimize the odds.  I remind myself daily that health is my number one goal and drag myself out for another walk. . .  At least that is something that I can control.

peterz54's picture
peterz54
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Yes, I recall a study (will try to find) that demonstrated very positive effects for exercise among cancer patients.   

SandiaBuddy's picture
SandiaBuddy
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Joined: Apr 2017

A couple of entries from my research on exercise:

Well over 50% reduction (61%/57% in one study) for higher levels of physical exercise: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3150459/
Same study includes aspirin, diet, vitamin D (51% reduction in mortality)

Physical activity: The reduction in risk of all-cause mortality ranged from 25% to 63%.
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4922494/

Individuals engaging in more than 18 total metabolic equivalent task (MET) hour per week experienced approximately 50% reduction in recurrence or death compared to those who were inactive. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3818492/

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